i'm not certain why we were doing warrant checks at the sheriff's office. i mean, people normally walk through and come in and i just

believe that it would be good if we investigated ourselves and understood what the policy is and whether the policy should be changed. it seems to me that patients coming to our facilities just like we said for the undocumented should not actually be screened in that sense unless there was some real reason that the person was acting out of sorts. and therefore you need to know as much background as possible. from the testimony we heard, it's almost like it was random. so not knowing what the department policy is and what we have set up with the sheriff's office, i think it would be well -- a time well taken for us to understand that portion better and i relieve that to the discretion of the

president. >> president bernal: thank you commissioner chow. let's get back to how that is implemented in practice. >> commissioner chow: thank you. >> president bernal: thank you commissioner chow. and i join you and secretary morewitz and we're grateful for everyone who has called in to express their perspectives on this and it will help inform us moving forward. moving on to our next item. the director's report. director grant colfax. >> hi, good afternoon, commissioners. grant colfax, director of health. i will go through some highlights and be available, of course, for any questions. on may 13th, the cdc announced new mask guidelines particularly focused on vaccinated people.

to put it bluntly, vaccinated people for cdc recommendations can mostly not wear masks in most settings, including most indoor settings. there are some exceptions to that. after we reviewed the recommendations from the cdc, the decision was made by the state to delay adoption of the cdc guidelines until june 15th. we will therefore adhere to the state recommendations as we're required to do so. we also believe that this will provide more time for more people to get vaccinated so that more people will be safe with masks off. i noted two weeks ago at the last health commission, i'm delighted to announce our new health officer and, before that as deputy health officer and

dr. philip is more than stepped into the role has been a delight to work with across the department and with other city partners and has been doing an outstanding job, so just to acknowledge that that work continues and really delighted to have her in this new capacity. i also on another note with regard to our new health resource center located at 1064 mission street as part of our whole person integrated care work. we are planning to honor a former member of the health department who died on july 15th. maria martinez. a mentor to us and many including myself we were very saddened by her passing and her

contributions and is important to the community we're delighted to name the health resource center in honor of maria and multiple people in the health department and other entities wrapping services around clients who need these services most is very much in keeping with maria's priorities and approaches to the work and so we're just so we will keep you updated on how that continues to proceed. back to covid for a minute, we now have people 12 and up who are now eligible for the pfizer

covid-19 vaccine. so we are rolling out efforts to and in the director's report, you will see many options for people to receive the vaccine whether they're 12, whether they're 120, we're making vaccines available to whoever is eligible for a vaccine. and, again in my former presentation, i'll talk about where we are in terms of being in the yellow tier consistently with the low rate particular to what that means in the director's report and i will stop there. there was a lot of but happy to read for you articles and

answer any questions thank you. >> president bernal: thank you, director colfax. we certainly congratulations dr. philip and thank her for her leadership in the pandemic before and beyond and also the board of supervisors for their wisdom in unanimously approving her. it's also very fitting to maria x. martinez and her equity with any other matters within the department. commissioners, do we have any questions or comments for director colfax before we move on to our covid update? >> clerk: i apologize. there are a few people on the line folks in the public comment line if you'd like to comment on this line, please press star 3 to raise your hand. star 3. no hands, commissioners.

>> president bernal: thank you, commissioner motherwitz. we'll move on to our next item which is covid-19 update. still director colfax. >> great. thank you so much. i'll just quickly go through a few slides to provide a broad city update. next slide. so san francisco cumulative cases and deaths. 36,487 cases of covid-19 diagnosed and, unfortunately, we've had 541 people in san francisco day of covid related complications. i think, on this side, the key point more recent points demonstrated on this slide is that leveling of the curve. as you know, we've talked about the flattening of the curve. don't think you can get much

curves flattening in the city. our safety precautions. the best of which which is shown to be outstanding. increasingly be demonstrated in other parts of the world that have that high vaccine coverage hopefully increasingly in other parts of the country that have experienced surges that were much worse than san francisco's. next slide. this is our population characteristics of positive cases. this is cumulative. so these numbers, these proportions are not going to change dramatically over a month's time even increasingly over a couple months' time.

you will see that inequity with regard to latinos diagnosed with covid-19 which was above 50% of positive cases has gone down to 40%. the age groups were seeing even fewer infections among people 60 and up than we were earlier in the pandemic consistent with their earlier role, the vaccine's focused on people 65 and up and younger people make a larger proportion of the larger cases and then you'll see sexual orientation has not changed dramatically recently. next slide. this is looking at our covid-19 cases, rates per 100,000. we peaked at the beginning of the year at over 42 per 100,000 cases. we're now down to 2 per 100,000 cases. so remarkable to climb.

you see there as we moved into the red tear, orange tier, and yellow tier, gradually re-opening while we're getting vaccines into arms. we were very concerned. i was very concerned as we moved into the red tier and the orange tier to see if we were going to have cases go up. because san franciscans took the safety precautions in terms of the masking and social distancing combined with increasingly wider coverage of the vaccine, we haven't seen a surge or a swell in new cases. next slide. this is a slide that's a little busy. it's a reproductive rate since the beginning of the pandemic. all the way back to march of 2020. yeah. march of 2020. all the way through to may of this year. that reproductive rate is shown

in the blue line going across the slide. remember, we wanted to keep that reproductive rate below 1. the increase above 1 is shown as we reflects our surges in the last spring and summer and the winter. and you can see here that number, that reproductive rate is now well below 1 again and, in fact, today is at .79 which is the lowest it's been in awhile and hopefully this reproductive rate will remain below 1 unlike it did last year similarly in the fall in the red and yellow tiers. next slide. our key health indicators, rate of hospitalizations remains in the negative territory, hospital capacity remains good. that case rate 2.2 per 100,000. testing numbers have dropped

off to some degree especially given the large number of testing we saw during the holiday season. contact tracing down a bit. one hypothesis to why that number is down. a higher proportion to younger people making up new cases and it's plausible they are less likely to respond to a call or to an e-mail in terms of being asked to respond to a contact tracer and then, of course, our p.p.p. supply as it's been for a number of months now. this is our hospitalization numbers. the peak of 256 and just very pleased to see these numbers starting in early march not only dropping, but stabilizing. we've been consistently below 20 people with covid-19 in the hospital for a number of weeks

now and just a couple things i wanted, we put the state color tiers consistent with the hospitalizations. remember, the purple tier on the far left, well, on the left is the most restrictive chair that the state put us into has happened. red chair less restrictive. orange, yellow. you can see again that these hospitalizations consistent with the case rates did not go back up. and you can also see that the vaccine numbers, this is percentage of all san franciscans vaccinated with all san franciscans vaccinated, you can see that our vaccine coverage hasn't increased. these numbers remain flat. so a common number of gradually re-opening and right now we're optimistic and hopeful we've got that balance right, but we

continue to follow the data carefully every day. next slide. 76% of san franciscans over the age of sixteen have received at least one dose. 61% have received -- has completed their vaccine series. you can see the numbers there. i'm pleased to say this week we will reach 1 million doses of vaccines administered in san francisco thanks to the hard work of covid command and the vaccine teams to acknowledge that, this has been incredible progress i believe it was december 16th. i believe that was the right date. next slide. so our vaccine numbers as we've

seen across the country, our numbers administered per day have started to decline. we peaked at over 14,000 vaccines administered today. can we go back to the last slide. thank you. we had more capacity to do more than 14,000. that was limited again by supply, not by our operational capacity. these numbers as we're seeing across the state, across the country have declined across the state, but a lack of demand. the demand has decreased substantially. particularly and this is focused on the demand is around first doses. the second dose uptick remains robust and the second dose is smaller than the national or state average, so we're pleased with that. again, we're down to about 7,000 doses a day. 12 to 15-year-olds, we are

getting the younger population in for vaccines, that's a relatively small proportion of all san francisco residents. so even with there being eligible, we do not expect to see a large bump in that first vaccine uptake compared to other places with the larger numbers of younger people. next slide. so in terms of vaccinations by race and ethnicity, again, these numbers remained relatively stable you see on the left. the proportion administered by racial ethnicity across the city we administer anywhere from a quarter to a third of vaccine available in the city and you can see that at d.p.h., we are providing a greater proportion of vaccine to communities most affected by

covid-19 particularly with regard to black and african americans and latinos compared to the vaccine administration by all providers. so in terms of our vaccine uptake, we are increasing our efforts to a large degree to a more granular outreach effort with regard to the vaccine administration. while they've done a at the knowledgeal job, it's increasingly parent when we talk to community leaders, community partners, people living in the community that we need to go hyperlocal to get these numbers above the 70%, 76% first dose rate that we've had so far to get to the next 5%, the next 10% is going to be very intense almost door to door in some cases literally door to door work.

so we are adjusting. we're expanding drop-in access. we're extending to evening hours. those are the small types of change. going hyperlocal with regard to neighborhood access sites. student ambassadors, we have a number of student ambassadors helping community members navigate the vaccine network. we're working to place physicians and other health care providers at neighborhood access sites and others who may have questions about the vaccine and want to talk to a health care provider about the vaccine so we're operationalizing that. and then we're also realizing that people want their own primary care doctor or primary health care provider to be the one that gives them the vaccine so we're currently exploring and determining how to best

make it so that if you go to your provider just like when you get the flu shot for some of us, you get the vaccine when you go to that provider. so that's something that we're exploring and dr. chan will talk more about that their and then we're trying to make it a bit of a celebration to get the vaccine. it's not just about getting a shot. having music at events, having food at events, focusing on vaccine outreach and perhaps even vaccine administration as some of our larger festive events that are becoming more and more possible to do in san francisco including carnival possibly some pride celebrations and many juneteenth events. really looking at an all of the above events having these conversations realizing it's going to be high touch.

low barrier, multiple conversations to help people feel comfortable getting these incredibly effective vaccines. next slide. so i have to show you the comparisons of the san francisco to global rates. in this case, many parts of the world, um, with regard to first doses, a country of 97,000 people in terms of vaccine going into arms. vaccines were at 53%. other countries are 47% first dose rate. what's interesting is our curves in terms of infections and hospitalization numbers are

very similar to the u.k. and israel and when those vaccine numbers in those countries reached a level i'm rounding here, but at a 50% first dose, you see dramatic changes in covid-19 rates and so these vaccines work at the population level and i think particularly in the last few weeks, there's been some positive news about the vaccines, one dramatically reducing transmission risk one in people who are vaccinated and, two, being effective against variants which is very reassuring given how concerned we were about variants earlier this spring. we're still concerned about them, but so far the news has been relatively or i would say positive in regards to that. next slide. and then just an update on the health order changes in the past two weeks since we met

dr. philip in conjunction with other people on the d.p.h. team made these changes in collaboration with the city attorney's office who have by the way just been incredible this year in every respect with regard to our covid-19 club. crowds. if unvaccinated people cannot or partially vaccinated people cannot socially distance, face coverings are required still transit, the stay-at-home order has been modified. you can see there the outdoor, indoor capacity for people gathering has increased and then youth sports are now all allowed with some very limited testing requirements for the highest intensity contact

sports and dr. philip can answer additional questions that the commission has with regard to health order changes and i believe that's my last slide and i'll take questions either now provides a network update. >> dr. chen isn't for a few more items just for everyone to note. >> i'm sorry. forgive me. >> president bernal: secretary morewitz let's proceed for public comment. >> folks on the line if you'd like to make public comment, please press star 3. i don't see any hands, commissioners. >> president bernal: thank you secretary morewitz. commissioners are there any questions or comments? i would like to make a comment in addition director colfax in addition to acknowledging the

city attorney and other matters, i would like to acknowledge the data team within the department and within the covid command center for their excellent tracking of the data that has informed our order and our policy and how we've tread the pandemic and put us in very good standing and what we saw compared to other jurisdictions not just in the u.s., but around the world, particularly the historic charts of our reproduction number and our hospitalizations have really shown where the different interventions that san francisco has taken both on its own and the direction of the state have really served to help crush the virus and get us to the place we are now with the hopes of opening up more fully in the coming weeks. thank you to our data team and also to director colfax to your presentation. any other questions? >> commissioner chow: i have a

question if i could, commissioner bernal. and it's probably directed to dr. colfax and it's really related to our health care workers one expected at hospitals, but most importantly what about small office settings. and without vaccination. i mean, how best is the advice right now in terms of masking? i assume social distancing is continuing, but maybe not and/or are we supposed to segregate the vaccinated from the unvaccinated and many small waiting rooms can't do that. just wondering how dr. phil philips would envision? let's just stick with the small

offices first. >> i appreciate that, commissioner chow. and dr. philips may not have been able to join us quite yet. so if we can hold that question as we try to locate her or until later in the commission meeting if you don't mind. in terms of the hospital question, i see dr. earlick is understanding what's happening at the hospital at least into those waiting rooms would be helpful, sir. >> commissioner chow: thank you. of course. >> commissioner: hi, good afternoon, dr. chow. right now, we're continuing with exactly the same practices that we did before which is masks and 6' of distance. and, to the extent, we can't keep those distances, we can either put people in exam rooms or we have them wait outside,

but we're still masking and distancing in the same way we did before. we have started to, in fact, just today, we had a meeting where we're starting to review these practices in conjunction with the network come up with new guidance where it's appropriate, but, to be honest, the guidance is not always consistent. it's very challenging for us to come up with new guidance and as dr. colfax suggested, we will be moving very cautiously with our staff recommendation, our patient recommendations, you know, because it's not consistent and things are changing. >> commissioner chow: so just as a followup, are you getting resistance from people that might have been vaccinated and perhaps misunderstood the orders because of the [inaudible] order that you didn't really

need to mask or has that not been a problem for us? >> it's not been much of a problem for us in the health care settings because the cdc guidance that came out really isn't attached to health care settings and i think people mostly still want to be cautious in our settings. so we haven't really read into that. we anticipate those soon people will be asking but we're not quite there yet. >> and i know dr. philips isn't able to get the.

>> that's perfect fine when she's for many other smaller practices. i do not see any other commissioner questions which is general public comment. i realize secretary morewitz will be occupied. >> folks on the comment line. item 5, please press star 3. >> president bernal: thank

you. the public health meeting. >> thank you. we had an excellent presentation from the maternal child and adolescent health division. the focus of the meeting was an update on the public health visiting program. it consists of two programs that are serving 480 clients and the focus is intensive case management, medical, social assessments and intervention. the first program, the nurse family partnership is a national program and it serves pregnant people in pregnancy to the child age 2 and they're currently two hundred eighty-two open cases and it is one to four times a month of a

visit. in 2019, there are 316 families served. the second [inaudible] of the visiting program is the field public health which their focus is improving maternal and child health for a low income pregnant people and it is pregnancy to the babies -- age of 6 to twelve months old. home visits one to four times a month. and this program has 199 open cases with in 2019855 clients were served with 451 families. the other program that was most interesting going forward that

will launch july 1st is a multi-county partnership with san francisco napa sonoma that's funded by the state and this is a trauma informed approach public health nursing for that low income families that are at high risk for trauma. this is one to four times a month until the public health nurse [inaudible] and the goals are met. the focus of this program is as well pregnant people post pardum and pediatric referrals. the goal is fifty clients per county in year one and one hundred in year two, but because san francisco is the largest county, it will -- we will be serving more families

than the others. the last part of that presentation was the domestic violence within both of the public health that's integrated and is in both of those programs. a case was presented to us of one of their successes that was really great to hear and it was emphasized that particularly with domestic violence it is the trust is able to bring these issues to the forefront

that the referrals and support can be given within this area. so it was very good presentation and i thanked the group for answering our questions and in going forward. so that's my report. >> president bernal: sorry. i was muted. thank you, commissioner giraudo. secretary morewitz do we have any public comment. >> if you'd like to make public comment please press star 3. >> president bernal: thank

you. commissioners do we have any comments or questions for commissioner giraudo? vice president green. >> vice president green: yes. i just wanted to say i'm so excited about this work. excited to see patients come to the hospital. very organized support, the idea that you're doing this and so forward thinking and ahead of what's been done in other places in this area of medicine is absolutely critical improving infant mortality and outcomes and morbidity and supporting families is something that i think is critical beyond education to so i will really look forward this

effort will lead to outcomes that have really dluted our ability to improve for many years. so i just wanted to say how positive and excited i am about the work that's being done. >> president bernal: thank you, vice president green, and also for your knowledge and expertise that you bring to this area. any other comments or questions for commissioner giraudo? okay. we can move on to our next item for discussion which is the san francisco health network, balancing equity and speed in covid vaccination. and care director population and health and quality dr. chen. >> hello. good afternoon commissioners. i am delighted to present our

work on our covid vaccination efforts over the past year to this group and will be sharing my screen. can folks see my screen now? okay. as you all know, we are the health care delivery arm of the department of public health and have been very involved with the city's covid vaccination response and i'm really delighted and honored to have the chance to share what we have tried to do to contribute to the success that dr. colfax described before as a city. we have been encouraged from the covid command center to really take this opportunity to celebrate our moment of getting to 1 million vaccinations and so i do have my hashtag celebration there for you.

so our health network, we put together a taskforce that was specifically aimed to work on covid vaccine and, from the start, made our mission to ensure that every patient and staff member in the health network who desires a vaccine can receive one as quickly as possible while balancing the following principles. so, first, to deploy the vaccine supplies equitably, fairly, and transparentally with the guidelines and the state. and, initially, this was really around following the evidence and the guidelines, but also making sure that we were not putting the city's vaccine supply at risk and so really learning about that risk gratification in the early days, in december as dr. colfax stated, maybe mid december.

this was around some pretty complicated risk strategies around health care providers and different kinds of essential workers looking at age demographics, of course, and later chronic conditions before opening up to the whole population. so doing that work in a transparent way coordinating with the covid command centers so that we didn't duplicate our efforts and that we used our resources effectively across the city and then at the heart of why we exist as a health network really prioritizing equity for the patients that we serve and the communities that we come from and these are the communities that we've seen over and over are the ones that have been disproportionately harmed by covid-19 in our city. and our photo here is of southeast health center which i'll talk more about our vaccine task force was made up of amazing leaders from across our health network, you see

here the different sections that were represented and who really met tirelessly to put this effort together across our integrated health network system. and, our initial goal really worked to fit this in the strategy of the city. so and within that, because the city, you know, 95% of the population is considered insured and 85% of those are privately insured, we really wanted to focus our efforts on the uninsured and the patients who are in network for our d.p.h. health care delivery system and as you all know, we care for mostly uninsured and publicly insured folks and so the high volume vaccine sites were run by the multi-county agencies entities and we were

really part of community response. in reality, what this became is that our two largest sites essentially became some high volume sites. so both the esg and the amazing leadership that was shown there around the vaccine response and also the southeast health center. our initial goals were really to ramp up to get to 2,000 vaccines a day and to be able to vaccinate approximately 100,zero people in the first three months in terms of the numbers that we usually serve in network. and how we go about some of the key strategies and we move to drop-in system. we saw very quickly that some

of the digital gaps that our patients experienced in terms of signing up for the vaccine were huge barriers in terms of people getting in and so moved to a pretty complicated and we've heard from community members and our patients that this was key in terms of people knowing how to get a vaccine. we also moved to prioritize this code. for each population, we would start with our own health network patients and then open up to the priority zip codings that we also serve, but also that were hardest hit by covid-19 and you can see here on the left side, these are the

and the community members that we vaccinated and then compared to the heat map of the cases that have been seen in the city. in terms of another key strategy that we have also integrated and continued to use is mobile vaccinations. because we care for some of the most vulnerable populations in the city, we have a number of teams that have gone out. the whole integrative care section team has been going out to shelters and to s.r.o.s in order to vaccinate some of the most vulnerable. these groups are range up to 300 people. we also have a health at home

service that vaccinates homebound patients that you'll hear more about in terms of future response as well and they continue to vaccinate folks every week and go into peoples' homes and that's the door-to-door approach. and that's the partnership that has been absolutely essential in our work. we have worked across the entire network together in order to get this work done. the health plan actually has been a huge supporter and collaborator in terms of our efforts. they set up a call center along with the covid command center to serve our patients and their members in terms of being able to sign up for vaccination. a number of the c.b.o.s that you probably have already heard of, there are 15 at this point that the covid command center

is working and community stakeholders who help that we need to message to the public and the resources and, of course, the vaccine supply. so this represents the roll-out and, at the bottom of our operations across time across the health network and it has been pretty steady after getting our occupational health sites focused on staff members from december through january and then we started vaccinating patients. our largest sites went first and then we started opening and going into more and more sites that are smaller, but situated in key communities and now

we're at the point that all of our of our health networks have been vaccinating our patients. and, at the bottom, you'll see the volume graph and so we did hit our target and surpassed it in april when we opened it up to all patients and community members who are 16 plus of certain zip codes and that we got up to 2,500 vaccines a day across the network. while we set up operations, it's not always, you know, that you build it and they will come. they will come if they want it in terms of vaccine readiness, but also if they know how to get it and that is easy to get. and so what we've had to do for each of these phases as different populations open up

is really figure out how to message out appropriately to people and make sure they knew how to get in at as each group became eligible for the population. and, so, overall, as of april, end of april, the health 20% of the vaccines that were given in san francisco and this included over 23,000 just given to staff and over 152,000 doses for patients. so just focusing a bit on staff. i know commissioner told you about staff vaccination our hospital site has done very well in terms of vaccination rates of staff. the caveat that i would just

share here is that you'll see it's a little lower for care but quite high still. the caveat being that we do not know when staff receive their vaccinations at other sites or from other private providers and this is happening more so with ambulatory care. in order to address this to really make sure that all of our staff are vaccinated who want to be vaccinated right now. we are having webinars to address any kind of hesitancy that staff themselves may have to increase confidence and also there's messaging out from the staff who have gotten it and dr. gomez that you see who's the very first person who was vaccinated in the city himself has been messaging out to

communities, but also staff in terms of the benefits of vaccinations. i just want to take this moment to express tremendous appreciation to occupational safety and health as zsfg who took on the task of vaccinating not all staff not only across the health network, but across d.p.h. so moving on. 67% of the people that will be vaccinated so we definitely have been vaccinating the community. what we continue to see over time continues to be the case and the numbers are going down, but the proportion that represents our patients is going down at the operations that we've set up how do we

focus in on our patients in terms of getting all of them vaccinated and encouraging that and so when we look at our rates, 61% of the 16 plus patients in our network have received the vaccine compared to at the time that this data was run 70% across the city. so there is a lag in terms of our patients compared to the rest of the city and i think that this is not surprising. for the 65 plus, there's also a gap as well. although the rates are very impressive, i would say across the city and also for the network. we want to do better and close that gap. i think this gap is not surprising given the population that we take care of we'll look

at who's left in terms of our own patients to vaccinate. we look at the map again and are reassured it's still in the areas that we're focusing on. our patients do come from the neighborhood that we've been already vaccinating, but there's still need in those neighborhoods. and, we are reassured that the percentage of people we have vaccinated who are older and more vulnerable is actually quite high, but we still have all of those blue populations to vaccinate and, of course, under 12 is not eligible quite yet. breaking it down by race, we do see racial disparities and this nears the disparities that are seen across the city and for many months now been thinking

about how to address this gap and so there's been quite a bit of work that has started and a lot of thinking about continued work in this realm. i'll just share some of this work. southeast health center continues to be open to drop-in. definitely for that community. probably to anyone who wants the vaccine who's eligible by age. then to across the network. compare today when we have been texting them or sometimes calling them. so the response to snel mail is

something that our patients like. this is just picking someone and calling people folks who talk to their own primary care providers. they may not but they want to talk to their provider to talk about whether or not the vaccine is right for them, and so we're starting at this point to give lists of our patients starting with black african american patients to doctors and giving them time to call folks and really talk to them about this. in addition, we are planning and piloting that our help at home program that goes to vaccinate homebound patients, we did notice that they have had a very good success rate in terms of reaching out and successfully vaccinating some of our homebound patients, so

after they finish the roster of patients who are considered homebound, we are also going to be offering the services of that team to patients who are black/african american patients who are still not vaccinated to see what the response might be. we're working very hard to set up electronic work flows and team based work flows and this means getting the vaccine with all of this logistics, the complexities of the logistics around it to all of our site. and there has been some change in the policy of wastage around this from the state. previously, we did not let this happen because we could not ensure that all 15 doses of

moderna would be used within the hours needed but now we are prioritizing easy access for anyone that wants to come in and have that vaccine. and so finally for the future as we're pivoting and we're seeing the demand go down, we are going to be pivoting our operational strategy as well. so we're thinking it's going to be key in terms of equity and drop-in. mobilization. we're going to intensify our collaboration around the public outreach and intensify our focus on racial equity. our operational shift is going to shift from the high volume

to integration into routine care and really focused on that relationship based model and also data driven q.i. approach in terms of where to focus. i don't have a slide but as you all know, we have opened up to 12 to 15-year-olds. and so there's a lot of work going in to making things family friendly. we've walked through our sites and made sure that things especially with the command center to make it a little more fun to make it a celebratory

event if cases increase or if a booster is recommended in the future and we're really working to re-establish the volume and access to our routine care for patients. many of them have been out of care in the last year and so we're needing to balance this work in the setting of reduced staff. staff who are experiencing fatigue. so i'll stop there and just but also operational leads within our systems who came together

and worked tirelessly across the entire system to make this happen. i have to say this has been for my 20 years thank you for the chance to share. any questions? >> president bernal: thank you, dr. chen. before we go to commissioner questions or comments. secretary morewitz do we have anyone for public comment? >> there's no one on the line. >> president bernal: thank you. commissioners, any questions or comments for dr. chen? commissioner chow. >> commissioner chow: yes, thank you, dr. chen for this very enlightening presentation. i had two questions because much of this was focused of course on the services to the

san francisco health network, but in the health at home or trying to do home care which the network has recognized as needed, would they also be doing that for the nonnetwork patients because i've had inquiries about doing that now. i've referred people to our covid line to get their vaccinations, but now i'm curious, is it only for san francisco health network patients? >> thank you for the reminder, i actually did have information to share with you all about the citywide approach. the covid command center also has a very robust mobile vaccination team. and so they have in addition to individual kind of buildings where folks are homebound or who have difficulty getting

out. they're also doing individual homebound vaccinations. and so i believe the numbers for the covid command center mobile team, they have vaccinated over 6,000 individuals and our health network has been around 2,400. >> commissioner chow: very impressive. so it's correct to go through our vaccination line in order to get that service if that was needed because we do know, you know, people have called me about this and asked this. or she's afraid of going out right no and, of course, with the vaccination, she shouldn't have to be afraid. >> sure. you know, i do think that it's probably -- if someone [inaudible] to a system of care, i know that a number of the larger health care systems have also

set up homebound vaccination programs and so if they're connected to a system of care, i think the place would be to start with that system. if they're not connected, absolutely, they should call and there are navigators to find the right place to give vaccinations. >> commissioner chow: wonderful, i think that's a great service. on page 16 of your slides, i did have a question of how i was supposed to read it now that i was reading it. it's a little discouraging if i'm reading the colors correctly and the numbers you're telling me about the black african american communities. that looks like the lowest line aside from the pacific islanders which is a very small number of people. you have in the block that the black/african american equals

47.5% of the 7,635 patients. now, is that the population that got vaccinated and therefore what is the population still unvaccinated? or is that the total number that you're looking at that's eligible and therefore there's still a lower number? i guess i'm trying to understand what the 47% represents. >> yeah. the 47% is the percentage of vaccinated individual. as a denominator of eligible patients. so as of the end of april which is when that data was pulled, was for black patients over the age of 16. >> commissioner chow: okay. so i guess the scale is not working correctly because

according to the scale, of course, even the numbers you have on the dots don't match the scale. i'm realizing that now. >> i see. >> commissioner chow: because if you have 61%, it's not even up on the scale for 61%. is that correct? >> yeah. it looks like the scale, it looks like the visual scale is off in terms of the access. yes. but the numbers are correct. >> commissioner chow: okay. great. great. the numbers being correct then that would be appropriate. on the latino population, since that wasn't there, is that higher than the black

population at this point? >> yes, it is. >> commissioner chow: we're vaccinating a lot of latinos in terms of the percentages. >> so, on this visual, it looks like it's very close to the total overall number, so it's around 61%. >> commissioner chow: oh, okay. yeah. >> yeah. so less of a disparity. and, what i would say is that the health network tends to take care of more african americans and more latinx patients than many other health care delivery systems across the city and our vaccination rate of these populations is higher than the city overall, but we absolutely want to follow this trend and we are

seeing this disparity and that's why we are really wanting to focus efforts on that particular disparity at this point. >> commissioner chow: no. thank you very much and thank you again for your excellent presentation. >> thank you. >> president bernal: thank you, commissioner chow. vice president green. >> vice president green: thank you so much. this work is incredible and remarkable the way the network has come together. i had some questions also about the numbers. i was talking to one of the leaders at the mission neighborhood health center who was telling me that 35% of the people they see were uninsured and i was sort of confused about the number of information we have and the answer was we've seen quite a few undocumented and mainly latinx patients and so i was wondering how secure we are in looking at the denominators here and, in fact, when it comes to the

undocumented population we had taken that into account and therefore we are successful with the latinx population. i mean, the outreach you guys have done is incredible, but i'm curious about that whether our denominators are counted. there was a really interesting article in the new york times, the reason people weren't vaccinated and they broke it down into watchful system distresstors and i wondered in particular whether the cost component. people are a bit confused by that and i wondered if that has been a barrier at all for our populations. how well we've been able to communicate the message so i'm wondering if you had any in sights about those two areas. >> sure. so just one comment about the numbers here. these are patients who are

enrolled in our health network system. so they are assigned to us as kind of members to receive their primary care within our network. so most of those folks are publicly insured or they're uninsured usually coming through the program healthy san francisco. so the majority of healthy san francisco members are actually uninsured, undocumented populations and access care through that program including mission mental health and so that's where maybe that is the way that they're also tracking those numbers at mission mental health. so the denominator that we

track here are individuals who are assigned to us and that we deliver care to. in terms of making sure that people know that cost is not an issue at our site, we actually went to the zip code strategy because we found that people were so confused about even knowing. i mean, they knew we were their health care provider, but sometimes only as one site not necessarily as a network. right. and so they in terms of knowing their regular source of care, knowing their coverage status, it became very confusing for people in terms of getting the speedy response that we wanted people coming in for and that's one of the reasons why we went very quickly to a community based zip code response. and, then, when we did that, we made sure that we were trying

to ask people to bring proof of residence in san francisco because we wanted to focus on san franciscans. however, if people did not have documents of any criteria, actually, we would not necessarily require it. right and we've never -- we asked people if they had insurance, but we never turned people away and we made sure in all of our documents and our outgoing public messaging that we take uninsured no matter where they considered their regular care. >> vice president green: great. and thank you again for this remarkable work. truly. >> thank you. >> president bernal: thank you commissioner green. dr. chen, first of all, thank you for this excellent presentation. i was looking at my version of the slides, and the scale appears to be correct. we'll just make sure whatever

version we post on the website is the actual one with the correct scale. but it looked to be correct on the version i was looking at. but, that aside, it's difficult to believe that just five months ago, we were vaccinating just our frontline staff at zuckerberg hospital and laguna honda hospital and how far we've come in just five months in getting to where we are in being one of the leaders not just in the country but in terms of the world and vaccinations and all of the commissioners and i have been watching very closely the leadership of the department and your entire team and ensuring that the vaccines that we administer are administered to are underserved so it's been a real point of pride for us to see this work within the department and thank you very much for your leadership. i know before we move on to our next item, dr. horton would

like to say something. >> i just wanted to publicly thank dr. chen, ellen, for this work. it's been an incredible effort and kind of an exhilarating ride to see all of the different elements coming together on this including where the vaccines are coming from and turning everything and sending them to whatever spot that needed them that day and zuckerberg offering the high volume site and all the clinics working in and all those pieces. but, you know, ellen has been at the helm for the entire time. it is nowhere in her job description and she poured heart and soul into it and has done an incredible job. >> president bernal: thank you, dr. horton. and we all associate ourselves with that. so thank you, dr. horton. and thank you, dr. chen. commissioners any questions or

comments before we move on to the next item. >> commissioner bernal, may i just add my appreciation to dr. chen and her work and leadership. i think the covid-19 pandemic has revealed is that because of the pandemic and in terms of what we've had including primary care and hospital care to the city's most vulnerable in the commitment and as dr. chen herself mentioned she has two decades of experience in the department, we were able to build on that expertise to draw on it in an incredible way and just to thank dr. chen and the team across the network for their work and also for their commitment to breaking down silos and working with other providers across the city and community members to ensure that people whether they were in the network, whether they were network members or not the people most vulnerable to

covid-19 getting the vaccine. so thank you, dr. chen and thank you to the network leadership and to the network team for helping us get this far. a million vaccines in the city. >> president bernal: it's great. thank you, director colfax and thank you again, dr. chen. okay. we'll move on to our next item which is an item for action. it's amendments to the resolution that was passed back on april 6th in our meeting in support of communities of individuals of asian pacific islander descent and denouncing racism and violence against these communities. this item did appear on the agenda for our last meeting, but we went late and had to defer to this meeting, but it's appropriate that we would consider it today given that the u.s. house of representatives just passed the covid-19 hate crimes act which in the senate it also passed.

it was bipartisan, but this now goes to the president's desk and passed in the house of representatives today. as well as congressman judy chiu from southern california and of course our own congresswoman speaker nancy pelosi. i'd like to hand it over to commissioner tessie guillermo to introduce this item. >> commissioner guillermo: thank you for acknowledging the passing of the anti-asian pacific islander hate crime. revisiting this resolution is sort of appropriate given that this is asian american pacific islander heritage month. even though this was introduced in april, hopefully we'll get to the finalization and passage resolution here in the month of may.

i just want to -- it's unfortunate that commissioner christian isn't with us at this point because she was in large part responsible for asking us to hold off on the final passage because there were some very key things that she thought was important to add to this resolution and was responsible in many ways for making this a much better and more comprehensive resolution along with our fellow commissioners in supporting this. and so i want -- and i'm very happy to reintroduce this resolution with the changes in information and recommendations that you will hear from that make it much, you know, much more meaningful, much more

qualitative and much more appreciative of the history of asian american and pacific islanders not just in san francisco, but california and the u.s. and so i'm happy to have the opportunity to ask mark i guess to read the changes, secretary morewitz read the changes in the resolution and offer that commission approval. >> give me one second. sorry. >> president bernal: and thank you, commissioner morewitz in making all these amendments. >> sure. i'll be very happy to assist. i need to -- i'm sorry. i'm having a technical issue. so i need to close out of the application in order for me to -- there we go. here we go. is the size okay on the screen

for ya'll? it's okay. all right. so if i may just make a few comments before i go will you there and actually read. commissioner christian any of the edits that are partial edits like for the small "w" to a capitalized, commissioner christian made all of those recommendations and i want to make sure that commissioner bernal make sure i give credit to all the different passages. she suggest any racial description be capitalized and so "white" is capitalized throughout this. the california school law of 1860 into separate public schools. in 1870 and 1872, the california state legislature

revised the 1860 law to exclude children of chinese descent from attending any public schools. in 1871, 17 boys and men of asian descent were lynched in los angeles by a mob of white and latinx men in response to an unrelated murder of a white man. in 1875, the congress pass the page act, which was the first federal poll tea. require that these children be segregated. the chinese primary cool was open in 1875. individualing of chinese descent were excluded from accessing health care with the exception of tuberculosis.

at the 1904 world's fair in st. louis, a 7-month exhibit of 1,000 individuals from the philippines was derived from the ten distinct ethnic communities was designed to show the group as savages. even as individuals of chinese descent were barred from receiving healthcare at local hospitals, the city and county of san francisco withheld permission for the chinese community to build a hospital to serve its community during the early part of twentyth century. a four-day riot due to racist resentment towards filipino agricultural workers who had

helped organize labor unions in the area and who socialized with white women at dance halls; the attack resulted in the murder of one person. the under lying motive for the murder. the japanese car industry was over taking the united states car industry. the murderers no jail time served. in 1984, the kluklux clan. following the attacks on september 7th, 2001, hate crimes perceived to be muslim spiked. federal and authorities screening practices at airports. violence against many middle eastern and south/east asian communities increased.

where the use of bias and terminology related to covid-19 by former president trump as perpetuated against asian and pacific islanders in the united states. whereas, in its march 16th report, a nonprofit organization reported that 3,800 incidents of hate and violence against individuals of asian and pacific islander descent throughout the united states during the covid-19 pandemic. the report notes that the number of incident its reported or likely only a fraction of the number of hate incidents that actually have occurred during this period. whereas racism has been demonstrated to be a fundamental for black indigenous and other people of color. where statistics show that individuals of asian and pacific islander descent are

the least likely racial group to seek health as mental health issues. i will reach this passage from this whereas clause. to encourage development of a clinical development environment and welcome patients and staff who are asian and of pacific islander descent. and this is the one that's edited. create safe space for patient by separating those who make bias comments from them. whereas the 2019 san francisco health community needs assessment identified racial health equities, but an ongoing corruptible injustice and whereas the asian and pacific islander communities contributes in the xursing groups. that was referred by dr. chow. whereas this lack of data of

communities. another one by commissioner chow. the health commissioner expresses its heartfelt solidarity who's been attacked along with their families and communities and sends its deepest condolences to the families and friends of those individuals who were murdered on march 16th, 2021. the health commission acknowledges and commends the impactful work of the san francisco department of health. the department's outreach and effort to provide support and education and later testing vaccines has been crucial to addressing public health needs. to the mayor's office, board of supervisors, san francisco covid-19 command center and the general san francisco community regarding covid-19 information and including the harm of

stigmatizing an individual group during the pandemic. further resolved. the san francisco department of health to utilize innovation to address disparities in all san francisco communities including those of asian and pacific islander descent. this includes this aggregating data instead of groups data into a category as asian american/pacific islander. the process of this aggregating data may require several years of utilizing small communities. and, further resolved, the health commissioner and the department of san francisco health to add a footnote including race and/or ethnicity data for lack of data for a specific community to ensure no community experience is visible due to its size or small data set. and, finally further resolve, the commissioner recommends that the san francisco

department of public health stay updated on changing service needs and all san francisco communities. >> president bernal: thank you, secretary morewitz. i do not see anyone on the public line which means before we go into commissioner questions or comments, we can have a motion to amend the resolution that was passed on april 6th. commissioner giraudo, will you be making that motion? >> commissioner giraudo: i will be making that motion. thank you. am. >> president bernal: thank you. is there a second? >> commissioner chow: i will second that. >> president bernal: thank you, commissioner chow. commissioners, do we have any comments or questions on the amendments to the resolution? i would like to just add not as an amendment but just as a point of information that the stop a.p.i. hate initiate iand reporting center is here in san francisco. 's a coalition of asian pacific and planning policy counsel

chinese affirmative action here in san francisco as well as the asian studies they launched the reporting center back in march. so we're grateful for their leadership here in san francisco. commissioner chow. >> commissioner chow: yes. thank you. i thought i'd take just a few moments and it's very appropriate and commissioner giraudo said that actually we had the opportunity to take up this resolution in may as it is asian pacific islander heritage month and is being celebrated citywide in spite of the covid restrictions and very large number of virtual programs at the heritage website actually has for those that might be interested. but, commissioner christian spoke to me about the need of

adding some of the history that she was not able to be here for that commission meeting, but felt it was really important, so we added some of that along with some of the history in regards to the other populations, also that at the time that we were moving quickly to create the resolution was submitted. there are obviously a lot more, but we tried to focus on the populations that particularly were very important here locally. it's also, i think appropriate that we take steps as we have with other resolutions to also try to correct issues or to try to address issues of health and equity and that, in this case, part of the misunderstanding and the xenophobia from also

the fact this is thought to be a model minority and also then that a minority that's a silenced minority and therefore particularly when one merges data with the asian population, it does not allow for an adequate study that would then disclose disparities and our own department has also noted a number of disparities, but would not have the opportunity to work on them as much because they don't come up to the. the department in the past has supported the program for particularly this chinese and southeast asians that were affected by hepatitis b a number of years ago. we also put in place that we would support a b.m.i.23 for

being the cutoffs in asians. the additional 25 points of b.m.i. versus 23 actually we're leaving out at least 50% of the asians and was felt that with the improved and lower score proven scientifically and now accepted by the federal government that over half of those being missed will, in fact, come back. but the question as to whether our department has been using the b.m.i. would be helpful to understand if we are doing that within our own system. those are just examples of when you start parsing out as dr. chan back in a paper in 2019 we need to address social and racial equities and then part of this also then comes

from the bias that has occurred that does not address all disparities. so with commissioner christian's help, we've rewritten part of the resolution to make this also an action resolution to which the new part points that we were trying to respond to that which was part of the reason for hate. there was one more disparity which i thought was very interesting when you disaggregate the asians which actually relates to the covid situation. clearly, disaggregating the larger racial and ethnicities for this city has helped us answer part of the need, right, within the latino and black population because we disaggregated that. in hawaii, they have the opportunity to read this aggregate data amongst the asian population and i thought

this was a very illuminating differentiation that is current to january 31, 2021, published by hawaii which was part of a case study where taking their state population, they, in fact, showed that of the total population that was affected by covid, the chinese population was only affected, they had a 5% of the population and they had only 3% of the cases, but in the case of the filipino population, they were only 16% of the population, but they were 20% of the cases. in the pacific islander and there's a fairly large pacific islander population in hawaii, there's about 4% of the population, but they were 24% of the infected.

it's that type of disaggregation that can help us point to where we should go with our care programs and that's the reason that i think that this will be very helpful for our department to be able then to really hone down more finely and also then help address these needs within what often are not seen because of the melding of the data. so i encourage my fellow commissioners to accept the new resolution as strengthening and helping us demonstrate as a department, we're not only decrying a terrible problem, but that we are also going to face it by assisting in responding to health disparities within all of our communities including the asian pacific islanders. thank you. >> president bernal: thank you, commissioner chow, in particular for all of your

leadership in strengthening this resolution. commissioners, do we have any other comments or questions before we move to a vote on the amendments? all right. seeing none. commissioner morewitz, can you call the role? >> [roll call] thank you all. the resolution passes. >> president bernal: thank you, commissioners. and, just as a reminder to folks in the community to report an incident of anti-a.a.p.i. hate or violence or to get safety tips in a number of languages, you can visit stopaapihate.org. thank you. moving on to our next item is other business.

commissioners, do we have any other business? seeing none. sorry. all right. seeing none. and seeing nobody on the comment line. our next item is joint conference committee and other committee reports. and, we'll have a brief summary of the may 11th, laguna hospital j.c.c. meeting again to commissioner giraudo. >> commissioner giraudo: thank you, president bernal. and, i'll just, again, congratulate laguna honda hospital for all the work that they have done to maintain really i think what is an exemplary with the largest long-term skilled nursing facility in the country as a

model of preparation, response, and safety for the residents as well as the workforce. the -- no resident has tested positive at laguna honda since january 18th and that is amazing considering what we experienced in the winter throughout the country, even here in san francisco as those spikes and surges were evident. 90% of residents have received both vaccine doses. it's a little bit different from what was reported earlier and so this is i think data catching up to the reports. 84% of the staff have received both vaccine doses. we experienced i think the

first time in over a year sort of the state coming to laguna honda on masks for the annual field nursing facility recertification survey which was completed on april 19th, resulted in some preliminary findings, but we were assured in i think subsequent reports have shown these were all very correctable items and the team was waiting for the final report in order to submit the plans of correction which they have assured the joint committee are items that are readily correctable. they also completed the annual fire/life safety and emergency preparedness survey on the 29th. again, some preliminary findings which were minimal in magnitude. the team is waiting for a final report to submit a correction as well.

laguna honda was happy to point the expanded visit option which now included on unit visits which began last month in april and so this has really raised the morale of both the residents and the work force to be able to slowly begin opening up the facility on unit visits as well as have opened upmost of the clinics there on site at laguna honda. and so again, it looks like at least for the moment, movement towards what used to be normal is continuing. the hospital every month recognizes a team that they want to honor for the work that they do to keep laguna honda in

excellent shape and the amount of sort of the challenge they were faced with from everything from signage to securing exits to keeping things as safe and kept as possible during all of those months and continued to do so. so that was sort of a nice recognition. the committee also we had a presentation on resident centered care plan projects. so each of the residents is required to have individual care plans and in some instances, they have as many as

six to eight care plans and it's required to both document, keep, and audit the quality and the execution of those care plans and they have engaged a process to optimize that care plan and have made some changes in order to make this a more effective and efficient process in laguna honda. and in closed session, the committee approved the report and that is the end of my presentation and report for the commission. >> president bernal: thank you, commissioner giraudo. seeing nobody on the public line. commissioners, do we have any questions or comments for commissioner giraudo? okay. seeing none. thank you, commissioner

giraudo. our next item is we'll consider a motion to go into closed session. do we have a motion? >> commissioner giraudo: i'll move. >> president bernal: is there a second. >> commissioner chow: second. >> president bernal: thank you. secretary morewitz, will you call the roll? >> yes. [roll call] all right. if you give me a few seconds to transition this over. if you're not supposed to be in the closed session, please, have a good night. know that we appreciate you attending and for the sfgov folks, i just moved you over to the attending so when we open

back up,

[♪♪♪] [siren] [indiscernible radio chatter]

>> hello. i'm dr. john brown, the medical director of the san francisco e.m.s. agency. this is national e.m.s. week. it's a time for us to take a moment and celebrate the e.m.s. providers throughout the country. i want to take this moment and this time to thank all of the e.m.s. providers in san francisco who have gone way beyond the level of care in this situation. as the covid-19 pandemic spread across the globe and we prepared to respond to this disaster, you stepped up to an integral part of that response. you wore cumbersome p.p.e. and responded to rapidly changing protocols on a daily basis. your commitment to this e.m.s. system is truly extraordinary.

additionally, you helped us push our care along even further, and about to start our lucas device program to improve the care for cardiac arrest patients. this is amazing to push e.m.s. care above and beyond where we are before during the midst of this pandemic. i thank you for that. i also wanted to shoutout and especially recognize all the folks that have helped us in the e.m.s. transportation hub, the 911 dispatcher, the paramedic supervisors, the patients transfer coordinators, the paratransit drivers, everyone coming together to spare the 911 resource and keep us responding to disasters in an appropriate fashion. while we can't celebrate e.m.s. week together, i hope you know how much i appreciate all of your courage, professionalism,

and dedication in this unprecedented time that we're living in. >> greetings, and happy emergency services week in san francisco. i am san francisco fire chief jeanine nicholson. i wish i could be there in person to express my gratitude to all of you. the call takers and dispatchers, the call taking personnel, and, of course, paramedics and e.m.t.s. i understand and appreciate what it is you do day in and day out. i sat where some of you now sit. i'm a firefighter, but i worked on both d.l.s. and a.l.s. ambulances in the san francisco fire department before some of you were born. i know what it is that you see and do while at work. i know the impact it can have. i know you make sacrifices to do what you do, and i know many of your families do, as well. so continue to take care of yourselves and each other.

go out and learn something new every day. keep up that positive energy and enthusiasm. thank you for your loyalty, not just to the job or to the fire department, but to the people here in the city and county of san francisco. there is no higher calling than one of service to others. you are appreciated. >> hi. i'm san francisco police chief william scott. on behalf of the officers and the personnel of the san francisco police department, i'd like to thank you and congratulate you on this, the 46 annual e.m.s. week. like our brothers and sisters in the fire and sheriff's department, we rely on all of you in e.m.s. for emergency medical care. i have experienced nothing but the highest level of professionalism from our ambulance crews in the field and know that each of you go the extra mile, whether it's a

broken finger or cardiac arrest. >> hi. i am mary ellen carroll, director of the department of emergency management in san francisco. we are the city's 911 center, and we answer every fire, police, and emergency medical service call. our dispatchers work hand in hand with field personnel to make sure that every call for medical care is handled not only efficiently but with compassion. you are the next link after we take the call. the care that you provide to these patients can truly be the difference between life and death. i want to thank all of you for your dedication, your service, and commitment. >> hi. i'm sheriff paul miyamoto, and i'm proud to call out the professionalism of our e.m.t.s.

we provide safety services for both zuckerberg and laguna honda hospitals, and we've come to know many of you. >> i'm grant colfax, director of public health for the city and county of san francisco. i just really wanted to say thank you to the e.m.s. team for your work. 2020s been a challenging and unprecedented year as we work together to address the covid-19 pandemic, and your work being on the frontline every day is saving so many lives. these are unprecedented times, and we've had to come to new ways to thank people. so while i can't do it in person, i want to thank each and every one of you. e.m.s. has always been an

incredibly strong and important partner for public health, with public health and our work, and it only continues to be more so during this pandemic. i want to thank you, but i also want to make sure, with those thanks, to express the clear ask of you to take care of yourselves and your families. we know that during these times, self-care and getting the help that you need is so important as you work on the frontlines saving lives every day. thank you so much for your help. >> hi. i'm mayor london breed. i want to thank every e.m.t., paramedic, firefighter, nurse, physician, and the support personnel who are part of our e.m.s. system in san francisco. during e.m.s. week, and as we are fighting this global pandemic, i am especially grateful for the opportunity to celebrate the important work

you do every single day. it's because of you that we feel safe knowing you are in that ambulance, in that fire engine, or in that hospital emergency department, really to provide assistance to anyone in need. most importantly, you carry out your duties with care and compassion. now more than ever, our city appreciates the extra effort and sacrifice you have made to keep us healthy and safe. tonight, we light up city hall, coit tower, and salesforce tower in e.m.s. blue and white to honor your service and sacrifice. [♪♪♪] >> e.m.s. strong.

thank you. >> e.m.s. strong. thank you. >> e.m.s. strong. thank you. >> e.m.s. strong. thank you. >> e.m.s. strong. thank you so much for what you do. >> e.m.s. strong. thank you. >> e.m.s. strong. thank you. >> e.m.s. strong. thank you. [♪♪♪]

>> providing excellent customer service to each other so that we can succeed together. because we're a small division out here, and we're separated from the rest of the p.u.c., a lot of people wear a lot of different hats. everyone is really adept not just at their own job assigned to them, but really understanding how their job relates to the other functions, and then, how they can work together with other functions in the organization to solve those problems and meet our core mission. >> we procure, track, and store materials and supplies for the project here. our real goal is to provide the best materials, services and supplies to the 250 people that work here at hetch hetchy, and turn, that supports everyone here in the city.

i have a very small, but very efficient and effective team. we really focus hard on doing things right, and then focus on doing the right thing, that benefits everyone. >> the accounting team has several different functions. what happens is because we're so remote out here, we have small groups of people that have to do what the equivalent are of many people in the city. out here, our accounting team handles everything. they love it, they know it inside out, they cherish it, they do their best to make the system work at its most efficient. they work for ways to improve it all the time, and that's really an amazing thing. this is really unique because it's everybody across the board. they're invested it, and they do their best for it. >> they're a pretty dynamic team, actually. the warehouse team guys, and the gals over in accounting work very well together.

i'm typically in engineering, so i don't work with them all day on an every day basis. so when i do, they've included me in their team and treated me as part of the family. it's pretty amazing. >> this team really understanding the mission of the organization and our responsibilities to deliver water and power, and the team also understands that in order to do that, we have a commitment to each other, so we're all committed to the success of the organization, and that means providing excellent customer service to each other so that we can succeed