are going to be going as we re-open our branches. today is a great day. the sun is shining on us and we are so thrilled. congratulations to the library system. >> thank you. speaking of the san francisco public library staff, we want to thank shauna sherman for joining us today. she runs the african american center here at the main, but she worked as a contact tracer and we really appreciate people like you and others for the work that you continue to do to uplift the community. and so, i know that and, again, carol, thank you for getting all of the staff back to the library because, let me tell you, i know it was hard work but because many of the library staff felt so dedicated to the work of helping to support the city, yes, they wanted to come back to work, but they also wanted to finish the work they were doing to address this

pandemic. so, again, we want to say thank you so much for your hard work and all that you did to help this city throughout this pandemic. and, unlike carmen chiu who probably returned her books to the library when she was a kid, thank goodness i waived all those fines and fees of the past because i'd be in real trouble right now. forgive me, library. forgive me. [ laughter ] but, with that, thank you all again to the commissioners, the friends of the public library. so many incredible people who care deeply about making sure that people in this city have access to books, that they have access to educational materials to computers and all the things that can help nurture and grow your mind, but also a really good for your soul. so, with that, i want to open it up to questions. do we have any questions?

no questions. easy. easy day today. all right. thank you all so much. take care. >> tuesday may 4th, 2021 we'll call this meeting to order. >> would you call roll [roll call] >> clerk: welcome. >> our next item is the approval of the minutes of the health commission meeting of april 20th, 2021.

thank you to commissioners for providing edit for the minutes. upon reviewing the minutes as amended, are there any further amendments or if not do we have a motion to approve? >> i move to approve. >> second. roll call vote. [roll call vote] commissioner, your camera not working. you are red and fuzzy looking. >> thank you.

>> i'm going to highlight staffing and leadership. dr. seuss an phillip is now at our acting director of population health for the city and county of san francisco. as you know, she's been a vital part of the city's covid-19 response and has been a pivotal leader in that work and has also served in her official role as deputy health officer and director of the disease control and prevention branch for the department and done some outstanding work in health equity, hiv and s.t.i.s. she's worked with d.p.h. since 2005. she's an assistant clinical

professor of medicine and infectious disease at ussf and also a primary care provider so we're delighted to have her as our acting director of population health and in breaking news, i'm also really please today announce that sheis the new health officer. great news there. and dr. rita nguyen is acting deputy at d.p.h. supporting the work on population level interceptions regard to chronic diseases, risk factors and outreach and she's director of information and guidance or the

entire city through the city command center and is just done an incredible amount of work that i was able to meet with last week and incredible leaders and doing the inspirational work. she is a practicing hospitallist, from san francisco general hospital and also an assistant clinical professor at ucst. together, these two will support the amazing team that contusion our phd division. i also want to announce, in another part of the department, that jenny louie has been appointed our chief financial officer and many of you response

and recovery budget working on the budget for funding and implementation on mental health sf and the department's racial equity work. she will continue to support principles and budget planning and administration and have been with the department for over 14 years. we're thrilled to have her join the department in this capacity after a decade and a half of working for us. so, those are my key director report updates. there's a lot of covid information here and i will cover that in my covid-19 update. certainly happy to answer any other specific questions now or after the presentation. >> president bernal: those are exciting updates about staffing

and while i can't even remember all of the different roles that all of our really valued individuals here are taking on, what i can do is express our gratitude for their fantastic work not only in the roles they've had but in the additional work that they've taken on during the pandemic and these roles that they have now just assumed and looking into the future. we're very excited so congratulations to dr. phillip and dr. nguyen and we look forward to continuing our work with you. any questions or comments for director colefax before we move into our covid update. >> i'd like to make sure that we're on that for every item. folks on the line, if you'd like to make a directors 3, press star 3 to raise your hand. star 3.

no hands. agenda item, members from the public can make a comment for up to two minutes. the public comment process is designed to invite feedback from individuals in the community however the process does not allow questions to be answered in the meeting or for members of the public to engage in back and fourth conversations with the commissioners. please note that the commissioners do consider comments from members of the public when discussing an item and making it for the d.p.h. the person who raised your hand. >> it looks like we can move forward with the covid update. item 4. >> thank you, mark, thank you mikaela. >> this is my update for may 4th and i will just frame my remarks by saying after 15 months of this pandemic, we are in a much better place and i'm

cautiously optimistic about the status of covid-19 in our city and the data will bear this out, as you will see. so, we've had over 36,000 cases of covid-19 reported in the city. i think what is really indicative of why i'm cautiously optimistic is you see that very leveling off of cases reported starting after january 2021 through may of this year. it's a very flat curve. unfortunately we've had 537 people in san francisco die due to covid. that is far too many. it's also a lower death rate than many other jurisdictions and again, we have thankfully seen these deaths decrease dramatically since our winter surge. population characteristics, this is cumulative cases covid-19 diagnosed in the city.

these will change very slowly and my next slide i'll tell you more where we are in real time and again i think the thing that stands out in terms of changes in this slide, is that you see on terms of race ethnicity, the over all percentage of latinos represented covid-19 cases has decreased in terms of percentage over all, that was over 50% this summer and in our age groups, we're starting to see a continued decline in older adults consistent with vaccination rates. this is really a measure of where we had been most recently in terms of cases just these are cases diagnosed between march 15th and april 15th and there are striking things to point out here in terms of the racial ethnic make up of people diagnosed with covid-19, again, you see that percentage of

latinos, 19% of covid-19 cases far lower percentage wise than we had seen previously. they are distributed by race ethnicity and consistent with what we've seen in the patterns of the epidemic prior to the vaccination roll out and then i think the other piece that's really important to emphasis the median age of diagnosis of covid-19 is now 31 and in january that was 37 so we're seeing a drop in age consistent with high vaccination rates among our older population. increase in covid-19 hospitalizationses and good hospital capacity. our case rate per 100,000 at 2.9

in the middle continues to remain low and it's going further down and it's been averaging before last week of 3.5 and it's now 2.9 and that's despite the fact our testing numbers are stable at 5,000 test per day and our contact tracing numbers you will see it's down to 77% and we're look agent this a little more to explain why it dropped and it may be that younger people are des responsive to calls from our team and our p.p.e. level is high, as high as it can be at 100%. hospitalizations are the lowest levels of the pandemic since we've been measuring. we reached a low of 14 people

hospital iced due to covid-19 in the city as reported yesterday can you see we're far below our three surges. in terms of the vaccination rate, 72% of san france have received one shot of the vaccine who are over the age of 16. 49% over the age of 16 has received a completed vaccine zeros you will see the cumulative doses by all providers hoar and i will say that we're starting to see a leveling off of demand you will see on that purple curve the first dose series we're start to go see a leveling off and not where we are in terms of ex

facting these numbers and i think the progression with which they succeeded in vaccination a high preportion at population is slower so we have our work cut out in these merges in the near future. and you see here that we have vaccination administration and we have reassumed johnson & johnson so that's been rolled out this week and the decline is contribution 0 our reduced supply in april and reduced access to some degree in a vaccine hesitancy we're continue to go work to manage and then i think that's a good news is that the pfizer emergency use authorization for 12 to

15-years-old could be grant the as early as next week and that's a population of about 25,000 vaccines so that was very positive news that we received yesterday, next slide. so this is vaccination rates by race and ethnicity and on the left is vaccine administration by all providers and vaccination administration by d.p.h. by race, ethnicity and you can see over all our numbers are still with the representation of covid-19 preference and communities by race, ethnicity and we're continuing to work neighborhood by neighborhood and community by community to get these rates up on the dph side the vaccine we have authority in control over you will see that we're doing farber over all with higher rates among black african americans and latinos in

particular. next slide. so, as of today, we have adopted the new cdc masking guidance and commensurate with cdc guidelines and the state adopted them so the good news is your vaccinated, outdoor activities with the exception of a crowded event, 300 people or more, can you go without a mask so that's really good noose and hopefully an incentive for people to get vaccinated and people who aren't vaccinated need to maintain masking and social distancing whether they're able to in the areas below. if you are vaccinated, you can gather indoors and small private groups mask off with other fully

vaccinated people. that is also an incentive to get vaccinated. so, we have met the yellow tier for the state so we will be moving into the yellow tier, the lowest level of covid-19 tier and san francisco and l.a. are the only counties and state that have moved into this tier and the most populous county to do so we are making changes with regard town door dining, outdoor dining mainly capacity numbers go up and then a key sector that opens in the yellow tier is indoor wars and wineries and up to 100 people and 50% capacity at serving meals and the other major changes noted on this

slide and i believe that concludes my presentation and i'm happy to take any questions from the commission. >> thank you, director coal fax. any questions or comments? while we're waiting, this is a really great day with great news that san francisco will be moving into the least restrictive tier. we wouldn't have been able to get here without the bold and decisive leadership of our mayor, and everybody in san francisco public-health and our partner organizations that we've been working with closely in order to really help stem the pandemic and the cooperation of the people of san francisco. we're grateful to be in this relatively good position as we are seeing a light at the end of the tunnel. i did have one question for you

director colfax, you mentioned that we're seeing a leveling off of vaccinations. to some degree do we have a sense of who the people are that are unvaccinated and how will this inform our strategies moving forward to help increase the number of san franciscans that are vaccinated or is it just too soon to tell? >> >> well, it's a combination of first of all, people are younger who are not vaccinated yet and people are still figuring out the system and accessing where they can get vaccinated. one thing i believe i didn't mention that may have been on the slide is for people 65 and older, we're at a coverage of 86% of people getting one shot and it's reflective in the covid-19 diagnosis cases that are presented and there is a degree of vaccine hesitancy and

that is very complex that there are many people reasons that people are hesitant to get the vaccine but we have access and helping people to decide to take the vaccine is talking to their primary care provider so, we're ensuring that we're linking people 20 care and helping them have that conversation with a care providers about the benefits of the vaccine and then we have a number of neighborhood access sites. and i think that's really where the access is going to be so

important to facilitate so the drop in people, i was just at our vaccine site this morning with supervisor preston and people could drop in and people were dropping into get the vaccine. working with community leaders with regard to ensuring that they were facilitating conversations about the concerns that people might have the vaccine, people have gotten the vaccine and they are from in part of that community are able to find a forum to talk about their experience and going door-to-door approach because this next 22% is going to -- 28% is going to be a challenge but we're well positioned to address hesitancy understanding not everybody is going to get the vaccine and some people want to

take more time but we are also promoting and explaining the benefits of getting the vaccine but it's really going to take the trusted family member, the neighbor, the college see member, and other people who may not be in public heath and in some cases, not in public-health to help people be comfortable about the vaccine they far outweigh the risk. >> thank you, director coal fax and i apologize, i had to commissioner comments before getting public comments so we'll move to public comments and come back to commission comments. this item is a covid-19 update solve if you have comments about this item, press star 3. i see one hand. and what we will do any other folks want to comment on the

covid-19 update? >> commissioner chow. >> i want to commend you on the appointments for our various department and all wonderful people who will also continue to excel. i had several -- not concerns but what we were going to be doing with the drafting of the age? are we going to change our messaging? we realize that as you get into the younger age, there really is not so much vaccine hesitancy but even a denial this is an important disease and that probably becomes truer as we have the vaccination of the most vulnerable at this time and our data and it's wonderful data,

the department certainly is ask the city and the mayor for having held to public-health principles so that we can assist and reduce the vulnerable so what are we going to be changing our messaging to the younger population because now, they will feel the most vulnerable have been vaccinated and what would be their reason and that's my first question. i guess my second question relates to the younger population. how are we doing with what we're trying to encourage to the opening of schools and institutions of higher learning. most of them that have held graduation ceremonies have had them virtual. a few have not. i'm not sure in the city whether anybody has actually had an

actual graduation in-person. for the coming summer or fall, what are the plans under these new guidelines and i guess lastly, is -- chief scott has been very good in keeping the respect of the people while dealing with the problem of our enforcement. as a matter of fact, i guess we don't have a problem but i remember the early webinars that we were here to help encourage following the rules and not just writing tickets, essentially. so, how do the ploys department then look at this issue of

sously the marking and non mask asking really a personal issue. and it would seem to me, and what is the role of law enforcement in this. >> thank you, week deeper dive with these questions. with regards to the younger population, becoming eligible, 12 to 15-years-old, we've been working very closely with the school district and with other entities including child youth and families and also ensuring we're prepared to support people getting vaccinated and informed concept forms prepared in advance so that people ask understand the process and be

ready to vaccinate children between the age of 12 and 15. your point about the risk is the difference in risk in terms of age due to covid-19, is important but we're also emphasizing that asking people to do their part to slow the spread, right. if you are not vaccinated, you could have covid-19 and there's certainly considerable numbers of people still not vaccinated in the city that you could spread it to. while we've seen the vast majorities of deaths including here in san francisco among older people there are consequences to getting this virus even if you are younger for many people. in come cases the medical consequences of having become infected whether you develop a long-hauler type syndrome aor some other medical complications that we're still in the process of being described are

significant. it's a combination of those factors that we're stressing in terms of being important for people to get vaccinated. many younger people interact with older people. so ensuring na there's that piece and of course, the third reason is the more people who we get vaccinated the less variants would have to worry about and variants are concerning in other parts of the world. so far we've not experienced then onslaught of variants in terms of creating major issues in the city but that could change. which is another reason i'm careful to say i'm cautiously optimistic. in terms of the graduations, i'm going to let our health officer weigh in on that because she's

been working hard request schools and others ensuring that graduations can be done safely. >> thank you so much dr. colfax. yes, we know that graduations are very important and we're working closely with our partners at rec and park for the sfusd graduations, many which will be held at the stadium to come up with health and safety procedures including two-hour spacing between events and making sure that distancing is safe and masking as well at the current time although we'll re-evaluate that in terms our revised masking orders.

>> they've been very helpful in testing students on a very routine basis and going forward our testing numbers are down and i guess one of the concerns that i have is it if a variant came to town that would change our caseload, it's likely to be spread by young asymptomatic individuals who might know that they have acquired the condition if they're tested and along with that comes the advent of a huge number of add-home tests. i have no idea how they are priced but there's a chance that with all the competition, that could mean people are testing at home and we might not be able to gather the robust data to have early warning a want is entering our community so i wonder if you are come in a lint more about

the how we proliferate and the pop up vaccine site and what you think might going forward with our ability to early to detect changes in case rates early given all the these changes that are going on. in terms of the schools and vaccines we're working the school team and the vaccine team are working together and we can have more on that but schools are being considered as potential vaccine sites and if and when the schools would agree to that and if we figure out how to mobilize the teams to do that there. if it's clear the demand will be adequate there to certain and a children. it's school informed consent and it would often and require a

parent's consents and it's another component here that is something that we need to ensure is fully addressed and in terms of testing in variants, our testing numbers, while lower than the holiday surge, they've stayed study around 5,000 over the last couple of months and our hospitalizations and continued to go down so that is very much consistent and in terms of the cost potentially emergence of variants and dr. phil i am and her team have been working hard on this aspect and a very small portion of the samples in the state are actually tested for variants and so we're working hard with ucsf to ensure a being collected and

tested for variants and that work is still underway. >> president bernal: we can move on to general public comment. >> so folks on the comment line, members of the public may address the commission on items of interest to the public that are within the subject matter jurisdiction and of the commission so if you were here for the security item later on and the budget, this would not be the place to comment. it's for other items or on not the agenda. the brown act for bids for discussing ideas not appearing on the posted agenda including those items raised during public comment. if you would like to make a comic comment, please raise your hand and pressing star 3.

>> president bernal: we can move onto the finance and planning committee update and we'll hand it over to chair chung and commissioner chow who had shared part of that meeting or however you would like to present it. >> i would like to yield this time to commissioner chow who actually chaired the entire meeting because i feel like i have relinquished my privilege to chair today's meeting because i was on hour, i joined an hour later than the start time so commissioner chow. >> thank you, it's my privilege to take your spot even though it's your spot. you did a wonderful job

summarizing something. i get lost in the details and forget exactly what we are trying to look at. we do have an extensive agenda and i'll make it brief. i will be happy to answer questions regarding them. those are extensions of contracts and it's the university of california which is adding six years to this project and it's a very well-known project for many years and they're doing a great job. this is the group the

eligibility and patients and the health access people are doing very well and an example for the cases that they have been achieved in 96 eligibility for medical and it gives you a feeling as to the type of work that they've been doing and we agreed with the renewal of the contract for another two years providing or recommending that. the next contract was also at ucsf and it has to do with child services and again on that one, they've been doing a good job and it's a grant added to this and it will help enhance the program and we grow with the increase of one more year in

their contract. per your recommendation and we also had a good number of these. helena, which is the public heath foundation that we work with that their name for these types of contracts and they will providing program administration support services continuation and there was a grand funded added to their program under the public heath community health equity and promotion program. we spoke about the work they were getting and there was at least a c.d.c. grant in this increase of the grant of about $797,000 coming in from t. d.c.

so it's an additional grant and an additional year of contracting. i'll skip over to another helena health. which was they take a look here. which was actually adding pre term program an already existing contract under maternal child and adolescent health supervision and that contract will have an additional one million 4 and and this new program we said that and another

contact with supporting the services of sister web community doula network and there's a $400,000 perinatal equity initiative in this and an additional add back on the part of the board of supervisors of 500,000 and it adds up to about 900,000 bob added. going back, they had taken over the suicide hotline which had been run for many years by volunteers and there is an increase in the amount of money. this started in 2019, well, actually, yes. in 2019, and there is an increase in the cost because

very now will adverse the old suicide languaging mostly a volunteer program. this one has much better updated infrastructure ability to do much more in their responses by telephone and they have a higher quality of service and they have not dropped and they've had oved number of people continue to use them and so we grow that this would be a good service to within and for an additional, well, it's a four year contract

and so basic three takes it and gives them added resources in order to have an even better approach towards the effectiveness in the suicide prevention. the last contract that we reviewed was the health rights covid isolation in quarantine, hotel support and that is a extension of one year there was a slight amount of increase and annual difference which was explained to be actually the annualizing of the contract and not an increase in costs, so that was the contract report that we are recommending and these are amendments to contracts already existing. they were looking at new and for

a consideration and calender and i'll try to go through these and the first one is a request for approval of three contracts and this is similar to other contracts we've had which is add needed. these are from services and permitted the department to do and the contractors and landscaping and in modular furnishings that may be needed and it's like a list of a valuable contractors and when sometimes coming to be needed they will look at the list if

there's more than one they will actually sort of bid for the best price but this allows them to have a list of vendors for the particular projects that the department needs and so those are a series of three contracts and and then there were two contracts on the list here which actually were by medicine line industries and we have been working on them for many years as suppliers worth general and the contract could be suppliers and for laguna and you might have wonderful and reading that wiser contract for both distribution and versus low unit of measure and i think we finally strained that out that both distribution and medical

supplies in large volume and the low unit of measure is we go to individualized areas and so the reason for the two contracts is at they're using different systems in each of these and by combining these, then they are actually able to use the taking bulk or mass when those are appropriate and doing smaller quantity tease and with need on time type of operations and i'll be under medicine line so there's h there's the reason for the contract and for

115 million, for the low devin nune its and 178 million and that does include a 12% contingency and this is for 72 months five years and don't be alarmed and there is a hold-over option and we actually inquire what a hold over position is and versus a regular option and it's when if the contrast expired this allows authorities to contract for one more year without having to come m back for approval it's a process of con begin again see so they don't disrupt supply lines. there is a contract for mass public-health campaign and would

be providing information to the public that way of variety of media campaigns. the next contract is aids population and this implements a low threshold street based service delivery model to help reduce fatal overdose risk in those people using drugs and

they helped us clarify it was really in the high-risk areas and was inclusive and includes the mission and they could under this contract, be in other areas that may be needed so for this type of street based service then let's see there's another contract with health this is new and this is one that actually i think we would all appreciate two weeks ago we had the presentation by the street crisis response team and the great work they were doing on their pilot and this is going to actually help validate that and

it's a contract from the robert wood i don't know son foundation to really do the study on this over 19 month period of time. and i suspect this will be just as important as for those of you who remember when we started a healthy san francisco report that showed how people actually reduce their emergency room and primary care connections so i think this could be just as a ground speaking of news in terms of validating what we're hoping to have a successful programs in this street crisis response team and the final contract is not a contract it's really approval of a list and we approve a list of soul source under city chapter

2142 and this is to be able to actually have the ability in those cases particularly where there are limited vendors, to go to a soul source contract and there's a list of those currently are being contracted under that and there's also a list of new contractors who have not through a soul source but there's the process we've been following a number of years places them on the list. they will have a list with those

who don't have a contract with us but have had contracts in the past under somalia soul source and we might need them so there are throw categories. they're listed for you and the action requests that we renew this. i think that ends my report and i welcome back happy. commissioner chung will be happy to answer the questions and i appreciate that she was able to join us and appreciate also commissioner bernal, president bernal, to have joined in the beginning so that we could get our work done with the quorum. thank you. >> before we go to commissioner comments or questions, do we have a public comment on this matter? >> >> please let's us know by press

are star 3. >> clerk: we can move onto the next item. thank you, commissioner chow, for that it up date. commissioner, as you have before you the content calender described by commissioner chow from the finance and planning committee meeting proceedings this meeting. do we have a motion to approve? >> so moved. >> second. >> roll call vote. [roll call vote] >> clerk: the item passes. in. >> president bernal: thank you, mark. we have move on to our next

item, then, which is security services staffing plan update for discussion. and we have basil price here to presents for us d.p.h. director of security. >> mr. price, i've given you permission to share your screen. let us know if you have issues or problems. >> thank you. >> good evening, commissioners, and i'm going to talk to you about our safety services staffing plan.

department of public-health has maintained a security management plan evaluated on a annual basis and as far as gaps in performance improvement, some of the contributing factor soldiers consist of conflicts with dph mission to provide patient care and law enforcement policy and the effects of the strong law enforcement present and the healthcare environment and then the negative. >> commissioner underwood: pact of the community as well as a patient experience. our goal is to provide a safe environment secure environment for patients that want to make sure that our program has a healthcare specific context and

we want to make sure we focus on prevention rather than reacting and responding. to keep us on task with these goals, we're developing a d.p.h. security equity group that will consist of the external advocates and employees and then representatives of the community and their role would be to evaluate the impact of these changes proposed further in the future recommendations and we look at this as we move forward and ensuring that d.h.p.'s healthcare security program is in align with industry standards.

and so as we look at use of force data from law enforcement, 91% of use of force within our hospitals actually are against patients and it's actually contradictory to hospital regulations when 2 comes down to law enforcement interventions with people that are in a hospital and actually says according to c.m.s. that the only time they had not committed a crime and 46% of those patients were black avenue fern and are the highest to be subject to use of force and any

other race and ethnicity. 34% and actually involve deputies responding to assist in patient care situation zoos while it's necessary for our clinical staff to call for ike at trick nurses and about what is likely the tech nurses.

they have behavior emergency response team and their role will be to actually prevent crisis development perform early stage deescalation and providing patient stand by patients assist and as well as patient restraints as necessary. to starred the safety tee to incorporate non uniform 'em das worse to support through patient stand byes as well as verbal deescalation and provide additional healthcare safety and security services. as we go to honda, we are proposing to replace 4.2 with 8.29 uniform embassadors and the purpose of increasing visibility across the campus.

and they'll also provide vehicle patrols around the campus and as well as deputy supervision. in our community clinics, we're requiring a different skills set than the traditional security and law enforcement services. we're actually looking to contract with community based organizations to provide safety services providing embassadors and these are people who are knowledgeable within the

neighborhoods and at d.p.h. and the locations that we're considering for this as you have listed there, based on three years of two incidents reporting data and there's been zero incidents where it requires a level of law enforcement and now similar to this last year we actually did the same thing where we actually removed six deputies from four clinics and we have them now providing vehicle patrols within the area and responding to secure emergencies as needed and they will do the same thing for the additional clinics through this proposal and we have sheriff deputies and the fixed possessions urgent care and mission mental health as well as d.p.h. administration and 101 growth and with regards to the

training they would receive as see listed there, he will learn and be caught how to recognize behavior and autopsy or the at the early stage to prevent the situation from escalating and also learn how to give directives that limit as well as impact a listening knowing how to anticipate an attack with their own self-deprivation and get free from that as well as respond to risk behavior from a team intervention approach. training for the embassadors,

the first three will begin this training and getting may 10th and the other four provided by the d.p.h. through education and training and the last one through security services we'll actually facilitate the international association for healthcare safety insecurity training and so that our embassadors are learned and our certified how to function in a healthcare environment. to summarize the changes at zuckerberg general we want to reduce the d.p.h. and by 11.4 deputy f.t.e.s and add psychiatric nurses 7.3 and

license tech and 2.5 care experience health workers and they would do visitors access at the health enter trance and la dhuna honda by 2.4 deputies to add 8.4 embassadors who will be trained and healthcare security as well as add three outside nurses. in the clinics, the proposal is to reduce 4.2 including five and from the clinic and adding the contracts safety services of 4.4. in addition to our goals, the goals and measures of success the law enforcement intervention

and as well as addressing equity and ratio disparity and especially in the areas of response and the shares office as well as security services and we want to start to drive equity and we have planned to accomplish this through the alternative staffing and the clinical safety services and as well as security equity proof. a timeline in the next step, steps in addition to this meeting, we'll also be meeting later on this month with the staff and laboringizations and the mayor and board of supervisors process will be underway in june as well as through july and august and then the last part from august through march would involve the highering and on board of the bert team as well as the

community clinic or contract portion and the implementation of the training program and the operation transition. that concludes my presentation and i'm happy to take any questions at this time. >> make a brief comment. the presentation. >> thank you. i just first of all i want to thank basil who has been working on this with leadership and staff within the health network for years and years. it's complicated and it's not simple and touches staff patients community and a really tangible way and i want to emphasize two points this is a big step but it's a big step in a process basil mentioned that

we are going to have an ongoing process that we used to work on this across the department to think about security equity and security. we have a lot of other things that are also under the discussion including policies and procedures and how we administer this and how we foster the relationship between the service and our clinical staff and all of that have is on going so it's not the end of the process but it's a big step in the process and lastly i just want to find out as mr. price did previously, opposition j approval and it's the board must approve contracting out of city services previously and provided by civil service and in this case the reason that we have

the. >> toni-marie: do that is because in the community clinics we would be moving from sheriff staff to a contractor to provide that patient experience aspect in the clinics but i do want to differentiate it's a significant different proposal than some commissioners would have been on the commission for quite some time remember the proposals and this is really a different animal but i do want to flag that that is the case and that would be part of what goes forward with that proposal. i'm really thankful for all the folks from within the department and engage great prove of staff and members and advocates who have been working on this with us and pushing us to better as we go through this process and

i'll stop at that. >> president bernal: thank you to those who contribute today this very important proposal before we move on to commissioner comments and questions and thank you to mr. price for providing clarifications to the things that the commissioners had, we will move to public comment. mark, can you get us started? >> i'm going to read the statement y'all and i'll go to the and members of the up to two minutes and the public comment process is input and feedback from individuals in the community however the process does not allow questions to be answered in the meeting or for members of the public to engage in back and fourth conversations with commissioners. please know they consider comments from the members of the public by discussing items and making requests to d.p.h. so folks in the line if you would like to raise your hand to speak, for two minutes, press

star 3 and i will unmute you one by one and just know that when your two minutes is up, this beet ep will go off and i will give you a little 10 seconds or 20 seconds to finish your statement and i will mute you again. first caller, please let us know this you are there. >> i'm martha lauren and i worked as a bio medicine tech in san francisco general. i lived 40 years in bernal heights and i'm on the board of senior disability action and i'm a strong supporter of we need to expand both the burden and patient support services to reduce the trade funding the unionized community safety teams and primary health clinics ex no expansion that d.p.h. and no deputies in san francisco

general. the mental healthcare provided and and in particularly and department and it's clear that such anxious stressed out and pain-ridden patients and families get frustrated and angry after excessive waits with no answers or no health and navigating the healthcare lab l. and hard to find locations and they were very relieved and think about how much more i could have done if i was trained to answer people's questions. d.p.h. must diverse doctors, nurses, other health qualifiers and community advocates and and based on the years of experience

and culturally appropriate and also community appropriate and class and appropriate healthcare doers are not a big part of it and thank you. >> thank you. >> clerk: caller, let us know you are there. >> i'm a medical student at ucsf. i want to comment today because of personal experience i had. i was in the tech emergency services on my rotation and a patient i was taking care of wanted go home but on a psychiatric hold. he banged on the walls. he was upset and three sheriff deputies came in and started punching him until he was bleeding all over the green and we stood and watched horrified and they broke his rib. when we had a debrief afterwards, we were all called back into the main room because

two of the patients had begun to fight again and i watched a nurse go over to the call button we use to call the sheriff and watch her hand hover over button trying to decide if she should call them again. nothing happened but we need alternatives. we need a behavioral spence team that can help deescalate patients before these situations happen and ultimately, we need folks who can help to manage situations where staff and patients are conflict with each other and that's why i would really support the expansion on the piloting of a community safety team but i want that to be good union jobs. we can't have turnover like contracted services we need long-term jobs that can later be expand today other sites across the d.p.h. system and that is

why i support d.p.h. and that is why i support the work that happens. thank you so much to all the organizers. >> thank you for your comments. please let us know that you are there. >> i'm here. >> >> thank you. my name is danielle and i'm a family physician and i work at castro mission health center and the san francisco general hospital. and over the years i worked. i've witnesses times in which the sheriff were not the best response to a patient situation and i just wanted to share one that is etched in my mind forever and i was working on the inpatient family medicine service a few years ago and we were taking care of a 40-year-old male like developmentally delayed and he was admitted for a seizure workup and in the hospital for many days and started becoming agitated by being in a different environment and noises and all the things that go along with

being in the hospital. he start today get verbally escalated so four officers came into his room. as soon as he saw officers in uniform it was triggering for him so he swung at a officer. at that point, because he had swung at an officer, he became arrested because he was attempting to assault an officer and that is a crime. so his discharge plan then became that he was going to have to go to county jail from his hospital room. it was just heartbreaking to me that someone who is so vulnerable and going through so much because of the inherently the people who were calling to deescalate patients, would end up in jail instead of his home with his family so i love working for the department of public health. i love that it's a mission-driven system. and that so many of the people who are employed there really are there for the right reasons and care about patients and respect the environment they come from and i just don't feel

that having the sheriffs at the hospital is really able to address the needs of our complex patients to experience so much trauma at the hands of people in uniform and if we can find an alternative that is trauma informed, that has community involvement, it would be a better place for our patients to feel safer and well cared for. thank you for your time. thank you for making these efforts to change. >> thank you. sorry i cut you off but i'm trying to give everyone their two minutes. next call are, please let us know that you are there. >> caller: hi, my name is lena and i live in district 4. i'm a fourth year medical student and a member of d.p.h. must divest. i urge the health commission to support the bert team and patient support services to support the 22 reduction in deputies at the d.p.h. and sign

the creation of a union represented community safety team in our primary care clinics. it will keep help our most vulnerable patients safe and before and through medical school i've worked with grassroots deescalation teams and i've worked through deescalation are critical ex caring for patients and these skills help environments that foster healing, but also do not perpetuate the experience of historical and current medical trauma for patients and myself as a heath care providers. while i believe it's important to have these skills, it's unethical and unsafe for the responsibility to fall only on people who have gotten this kind of train organize this care randomly or sporadically. we need skilled unarmed terms and social workers who are trained in trauma informed care. they've been proven to be an effective alternative to law enforcement for health related

issues. i demand this commission invest in the well being of all san france, both as the provider and the patients. your programs provide alternatives to policing and to create union jobs. thank you. >> thank you for your comments. you are unmuted, please, let us know that you are there. >> hi, this is jennifer. i'm calling from the coalition on homelessness and i'm the director. i want to point out that i hear a lot from department of public heath, as well we should, about trauma informed care and it's impossible, impossible to provide trauma informed care when there are armed paramilitary forces at your door, inside the healthcare delivery spaces. i would like the proposal to go farther. i do not think we should have

sheriffs at tom waddle that still have share i haves there and these cause arm and trauma for those the folks that they're trying to serve and i want today say we have homelessness organizations and san francisco and drop-in centers and coming through their doors everyday and they don't have armed security either. when incidents drop from frequency to a rarity. all staff should have hard deescalation and skills and all of them should there's ava vi tee of success with those depending on whether they're integrated into a philosophy and

whether they're well trained and integrated into the staff or that creates and there's not a way to address it and they're separate thing that is not really working cohesively and the mission that they're trying to address there and those were my points and i really support the effort from d.p.h. divest and thank you for your work on this. >> at this for your comments. please let us know that you are there. my name is naomi and i'm a nurse practitioner in primary care and street medicine and i'm a member of 10-1 a resident of district

nine and and moving away from having law enforcement in our states of healthcare and however, they're proposals are insufficient in several days and i would like to urge them to support the behavioral health response team and patients of support service and the production of the 22ste deputy of the d.p.h. and i support the funding and the creation of a union represented community safety team and our primary care clinics and i oppose the use of non uniform cadets and the deputies at sfdh and as mr. price mentioned, when people

are able to get the those are better jobs and wore going to get longevity in this position and if i have another.

>> can you say you are there. >> go fund me. >> my name is sarah shock' and i'm a patient at ucf and live in district nine. and like many of the others who are shared particular stories, my time was eye opening in a lot of ways and how the sheriff deputies and crops and even in a healthcare setting and there's a scene forever burned in my family and her parents who are receiving the devastating news of her terminal prognosis and one of the parents had disease and instead of and the cops and the clinic dragged him away and

an event and i will not stop demand tag this so-called progressive city uses and i have to agree with previous callers that what is proposed while encouraging is not enough and we need to not only reject and increase in and patient support service and the about the safety team in our primary care clinics and we need to decrease this number and i join my community and d.p.h. and demand tag this commission and from reforms that increase the presence of law enforcement and invest in san franciscans that provide alternative to policing.

thank you. >> thank you, very much for your comments. next caller, you are unmuted. please let us know you are there. >> i'm a physician at san francisco general hospital and we're at and i'm calling to echo previous callers and urging the health commission to support the director price and director coal fax's plan to expand the health tons seam and reduce the sheriff deputies and i also have to grow that increasing the use of non on form sheriffs at the hospital and the primary care clinics is not enough and having worked at san francisco general hospital since 2013, i've witnesses so many incidents where a patient was experiencing either a mental health crisis or behaving

inappropriate ledue to an underlying medical condition and the vast majority of instance have sheriffs have been called by staff, it's the only option they felt for support just led to escalation of this situation and lack of a cock passionate response and assault of patients and criminalization and arrest primarily of people of color and need of medical care. two instances that i won't forget any time soon, a patient went to pick up her hiv medication and on you are way, one of the sheriffs at the door saw she had an old warrant and arrested her and she certainly is not going back to pick up her medications there any time soon and another incident when i was a resident physician, a patient who is going through alcohol withdrawals and was not in his usual state of mind, started

acting out and as a native spanish speaker the sheriffs were called. they made no attempt to deescalate in his native language and assaulted him with a taser and although the incident was reported as an unusual and whatever took place and these incidents illustrate that. >> thank you, i apologize for you cutting it off and i need to keep everyone in two minutes. let us know that you are there. >> caller: yes. my name is teresa rutherford and i'm with sciu1021 and i called to first of all support the plan to expand the behavioral response team and to create a more trauma-informed approach and also to staff using a healthcare focus as opposed to a

milltarized focus and which has been part of the problem systemically, even within our communities. communities of color. we also want to focus on ensuring that workers are involved in this process as it is rolled out and involved in the solution and the decision-making process. we also want to ensure there's a just transition and a smooth transition that workers are not displaced. that contract the work of unionized employees and that the new staff will be brought in who are properly trained and on boarded before the removal of the existing securities system. that are in place. thank you. >> thank you, very much for your comment. let us know you are here. >> can you hear me? >> yes. >> caller: hi, my name is

dr. lee kimburg. i'm attending physician in the richard fine people's clinic at the general live in district five and i'm a member must diverse and violence prevention and d.p.h. and i do a lot of work on trauma informed care and what helps the for everyone in a clinical setting and i just want to really focus us and ground us in thinking about healing and how really a very deep sense of safety is necessary to law us to healment it's really important for everyone in the environment to feel safe and grounded so that they can accompany people as well and care for them in a healing way. so, we're very delighted, d.p.h. must diverse about the positive

aspect of this plan it's a major step forward to invest in the burt team. not only because they can provide healing and effective care when escalation occurred, we hope that they will be so well integrated into more clinical practice that they will actually help us prevent escalation in the first place. we also are really excited about the idea of care experience workers but we heard from the community and multiple meetings and really beautiful vision of the concept of healing care. they want this care experience workers role expanded to be a really culturally rooted and community-driven model of support. so we'd like to partner with you on that in the future. i did want to share one experience i've had because i

have decades of expertise in violent prevention. i was called into help facilitate a series of meetings in which the hospital leadership required the. >> i have to cut you off, i apologize. right now, as a frontline workers, vulnerable populations the situation is that when i need assistance and a crisis i basically have two options. i can either call law enforcement healthcare set organize handle the situation and either option and i've seen

them draw a weapon on a non violent patient in my clinic and avoided calling them out of fear and felt i was in over my head and neglected other patients to focus on the one in crisis. it's high time we had a third better option that provides a therapeutic alternative and highly trained workers and. >> she's a health researcher and

a parent at ucsf and and and the fire department presence of deputies at sfth as employees of san francisco sheriff department they cannot be held accountable to the same standards and nor do they have the skills to address the needs of patients. we ask that a newly created jobs be unionized jobs. we support demands of sdi all and 1256ing understaffed frontliners and dph and medical cystance and eligibility workers and staff are targeted by

violence and are not sufficiently protected by workers and existing security strategies in the d.p.h. divest survey healthcare workers 75% of the survey respondents reported the presence of the sheriff more violent. skilled teams of mental health clinicians, social workers and and proven to be effective alternative to law enforcement for issues. i join people in calling for us to invest in the well being of san franciscans through the program that provide alternative to policeing and create good jobs for san francisco residents. thank you so much. >> thank you for your comments. next caller, you are unmuted. please let us know you are there. >> caller: good evening, everyone. my name is (inaudible). i'm a physician at san francisco general hospital and i live in district 9. i'm here speak on behalf of my

patients, colleagues and communities and i urge the health commission to prioritize the safety and well-being of our patients and ask by not signing on to reforms treated in law enforcement and instead, i hoped that we can support our patients and our colleagues by increasing support forefront liners through avenues like mental crisis response teams and community basis and decrease our reliance on sheriff department and ka get officers and i like many officers have witnessed how unarmed mental healing workers and community members better assist in deescalating situations compared to law enforcement and we need services founded in trauma informed care to ensure accountability and i'd like to thank director price as well as everyone involved in the proposal but i do urge us to push for more and to push for

complete divested from the sheriff. thank you. >> thank you for taking time. next caller, please let us know that you are there. >> hello. >> yes, you are on. >> all right. my name is austin and i am speaking on behalf of the san francisco youth commission and we urge the health commission to support the expansion of the behavioral health response team and patient support services. between two full time employee reduction as a and fund the creation of a union representing communities safety teams in our prime ar eye care clinics. we oppose the expanded use of non uniform at the public-health and the continued presence at

san francisco general hospitals. we have heard numerous testimonies from the d.p.h. must divest coalition and we have empathy is and we acknowledge black and brown communities of color have been most impacted by the presence. please, to ensure that the success of the community safety team we ask that the unionized and we support the demand. as d.p.h. must divest to have community care and amend this commission invote in the well being of all san franciscans through the program that pro voids alternative to policing and creating jobs. thank you, very much. i yield my time. >> thank you for your comment. we have two callers.

please let us know that you are there. >> hi, my name is julie roberts fung and i'm a d5 resident and a member of surge. i'm calling to support dph must divest. i've had experiences both in my immediate family and the neighbor related to people needing mental health services and it's been really dis heartening and stressful to have the police involved and we have made efforts to avoid police involvement and yet time and time again, we felt like the people that we were calling for health with were we actually to inter and sheriff cadets can't

be held to the same standard of training oversight and accountability as d.p.h. led program and according to data from sfdph, 44% of the service calls to sffp in 1920 related to patient care issue and these complex situations need compassionate and skilled community workers and who are union staff and training and are longevity in that role and part of the d.p.h. accountability system and not the use of law enforcement for patients who are really needing support with healing. and d.p.h. must divest and support having trained people who are not law enforcement providing support in d.p.h.

at this very much for your comment. caller, you are unnewted. >> >> thank you to everyone that shared their experiences. i wanted to let everyone know if there's miss contact with the sheriff office, do a whistleblower, call d.p.a. or the internal affairs investigations office because we do not tolerate what i'm hearing on these calls and i'm

encouraged what he wrote down and we're committed to working together with you all to meet the needs that you have put fourth and this commission today the sheriff himself is encouraged and wants to help and so i just wanted this body of people, this commission to know and understand that we are on board and willing and wanting to work together to make sure that we can offer safety and security at your hospitals as dr. price has listed in his powerpoint. with our deputies, as we know that they are there to.

>> they would actually be trained for this particular position. i think my second question that you might be able to answer is, you've looked at other systems so i'm still curious about how uscsf handles their issues as they're a institution in similar as jurisdictions and there's a state place and there are their

hospital. >> thank you for your questions. with regards i'm sure there's members of the sheriff option and i can chime in regards to their cadet service and their employees and the cadets are actually the civilian workforce within the sheriff office and in most cases, we view cadets as trained and on a track inform are for law enforcement positions which is different with the sheriff office. if this is an opportunity, they would have to go and apply and go through the training process like anyone else and the majority of them and where they are career cadets if you there and it's the billion they are

outside of law enforcement. with regards to a healthcare security model, commission, you mentioned that ucsf, the majority with internationally there are hybrid models. hybrid model of healthcare security officer as well as law enforcement and especially in the public for county hospitals and in the state of california that's what you have and it's the deputy sheriff and the healthcare security. and the whole purpose of that, which is what we're trying to accomplish, is that you have that inter immediate response to support clinical staff with patient intervention and they're unarmed and only if a incidents rise to the point of danger could they involve any type of

law enforcement that works and it's been consistent across the nation and based on some of the testimony that we heard from the individuals, i've worked with teams and security programs that did not have individuals that were law enforcement or a lot of security background and just their ability to receive training and deka he is laying and we were taking a first step and we'll continue to, based on the history, we knew better to take a large leap out there but to take this in various phases and to be successful and measure our success and in this

particular phase, start making further recommendations as we move forward. >> so, thank you very much. i'm reminded that we used to have our own place for security force which was not well trained so i see the real difference here is to really take the needs of the patients and i want to commend you for that, thank you. >> thank you. >> it appears that we have much more public comment that just came in so i'm going to ask mark to return to our public comment. >> most of you have your hands up so i'm trying to track t i'm

going to do my best because i marked it as each made comments and you are only allowed to comment one time per item so i apologize. i'm hoping this will go more smoothly. >> caller: i'm a small business owner and voter and anti racism educator and post accountability activist and i'm urging you to remove law enforcement deputies and ka ket from public-health settings and the bias workgroup for sfpd and there's a study and

black and brown and san francisco and they're also the likely and with law enforcement and we they see a uniformed person, it triggers a very negative response them and i believe there's much better ways to resolve conflict and having a unionized consistent body that is twinged in anti racism that is not bearing in arms and that is trained in escalation and not wearing a uniform, is going to increase these for everybody and in the healthcare setting and actually make it a place not a

further harm and that is your mission at the department of public heath and and they recognized racism as a public heath emergency and the san francisco human rights commission and also declare anti blackness and racism a public heath emergency also, ensure that our community setting folks are not experiencing further racism and other forms of harm but can actually go there and be healed and restored as full members of the community. thank you. >> thank you so much for your comments. next caller, you are unmuted. let us know that you are there.

>> caller: hi, my name (inaudible) and i live and work -- i'm sorry. i'll start your time again. i pressed the wrong button, i apologize. >> caller: it's ok, and i live and work in san francisco. historical records gave the time financially out black of providing public safety for all and instead the shared of cost is purport at not enough harm and safety. stayed of keeping us safe we have brutalized us, brown, indigenous and people of color in our healthcare setting with into accountability for the harm and despite staggering evidence supporting the alternatives are possible we're here today, still, harmed and brutalized. on july 8th last year i witnesses an experience trauma in the proximity of six armed officers. sheriffs that worked in our health-care system and to this day there's been no a count ability.

complete contrast, it's been almost 10 months and i still fear back into my own clinical practice as a midwife because of the harm caused and the lack of transparency despite asking the sheriff for their badge numbers they laughed at me and i still don't know when they are. i am provided care while i don't feel safe. caring for my own community members and i identify with and the safe city i was educated with in and have raised my chide for the last 10 years. this is is unacceptable and we can and must do better. the united states less than 1% of healthcare facilities are policed. why is it that our safety sanctuary institutions is being policed? why don't we deserve better environments? can you please support us and reimagining what true safety looks like? we believe in you. we hope that you do too and make informed decisions on what is best for all of us, not just the selected few. thank you.

>> thank you, very much for your comments. let me make sure i'm in the right place. caller, you are unmuted. please let us know that you are there. >> caller: hi, i'm here. my name is shakira and i'm a primary care physician and with dph must divest and i was born and raised in san francisco and i live in district 9 and work in district 6 and 10 and needless to say, i've been in and around d.p.h. facilities for much of my life. [please stand by]

like law enforcement with a gun. i believe it looks like all of us taking care of each other and holding each other in care. i strongly support the expansion of the health response team and all other -- excuse me, but the reduction in shares. law enforcement is not the way forward. i thank you so much for taking the time to really listen to the voices on the line. i think that you will learn a

lot from these diverse voices that are calling in to let you know we care about our patients and the staff we work with and we believe another world is possible. thank you so much. >> thank you for your comments. >> next caller, you're unmuted. >> hi, my name is jessica hawkins. i'm a former employee of sfgeneral hospital and a current medical student at ucsf. i would like to say that i'm really happy that the health commission is supporting the expansion. i would also like to echo what others have said in reimagining the role of inexperienced health care workers to lift up this community vision and create a safe and healthy clinical environment. i want to share two quick

stories that illustrate health care. each patient and their family had to check in with that person to receive care or visit their loved ones one patient even told me that she told her family not to come visit her and her newborn because she didn't think it was safe. to make sure families feel safe and invite their families because it's such a special time. another story that stuck with me is a patient who was in the emergency department who had to wait for over 16 hours of care. and then tackled from behind with the lobby full of people

watching. i looked around at the community members and saw that they noticed how the sheriffs respond to people who look like them. i was completely devastated and heart broken to see how this environment was made unsafe. for people who were in the hospital to try to heal. i would really love to see dph work harder to create a environment and people that are just coming to hospitals for care have someone to talk to and improve their experience of care. i would like to thank commissioners and basil price for their time today. >> thank you very much for taking time to make those comments. next caller, you're unmuted. please let us know you're there. >> hi, i'm here. my name is jessica maw. i'm a medical student and i live in district 7. i'm also a member of dph and white coats for black lives at ucsf. i wanted to call in today to show my support for the

expansion of the bert team and the reduction at sfdph. but i also want to dual on the dph and the health commission to see more action to support the safety and well being of our patients and staff by eliminating the use of cadets for dph security all together. as law enforcement employees, these cadets can't be held to the same standard of training and accountability and transparency as a program that would be based in dph and led by union backed community members and well trained in deescalation and anti-racism. we know that there's plenty of evidence that spending more taxpayer dollars on police trainings and nonuniform police have not been effective in reducing the harm and violence caused by policing in our communities. we also know that sheriff's cadets are not equipped to deal with the health matters which according to dph make up half the calls in the sheriff's department. we know these situations are

complicated and have the potential to cause real harm and it's exactly why they need a response of compassionate skilled community workers, not sf police. to uplift the health of the san francisco community and should apply the same principles. i urge sfdph and the health commission to take immediate action on this issue because our places of health care will never truly be places of safety and healing until they're freed from the surveillance and violence of police. thank you so much for your time and for listening to all of us. >> thank you for your comments.

>> my some security model to the safety model grounded in care. i urge the health commission to support the expansion of the behavioral health team as well as the reduction of the dph. i'm opposed to the expanded use of the nonuniformed. visible policing on enhances surveillance base and there could be no response on health care emergencies and policing. to ensure the success of the community safety teams, it is essential to any new creative [inaudible] to unionized jobs. ensures that community safety teams are well con verdict sated. our patients need the continuity. furthermore, i want to support the demand for nurses and other

chronically understaffed physicians at sfdph. in the public health crisis of law enforcement and community members and establish itself as an innovator. i hope we will seize this moment. thank you. >> thank you very much for making the comments. next caller, you're on mute. please let us know you're there. >> hi, yeah. my name is leah and i'm reading this comment on behalf of jay who is unable to attend the meeting. >> my name is jay. i went out to my car to wait for my friend. as i got in my car, five sheriff vehicles turned the corner full speed. i got out and went to see what they were rushing to respond to. i saw eight deputies surrounding a single black man

in his wheelchair on an accessible walkway. they handcuffed this confused man clearly, he was not acting in any threatening manner to the officers and complied with all of his requests. after 20 minutes with the man cuffed hands behind the seat of his chair, they came back with a bag and said they didn't find hum. doctors were asking the deputies what the man had done. after 25 minutes, they uncuffed the man and said he had only been seeking medical attention and didn't know where else to go. i have all of this on cellphone video. one doctor asked me to sent her

the video. a person should be able to peacefully seek medical care regardless of past criminal accusation because that's all a warrant is anyway. point being. things will escalate. the doctors told me that officers frequently overdo it at sfhealth care. do the math. thank you. >> thank you for your comments. next caller, you are unmuted. >> hi, can you hear me? >> yes. you are on. >> hi. i'm speaking on behalf of a registered nurse at the san francisco general hospital and the department of psychiatry.

unfortunately, i cannot genuinely say that sfgh has fulfilled their mission of providing quality health care and trauma services with compassion and respect. sfgh's vision is to be the best hospital by exceeding patient expectations and advancing community wellness in a patient centered healing environment. this will not happen unless we make changes and work together to ensure we are truly creating a patient centered healing environment. i am here today with many other community members and health providers asking that you expand behavioral health emergency response team and patient support services as it would keep our most vulnerable patients safe. unarmed skilled teams of mental health professionals trained in deescalation and trauma and care have proven to be effective for law enforcement and health care related issues. it's no coincidence that less than 1% of hospitals use police as a form of security. sfgh, we must do better.

we must ensure that our most vulnerable patients get the treatment they deserve. i've had countless patients that have felt so threatened by police and sheriffs. this brings more trauma to a place that's supposed to empower patients to heal and recovery. patients have been affected the most by internal police presence as they have on the national level of police brutality and racism. i've seen this first-hand. a patient shouldn't automatic assume they are criminals because of their immigration status or because of the color of our skin. imagine a black person frantically kneeling on the floor with his hands up even if ip was not called for him. i've witnessed countless times the ip sheriffs many overuse or misuse of power, i even feel threatened by them at times. >> clerk: we're going to have

to cut you off. i apologize. thank you very much for your comments. your two minutes is up though. all right. next caller, you're unmuted. please let us know you're there. >> hi. can you hear me? >> yes. you've got two minutes. >> my name is jessica and i'm reading this written comment on behalf of arena alexander. she's a licensed mental health therapist in san francisco. and she says i'm writing to support the efforts of dph. i interact with dozens of people who are unhoused, lower income or otherwise personal. i see first-hand how much fear people have around sf medical care due to its devastatingly close ties. even the fear of a global pandemic wasn't enough to overcome the barriers for many. i remember talking to one client experiencing homelessness at the beginning of the covid pandemic who had just gotten out of jail, had a

high fever, but was too scared getting arrested. san francisco needs to do more to create a sense of safety and healing in places that are meant for that. i write today in full support of the dph campaign hoping we can continue to move forward removing the immense barriers towards access for health that too many people in our city face. accessing medical treatment should never be a punishment. thank you. >> thank you very much for your comments. next caller, you are unmuted. please let us know that you are there. >> hi, i'm reading for danielle herrera. a community health mental therapist working with harm reduction therapy in san francisco's sip hotels. i urged the health commission to invest in the expansion of the behavioral emergency response team at sfgh and the

san francisco sheriff's department. i ask that you support our patients and staff by rejecting sfdph's administration proposal to hire health care security officers. instead, we ask you to support good union jobs by piloting a community led trauma informed safety team in our primary care clinics. really develop that role of health care to support patients and most importantly, improve staffing ratios for our nurses and other: clooe staff front line positions that dph. law enforcement officials are not adequately trained to work with the community i serve. my clients have experienced complex traumas that manifest some of their symptoms today. most basic mental health and care for these folks has been nearly eight years. law enforcement has shown me time and time they have failed to humanize and criminalize them for poverty and drug use.

i've had countless experiences working with the public i serve and experiencing a severe physical health and instead, they're met with someone who punishes them for what they are often unable to control and more trauma to work through. mental health clinicians and social workers should be those on the front lines of this work. if you want to see healing occur, we have a responsibility to remove the harm of and potentially traumatize the experience of being policed. i join my community and bend with the commission to die vest from reforms that increase the presence of law enforcement and private security and to invest in the well being of san franciscans to programs that provide alternatives to policing. thank you so much. >> thank you very much for your comment. commissioner, it looks like we've got five more calls, but we're not quite sure if they'll continue. you're unmuted, caller. please let us know if you're

there. >> hello. my name is lj johnson, i'm a social worker and behavioral health clings. i'm also a member of dph must divest. the deputies at the dph and funded creation of a union representative safety team and primary care clinics. i am a social worker because i love my community. i believe that the lgbtq youth that come to my clinic are current and future leaders. from talking with my patients, i know that the ongoing presence of sheriffs and police as a dph prevents many community members from seeking care in the first place. our lgbtq youth should be protected, not policed when seeking care. i think of a former patient of mine who is terrified to disclose suicidal i'duations because of the fear someone might call the police for a wellness check or that they would be brutalized by police when seeking emergency care. my patients' fears are not

unfounded the. in 2015, reports in the treatment advocacy center found that a minimum of 1 in 4 fatal police encounters and -- sorry. excuse me. and the life of an individual with severe mental illness. commissioners, i am tired of grieving my youth lost to police violence. i'm tired of terrified phone calls from psychiatric emergencies. we can and must do better. we have what we need to build meaningful alternatives to this violence. unarmed skilled teams of mental health professionals and social workers and community members trained in deescalation and trauma informed care are proven to be an effective alternative for law enforcement for health related issues. i join my community and dph must divest in demanding that this commission invest in the well being of all san franciscans through programs that provide alternatives to policing and create union jobs. thank you. >> thank you for your comments.

next caller, you're unmuted. please let us know you're there. >> hi, can you hear me? >> yes, and you've got two minutes. >> hi i'm a medical student here at ucsf and i live in san francisco. i'm speaking to join my community and colleagues in calling for replacing criminal surveillance of patients i urge the health commission to support the expansion of the behavioral health response team and behavioral response teams at the dph and from the creation of the union represented community safety team in our primary care clinics. dph is here to provide health and well being to protect patients from harm. i oppose the expanded use of non uniformed cadets and i think a lot of other callers have spoken more eloquently than i can about the negative impacts of those employees being present in our clinics

for their interactions with patients and cannot be counted on but were surveillance, policing, and escalation. i join my community in dph must divest and the well being of all san franciscans to provide alternatives to policing and create union jobs. thank you. >> thank you for taking time to make comments. next caller, please. you're unmuted. please let us know you're there. >> hi. i'm here. >> hi. you've got two minutes. >> great. i'm calling with an interesting perspective. i've worked in hospitals or volunteered in hospitals most of my life starting from the age of 16 and i currently work at ucsf as a nonpatient facing side. but a few days ago, my friend was hospitalized. my friend is a latinx person on med i-cal who had multiple

friends killed by the police. some in notable police shootings here in the bay area. and, what i want to convey to the supervisors is for those of you who have never been at sf general, i was actually shocked by the amount of police there. there are police when you arrive. there's police in the ed and if someone gets upset, sf general actually calls sfpd to come and sit outside the door. so at the time we were there, we interacted with six police officers. those police officers watched my friend go to the bathroom presumably because they're hispanic and after we said, we're really uncomfortable with the amount of police presence here because our experience with the police, the nurse just said, "they're here for your safety." and we said, "that hasn't been our experience." and she just moved on "is there anything else i can help you with?" that is not an environment for healing. i've never worked at a hospital

including public hops where there has been so much policing at the front door. the policing there regardless of whether or not they're cadets or in plain clothed is really problematic. there's really someone watching every step of the way. but i'm white and i was uncomfortable let alone for my friend who was just trying to heal. so i really encourage you to get sheriffs but more broadly policing out of hospitals. thank you dph must divest for your work. >> thanks for your comments. next caller, please let us know that you're there. hello? >> hello, i'm here. can you hear me? >> yes. you've got two minutes. >> all right. so i really appreciate everybody's comments so far. i'm going to be brief.

but i was dropping my friend off for surgery at sf general probably about a month, two months ago, and i was about to pull out, i was waiting for her in my car, i was about to pull out and like eight sheriffs cars surrounded me, blocked me in. they all kind of got out of their cars and rushed into this courtyard and i got out of my car to see what was going on and it was eight officers, different colored uniforms, some came from inside the building, some from cars and they just surrounded this one man in a wheelchair, like a black man in a wheelchair who had just come out of the hospital or maybe was waiting to go in. i'm not really sure, but he didn't seem to be hurting anybody, you know, and they handcuffed him behind his wheelchair. they took all his stuff away from him and searched it on top of a police car. searched through all his pockets. all these doctors started coming out and seeing what's

going on and this one -- i started filming with my phone. i have a 20 minute video of this. a black doctor asked like what are you doing? you know and one of the sheriffs like stepped to her and said like, "what are you doing?" where do you work? like she has a badge on, she's a doctor. they just totally demoralized this dude just looking for medical care. i just didn't see a reason for it because he was just sitting there. he couldn't even get up, you know. and i don't think there's any reason why you need more police. clearly, that whole situation took everybody who should have been helping this guy out of power. they were all waiting for the guy so they could see what was up. how does that make a hospital function better? i don't get it. you know.

so there's overreactions. i heard from this doctor because -- >> clerk: i'm sorry. your two minutes is up. i apologize for cutting you off before you're done. next caller, please let us know you're there. >> i'm here. >> yes. you've got two minutes. >> my name is ronnie, i'm speaking on behalf of talia eisenstein. i add my voice to the call for the eventual complete removal of sheriffs from sfgh and dph clinics. starting with full-time reduction. we must invest in alternatives to safety and community based support for our patients. i urge the health commission to approve some of the initial proposals including expanding the behavioral response team. a team that's trained in passionate deescalation to appropriately respond to 60% of the security calls.

i strongly support pilot and community safety teams in primary care. these usually are stack wednesday community jobs. the model of this can be seen with st. anthony's client safety services which is a team of people through community knowledge are trained to deescalate a situation with compassion. i urge the health commission to prioritize investing with a similar model. i do not support health care security trained plain clothed cadets. additionally, i urge you to develop the health carroll and improve staffing. thank you in advance. we can carve the path to the future of safety and health care settings, a model that the rest of the country can look to as inspiration let's be on the

right side of history and our patients. >> next caller, you've got two minutes. >> i have been a resident of san francisco for more than two decades. i have served this community as a midwife and come to this work with a reproductive framework which means i respect the human right of all of my patients to give birth when they want to to terminate a pregnancy when they do not want to be pregnant and to raise their child in a thriving community raised from state and police violence. this violence frames our work and is also compatible with law enforcement on campus including

our labor unit. people are intimidated. i've had patients tell me they could not seek care because they see somebody in a uniform outside of that unit. this level of intimidation extends to all parts of our campus.

while we were able to prevent the patient from being exposed to the response, several people had to deescalate the situation. our patients are not criminals so why do we treat them like they are. especially the black african american community. we have an overwhelming amount of scientific evidence that

repeated trauma causes a fizz physiological response. it's costing the department countless dollars and sick leave for our staff, not to mention the huge cost of treating the medical conditions that we are causing and exacerbating. we are beating the drum about listening to science when it comes to covid. masking, distancing, safe schools and re-opening. by condoning the presence of law enforcement, we are hypocritely ignoring the sign tichg evidence that links trauma to poor health. >> clerk: thank you very much for your comments. i apologize for cutting you off. next caller, you've got two

minutes. please let us know that you're there. >> hello. my name is lj. i'm reading on behalf of montida flemming. i'm a strong supporter of dph must divest. i'm calling in support of the expansion of the behavioral response team. and deputies of the dph and fund a creation of the community safety teams. to ensure the success of the community safety teams, i support any newly created jobs in this effort. i support the demand in spiu and calling for staffing ratio and other front line understaffed. i strongly oppose the expansion use of nonuniformed. as employees of sfsd, they cannot be held accountable to the same standards as the dph employee. our hospital campus is a place of healing. instead, they are confronted with the oppressive sheriffs who are ill equipped to treat

medical information. i join my community and dph must divest in demanding that this commission must invest and create union jobs. thank you. >> thank you very much. and, commissioners, we have our last caller. here we go. caller, please let us know that you're there hello. >> sorry about that. i'm reading on behalf of alex markovich who couldn't be here today. he says i live in district 1 and i'd like to support the reduce and remove of security officers in all health care settings. and then i'd like to [inaudible] the fact that the sheriffs

cannot be held to the same standards as the dph we need bold new solutions to meet the real needs of our patients and staff additionally sheriffs are ill equipped to deal with the mental health matters. 44% of service calls to sfsd and the fiscal year 2019 and 2020 were related to patient care issues. these complex situations require the response and the compassionate skilled community worker, not police. in or out of uniform, the use of law enforcement is emphasis thet cal to the mission. police cause trauma and the presence of police reactivates that trauma. let's invest in community-led safety teams. let's support union jobs. let's uplift patients.

let's staff more nurses. there are alternatives to policing. there are good alternatives to policing. we keep us safe, so let's invest in us. thank you. >> thank you, caller. and, commissioners, another caller has called in so we will unmute you. please let us know that you're there, caller. >> hello. my name is lj. i'm reading on behalf of catrina seraldo. >> clerk: i'm going to pause because you've been on before. we're not able to let the same people read and provide public comment more than once. >> this is actually a comment from a different person. >> clerk: okay. >> she couldn't be here today because she's working and is a provider in our hospital system. >> i'm sorry. i'll start the two minutes again. >> thank you for adjusting for me. this is read on behalf of

christina seraldo. she writes, i take care of patients who are disproportionately affected by the war on drugs instead of being inappropriately responded to by policing. i had a patient with opioid abuse disorder and came through the emergency room seeking care for a chronic flu. ment he told us he saw an officer nearby so he refrained from health care staff. instead, he decided to tell them he had tripped on his skateboard and that's how the wound got so bad. i solely support the expansion of medical assistants and nurses at sfgh. it's necessary that staff and patients both feel which may remind people of previous trauma that have experienced our systems. we must invest in safety and we must not invest in policing our

patients at their most vulnerable moments. thank you. >> clerk: thank you. more callers commissioners. all right. caller, i've unmuted you. please let us know that you're there. caller? all right. that person went away. caller, you're unmuted, please let us know that you're there? >> hi. this is stephanie freeman. i'm a physician at the general and i'm reading on behalf of cara leevy. i've been connected to the dph community for the past six years. first as a ucsf medical student and now as a primary care provider. i urge the health commission to support the expansion of the behavioral health commission to help keep our most vulnerable patients safe. when patients are in crisis, they deserve to be met with a team of trained, unarmed mental health specialists and not law

enforcement. in my first six years, i too often have seen the intervention and presence of law enforcement leading to escalation with patients. on the south side of building 90 i saw someone shouting. while i was not there to witness the entire interaction, there's no situation in which patients should be yelled at. and as a public health institution, we have the responsibility and opportunity to lead in a different way that prioritizes each of our patients humanity thank you. >> clerk: thank you for your comments. next caller, you're unmuted. please let us know that you're there. >> i'm here. i'm calling on behalf of jmc, a former sfdph employee who worked in primary care and laguna hospital.

i'm. ensuring staffing at sfdph. please reject the proposal to hire health care security officers and expanded role of sfsd cadets. instead, i urge you to support community job and community led trauma informed team and our primary care clinics to support patients and improve staffing ratios for nursing and other chronically staffed. to speak to further to union job creation, we need robust compensation and work place reductions for staff on these community safety teams. relationships of trust between patients and staff are proven to increase deescalations. high turnover hinders a relationship between staff and patients among our safety teams. please show your investment in

the labor and sustainability of these community safety teams by ensuring these teams are union represented. i join my community and dph must divest and demand that this commission must divest and invest in the well being of all san franciscans through programs that provide alternatives to policing. thank you. >> clerk: thank you for your comments. next caller, you're unmuted, please let us know that you're there. >> hi, i'm here. i'm a nurse with the department of public health in outpatient care. i've worked at castro mission health center as well as a number of different clinics. in two thousand six, i just wanted to point out three instances that i recall where a sheriff's deputy was involved in issues with our patients. the first one was a patient who was in an exam room and he was

sort of nodding off and tired and the sheriff's deputy with good intentions went in there to sort solve startle him awake and the patient, of course, you know, woke up and had this very large man over him so he freaked out. he was an african american patient and they tumbled to the ground and started wrestling. as a result of that unfortunate situation, that patient was denied service at our clinic going forward so he lost his primary care clinic going forward. the next incident happened because the sheriff's deputies apparently are allowed to arrest anybody who has an outstanding warrant even when they're seeking medical care. so 0 went in for his doctor's appointment and was subsequently placed in handcuffs. which is crazy because when i go to the doctor, i don't have to worry about whether i have

an outstanding warrant and i'm going to be arrested for seeking medical care. and then the last situation was a transwoman who was somewhat disruptive in the clinic and she was targeted by the deputy who was pretty much fed up with the mental health issues that this person is dealing with. so she started walking towards one of the therapist's office and then she started to run away obviously scared and then the sheriff's deputy ended up tackling her to the ground and handcuffed her after that. >> clerk: sorry. your time is up. i have to mute you. i apologize. all these are very heart breaking comments. i'm sorry to cut any of them off. next caller, you're unmuted. please let us know that you're there. >> i'm here.

>> clerk: okay. you've got two minutes. >> i'm calling on behalf of claire warren, a social worker, a student at sf state. claire says i was born and raised in san francisco district 10. i urge the health commission to support the expansion of the behavioral health response team and patient support services. from my educational background, i've learned that when someone is in a mental health crisis, police are the first responders. the first thing that comes to mind is armed law enforcement. a person experiencing a mental health crisis does not end up dead. second thing that comes to mind is hoping that the police do not further escalate the situation, but further trigger the person in need. having social workers and people in the profession of helping others as first responders is the step in the correct direction towards providing proper care to our community.

thank you. >> clerk: thank you very much. commissioners, that is the last public comment. >> president: all right. moving on to commissioner comments and questions. we have commissioner christian. >> commissioner: thank you, president bernal. first, i wanted to thank director price for his obvious and ongoing dedication to the safety of the workers in the department of public health at various hospitals. i've been on the commission a little less than a year, but even in that time, i have learned because of your presentations and the things that you -- the way that you speak to us about this work that you take this incredibly

seriously, that you take the safety of each worker at the hospitals safely -- seriously, as well as the patients and the community members who have a right to access health without being frightened for their own safety. so i also want to acknowledge the fact that in this last year and longer than that for many people and i'm sure your experience with this exceeds many of ours, it has become clear that policing as an institution at every level is structurally and foundationally in need of great change. and, given that we're at this moment and we're looking at how

to create safety within the community and specifically in the context of dph and i know that you're looking at it on a minute by minute basis, can you as opposed top why is the right choice to kind of move away from the sheriffs, but still stay with the cadets who are as i understand it civilians who have no expertise other than what they're given. why it's appropriate to go in that direction rather than to go in the direction of the clinically trained people could be given instruction in what it

-- whatever additional instruction they need to increase the increase their level of safety and to deescalate things. why is it appropriate to go in this direction now rather than to move in the direction of expanding the behavioral health response teams. >> thank you, commissioner, for your question. i would agree that when it comes down to health care, we want to make sure that our patients are safe. if there is no room for law enforcement and patient care situations that are not based on a crime with regards to the cadet services, i actually saw this, we saw this as an opportunity for additional change with a more clinical

model. again, it was important for us based on the history to take this in phases and then examine it from there and then move forward into further steps to bring that vision into how health care safety should actually look. but just, you know. i would say wisdom isn't being strategic. it was really important based on not just my decision, but dph has a whole to be taken this approach as we look forward to other opportunities and move forward.

>> commissioner christian: i thank you for your response. i think i want to emphasize what everyone else is feeling. we're at a time where we need to imagine boldly and to take bold steps and whether i appreciate your expertise and this is your work and i'm not telling you anything you don't know better than i do. we have a lot of steak here and public health is our responsibility and law enforcement and public health don't mix very well together. >> thank you, commissioner. >> president bernal: thank

you, commissioner christian. commissioner giraudo. >> commissioner giraudo: thank you so much for your presentation. and i am really looking forward to the innovative ideas and the behavioral health implementation. i appreciated your response to my question about training, but i would also like to encourage and add that you had responded the staff i am suggesting that as least in year one and year two for a program such as the training be considered for

every six months as a way to kind of problem solve what may continue to be occurring and what the behavioral health clinicians will have experienced in their new roles. so it's just my encouragement to think at least in the first two years to increase the training. thank you. >> thank you, commissioner, for your counsel. >> president bernal: thank you commissioner giraudo. commissioner chung. >> commissioner chung: thank you so much. i just want to join my fellow commissioners and thank you for the presentation and also thank all the public comments with all the really heart wrenching testimonies, you know, as somebody who has been a service

providers and i too have experienced stigmas against, you know, like our clients, you know, like who maybe something some challenges and issues around behavioral health. i'm hearing that we are trying to find community driven solutions and i don't think it would be too practical to have agenda items like today and then becomes the only time that, you know, the community comes and makes public testimony. so would it be easier, mr. price if there is like any mechanism that's being set up so that like community can really like share, you know, like on, you know, share their

experience and what they have witnessed, you know, in a more meaningful way so that, you know, we don't have to feel so overwhelmed during one meeting and trying to come up with solutions. and i don't believe that, you know, what we are presenting right now is the final solutions either. it

. >> vice president green: i don't think we're going to initiate train and workers who can then execute on this vision and i hope you would not only give us feedback to what is successful and what you might want to change, but also, and we really appreciate you answering all the questions in writing and i think you gave us more information about cadet training and details in the written responses, but i hope we critically look at that part

of the program in terms of how we can migrate this so we really do answer all of the concerns i personally as a hospital worker experience many of the incidents that have been outlined here and it's jarring every day to walk into work and the first person i encounter is a security officer and it doesn't create a good atmosphere. so i'm very grateful to everyone for all the work, for all the comments and we'll really look forward to hearing more about the prioritization of this really important initiative. so thank you so much. >> thank you, commissioner. >> commissioners, i just wanted to quickly say i wanted to respond to commissioner chung also. i couldn't get myself off mute, but i'm one comment late. in terms officers for input, we can't have and we will continue to have quite a lot of

conversations and process around these issues. director price, and the network have done a lot of meetings with staff. and then we will have in addition as we talked about earlier a process around that will involve community members in terms of planning with a roll-out of this and valuation of this going forward. so i think, you know, we're hearing there's a lot of energy around this today and i hear your comments. i know director price is more aware than i am from all the

conversations we've had. we do plan and attempt to make this an ongoing conversation within the department. >> president bernal: thank you, mr. wagner. director colfax. >> director: thank you, commissioner. and i just wanted to quickly add my thanks to the people who made public comment and acknowledge director price and his incredible work. the extensive input process that's gone into this work this is a key step for the department and just want to thank everybody for the work on

this and this is an extensive process. this has been in progress for a number of years and i think it's indicative of our commitment and director price's incredible work to getting us to where we are today. so thank you, commissioners. >> president bernal: thank you director colfax and director price and everybody who called in to provide public comment and shared many experiences. i know that we all have experienced many heart breaking experiences and thank you also to director colfax and mr. price and director wagner for your commitments to continue to examine this program as it moves forward and collect input from the community and make whatever adjustments are needed as you move forward. i believe that is it for our -- for this item which was a discussion item. and our next item will be the fiscal year 2021-2022 and

fiscal year 2022-2023 budget. and we have our newly installed dph budget director jenn louie. >> thank you. secretarimorewitz, i'm having trouble. >> i didn't give you permission. hopefully it will pop up in 3 seconds. do you see the button now? >> yes. >> okay. i apologize. >> no worries. all right. good evening, commissioners. jenny louie, dph finance. i'm here to bring updates to our 21-23 budget proposal. and so as you may recall in

february, there were several key stakeholders. as promised, i am back here before you to mr. several initiative its. and, to the first one, [inaudible] covid-19 response for the next year. we will also bring forward the budget changes related to the staffing changes that you heard in the prior item as well as one item related to rev view related to medi-cal. also related to sf programming and funding proposition to be discussed briefly preparations for changes.

so, with that, i'm going to turn it over toll dr. albert yu head of our covid command and he has created an incredible robust process and the program we have for you. >> good afternoon, commissioners. first of all, can you hear me okay? wasn't sure whether my sound's going to come through with my mask. i'm going to share a couple of my slides and some of the assumptions and then, jenny louie's going to get into the more specific budget numbers. this slide i shared with you two weeks ago. i won't get into too much. essentially, we are in that transitional state of moving into eocdph structure. next slide. and, as noted last time.

we are taking a phase approach to our transition when it returns back to dph to continue to run the ongoing covid response at least from the health department perspective. clearly, there are multiple departments doing similar transition planning work. next slide. i want to, i think i talked about this briefly last time, but i do want to spend a little bit of time on this slide because it is the grounding assumptions from which we are driving the plannings both at the surface level and the corresponding personnel that's needed. starting with the sass cov2 we are assuming that over 80% of current eligibles 18 and over

were vaccinated. that, by the end of the year, we will begin vaccination of the pediatric population pending at the 12 and younger age group in terms of whether we will receive the emergency use agreement later this year and the assumption that we will continue to vaccinate the pediatric population into the spring of 2022. we're not assuming there's any need for boosters or due to the varying impact and that there's no change in the vaccine efficacy. next, we're also assuming that we are not surging, that means no more than 400 cases per 1,000. population about 36 per day and the associated individuals that we need to trace as a result of those positive cases. the assumption is that there is no need for any medical, surgical, icu bed because we

have sufficient capacity. what all of you may have heard about last december when troy williams presented in terms of alternate care sites, care clinics, our location as well as ongoing acute needs for medical, surgical, and icu beds. i should mention that we did budget for at least one unit for the san francisco general covid positive unit to support that ongoing demand to cohortations. that there's also adequate resources for this point going until june 30th before we begin the transition of continuing our ongoing response and that any surge or change in the biology of the conditions related to sars cov 2 would have the financial contingency from the controller's office when we hit those conditions. next slide.

this is a high level just to show new terms of the progression of staffing. the point is as you can see from may first, you know, right now, we have about 86 teen individuals that are dsw activated in supporting the covid response at mascone and in the field. as you can see in july, october, and january, there will still be a sizable number of dsw coming from dph as well as other departments in the city. it is a drop-off. a sizable drop-off from the 816 to 445, but nonetheless a sizable commitment and that will further drop 272 in october and then beginning january of next year, there will be no ongoing activation of dsw or any other departments. the second roll is also to note as part of the staffing model

beginning july 1st r 1st, there's also an assumption that a number of contractors as well as ongoing temporary hires that we brought in this year as well as additional approved positions in the 2022 budget to support this ongoing demand low to balance the dsws. next slide. this is the final numbers that we have submitted to the mayor's office and controller's office and received approval last week. it's broken down by each one of those service categories in the top half of the slide. covid disease control includes investigation as well as outbreak management. community engagement is clear. we call it data intelligence, but this is really virus tracking our data strategies wells data monitoring. there's also a big budget

roster. many of those service that is we are returning or that have been pause over the last rear. or returning our behavioral health service team to support the ongoing need for our patients receiving care in our

positions. 52 of whom will need to be hired by july and then an additional 26 will need to be hired for october 21st and can

even do the math now. that needs to be added by january. the bottom set of two rows tells you how many of the dsw are coming from dph as well as other departments in sort of aggregate. next slide. the next two slides just gives you a very high level summary in terms of what the personnel resources will be supporting. what type of services will we continue beginning july and which type of services we won't. the citc is assuming they have enough staff to manage essential thirty new cases and probable three to four contact tracing per case based on the past year's experience. they can manage that and they can manage publicly field outbreaks, but not sizable outbreaks because that was budgeted for part of the

service level assumptions. we have budgeted some staff to make sure we continue engagement throughout different neighborhoods and communities with really priorities focusing on populations and settings most impacted by covid as well as those neighborhoods that have the most health disparity in terms of where we are allocating the community engagement equity resource. obviously, there's a big shift in the community branch resources from skill nursing facilities or rcfes. over the past couple months, some of that staff will shift into the schools, work places as we re-open various industries and persons experiencing homelessness due to the re-opening. our data intelligence based on resources be able to continue to support the current dash boards that are accessible to

the public as well as how we're doing and the virus progressing. we will not be supporting any new requests unless it's an essential prioritized the request coming from various department heads following sort of the dph data requests protocol. the re-opening as i noted earlier, much of this is about the need to maintain one unit to make sure we can cohort and the other staff is about turning back and backlog and in patient and outpatient care to our residents whether there's medical services or surgical services or diagnostic services and many involved behavioral health services as well and i

mentioned sort of the primary care, chronic health care. the covid task force will from planning administrative coordination as well as bridging with the external departments. so much of that budget is in the doc budget. also within this budget. there is a good number that's called out. even though we are starting to point all of these documents to the state and the federal government, cdc, and cdph. however, many of the questions that we've been fielding and we'll continue to field are

various industries opening up so we still have some staffing and part of that is also about translation given that our cities and language requirements obviously those will even if we take the cdc and cdph guidelines, they still would be needed to be translated to be relevant to our communities. most of this budget is to continue to provide the clinical services we're not managing the hotels, the sites, the physical asset, but mostly provide clinical services and wrap around services. much of that is supported by our whole personal integrative care team and they're able to hear with dr. halle hammer's team. the dph covid vaccine we have as i noted earlier, we're not budgeting for boosters or impact on efficacy. we are budgeting for pediatric

beginning late this year continuing in spring as well as budgeting for sort of the remaining 20% of the population that have not been vaccinated, that's what we're calling the hard to reach individuals in some populations that will require more mobile assets as well as direct community engagement. so much of the vaccine for next year is not really in the high volume vax site that all of you have come to know, that much more targeted outreach, much more targeted mobile asset to bring the vaccine to people rather than having sites and expecting them to come to us. the testing and laboratory, we have primarily contracted most of our testing requirements beginning july to third party contractors. they've been working with us already. so these are new contracts, but

these three contracts will take over except interest the testing services that will continue to provide in the network whether it's at a hospital and various ambulatory clinics. that next slide. i think that is it in terms of the assumptions and services. i'm going to turn this back over to jenny. >> thanks dr. yu. and so the slide before you shows our proposed level expenditure for our baseline covid health response here. and so you can see the divisions. we are assuming fema revenue for the first quarter of next fiscal year because that is our understanding of when the fema revenue would reimbursement program would expire. a portion of the cost offset by revenue and we also have one state grant $14 million that will support some of 0 our

contact tracing. so,overall, a proposed of about $35 million of other revenue for net general fund supportive. i will note that we had a similar table in your commission packets and i apologize, but there was a labeling error. while the numbers were right, we had mislabelled a portion of some of the line items so they were actually -- there was a bit of a disconnect between the program and the effort. you should have received corrected documents. and they've also been corrected here. so we will continue to work to refund these members and work with the mayor's office to get them included as part of the budget. this proposal represents sort of our baseline effort around mitigating and managing the spread of covid-19. what is not included is in the additional community response that may have been adversely impacted as a result of the

pandemic. we will be working with the mayor's office as well as other key city partners including office of economic and work source development and the human rights commission to coordinate a city wide approach to address issues as a result of a pandemic that goes beyond the health response. so we will -- we do not have any updates on that, but we will bring them forward at a future -- for future discussion at the commission. in addition to covid, we will be requesting a change in budget to meet the staffing changes that mr. price had presented earlier. i won't go through all of this because i think he did a great job talking about the operational changes, but there's a net impact of about $1.8 million ongoing. deputy sheriffs with other teams and again, this is a

similar slide to what he presented earlier and the version of dph or sheriff work order to contract [inaudible] services. and, lastly, i just want to bring forward one revenue meeting. it's an opportunity to update you on the budget. we believe that there's an additional up to $43 million of one-time revenue. this sort of continues the current revenue in which we projected the reports to be closed out by the state and cms at the end of the medi-cal waiver. in the current fiscal year, as you know, the state continued many aspects of the 11-15

waiver and extended it for another year and so i think the state kind of took their foot off the gas a little bit in terms of closing out those payments which we originally thought or the settlements which we thought would be closed out by the end of calendar year 2020. and so we are still in the process of doing so and we received a number of settlements to date already and, at this point, we expect to meet our current budgeted year number at $65 million. but it appears that they're settling a little more favorably than we expected. so we project the remaining value of the open support years are and we believe what is budgeted in the current year of an additional $43 million of one-time revenue. >> we're including part of

that. so here's a summary of the initiative that we have before you. but what we do not have any additional financial detail on are two initiatives where the processes are still continuing, but we did want to update you on what's happening this spring. the first is funded under proposition c. just yesterday, we had the our city our home oversight committee has made registers in conjunction with the department of health's proposals for additional spending including overdose response, individuals, and permanent supportive housing, increasing behavioral health treatment capacity and

keep populations and transgendered. we are still working with the mayor's office on the final spending plan. we will not likely have them available. so we have been with members of the community as well as participating in stakeholder processes and we will continue to work with the mayor's office on finalizing this plan for budget. the other update i have is related to cal. which issued broad changes and in preparation with the health plans as well as anthem blue cross and the department of homelessness and other key stakeholders to begin the preparation for it. we started to analyze the services we currently offer as

well as provide feedback to open comment series and i remember working with the health plans to identify the priority population and also vaulting our program capacity to be able to provide the data sharing. to date, there's no information on funding levels and we're still waiting additional information regarding detailings on how the plan would be rolled out, but we do expect to have additional information by the end of may. they will be available for questions should there be any. >> in terms of next steps, we

will submit these to the mayor's office for consideration. we will continue to work on the initiative and continue to plan for proposition c as well as cal aim. we are running close to the mayor's deadline and as you know in june and july, we will move forward to the board review of the budget. so we're on a short time frame, but i am happy to answer any questions anybody has. >> president bernal: thank you to dr. yu and also to director louie and congratulations on your new role. thank you for incorporating some of the questions that the commissioners had earlier. do we have any public comment on this item, mark? >> person on the comment line, if you'd like to make a comment on item 9, please press star 3.