>> michele gile. >> present. >> commissioner chung. >> present. >> commissioner. >> present. >> welcome everyone and thank you. >> [dan bernal, president] thank you very much and i'm going to talk and try to continue this hoping my bandwidth will improve. the next item on the agenda's approval of the health commission meeting june 1st, 2021. the commissioners are reviewing

the minutes. we have any amendments for a motion to approve? >> a motion to approve. >> second. >> is a time for roll call? public comment. first on the line if you'd like to make a public comment on item two the minutes of the meeting please push * 3c can raise your hand to be acknowledged. no hands commissioner. see next thank you secretary call the rolesywñ?ñ?.xñ?ñ?ñ9 >> commissioner child. >> yes commissioner green. >> thank you.

>> [dan bernal, president] okay our next item is her direct reports from director grant colfax. director colfax. speech that >> [grant colfax, md, director of health] you have a directors report from view there's quite a bit of detail on covid-19. the coed pandemic being what it is more up-to-date information to show you what i would like to focus on the next agenda item. the other item of note in the directors report is the facet board of supervisors unanimously approved a lease for our center of the commission heard about a few weeks ago and we are excited to open that center with the target opening involved 2021. a directors report to be happy to take any questions. >> [dan bernal, president] thank you director colfax before we go to questions or comments from

commissioners to be having public comments? >> on the line please plus start to retrace your hand if you'd like to make a comment on three item three. * three. no hands commissioners. >> [dan bernal, president]. commissioners, any commons or questions before we goóqñ?ñ?ñ ie broader code of 1999, director colfax will go to the next item. >> [grant colfax, md, director of health]'s life. happy to provide this covert update on june 15th, 2021 which is a big day for our city.

it is. this is a big day because the state under the governors directed is for tiring our ts views here are colored tears that are going the way as of today, most preachers stems from the california public health will be gone with the exception that you can read on the slide. the state will defer to the cdc guidance on many studies, including with regard to health care and shoulders. there are safeguards in place and face cardso acquired in certain areas as you can see on the slide including public transit for public order, healthcare settings, indoor schools, jails, correctional facilities and shelters. as of today and the states and

in san francisco all facilities have three options and other facilities have three options with your card to save covering instruction. san francisco jurisdiction will align with the state with a couple of key exceptions there will be upcoming station requirements for personnel and the risk of settings including hospitals, skilled nursing facilities, residential care abilities, shelters and jails. and then with her guard to do with the state were first to as indoor mega- events, those are indoor events with 5,000 or more people we will be more restrictive having an honor system, organizers need to require 100% masking or require personal and patrons aged 12 and plus to show proof of their fully acclimated or tested, with that tested being done and negative two hours of the

events. our health officer doctor susan is available to answer more questions with regard to these orders and cases in san francisco we have 36,875 cases, you can see that flattening of cases and it's really occurring in march of this year. unfortunately for up to 550 people dying from people from: nineteen examines the school at this time. you can see that that rate has greatly decreased the spring and that curve is fortunately very black. obviously our condolences to the families, loved ones and communities of the 550 san francisco that we have with regard to our case rates, our

cat case rates for my low at 1.624100000 residents. that is compared to our peak this winter up over 45 for 100,000. case rate has remained low as we have remained in the yellow tier. i will say that now that we are out of this colored tiered system in the state is opening up in san francisco is opening up even further we are in a really good place right now with regard to her vaccination rate in our case rate. it would be somewhat expected if we would see these case rates increase somewhat due to increased activity and a decrease in instructions. and two weeks would not be surprised if these cases start to climb up to some degree. this is obviously very much dependent on her ongoing vaccination rates and to some degree, on variance participate which is concerned"mñ?ñ? it is y

infectious and much more infectious than the wild type and as i believe the commissioners probably know anything to him, condemned lighted delayed in three opening four weeks, i believe yesterday because of the variance and they are having a swell of cases in the kingdom. sly. hospitalization passed up a bit in the past couple of days. there has been a low hospitalization number overall and even with that, i will show you the hospitalization numbers and that is not cause for concern at this time. again, it is really because we're down to such a low level that even a 50% increase in the hospitalization rate is actually not a large hole number and you will see that our hospital and

other simple occipital indicators are in green. that case rate, the all-important case transition less light at one point is at 1.6. i did want to draw detail to the commission that the covid case demographics from april 207th to may 207th. you can see here of the cases that total number of deaths during this period was to, that is again much lower than the rates ofvwñ?ñ? death we have sen previously. and that in terms of race and ethnicity, that make up of in these last few weeks of a higher concentration of blackened african-americans representing cases and 21.7 as compared to the pandemic as a whole. latinos are resenting 27% of cases compared to 40%

representation during the entire pandemic. and then you can see the age in years. we settled for the last couple of months now at the median age of 31 people diagnosed with covid-19. that is the next point down for the median age during the pandemic overall. next slide. this is that hospitalization slide that you're all familiar with. again i would just point to the case. in march of this year and staying pretty flat through today. on the far right of the slide. in terms of vaccine administration there is 14,500 vaccines in one day and you see a decrease now as we are seeing across the state and across the country in terms of the vaccine as you can see in a minute. san francisco has a relatively high rate of vaccine coverage, compared to other jurisdictions and countries. but we are down to 2200 rolling

day average and we are currently down to below 1,001st dose is going to arm today. the median population that remains unvaccinated will continue in community and going door-to-door and>yñ?ñ? working h trusted community leaders and other stakeholders to ensure that4qñ?ñ people have ready acco vaccines and have information they need to make a decision about whether to get a vaccine and to really understand of these vaccines are still critically important as we move forward. especially, as our concern about the virus includes and increases especially as a city and the state continue to reopen. excited. this is our vaccine administration and you can see in the box i wanted to highlight that san franciscan is eligible for that vaccine whereas before people have received one dose

and that's for residents 65 and above rib 95%. then at the far right that slide are present over 12 they were at a 70% coverage for 65 and over they were at 81%. those numbers are substantially higher than the state are overall but again, we are not letting up on outreach efforts. our efforts to ensure that there is ready access to vaccines and there's many sites across the city right now that people can drop in with an appointment to receive inoculation. slight. with regard to vaccination by race and ethnicity, we do see ongoing discrepancies with regard to vaccine uptake. you can see particularly among black african-americans the estimated percentage of san franciscans that received one dose by race and ethnicity the distinctions they are with black

african-americans at 56% compared to 64% of people who identify as whites. 75% of people who identify as asian and then among latinos the rate is 68%. these differences are reflected in the state and national level. numbers overall or percentages that are significantly higher. i also wanted to bring the commissioners attention to the population over 65 where we do not senior that level of discrepancy. some people over 65 you are most vulnerable to covid-19, you can see that the rates overall are relatively high. to say that! on the right of the slide for hawaii or other pacific hawaiian or, or other islanders are reflective of the relatively small numbers of the population.

the estimates are considered by a statisticians to be somewhat unreliable. next line. and then i just wanted to share with the commissions in closing, this is a day of hope and cautious optimism and celebration just wanted to share with you a video that was compiled at the coven command center and compilation with other city departments and i thought today would be a good day to show that celebration and i have asked to encourage you to turn your volume and were going to see if he can roll the video here. video playing mac over the

past months we have made history together on february 5th, 2020 we have created a mobile allowing the city to begin activating the advances servers workers in regards to the covid-19 spots.yoñ?ñ?ñ march 16th, issued state order in life as we knew it turned upside down. with conferences canceled and the muskogee center became the hub of city government. hundreds of staff from dozens of calls worked together to save lives. more.y0ñ?ñ? [inaudible] stand up and sit, support the public and on a case investigation we have a cat outbreak investigation, case by

case investigation and we do the work on the ground to see san francisco safe. by the end of the month stay safe at all borders across the bay area were put into place to remain and then we had the realization that this was not going to end anytime soon and we need to be safe. this is going to go onto the record of our country's history to institutionalized racism as the black life matters movement the man followed by the murder of george floyd, brown and taylor and others at the hand of police. and you can step up with historic investments with san francisco's black community. with anti- asian hate crime skyrocketing we are still trying to stand in solidarity in san francisco. our first surge in covid cases made way for brutal honesty that

choked the city and even turned the sky orange. little did we know that was all just a warm-up for the impending surge that pushed the bay area no-no on with three openings and case numbers soaring we did our ñ?ñ stao contact trace and working with community stakeholders and opening additional beds and overflow sites for hospitals. the purpose of this verse. [inaudible] [inaudible] taking every possible precaution just as this pandemic pushes all door breaking point after nine months we were had orders to stay home to stay safer.

[inaudible] administer the first vaccine dose. less than a year after he moved into the more sony center, we were vaccinating thousands and san franciscans a day here and thousands more throughout the city and this could not have been possible without your hard work. you need to this is not possible that you standing up having remote sites and thanks to your commitment extended eligibility for everybody as soon as possible and we are now able able to focus on reaching families today are vaccination rate is among the highest in the country and our case rate is the lowest since last month or last march and the vaccination rate this is all thanks to you. as we enter the opening of our city phase and restructuring our

covid response this took working together to make sure that our hearts were in it and we can get everybody vaccinated together. >> thank you commissioner, that's thev8ñ?ñ? update and be y to take anye]ñ?ñ? questions on s historic day. >> [dan bernal, president] thank you director colfax before we go to commissioner comments or questions we need to see if we have any public questions or comments. we met folks in them i would like to make comments on item four, the covid-19 update starz three, press * three to raise your hand. there's one hands up in the statements read before i unmute you caller. each item number the members the public have the opportunity to

make comment from to two minutes. the public comment process designed to receive input from people in the community. however, the process is not meant for people of the public to engage in back-and-forth conversation with members of the public. commissioners can make please note that each individual is allowed one opportunity to speak for agenda item. individuals may not return more than once to receive statements from individuals unable to attend the meeting. caller i'm going to unmute you and you have two minutes. please let us know that you're there. caller are you there? >> can you hear me? yes you have two minutes. >> hello my name ishsñ?ñ?ñ

management receiving steps to protect us from our families from infection. for example, our department manager, helpers and inspection prevention and everyone of the meetings was telling everybody that we tested positive for covid-19 supposed to work with the last one still. to our fellow officers tested positive for covid-19 ended up infecting their whole families in all of their friends. even though we have the covid-19

vaccine authorized by the fda recently better protection and protocols against the virus. the virus is here to stay with us forever. >> [dan bernal, president] thank you very much for your comments. that is the only hand. thank you secretary, commissioners to be have any questions or comments on director colfax on the covid-19 update? >> i have a comments. thank you so much doctor colfax for not only your report but sharing the video with us. it was wonderful and a good reminder of everybody's hard work. they don't know and my comment is a suggestion. on the front page of the chronicle this morning there is a very simple diagram and it is

a first second grade type diagram of face coverings, capacity limits and social distancing. and i would highly recommend this as a, as it is updated if possible to put it on something similar on the dph website. i know at least in our facility we are getting lots and lots of questions that i could just go to the website for clarification of what is opening i think it would be a great, simple service to the community. thank you. >> [grant colfax, md, director of health] thank you so much commissioner i will definitely take this to our staff and our communications people and graphics and see how we can get that up, thank you very much.

>> [dan bernal, president] thank younvñ?ñ? commissioner, commissr chow. >> [edward a chow, md< commissioner] thank you and i would actually like to thank commissioner gerardo comments concerning the front page of the colon made a very easy to read in my in fact become a very nice poster. or something similar. and of course updated. i have several questions on the borders because going to be changing but a visual guide lines people. one is in the health order it does speak about hospitals but it is not really speak about private offices such as: medical or dental offices. podiatrists are slow and i wonder what your advice is in regards to our many private practitioners? i'm assuming from the medical office it would come under the rules for masking, but it isn't

on your slide. that was question number one. question number two, related to the recent release today from the human resources concerning bats, again, the office settings for the city that it was still mandated by its made no mention, but as you know that patient board is considering actually voting otherwise and it sort of seems odd to put a notice out when i guess in fact almost everybody read newspaper or hear the news blues of change. in any case, i didn't know for sure with the official city position might be in the future. thirdly, was what would the tolerance of knowing that

1.624100000 resin in terms of the infected rate and the doctot the right to monitor less than one per 100,000 but are you considering as a possible yellow light to estimate estimates? those are my three questions. >> [grant colfax, md, director of health] thank you commissioner and i think i will address your last question first and then refer or have somebody else to talk about the other health order questions. i think what is really key here is we have a low stable level of case rates. only looking at that level of case rates but particularly look at the rate of hospitalizations in our city. because we have very high coverage among people 65 and older who are most likely to be hospitalized and unfortunately, died from covid-19. at this time we have not

set a hard number in terms of the case rate or hospitalization. we will continue to watch that very carefully. her message right now is though, do we still have thousands of san franciscans even with our high coverage rates, thousands of san franciscans eligible for the vaccine who have not received the vaccine yet? our focus right now as we reopen would still have cautions in place that we reach as many people as possible and work with them to get the vaccine and that will keep our case rate and hospitalization low. and then all i will turn it over to doctor philip for the questions that you have about the health orders. >> thank you director colfax and good afternoon commissioners. commissioner child, for your question around provider offices: for

our state coverage guidance we are almost entirely aligning with the state and our understanding from reading their guidance as a health care settings are covered in terms of faces being required. so offices and clinics are required in addition to hospitals so that is kind of our interpretation it seems to go with the state as well. the second question about city employees in the and heading changes is a very good .1 of the things i want to point out is that within the regulations, the proposed regulations that we are hearing might come into effect as early as this next week. employers are required to document and understand the vaccination status of their employees before following the guidance that may allow vaccinated staff to remove their masks. for large employers that will likely be a period of time when masks have to remain as they are doing that assessment. it is likely it will

happen within the city but i think that would still have to be determined. >> [edward a chow, md, commissioner]. thank you i'd like to take a moment to express my personal thanks. i remember this all first started,cjñ?ñ? even when prior to that news conference doctor colfax had invited me to join with our asian community leaders to start discussing what to do. but i don't any of us realized what was going to happen but i think it is through leadership like director colfax, yourself which is really wonderful. and all of the wonderful people that have worked so hard to see that public health really was the most important issue for our city. even though we suffered severely economically, that we were a city that was compassionate and felt that it was really important to protect our people. i guess as some people have said when you go out of business you can

start a new business but if somebody died you can't really bring them back. i think for those of us who have come to believe that life is really sacred and important i think the city was a wonderful place for us all to be. that is because of all of you. so, thank you very much. >> thank you for your kind words commissioner. >> [dan bernal, president]. commissioner green. >> >> [laurie green, md, vice president] i cannot say it better than doctor child but in my day-to-day work i interact with a few hundred people every week into the last one regardless of the situation or age, they are so grateful and they dress our department of public health avenue as really the resource for their health. and i think that is such an important acknowledgment to anyone who has worked in the department. that no matter where i go it's 5:00 a.m. on saturday morning want to

go to work they really are so grateful to you and i hope that has been heard loud and clear. they had two or three questions. one wise, signage is an interesting issue that has been brought up. and i wonder if there is going to be any guidance from the department to help all kinds of businesses big and small, to have uniform signage with regards to mask and other aspects. for a while there was the one that kind of everybody had kind, but now as orders are changing and some businesses may have slightly different requirements than others, whether there is still a possibility for uniform signage. but he knows the stop sign in a clash in china's son just wondering if there is interest there. the second question i had is about the vaccine. because now that we are opening up our borders as it were and dealing with new families there is a tremendous number

of patients of mine who are coming from out of town and some of whom have not had easy access to vaccines. and i have people whose relatives are coming from overseas. i'm wondering because they are reluctant and they don't know what to do to be able to get vaccinated and of course i don't know what to tell them frankly. yet if we are going to maintain our herd immunity in san francisco anybody is going to spend a lot of time here should avail themselves to the vaccine if they're willing. i was wondering what kind of message there would be to those that are now san francisco being a tourist center and so forth, what are ñ?ñ potentially help people who might be spending more than a week here to get vaccinated? >> [grant colfax, md, director of health] thank you commissioner for that i think with regard to people and we opened our sites there was lots of intercounty

back-and-forth with regard to being people being able to access the vaccine. we can provide you with4ñ?ñ? more detailed information about if people are coming in from out of town's visitors or otherwise went to the vaccine access would look like. i think you bring up a good point that her vaccine axis cannot necessarily be circumscribed by county lines especially now that there is sufficient vaccine available for residents in san francisco. we can provide more details about the subsequent meeting. and then with regard to signage we are developing some uniform signage with regard to mask in particular and were happy to share those graphics again in an upcoming meeting. >> [laurie green, md, vice president]. great thank you. >> [dan bernal, president]. commissions give any other questions or comments? alright, saying none and thank you director colfax and thank you again doctor philip for your leadership and everybody at dph.

going back to the earliest days of the pandemic the way that dph was able to ñ?ñ? was going to be happening particularly at laguna hospital and other care settings, to really avert some of the tragic impacts that we have seen in nursing homes and other parts of the country and all the way through the owner is extraordinary, bold leadership. again, the work of the department of public health and the people of san francisco people until he helped us to get to where we are today. and i think that one thing that made us so successful in our was a response in sense of community that we have here in san francisco and in the bay area. the responsibility that people feel to care for their families and their communities was an integral part to how well we were able to address the pandemic so that is something that we know we can continue into the future and beyond the place that were in today. thank you again to dph

staff and to leadership, the mayor, the people of san francisco have had a very good day. so, thank you. we will move on to our next item which is general public comments. >> person on the line if you would like to make general public comment which means that she would comment on something that is not on the agenda please press * three to raise your hand and let us know you would like to speak. * three. no hands commissioner, there's only one person on the line. >> [dan bernal, president] thank you secretary maurice, i was hoping would have more than one person the line for such an important day. our next item is san francisco city option programs simplification resolution for action. we have alice who is the manager of the office of managed care he will present on this item. grade a wagon or would

like to introduce alice and item. i discussed the tax that said that. so ms. wegner. >> [dan bernal, president] go ahead ms. wegner mister wagner you there? >> he just texted and said his computer is on the fritz so how about if alice starts and then greg can come in later is it okay commissioner? >> [dan bernal, president] that is great thank you. >> hi this is alice and i am going to go ahead and share my screen for my presentation. our folks able to see my screen? >> [dan bernal, president] looks great kurniadi.

aunt kurniadi, if you would not mind speaking up a little bit. >> [alice kurniadi, manager, office of managed care], o is this better? >> [dan bernal, president] is great. >> [alice kurniadi, manager, office of managed care] good afternoon commissioner's my name is kurniadi with the office of managed care and today we would like tot a proposal to simplify the program. i will be going over some program backgrounds and how the program works today. the goals and rationale of the civil litigation we are proposing and then i will share a snapshot of the before and after, a schedule for implementation and end with to take currently to improve the overall program utilization. to start and 2006, the health kilts security ordinance was passed to support uninsured san franciscans and workers access our healthcare. the two main components

the first is the employer spending requirement or esr. which mandated certain employers to make certain healthcare contributions on behalf of their eligible employees. employers did have multiple ways to satisfy the requirements including providing insurance and that is the most popular way and also to contribute to the fs city option. the second component that the hds o created was a healthy san francisco program. at the health access program providing comprehensive health care to uninsured san franciscans regardless of their immigration status, employment status, or pre-existing condition. dph was tasked to administer the healthy san francisco program and to the sco option or program. that's program is option that players are subject to choose to use to meet their obligation. while it is not the most popular option for employers, we have had over 1500 employers who

have contributed to that hs co program this year. currently if the employer chooses to use this program and deposit the contribution on behalf of their employee, the employee is notified that the employer has made the contribution and they are invited to enroll in one of the three benefits. ask fm, hsf with the discount. and an employee who receives an aspect mra receives a dollar for dollar medical enforcement of crap similar to many fsa's that they receive their their employers. employees who receive the hsf with the discount receive a 75% discount on their quarterly fees, which range between zero and $450 depending on the individual's income and an employee who receives an mra receives a calculated subsidy to support their enrollment into cover california,

that is based on individuals and epistles dissipated out of pocket costs for covered california insurance after other federal and state subsidies. of all employees who have rolled and rolled into one of these programs, 98% are enrolled in sf mra, 2% are enrolled in hsf with the discount in less than a half% are enrolled in emma covered mra. the simplification proposal of effects the s fco program and it does not affect any other programs such as hsf. i see that greg is on, did you want to make a comment now? >> i'm sorry to interrupt here but the logic is going and i was just trying to briefly say that the to the commission and ask the expert to continue. this is really the culmination of a couple of years of work, this has been going on since

we let the dust settle with changes made after the affordable care act to this program. and kurniadi can go through all of that and things have changed substantially and we have between the department and health plan we've been working on thisl with the goal of expanding access by employees to the funds provided to them under this program and making it simpler to use. i think that we have learned a lot and we made changes when it was coming and made modifications to this program and we learned a lot in the yearswñ?ñ? sense and i think that it's going to be a great improvement to make it simpler, make it easier to access and ultimately get more self healthcare dollars and support into the hands of the people who need the program. with that nonsecular, sorry to interrupt here

kurniadi, i will stop and you can get back into it. >> [alice kurniadi, manager, office of managed care] like a greg mentioned, the hsf with his count in sf mra were launched initially in 2008 and the sf covered mra was launched later in 2015. 2015, dph was tasked to create an affordability program to provide additional subsidies to those who continue to save cost barriers to enrolling in insurance. during the development of that program there were two really important program goals. one, was to encourage enrollment into insurance and support to the aca and to what was to ensure that employees were enrolled into the right at the fco program, which one of the three was the most appropriate. as a result it was implemented into the

modernization program and through that we launched the ssc mra program in october of 2015, so employees can start utilizing the benefits and time for plan year 2016. we also implemented the sf mra deactivation policy in july 2016. so they redesigned the enrollment process to include both the new covered mra program and it incorporated a way to screen employees for the right fco program. whether it's hsf, sf mra, or sf covered mra. previously the enrollment processfpñ? required very little involvement from the employee. if the employer simply indicated that the employee had insurance or was not living in san francisco they are automatically enrolled in sf mra otherwise they were enrolled into the hsf with the discount. so today the enrollment process which was really implemented to screen employees for the rest

right sf do program. it's complicated, multistep and requires in-person enrollment. when the player makes a contribution on behalf of their employee's contribution is held in the pool until the employee takes action and to enroll into one of the programs. employees are given a notification that they have contributions available and are encouraged to complete a program find your form. that form is the first screening step to determine which of the three programs is the right program for the employee. if the employee is determined to be eligible for sf mra they will be enrolled and then they will receive an mra account that they can use for a variety of expenditures. they are determined for sf covered mra or hsf with discounts, but in order to be enrolled into either program they will need to complete in-person roman process to receive the benefits. this multi step enrollment process is required to ensure that employees are truly eligible for hsf and to

receive their calculated coverage mra benefit subsidies. this income verification step is needed to verify whether person is eligible for hsf and it is needed to determine the amount of their covered mra subsidy. but it is not necessary to provide an individual with the sf mra. which 98% of participants are ultimately determined eligible for. at the same time, this process has become a major barrier to participation and utilization of the employers benefit in general. just to give a snapshot as of march 2021, 41,000 were enrolled in sfmra, 700-1100 had hsf with discounts. out of a total of 15,000 hsf participants and a little over 100 were enrolled in sf covered mra. at the same time, the number of employees who were enrolled into one of the three programs,

currently only represent around 20% of overall employees who needed employer contribution. so, in order to improve the employee's experience with the sf co program and to increase program and utilization we are proposing to simplify the sf co program. originally when we launch the sf covered mra program and the current process, the projected enrollment for sf covered mra was around 3,000. however, the actual enrollment has range between 117 and 489, with less than a thousand unique individuals served cumulatively. the same time, the program has her consistent feedback from both employees and employers and making it easier to enroll and make it easier to use the benefits. we think that with the simplification will cover driver participation and utilization of employer contribution. the sf co simplification has three key components. number one: transition

from three benefits into one benefits, the sfmra. number two: provide a transition period for the employees are currently enrolled with hsf at the discount and sf covered mra benefits. a number three: relaunching and affordably program for plan year 2023. the diagram shows the proposed use of the five program and simplified enrollment process. when in a player makes a contribution for an employee, it will remain in the pool until the employee takes action to re- enroll. when the employee takes action to re- enroll they were now complete a simplified form. the difference here is the form's function is now two really just to verify the employee's identity so the program can insure any contributions are deposited into the account of the employee and to prevent fraud and misconduct. once employees identify is verified, they will be able to mra, receive an mra account and they will be able to use it for a variety of

expenditures. the employee still chooses they could continue to enroll in hsf and use their mra to pay for any applicable fees. once the new affordability program is relaunched an employee can apply for it as well. the first key component is a transition from three benefits to want event event, the ff mra. this will allow us to provide a simplified and streamlined new enrollment process with no person injured action required and that would remove barriers to participation in sfco program. in terms of impact, it would have no impact to the 98% or 41,000 employees, who are currently enrolled in sfmra. no additional action is required on their part. once implemented though, all future employees will have a similar process and because all employees will go through the same enrollment process, which is verifying their identity, it will be a lot easier for the department to administer. for employees who are currently enrolled into

hsf with the discounts, transitioning to this would allow the employee to access the full employer contribution in lieu of their current hsf discount. which the participants can then be used to pay for an array of expenditures, including any applicable hsf fees. this reduces the complexity increases the stability and choice of employees and how they would like to use their contribution. for the 700-1100 participants who are currently receiving hsf at the discounts, they will be auto enrolled into an sfmra program, receive and sfmra account and they will not need to take any additional action. of the 700-1100, 95% will receive a larger benefit from sfmra which is a one-to-one contribution from their employer and then their current hsf discount value which is 75% of the quarterly feed. in addition, the 711 participants will continue to receive their current to discount to the end of

this calendar, 2021 calendar year to help the transition period for employees who are currently enrolled in the sf and colored mra the transition to the benefits will allow them to have access to their full employer contribution in lieu of a calculated benefit and provide the employee with greater flexibility in how they would like to use that. of the 117 participants currently enrolled in sf covered mra, all of the auto enrolled sfmra and there will be no additional action needed on their parts. 60% of the 117 will end up having more contribution as a result of the transition meaning that 60% of the 117 will receive more contribution through sfmra which is a1 to one employer contribution benefits as opposed to the calculated covered mra benefits. in addition, prior prior

to the relaunch of the affordability program for 2023 to support these transitions and to support the employee transition everyone will receive a subsidy for calendar year 2000 and '22 and that is a fee amount equivalent to their covered mra 2021 benefits. it will be deposited definitely or into the mra account. anyone who needs additional support can apply for the new affordability program that is planned to relaunch in 2000 and '22 june in time for planning your 2023. this would have a cost covered by the excess sfmra fund and would have no general fund impact. the third key component of sfco simplification is to relaunch the health insurance affordability program. this would be to continue meeting the requirements of the hsc okay the health care security ordinance for dph to affordability program

and it would continue to support employees who still seek cost of barriers to enroll in health insurance. still working on details of the program with stakeholders but our goal is to simplify the program, the enrollment process, the program eligibility and the program benefits roles. we will anticipate coming back to the health commission when these details are ready to be presented. to quickly recap, the before and after of the simple vacation. currently we have three benefit programs that require employees to complete the multi step in person enrollment process that requires income verification and eligibility. after the3zñ?ñ? simplification, sfco will have one benefits excess mra which is a dollar to dollar benefits of their employer's contribution and the aroma to process will be a streamlined identity verification step. it will not require in person enrollment. employees will still be able to apply or enroll into hsf and

affordability program once relaunched separately. with respect to timelines we hope that the commission's support and approval will be able to outreach to stakeholders of upcoming change in business month and next month. during the remainder of this calendar year 2021, dph will be implementing the sfco simplification and transitioning any employees who are currently enrolled withp hsf at the discount and sf covered mra and relaunching this new streamlined enrollment process. we want to make sure that we are providing as much notification is outrageous possible, head of the open enrollment period for 2023, which is starting in the fall. and then mid 2023, we will relaunch and affordably program again ahead of open enrollment plan year 2023. while we believe that the sfco simplification will reduce barriers to employees, participating in this program and it will increase

utilization of their employer contribution, we know that simplification alone is not enough. we are currently undertaking other actions as well. one of them is that we are developing new dashboards to monitor our progress and engage perspectivism simplification efforts and make any adjustments as necessary. currently we are working with the san francisco health plan as well as the controller's office on projects to identify metrics and benchmarks, to measure progress that takes into account similar programs such as sfa type programs. some of the metrics that we are exploring are the rate of conversion from wants to mra accounts, enrollment into sfmra a as a program. these dashboards and metrics will improve data quality to improve decision-making and to also shorten the turnaround time to information request and stakeholders. at the same time we are continuing to improve our communication outreach, including better outreach of texting options which make info system updates

and really trying to improve the mra reimbursement process to include utilization of debit cards. thank you commissioners and i am happy to answer any questions. >> [dan bernal, president] thank you very much for your presentation and distilling such a complicated topic for us. commissioners, before we go to questions are there any public comment from anyone on the line? secretary? >> folks on the line if you would like to raise your hand to make a comment please press star three this is item six and please press star three if you would like to speak. there is no hands commissioner. president] thank you secretary and i know this item has come before the finance and planning committee before coming to the full commission. this is an action item for today, so we do have a resolution is that correct secretary more

or less? >> yes. shelley read the resolution internal questions? okay i'm sorry there are questions i need to scroll up. part of me commissioner green. >> [laurie green, md, vice president]. i just want to say thank you so much for answering questions and for also distilling some of its incredibly complicated into an understandable form and format, that presentation was really great and especially as you started it off and you divided the rubric. i am so impressed by this work and i had actually had some questions before i asked you i asked a friend of mine and she is in one of the big health plans it did not have the ability to understand the complexities of this thing that you have done. you have only done it but it is a real skill set to be able to take something as complicated and make it understandable. i think you so much ramble to do that and for patients that are looking for coverage. once again, making san francisco the best place to get healthcare

because you got a make simplified options for the lay people as possible. i want to say how much how impressed i am and express my gratitude. >> [alice kurniadi, manager, office of managed care] thank you. >> [dan bernal, president] iac research house hand. >> [edward a chow, md, commissioner]. thank you and i really appreciate the revised presentation as this was, as comment and presented the finance committee and i think those of us there had very similar questions that commissioner green had. and i think that it is so much clearer and i'm hoping that the people who might be hearing

this for the first time anyway. i wanted to commend the department for really trying to simplify something. i don't think we see that very often. we seem to just keep adding onto things and produce even more difficulty trying to answer questions. and this time i am really struck by the fact that not only is it streamlined but it makes a lot of sense that employer contributions for employees belong to the employees and they should have the ability to use it. and so, i encourage my fellow commissioners to support the resolution and to really think the department for its thoughtfulness in ministering sfco. >> [dan bernal, president] thank you commissioner chow. it was on9nñ?ñ? you earlier and i was also

commending you the presentation and echoing the words of commissioner green because i was on mute. thank you for the excellent presentation. >> [alice kurniadi, manager, office of managed care] you commissioner. >> [dan bernal, president] is seeing no other commissioner comments or questions, commissioners you have a resolution before you which again, which was considered for our approval from the finance and planning committee. do we have a motion to approve the resolution? see that i moved to approve this resolution. commissioners chunks yes. >> commissioner christians connect yes commissioner grotto. >> yes. >> commissioner green. >> yes commissioner chelsey mcginnis and commissioner. >> yes. in the past. then it passes.

>> [dan bernal, president] thank you commissioners and thank you as well. our next item for discussion is that the 2014 public health safety bond update and apologies again to mister primo and your team. i know this is an item that we carried over from previous meeting we had a very full agenda so thank you for your flexibility and thank you for coming before us again. we are giving you permission to share are you the right person? >> marc, this is terry salt can you have a share? course, doing it right now. and you need to yourself. can you hear me now?

thank you president and commissioners afternoon doctor kovacs we are happy to be back after ten months. the last time that we saw you was in august of 2027 spent a long time and a lot of information and i somewhat apologize for the daunting and detailed reports but we wanted to present to you with a document that was as transparent as possible to let you know both our past way to trying to solve some of this. joining me today is terry saltz the facilities director at zuckerberg, joe chen at senior project manager and alicia mercer talkie at ucsf campus architect and vice chancellor for planning. i am not that i think the team and i are not going to read everything because it would be here for hours. so we will just highlight some of the

issues and then get to some of the challenges and solutions that we see as beneficial to helping us bridge the gap that we have. c. slide three. >> can you see slavery? >> the next one. >> i'm on slide three. >> there is a slide lead. we presented as much detail as a process because i know some of the shares are due so we wanted to present some of the older slides that we have been sharing for the year two. basically, the 2016 health and safety bond with the 750 million-dollar bond was split three departments. what we are showing up is our peace, we sold

bonds in the first sale and we did not serve in the second. some of the numbers don't add up and i think commissioner green, you had great questions that you sentenced in may that helped us to clarify some of those issues that we're so close to we don't realize that there could be questions about. that is the missing link, there was a second bond issued prior for 49.6 million that makes up the difference that gets us to the 350 million. so the next slide four, shows you without that second sale, we are at 300 million in the marauding up to make it to 350 million. so, the next slide that focuses on theexñ?ñ? two components of the dph portion of the bond for the zuckerberg project

and clinic. this is the zuckerberg picture, financial picture as you see. if you look at the column that says other funding sources we are introducing now a mechanism and strategy to help supplement the general obligation bond. so, the 1100.4 funding is actually coming from the recently passed 2020, november bonds, the health and recovery bond. the v apply that to this program to help fund part of the psychiatric emergency services in building five that is desperately in need of expansion. in 1987 they were serving 4200 patients on an annual basis and now there are over 8700. we are include increasing seclusion rooms, day rooms, reconfigure the nurses station and÷ñ?ñ? to make it a

much more viable state-of-the-art psychiatric services. the next slide goes to the clinics. we have a similar situation where we are funding through different mechanisms and if you will note five the bottom, the 14.430 is coming from a number of sources that we have been aggressively%ññ?ñ pursuing. ñ?ñ? we have a pec grants for energy at southeast health center, the mayor's office kicked in 1.8 million to do electric creation of the clinics. we have a state grant of 3.2 million and then on and on and on. we are looking at all of the buckets that are on slide 19 to help supplement geo bond as is just about every other departments and particular parks and rec

has a very, very robust donor philanthropic program. they also match their local money to their state money. so, we are almost doing the same thing even though we don't have the state components. we have the federal component and then we had the san francisco roll general foundation that open talk about later and maybe susan would like to jump in on that conversation. on the next slide and going to turn it over to terry, that gives you a little bit of a historical perspective on cost per square foot prior to the pandemic and then right after that. >> terry saltz here, good evening commissioners. as marc pointed out this is a historical look at what project costs were on some other projects and what some current costs are that we are seeing on some projects and play right now.

it is not exactly apples to apples, but you have in the upper left-hand corner you have the 2083 build projects which was roughly close to $1,300 per square foot construction cost. and then with that was in 2009, but in 2017, we went out and do a rehabilitation of braid and building five. we had a lower number time but it is a real live dollar cost of $969 construction cost. now, that is in contrast to the lower box which is a couple of projects. we have three projects out to bid right now, we have received it and these are the cost that we are seeing. we are seeing a little bit under $1,300 per square foot for both of these projects. which is a bit higher than the less then $850

per square foot estimate that we did in 2016. this tells us that the $2,016 certainly does not buy as much in 2021. even when we accounted for escalation, the impact of the past year with the supply chain which i will get into on the next life, actually the slightest current state that we went out to bid on these three projects, the seismic upgrade, thousands and the public health lab and what you see here is where the city budgeted about $41 million of the bond for the construction portion of these projects in total; the bids have come in at 79 million. we are about 39% over the end we hadn't and subpoenaed.

this of that. we are not going to be able to go as far as we thought the bond of dollars alone which means additional funds or other funding sources that marc had alluded to in the previous budget slide, make them all the more important to reach your goals. so, what is going on? why are the dollars so far off? we have created timelines and hopefully we can speak to where we started and what has been going on and how we got where we are. going to ask marc to start with the explanation on the left-hand side of this line about how we started with the $535 million estimate. >> i think this commissioners is a very important slide and we tried to make it sort of graphical to show both the issues that we were challenged with as well as the timeline and what was happening at certain times. i don't know if greg is still on the line, but he and former director

and i fought tooth and nail to make sure that we got something in the 2016 bond. back in 2015, we actually proposed $535 million bond. solely for dph. that included relocating everything out of the building 8090 or the family health center is and redoing a complete renovation of that and bringing that up to code compliance standards. it also included money for chinatown to do a complete renovation as well as some other infrastructure projects. but more specifically, we had 335 million targeted building five. when you look at what we've got, 222 and this

went from between 2015 and december 2016, 11535, we were told to cut it to 335. we cut it to 335 because during that time to other measures that the mayor wanted, one was for affordable housing for 300,000,004,000,000,000 for ss and mga. those two to $800 million about bonding capacity question. all the minutes and cause them to be praised. at one point we were told, you're not going to get anything. we were like, this is crazy we can't keep building five open and keep our staff in there with their seismic policy and fees. we ended up getting 272, 222 for zuckerberg and 50 million for the clinics. basically, take it or

leave it. so of course. and that has kinda formed our first challenge. our first challenge of dealing with budgetary restriction, so we dropped off chinatown, we dropped off at building 8090 and we took another look at building five. thinking what can we do with the 222? then we get into the pandemic, which is a whole another challenge that terry will talk about and both of these challenges we are trying to deal with but this is sort of the timeline of when they happen and as we go forward into the future what sort of solution and pathways we are looking out to solve these. terry do and go for march 2020? >> yes, so on

march 2020, of course we know what happens, that covid help orders were issued. but what happened with the projects at the time, we had flooded our gm contractor he was going to provide a list some cost reduction. already had a city control contractor provide estimate and we were beginning to reconcile their estimate versus ours. this is when covid health orders hit caused a lot of confusion. people did not know what projects were essential, which ones are going to go forward, so once we got clarity we were able to provide that. there was some confusion in the beginning and some of our organizations actually pulled off for a good date months that we kept plugging away. there was a big gap between having moved into up to work. there was a big gap between cnbc and the city's estimates. we just

reconcile how much more, there's always about 30 since morevmñ?ñ?ñ than ours and sometimes 40% higher. we were working with the two estimators to reconcile, reconcile, reconcile and what ultimately happened was, talking them down in the city estimator came up to a number we still did not like and we went out to bid to see what the reality was. and we received bids year later, march 2020 they were higher. i'm sorry, was there a question? okay moving on. the bids were a lot higher and so we were trying to figure out why why are they so much higher? we had a covid-19 impact and that is what this whole brown, beige cloud is. kind of the impact of covid. we created also to supply chain issues,

material cost issues, market inserted, bitter risk avoidance, social distancing and all of these elements were covid-19 impacts. we also had unforeseen impacts. we had code changes of the seismic performance standards, city planning was the historical world view of buildings were causing an scope, enabling work for temporary clinics during construction, with the seismic work there is 206th touch points for construction to happen. everyone of those acquired somebody to move and be relocated and we move up in. in some cases removing entire clinics and that is a huge element that sp got into the planning we had to wrestle with. then there was an existing hazardous materials that we ran across an aging infrastructure issues. so, that is the picture that we wanted to present to you our timeline and kind of we wanted to go into some of the other cost

drivers on the next slide. utilizing a inset to the right is the construction inflation alert that came out of a contractors association where they highlighted-yñ?ñ? certain cost drivers and this is that health or help supply us with some of the data is required for us to understand this problem. we have unprecedented material cost escalation. if anybody has gone out there about a piece of lumber lately, you were wise that is quite higher than the last time you bought a piece of lumber. examples are the lumber is 62% higher, copper is 37% higher and still is 20% higher. that production was scaled back in anticipation of a bust in 2020, but actually it was a boom. and that productions have not caught up to speed and they are up to

speed now but they still have not come up with the demand. another driver is the construction market shifting to residential construction. residential construction is not as risky as commercial, especially with holes. we are seeing it very risky and a lot of contractors and this time of uncertainty are going with the left. to get people involved are projects we are usually paying premium. we definitely are paying the premium. another cost driver is the construction completion is challenging. we have project projects and occupied building, it's occupied jurisdiction and is surrounded by covid-19 testing station and research sites. it makes it very difficult work environment. that covid-19 outdoors, they created added scope

for the contractors as well as added confusion. the cost driver number five is that we are in a challenging bit environment. we have tosñ?ñ? prequalify subcontractors and we have to entice them to be part of the process of bidding. there is a limited pool and all of these kind of drive the cost of doing business a lot higher than we had anticipated. what are we doing about it? this talks about cost and risk management so on the first wave of bidding ready had the seismic dialysis and public health lab. we picked out certain packages that we felt were kind of alliance up with the scope and we had to have them rebid. when we rebid we clarified scope, modified the trade packages to avoid any assumptions of risk on the contractors part, we

had outreach to get more qualified to the contractors to have increased competition, we repackaged the packages in this morbid packages so they weren't as overwhelming and confusing. and we also had to educate the contractors on the city's process acquirements. that was a worthwhile experience and we were able to drop the price of construction by three and a half million dollars from the first set of bids to the rebid. we also created an early demolition packages because we learned is when you start construction and go into a site there is a lot of surprises that you get during demolition, especially in a whole building. the pipes, hazardous materials and what not. we decided to move the demolition packages and identify those conditions and address

some of the construction continued. or even starts so that they have more chance of success. reincorporated lesson learned from project to project and we still expect because experts are forecasting a very slow recovery in the construction to string 2021. with that i'm going to ask more to expand on the alternative funding component here. >> we mentioned these nine other potential and existing buckets of finance that other departments are also in different forms are sinking and i just wanted to say in addition to this, doctor, terry, alicia and i did a presentation before s and t in order to 2020 and we were thrilled to get the san francisco general foundation board to put a $750,000 to hire

consultants to come up with a plan that would look at some of these funding needs for building five and gaps in how to package projects that a resignation with donors and to raise money for us. we just started that process about a month ago and we just hired a team of consultants who are working with us. we just had a meeting yesterday with kim and meredith and her staff at the foundation so we are moving forward and i think they're going to be a resource in addition to the resources of the city and the federal government has put up to make this program successful. i don't know susan was to weigh in on the back efforts, she has been closer to the board than any of us have. >> i am happy to make a few comments about this topic if you would like

and i really want to appreciate marc and joe and terry for doing such incredible work and it's very complicated area of capital funding and capital building. just to say that that pandemic has been an incredible teacher. one of the things that it really helped teach me and our team here is how incredibly important a modern building is to address the needs of the community. what i'm talking about is building 25. if we did not have the emergency department, intensive care unit, inpatient unit, if we had not had those modern facilities we had never would have been able to serve the community as quickly at time of this pande@0ñ?ñ?mic. but it reminds us is that we really need a modern building for our ambulatory services as well. that is really going to be the key to our going

forward. telehealth is the beginning of it, but if we don't have modern facilities to accommodate the 600,000 visits that we do here on campus in the pre- pandemic time, were not going to be able to serve the community at ultimately. this is really critically important and in many ways but we are facing here is a much more complicated process problem that may have with building 25. there we had a bond that was carefully constructed to fund the full project we built the building from the ground up. not me, but terry, marc and joe really helped to build this building from the ground up. here we are basically building up play mold and trying to raise money to do the whole project at the same time. it's very complicated and what we have with the 2016 bond is a lot of money that has a very densely been provided by the taxpayers but it was really only for a few

designated projects in building five. and now we see from this presentation that those projects are not even necessarily fully funded. so creative financing and thinking about this problem on the part of the city as marc alluded to and our partnership at the foundation is going to be critical because the foundation is well positioned to help us. this is a very sophisticated public hospital foundation and i think it is very much among the best in the country if not the best. it raised $145 million for the building 25 project. we are working, as marc talked about to get funds for building five is well. this is going to be a continued partnership over the next several years to foundation and work with donors to help them understand what it

is that we need in this building. i don't know if were in a better position to raise the money because of what this hospital campus meant to the community during the pandemic. i am happy to answer any questions but i think that my thinking about this and i am so grateful to partner with marc, joe and terry on this very project forward. >> thank you susan, joe can you give the commissioners are real brief overview of the progress on both the health centers as well as the afterbirth and then we will conclude with a click slide on ucf and then be open for questions? of course. but even commissioners by name is joe chin, public works program manager. i will be doing a quick update on the next two slides about the project updates on what we have

done since revision ten months ago both the building by. in building five, we are tracking tiered projects and construction of the space station project. both projects are targeting construction completion by late summer of 2021. and then we had a contract see mgc contract which the total of eight projects being delivered. terry mentioned, we are rebidding three of those projects. we have the seismic upgrade, dialysis and the public health laboratory projects. two other projects we will be bidding by late second order of this year, the then results of these five projects will inform the team on the next steps of funding availability on the subsequent projects and in design. next slide please terry. then on the unity health

components for tracking three health projects, southeast center is the new 2022 square feet center that's under construction. we have recently completed the still topping off celebration in march, which is a significant milestone for the project and signifies installation of lost still for the new building. building completion is targeted for completion in 2000 and '22 and the maxing hall health centers are also targeting completion by the end of this month. the project's scope includes an upgrade ensure renovation. and then on the castro mission health center project we started construction earlier this year with construction focused on demolition, hazmat abatement and removal. this project scope is similar to maxine hall health center which includes the seismic upgrade and interior renovation. this project is targeted for completion by late 2022. with that let me turn it back to marc and alicia

to talk about the dsm research building project. >> if you've not been on the campus, you're going to be impressed to see this building going up with great speed. right now it is at about 3% complete for 33% complete, there is an urban roadway that terry has been working on with ucsf to open that a piece. it's above a 75-foot wide new roadway with landscaping and ada parking between existing buildings to the south and then to the north face of the ucsf research building so that is going to be turned over at 100% complete either at the end of the month or early next month will completion about the building and the roadways is about 33%. alisha is here if she wants to add anything for she could be available for questions. i think rat questions.

>> we were able to add i will be able to be turned rub it june 7, were ahead of schedule. >> your ahead of schedule! i think marc and the commissioners we are ready for any and all questions regarding any aspect of the presentation. >> [dan bernal, president] secretary moore west we have in a public, on this item? >> no on the line in the comments. commissioners you any questions or comments? commissioner shall >> [edward a chow, md, commissioner] want to think more commentary and especially joe for me, i just before the nine months of understanding what has happened and unfortunately reminds me of laguna honda, our

problem of not building the fourth tower. but this is much more complex because it involves many more things and i'm really pleased to hear that san francisco and the general hospital foundation is going to be very interested in helping with this project i would encourage that susan and i'm sure she is going to continue to work with them on this. there have been times when we have not always been on good terms and this sounds like a projects that they also feel it's very important. so, i wonder if and marc was involved with laguna honda, how will this be different. it sounds like were going to probably be able to look at completing most of the projects in mind and then what happens to the deferred projects that are sitting in particularly of course

i'm very concerned about the chinatown public health? >> when we got this data you must have been reading my mind because i was about to say the same thing with laguna honda and that was at the time that i left the city and started consulting before mitch got me involved with public health. though we have planned and we have a commitment so far from city halls to include chinatown and a bond in two years, along with building three and some infrastructure, so we have that solid, we hope to cross our fingers and 2023. we had it in 2016, we had it commissioner 2020, and it got taken out both times. so we have aggressively allocated for chinatown because it's an

important project for the community. we do have it in 2023 bond. there's another form of financing called certificates of participation. we also have a commitment from the city, the mayor's office to make more investments over at zuckerberg, particularly involved with the chiller and cooling tower which terry can talk to in detail if you have questions about that. we are looking at every possible funding pathway to make this a success and i think with the foundation and with susan's health and kim meredith and the support of the board we had a unanimous vote for the 750,000 in a commitment to go after developing a plan to make a campaign specifically geared towards building five. i feel pretty good about the support that we've gotten and i think susan

probably feels the same way. >> is in contrast to laguna, that was a single project them and seem by removing one tower and reducing the capacity which actually has worked out for the operation but this is where so many projects it sounds like you are all taking on to the task of not living any of them behind and continuing to work on rebuilding our infrastructure because that part seems to be one of our problems which is to leave it alone and then we run into operational problems and then just like susan said, unless they are really going to be up to date on the facilities were not going to be able to deliver the care, course

we have a first-class staff. i appreciate you but i wonder if we can get an update on this that is not going to be nine months away? it does sound like, what would be a good time? a quarter from now we would know how the bids came out but i would remind the commissioners that we did at laguna honda have very regular updates and it was very well-known to the commission what all the problems were. to those that were on the commission whether we were able to say that we tried our best in monitoring the cost were. i think this commission has the same interests in making?bñ?ñ? sure that, that the bond is properly spent but that the project that we have all identified as being essential, will in some way be carried out with the innovations and the means that you have now displayed that we could all try to piece together funding so we

don't leave them alone or behind rather that we tried to try to be sure to cover the needs of the department has. we did mention the apartment to move up as of the offices, is that also delayed due to the, i don't see on the list here? >> let me just go back to your first point. susan's vision and our vision for building five has always been an ambulatory care center for excellence. so we are going to drive towards that and anyway that we could possibly do it. feel assured that we will seek out any kind of funding task way that is out there and pointed back to the campus. the one on one exit is still in discussion because of the pandemic i think it's been difficult to get focused

conversation with everyone around it with all of the stakeholders and what it does do though, building three is one of the buildings that we have identified that is the least costly to upgrade and gives us the most square footage, like 63,000 gross square feet. because the building is a little bit newer and the structural system is such that we don't have to spend a lot of money doing the structure. that is a candidate right there that we are looking at is a possible relocation that would put people in the vulnerable building into something that is safe. >> [edward a chow, md, commissioner] i guess i would asked to schedule an appropriate time to bring us an update for this rather critical period of the funding in the project. >> if i may

commissioner, commissioner chow these updates are usually scheduled quarterly but because of covid scheduling some of the presenters it is due to a meeting this is been delayed but usually you won't argue would hear every three to four months less the attention of the department i would make sure that happens on my hands. >> [edward a chow, md, commissioner] i understand the reason for the delay and is just to make sure, to remind us that we do get regular quarterly reports. >> think you commissioner and we will have timely moving forward. and again apologies to mister primeau and your team having to delay this presentation due to a meeting that ran along a few weeks ago.ñ?ñ?ñ we will go next to the commission's representative on the san francisco general foundation board. commissioner. >> [suzanne giraudo, ed. d, commissioner] i want to thank you terry for the presentation this

evening. i know did not completely understand the bonds and i read the material but your presentation was excellent and i really appreciate how thorough and also easy to understand as you go forward. i also wanted to, as a representative on the differences for general foundation representative, the capital campaign in two different iterations is on the board's agenda for this thursday. so i am hoping that the next meeting to give the commission more information, but it will be on and it is on the agenda for the board

thursday meeting. >> great. commissioner, this is an excellent presentation and i think i still have the pride of being the newest member on the commission, so this is very important to me to have and to have such a clear and informative presentation. i think you greatly. i wonder since the recent focus and the last year especially and understanding and growing in understanding of institutional barriers and systemic barriers to health and equity and equality in safety and how important public health is and will be to solving the problems that have unidentified across the

nation, but certainly in our city. with that greater emphasis on public health and taking in addressing people's needs at their root level as opposed to relying on police officers and criminal justice systems to try to start out social problems these buildings in the simplest structure are more important than they ever have been. i am wondering, how and whether right now this greater demand from our city and the state for public health to step into the breach and to try to create greater equality and to create greater public safety, how that emphasis is or might help us find the funds that perhaps we were not available even

just a year ago in terms of the way that government, federal, state and local think about the critical nature of this and pointed out. commissioner, i think that you really hit something on the head of the city. during the pandemic started creating a whole category of conversation around racial equity and equality with infrastructure. so one of the capital questions or one of the factors when we requested money, we all thought to talk about how we are going to do better in those categories. that is the first time that i have ever seen that happen and i have been in city government for 32 years. so, i am seeing a sea of

change where departments are asked to present how are you going to make things better? how are you going to make improvements better in these areas? so, i think that's the beginning and i think there's a long way to go but at least there is a beginning. >> [susan belinda christian, jd, commissioner]. thank you for that and i'm glad to hear that is the experience, but i am kind of thinking of it as us saying to the government that had told us and have told you that you are just not going to get this money and we are going to use it someplace else. now these same entities are demanding in the people, the public is demanding that we as a city, state and as a country create the infrastructure that is necessary to create greater equality and to solve the problems that we have never been able to solve. and now that we are only

going to have some consensus around were going to do with them and it's unacceptable for government to say, we are not going to give you the money that is necessary to create what we need to provide our citizens with the level of care and treatment and safety and help that is foundational. and these entities are recognizing these things as foundational so i guess i'm just wondering what we are doing to add that perspective to our messaging intojnñ?ñ? art? >> do you want to respond? >> guess i wouldn't commissioner i really appreciate you raising to this point. it is really important and i guess i will respond to it in÷!ñ?ñ? two

ways. number one is i know that you are well aware of the security proposal that director price put together. i think that is really a transformational thing that the department is doing to address health disparities and equities and treatment by the police and sheriff of different groups, racial and ethnic groups. i am soisñ?ñ? excited about that and i think that we have a real opportunity to transform the way that he provide security and safety on campus. with respect to the building, i worked in the safety nets in healthcare for decades and what i see and to what really has been again, change by the pandemic i think. is that earlier on in my career the attitude

about safety nets and about all kinds of investments for safetynet was that this is public health and patient should be happy with whatever we are willing to provide. and it was always less then what people and other kinds of facilities would get. and that was just that we lived with and it was not only disrespectful of our patients, but it was disrespectful of our staff. death has to work in this facilities. the attitude has really changed over time and we have been held to a higher standard but also we have had more funding to meet those standards. the pandemic and everything else that has happened over the past7çñ?ñ? year and a half has really driven home the fact that we cannot provide healthcare and wellness without modern facilities. and without facilities. and we cannot expect our

staff and our team to provide care and substandard facilities. so, when i spoke before about the opportunity that the pandemic and george floyd's murder and so many things that have happened during this year i think it really gives us the opportunity to prove to governmentc,ñ?ñ? and to private philanthropy that this is the time and we need to make these adjustments. i am really excited about the opportunity going forward. >> [susan belinda christian, jd, commissioner] thank you and it is exciting and because of my day job i guess i just admits that how necessary it is forvpñ?ñ? these entities that have been denying funds for the state up until five minutes ago to be told and for us and all of the appropriate ways to

demand more resources because of reading the pages and reading the paper. people are demanding mental health treatment, addiction treatment services, more services for children in our public schools and in our communities so that they don't have to face the kind of trauma that leads to all of these many negative outcomes. and so this is being demanded of us, as you well know, we are being criticized as well because public health is being criticized for not providing these things and you can provide things there is not funded for them and we have been fortunate to have the funding that is creating more of the outreach that is going so well and the feds that have been projected. but those are not going to be enough for the kinds of transfer of responsibility from and for safety from the

ground up. from the criminal justice system to public health and i think that needs to be raised and puts front and center with these places that we are going to get our money from to do this necessary infrastructural work. but also just wondering how that is going to be and is being wrapped into the way that you seek reconsideration of the level of funding, perhaps reconsideration but also sources. for the funding and the reasons why it has got to be given.

>> i was going to say that i agree and there needs to be a comp opponent that is integral with any kind of capital request that we directly linked to how we provide services in a better way than we have in the past. that commissioner i'm just like to add, to the points of the pandemic highlighting the importance of public health but also highlighted exposed and increased inequities, income and equities. not only does health and equities but also the income and only become challenging. one of the fundamental issues here for recent reports is the system to support or for the government to support massive info structure changes, including better support of public health has not realigned itself and it is anything that tax

structure has become more and vote that we have seen in recent reports and in this regard. i just think one of the key things that our policy that will very carefully with some hope and optimism is with regard to infrastructure and large federal infrastructure bills and how will that intersect with public health infrastructure? i think when the public thinks of infrastructure that think of bridges and roads, but i think that the public health and the democrats really highlighted the lack of adequate public health of the structure, which is out of date and then exemplified currently in the issues that we have been discussing. but this is also across not only our public health system right now locally but across the state and country as well. >> [susan belinda christian, jd, commissioner] this is so critical to criminal justice reform as well so as not only the infrastructure, separate and apart criminal justice must form and

structural change, it is also in that as well look forward to that case being made strongly and persistently. >> [dan bernal, president] commission thank you commissioner and thank you mister colfax and we have any other comments on this discussion item for move on to the next discussion? okay our next item number eight for discussion is the annual dph , okay sorry backing up thank you mister primeau thank you for your team and thank you to mister saltz and to miss my ascii and to mister chin for this presentation we look forward to seeing you back soon for an update and we will move on to our next i started with somebody else about this? okay, moving on to our next item which is the

annual dph sole-source waiver usage report which was reported to this department this month or to the board of supervisors this this is from the preaward unit office contact management. smack hello and nice to see you. can you see my screen? i am sharing what i don't know if it's working? i will make this fast since i see that you are nearing the end of the agenda. this is a routine matter and it does not require your boat it is for your information. prior to submitting this report to the board of supervisors, which we are required to do by the sunshine ordinance which of course, is ultimate transparency for the city, especially for contracts. so what is required is that at the end of every fiscal year we have to provide a list of the board of supervisors and

all of the professional sole source those that were selected without a solicitation, without an rpr rfq. those that were entered into the fiscal year and those include contracts that are under different parts of the city's acquisition ordinance chapter 21 of the administrative code. they are morewitz classified as chapters 21.5 as regular soul sources and chapter 21.30 which are mostly software proprietary and software and chapter 21.4 to which our own special part of the organist that is basically for dph sole-source. effective in fiscal year 2015 to 2016 we have been reporting this to you as an update so no voter official approval is required on your part. so, that said i also need to go over that the

administrative code provides that commodities or services are available only for the sole-source sobbing procured in accordance with the city purchaser's regulations. so therefore are acceptable justifications under those regulations that it is only one source that we can prove that. that only one adventure is willing to enter into contract with the city that the things that we are contracting for having features that are essential to us and satisfy our require requirements, that it is licensed or patented, or if it is justifiable under some other reason that the office of contacted ministration will except, basically. chapter 21.30, that is mostly for software and then for chapter 21.42 this was passed in 2006, where they amended the chapter 21 so that you as a commission approved a list every fiscal year for the coming fiscal

year of those contractors that are in your service categories, you are designating as a dph sole-source and i believe this year you did that in the may meeting. i believe it was may 5th. no may 4th. so, we appreciate that very much, that helps is a great deal in getting contacts through and that said the actual report looks, if i can go to the right place looks just like this and you can see that it is divided into different parts. the first part is chapter 21.5, the regular sole-source are unique in some way or another. and in chapter 21.30, which starts on page five and that is mostly software that is proprietary so that is pretty much by definition a sole-source

contract. and then the chapter 21.42 contract, which in general if it is not a short term objective or like a short-term one-time grant in general, for all of those 21.42 soul sources we are planning on doing a solicitation. with that said, i probably should let you just ask questions. >> it is very thoughtful of you to ask if it was your speaker, no it was my microphone that i apologize. thank you for your presentation, commissioners do we have any questions? i see commissioners christian hand is up.

>> put my hand down, i see commissioners challenge. >> [edward a chow, md, commissioner] i just wanted to again, commend the fact that we get to see this report which goes over to the board, because it kind of closes one of her circles that when we pass the contract and they are a sole-source, this kinda gives us an idea, again of how many of us in the services they were what they have and many of these is they are meant, censure mister weidner can confirm, to help by sole-source same, we know that a number of the contractors are unique and we don't have to go through the enormous bidding process for contracts in which

there are only one bidder for that particular project. i known it first came on with the commission, we always thought that everybody should be fitted out and it turns out that after all of these years, a good number of the same contractors come back after rebid and many of them do have unique services. i think that the administrative code has allowed and we are able to actually have three different segments of how we have the sole source, clearly defines here will be helpful in the continuation of the work that we are all doing in terms of when we are looking at contracts and understand under sole-source and we always get the number of the sole-source, why it is. i just wanted to comment that i thought that this

actually is very helpful for the broad understanding of sole-source on the part of the commission. i wanted to thank the staff for presenting it to us and prior to going to the board. >> thank you. >> [dan bernal, president]. i would echo commissioner chow's comments, thank you. this report and all of the work that goes into it is the key to us being able to conduct the work of the commission and the department in a way that is both efficient and accountable. thank you very much for that. i see commissioner chung. she has her hand up as well commissioner chung. >> [cecilia chung, commissioner] yes, thank you commissioner and i just want to also add a little bit more to this list of sole-source contract did. the fact that we also want to promote the transparency in order for local businesses if they think that they could compete for these

contracts. to know the nature of them and if they decide that they have the skills they would be able to come into as well because we want to create that balance. i love that it's true that they have the proprietary software for instance some other licensed things but it does not mean that that is not compatible and it's really important for us to highlight that as well. so far right now those expresses were sorted and the businesses that actually feel confident enough tends to be out of non- local businesses. so i just want us to be mindful of that as well. thank you.

>> [dan bernal, president] commissioners any other questions or comments? all rights, if not ms. hale, i understand after decades of dedicated service to the department you will be retiring in a few weeks. we just want to thank you for your decades of dedicated service and we wish you well in all of your future endeavors and knowing the way folks are in our department and i'm sure that they will all stay connected with all of your colleagues and folks here. thank you again for all of your extraordinary service and we are happy to have the opportunity to wish you well. the next. thank, i appreciate that. >> [dan bernal, president]. thank you, thank you and onto our next item which is other business. do we have any other business?

seeing no other business, the next item is or for discussion is joint conference committee and other committee reports. we will have a summary of the june 8 ghana hospital jc meeting and commissioner palermo. >> [tessie m guillermo, commissioner] thank you and it's a short report again. we continue to be impressed, that committee does with the way that the executive team has prepared the ports for us. very consistently it highlights and usually are at least four the last few reports very lifting in terms of highlighting the work of the different departments and how the teams have come together and really just a lot of the progress that has been made at the honda over the past year and a

half with the dealing of the number of struggles and challenges that they have had both prior to covid and certainly with covid and certainly opportunities to celebrate in advances in progress. then we had a presentation that updated the nursing department. it was very comprehensive, very complete, chief nursing officer monica bailey, who i think who has been there less and then a year now that laguna honda has been a very, very impressive with how she has really rolled up her sleeves and dug into improving morale and improving quality, improving professionalism and really bringing a number of operational and clinical improvements. working also very well

together with the other clinical departments as well as the overall sort of functions. i think is just indicative of a good environment over at the honda and things that we could expect in the future in terms of progress and improvement. and then as per usual, during closed session committee improved or approved the credential report quality report. and also the history report and that is end-of-life. unless there are any other questions or comments for my fellow committee commissioners. >> [dan bernal, president] commissioners any questions? all right. we do have one commissioner green. >> [laurie green, md, vice president]. i just want to reiterate

what was said about the presentation from the nursing group. it was truly incredible and i think we would all agree that the rest has been made in a very short period of time and is quite impressive. the plans and the way he presented them to us were really, truly impressive and i think they could be a model for not just long-term care facilities, but for others in terms of their thoughtfulness in a way that they have determined their ideas. i think a lot of the people that were involved have mass experience and other organizations. i know monica had time at kaiser and i think they put their heads together and created a program that has terrific potential and it is quite exciting to be in the room listening to them present this >> [dan bernal, president] thank you commissioner green peering seeing no other comments on this item, the last item on the agenda is

adjournment. do we have a motion to adjourn? >> i second. >> the roll call list? commissioner geronimo? >> yes commissioner christian? >> yes commissioner john? yes commissioner joe? my guess commissioner green? yes. already the >> [dan bernal, president] thank you everybody

>> once i got the hang of it a little bit, you know, like the first time, i never left the court. i just fell in love with it and any opportunity i had to get out there, you know, they didn't have to ask twice. you can always find me on the court. [♪♪♪]

>> we have been able to participate in 12 athletics wheelchairs. they provide what is an expensive tool to facilitate basketball specifically. behind me are the amazing golden state road warriors, which are one of the most competitive adaptive basketball teams in the state led by its captain, chuck hill, who was a national paralympic and, and is now an assistant coach on the national big team. >> it is great to have this opportunity here in san francisco. we are the main hub of the bay area, which, you know, we should definitely have resources here. now that that is happening, you know, i i'm looking forward to that growing and spreading and helping spread the word that needs -- that these people are

here for everyone. i think it is important for people with disabilities, as well as able-bodied, to be able to see and to try different sports, and to appreciate trying different things. >> people can come and check out this chairs and use them. but then also friday evening, from 6:00 p.m. until 8:00 p.m., it will be wheelchair basketball we will make sure it is available, and that way people can no that people will be coming to play at the same time. >> we offer a wide variety of adaptive and inclusion programming, but this is the first time we have had our own equipment. [♪♪♪]

>> all right, mayor, we've got a program. so be patient with us. all right. it's been a long time coming. hi, everybody, my name is phil ginsburg and i'm the manager of your recreation and park department and it's about time. it's really happening. it's really happening. you look over my right shoulder and you can see all of the work that's already started on our pathway to environmental justice. and -- and joy and community and resiliency. but before we jump into our program, we want to do a couple of things. and the first is that we want to acknowledge that the land that we are currently standing on is the unceded ancestral home of