[♪♪♪]>> july 20th, 2021.we wille roll. (roll call). >> thank you, secretary.

our next item is the approval of the minutes. commissioners you should have before you those minutes. upon approving do we have any amendments? >> i move to approve the minutes. >> i wanted to move that the bottom of page nine, i made an error. the word should be implementing, the sentence should read ask for more information regarding this plan for implementing vaccine

distribution. as it reads, it says implanting. >> i didn't say that. >> i wanted to make sure you had the correct version. if you have any comments to make about the minutes. please press star three to raise your hand. seeing no hands, i'll go through and redo the roll call vote. (roll call). >> all right. the minutes pass. >> the next item is the director's report. sitting in for dr. co lfax. we have dr. baba.

i want to thank her for contributing to where we are today and how the city has addressed the covid 19 pan dem pandemic. >> thank you so much. i really appreciate the thanks. i want to highlight a few things in director's report. i wanted to specify point out that the health officer provided a strong statement. our school teams worked very hard to get that guidance up and running last week and is working closely with the schools to ensure that we can successfully open in august which is right around the corner. that's wonderful news and great

work to those teams. additionally i wanted to point out as the delta variant becomes more predominant that we really need to push on vaccines particularly where vulnerable populations live. she revised her health order to say we wanted to ensure those vaccinations move forward even prior to fda approval. i'll stop there with those highlights if people have any questions about the director's report. >> commissioners, any questions about the report? >> i just have one if possible, mr. chair. on the school guidance, i know we've been putting out school guidance and there have been problems at getting it implementing at the school

level. it is wonderful guidance in compliance with both federal and state rules. one has been the uptake within the school district or are they still fussing -- and do you know the date they are supposed to open all the schools. >> yes. i believe there's an open date. we'll get back to you on the date. the classrooms and ensuring they meet the requirementses. i'm working with them around the masking issues and triaging if there are symptomatic students. it's been a very close partnership. i think the the team has been doing everything in their power to ensure that they feel fully supported before reopening. >> okay. thank you. >> commissioners any other

questions or comments before we move onto the next item. >> if you may just ask for public comment on that. if you would like to make public comment on the director's report please press star three to raise your hand. no hands, commissioner. >> i know for our next item for the covid 19 update. we have an update from dr. lisa pratt regarding jail health services. with the commissioner's agreement we'll go ahead with commissioner baba's presentation and take questions before leading into the presentation from dr. pratt >> great. i wanted to provide you an update in terms of where we

stand. we're seeing an uptick in cases. i wanted to give you a little more data around what san francisco is experiencing. our case rates really did -- right prior to opening. we're seeing an incredible rise. it's on our public dashboard. the difference between full live data and what you see here, we make sure we put out publicly all the case data that we have. we wait about a week before publishing because cases come in throughout that week. our case rates have increased and we're seeing an eight point

increase and are likely to hit ten before the data has arrived for this week. our hospitalizations are rising. they are not rising at the rate cases are. i think as you know hospitalizations can be a lagging indicator, we're following that carefully. again, our lowest point was around nine hospitalizations. today we're up to i believe about 43. i will say that out of the 43, about forty three percent also are out of county. not all of those are representative of spread in the county. it's definitely an increase from what we saw at the bottom. we do know that in terms of our hospitalizations, we're seeing an disproportionate impact on communities of color. black african americans made up

28 percent of hospitalizations even though they represent 5% of the population. the low points are below one. we have increased to one point six. this is is likely what the major contributing fact to our case rates really starting to take off as well as the delta variant. in terms of the vaccine administration, our peak rates have dropped off. right now we're down to about, i believe, four hundred, between four hundred and six hundred doses a day. that averages about a one point three percent increase in vaccination rates per month. the team is working very hard on

vaccine and ensuring that messages get out and there's better -- that those still living on the fence and need more information are getting that information. this gives you a trajectory of the vaccine uptake, where we peaked back in april and have had a steady decline. it's about 400 a day which is about one hundred per day. in terms of our over all rates. about 69 percent of people are fully vaccinated. for those that are eligible it's about 75%. we know that the seventy five and over probably remains one of the most vulnerable to covid.

we make sure to continue our efforts that that doesn't rise in that population. where are new cases happening? this is from the last two months. you can see the south east sector is the most heavily impacted. it continues to be a place where we see a lot of cases. that's despite a fairly decent percentage of people being vaccinated. in june the black african american case rates were higher than white san franciscans. latin x cases were higher when compared to white. vaccination rates by ethnicity. overall asians have the highest

vaccine rate and next are by latin x at 72 percent. our white population and black african american. by age, it's 25 to 34 year olds that remain the most under vaccinated group. i wanted to talk a little bit about our planning team about vaccinated versus vaccinated case rates. what we're seeing is -- one of the things to remember is that because san francisco has a high vaccine rate there will be a percentage of people vaccinated that get covid. the difference between getting covid and being vaccinated and unvaccinated is symptoms are very mild.

five hundred cases among those who were vaccinated versus fifteen between those who are not vaccinated. hospitalizations are very telling. if you take the number of people who are fully vaccinated four people have been hospitalizationed versus seventy four people not fully vaccinated. when you do the rates, four people fully vaccinated over all of the people fully vaccinated that's less than one percent of that population. almost eleven fold increase of people who have not been vaccinated in terms of hospitalizations. we have not seen any deaths in fully vaccinated. this is trends we're seeing across the nation.

people being hospitalled and dying tend to be unvaccinated. we're seeing a rapid rise in sf. due to a couple things, the delta strain is here and spreads more easily. contact rates due to our june 15th opening. it's too soon after our rise in cases. the hospital sentence delta does not cause more severe disease, that's something that's still under investigation. if that's in fact true, it can be managed with existing hospital resources. we know vaccines are highly effective at preventing hospitalizations and death.

most if not all of the hospitalizations are preventible. those that are infected and dying are disproportionately represented by unvaccinated. that is my summary about where we are with covid. i'm happy to take any questions. >> sorry about that. any questions about that from the commissioners. >> thank you for the presentation. can you just give us a brief explanation about what department is saying and doing about testing at this time. i know that our last meeting commissioner green asked about testing and how difficult it was for her to find a site. is testing still being put out

there and -- >> yes, absolutely. especially for those who remain unvaccinated. that message is going through our community partners. if you remain unvaccinated it's a good idea to test regularly. there are someplaces that have you to test regularly. we have most of our assets in most vulnerable communities. communities disproportionately effected by covid and the south east sector. we're relying on our health care system now to do testing of their patients. we saw testing rates really drop off especially as people got vaccinated. i think our team is working on how to get that message out

there. >> i would imagine there's tracking going on even though miles projected an out break so for. >> when a case gets put into our cicp system part of it is tracking which of course is during the isolation period or during quarantine. if somebody gets hospitalized that gets reported as well so there's a tracking of that. >> thank you. >> thank you commissioner christian. >> thank you for the presentation. i had had two questions. one had had to do with the potential mask mandate being instituted.

there's been a lot of talk about that, i don't know whether and where the department will be weighing in and the timing of that, that would be one question i would ask in san francisco. the other is even though when you showed the data on the vaccination and the seniors are still the most vulnerable as well as those in the south east part of the city demographically, we're hearing from an age demographic, younger people are also both unwilling to be vaccinated as opposed to be maybe an access issue. i don't know if that's true in san francisco or not. also because of their

vaccination status more vulnerable to the virus. i wanted to hear a little more of the nuance on that from your perspective. >> thank you for both of those questions. in terms of the masking, we put in a recommendation with the whole county. all the counties are seeing a rapid rise to see if we can really get a turn on this. what we'll do is monitor if that is making a difference. if it's not, what are the next steps there. we're in a monitoring situation, we'll keep the commission arised if that changes in any way. in terms of the demographic, it's a extremely important point. we have heard younger age groups, especially that 25 to 35

are the least vaccinated groups. there is some thought that maybe covid doesn't impact them as much and why get the vaccine. we have seen seen definitely hospitalizations. 25 percent of our hospitalizations are 35 and younger. this is not a disease just for the elderly and it has serious consequences in all age groups. the best way to protect yourself is to get vaccinated. we're having conversations and physicians to provide people with that information. >> i understand the importance of the message that is different from the message that was being popularized or shared because the reality of the vulnerable

populations early on in the pandemic. i also wonder about the channels in which those messages for that population are being delivered. it would appear to me that the -- is there social media, popular media, other kinds of channels are the ones to reach that demographic. i don't know whether that is something we have in the past incorporated as much as we have in a more traditional messaging strategy. >> that's a great point. there's a couple different ways we're approaching this. we have a max the vax group which is made up of teenagers an young adults to talk about what they are hearing in social media

to provide those messages. there's still a lot of misinformation about vaccine. really wanted trusted share groups to provide those messages. throughout the state young adults are going door to door and talking with people about vaccine and talk to that age group and their peers about vaccine and try to provide the best information for people to make an informed decision for themselves. >> thank you. >> thank you. i will note that i think four more bay areas have joined the seven bay areas that have put in a mask recommendation. it seems to be a growing trend

certainly with the bay area certainly in the lead again. >> thank you for this up to date and concerning information. i wanted to echo the concerns that commissioner christian raised and also the issue of communication is so important depending on the demographic. my demographic at work is exactly the group that we're concerned about. many pregnant women are afraid to get the vaccine. i'm curious about our data about not only testing but also the probability that vaccinated individuals actually continue to have the vaccine. people coming back from mexico have to get tested. i've gotten two calls this week who were coming back and got tested who never otherwise would

have been tested if not coming back from the country and had covid. vaccinated are less symptomatic think it's seasonal allergies. we have young children, unvaccinated eleven year olds, grandparents, i'm sure you've all observed people are really not using masks. i would say 70% of the time when i go into the labor room, no one in there is wearing the mask. this is when it was released from wearing the mask requirements. i wonder if whether we should think about expanding our testing again and how we're going to get, if you can comment

on how we're going to get data and these shutters might esk tht the spread of the disease? >> it's a great question, how well vaccinated people are able to spread the disease in general, that's something that's being discussed. i know at the state and national level, we'll get information about people and who they came in contact with. who they were able to spread it to another vaccinated or unvaik unvaccinated person. get better insight about whether -- how much vaccinated people are contributed to the spread of delta. i completely agree with the testing. i think we have to get back to really messaging about the

testing. tests are available in many different forms. that might be at least one way to start getting people to think about testing. this was always a hope that people would do rapid testing when they went out. we never got there. rapid tests are acceptable. they can be utilized if you have mild symptoms. you can buy one and do it or go somewhere and get one done. >> if people are doing it at home, how will we get access to positive? >> that's the big question. we can empower people but also have to make sure that they connect back to a health care provider or department of public health if they do have those positive symptoms. at this point we want people to have access to the tests, so there's less of a barrier in

terms of being able to get tested. the city run tests, we are seeing, you know, that community connection is still very important. that messaging through community partners is still very important. i agree with you we'll work with our task force on how those messages can penetrate the community. >> i think it would be really helpful for the group to take a look at testing availability north of lincoln boulevard. if you look, and i have, if you're a working person, it's almost impossible unless you're willing to pay one medical pay center and come to very specific hours, it's very hard to get a test. i just got the covid update, they certainly aren't talk being

it. it might be helpful to take a look. there are a lot of young people in that marina district that are going to make everybody else vul vulnerable. >> thanks for that, we'll definitely look into that. >> thank you, doctor for these wonderful answers. you answered most of my questions. i am wondering if we're also going to be potentially doing something with the schools in regards to that vulnerable age group, remember that a lot of the campaigns in the past such as polio went through schools. people have a right to say no. it's another opportunity to bring it directly to the kids. i think most colleges now sound like they are going to require

it. that should help increase the numbers when people go back to school in this area. i think almost all of them are. i'm wondering within our junior high, high schools, if this would be an opportunity both within our public and private sector? >> 100%. that really -- we're working very closely with the school system to work with their families with the vaccines. having events and ensuring the entire family is included not just the 16 to 18 year olds. definitely trying to continue that work. especially as we move into the fall and hopefully as the vaccine gets approved for those

under 12, that will be a large portion of the population that needs to get vaccinated. i will say the other thing that california did was that they said if you're in school, have you to mask. that is not what the cdc explicitly stated. i still think it's the right decision. we know masking can prevent the spread of disease. >> i just have one more question and it did relate to those not necessarily under 12, those in preschool or going to preschool because there is a growing concern about the long term effects. are we going to be able to understand that a lot better when that vaccine comes out and at the same time right now if

they went to preschool, i assume they would have to have a mask. is there any concern right now. preschools are still being run right now, history as we believe it is a very low risk. >> in terms of the vaccine or masking? >> in terms of coming down with covid. if you are between the ages of just born until five or six. >> i think the data has been showing that there is, these tend to be less severe in these age groups. it's not a completely benign disease. we also have to worry about

emerging variants and will they have a different effect in children. this will all be closely monitored by public health officials and academic colleagues to think through the different interventions and what is needed and what is best for those age groups. this came out with pfizer and the recommendation for the 12 to 15 year olds and the indications that came up after the initial sets of vaccination came out. overall, the recommendation is to continue to vaccinate because it's relatively short lived and didn't necessarily have to be consequences. covid had more serious consequences in that age group. >> i do think that the

information that was relayed to myo carditis would seem to be effective communications for people who could look at that and understand the trade off between one option to another. i think that we should do or that public health in general nationally should be doing a lot more of that rather than making it sound like it is a political rally or something. i know the city has done really great work in this. and these questions really do come up from our community and that's why i'm glad to hear that we're continuing to put those messages out as well as you have been doing. thank you. >> thank you commissioner chow. i did have a question.

looking at the slides it appears we're really losing ground in the black african american community. in regards to our case rates is looking like it did in the summer of last year. what are we doing to address that. not just our testing but vaccination efforts, what efforts are in place now to really try and regain that ground? it's a great question, one of the things we know is that, you know, we are here to provide support and really what we've heard and the data has shown is

whether it's trusted family members, neighbors, community members. those are the people that have questions about vaccines, that's who they go to. we are working with all of those different partners to think through how best to approach some of this work. i think what we are here to provide the information and the facts and really work with all those different partner it figure out the best ways to get that information out. again, anecdotally it's a lot of conversations that our community members are having to talk about the misinformation out there. it's often not just one conversation. it's multiple conversations. like anything in medical someone

makes a decision in one point in time and people want to make sure that's acceptable to them. it's a lot of effort. i want to lift up our community based partners because they have been baring most

to come back and talk about the jail. a little bit longer time line to look back and take a pause and figure out what went right and what things we did that were effective to protect the jail population. just going forward following dre the challenges with delta coming. do i have the slides.

while we're waiting to get this up, i'll go through orienting us to where jail health sits in the health department. a tiny little bit of information about the org chart and some demographics for the jail and what we have pre an post covid.

>> this is a little early. i think you had a comment that you were going to make later on but since we have a little time, can you make it now. >> i want to commend lisa. i think you know that the jails are a extremely vulnerable place. her an her team have done an extraordinary job of preventing covid from entering the jails. i want to commend her leadership. thank you, lisa to you and your team for all that you've done. >> i appreciate the opportunity

to go through this and also it feels like i'm setting myself up to smack myself in the face. i'm coming to this presentation with great humility because we got so lucky in so many ways, i don't know how much longer we'll be lucky. i'm one of those people who doesn't like to tempt fate. we'll go through this and i'll tell you at least the systems that we have to keep fate at bay. if you can go on -- thank you, mark for your help. as always. the outline as i mentioned, we'll go through where we are and our population and the response with testing and vaccination. next slide, please. i made a red border. you can see the infection that

sits with ambulatory care up through the network to dr. horton. we're an organization with about 154ftes, we have a nursing director. this is a twenty four, seven operation. we're always open. we have a incredible behavioral health director, behavioral health clinician. we have hiv integrated services and prevention team. we have a brand new pharmacy

director who came from san francisco general, fabulous. really lucky to have him juf justbefore we go live with empl. epic.just to remind us of your d work, incarceration declared a public health issue, preventing criminal justice involvement. the recognition that criminalizing people based on their race, people based on their housing status, people based on their improffer ishment, based on their substances and medical problems. this is where it was said was a

public health issue. a little bit of the pre and poaf. post. the red line is the shelter in place order. we were bouncing around 1200 to 1400 daily population in the jail. we had a rapid decline in the population. that depopulation was critical to keeping those who remained in jail safe and keeping the community safe as well. we'll go deeper into that. it's really important to recognize that that has -- that population has plateaued. it has gone up a little bit. 70% of the jails in the united states had an increase in

population with the advent of covid. in this case that difference has been critical and life saving. next slide, please. this is looking at both the historical jail population and incarceration, this is essentially the number of bookings. that translates to unique patients. we had 11,000 unique patients would were booked 18,000 times in 18, 19. if we look at covid, the population did drop. it had been declining for many reasons based on the reorientation of the community to incarceration. that incarceration and the efforts that we as the department of public health has

put forth and the criminal justice legal system. covid had had a very profound impact on the population as you can see. we haven't changed much in terms of sex or gender. typically we're eighty two percent men. 17 percent women. and gender queer non binary. less than one percent. looking at booking data. i show this every year. this is really not changed much. hugely disproportionate are

black and latin x. less than 5% made up of other, unknown, and american indian. i took out just for ease of looking at the pi chart. what happens, this is booking. what happened when people stay in the jail. who do we keep in jail? that's the next slide. this is point in time. the day we looked was june 20th. you see a huge jump in the percentage of black african americans who stay in jail. that means those are the people who are less likely to be released on all different types of alternative sentencing or

holding. increase in the latin x population. decrease in the white population. you see disproportionately of people who get to go home. the asian pacific islander population is a very small population. let's talk in context of who we have in the jail. as we all know well know, at the outset these are jails, prisons, detention centers are very dangerous places, they are overcrowded. congregate centers are overcrowded. largely out side of the reach of medical care and access in ways that would protect them. we were set up to have very

difficult and potentially deadly experience even in our jail given these conditions. next slide, please. but i won't burry the lead. we've had 161 people who tested positive. no deaths, no hospitalizations, and no in jail transmission of covid. not to tempt fate here but we had all sorts of systems in place to prevent that and variants and that's different than what we have now, i wanted to come to the health commission and give you this information before everything changed and things become more dire, which i'm afraid they might. this is what we had for the

first 16/18 months of the pandemic. this is how we did it. i have to say that there is no -- there's no possibility that we would be where we were in this without the sheriff's department and the leadership of the sheriff. they were partners and side by side in helping us educate staff and patients. hand washing, making them available to all of the incarcerated people, masks for all the incarcerated people. identifying people with systems. i just want to point that out. from a covid standpoint, the less movement in from the community,et better. symptom screaning and we know

where that led to eventually that was one of the first things we did because that was what we had to work with. the masking requirement for staff while that seems very straight forward and non controversial, you know for example, the alemeda county said he wasn't going to do that. he wasn't going to impose on the rights of his guys. there's no science to masking, he said. it seems incredible that we could live in the bay area and have people who are are charged with protecting incarcerated people bring forth that kind of

idea and it has been -- there have been a terrible number of deaths in la county. jails. a terrible number of cases and staff that have been infected. all sorts of lawsuits going on now. that's what happens when you have people -- is he an elected. he represents and reflects the values of our community in san. even in the area of law enforcement that he represents. i just want to under score how important it was to have that partnership with sheriff. this is where you all come in because the resources that were made available to us through the

department of public health and with dr. co lfax leadership. we got early and effective access to testing even while people were only being tested with symptoms. that was early on. we can have people coming into jail even if they don't have symptoms because the risk is so great. we got tests with a four hour turn around time from the hospital.

there was no spread among incarcerated people. now that we have mandatory testing in place. we hasn't identified a time. you can see that started as the case rate fell. we have identified some, that's critical given the location. now with vaccination we know that delta staff and the vulnerable incarcerated people will be protected. that brings me to the next layer of protection. the population density. we have been involved in trying to reduce the jail population in many ways.

it became a crisis, it needed to be much more expedient. we had a new district attorney who took that leadership, the police department was very involved in changing the way we did things, the public defender moving very quickly in the court. all of that part -- nothing to do with jail health. everything to do with maintaining the health of the people in the jail. we worked closely with the criminal legal partners to depopulate the jail as quickly as possible. because, you know, this -- i know it's really hard to see this. this is an open dorm. for those of you who have toured, i think that's really everybody. this is i'm going to say tongue

in cheek, a covid induction unit. this is shared space with shared ventilation. this is a good probably third of the housing that's available if not half. there's bunk beds and cubbies. there's a little bit of a partition there but nothing that would protect against the ventilation system. the next slide shows the dplas,. you can see the glass doors, for isolation, they have a solid door and people are behind glass. they are much more protected from each other, from anyone with covid or has symptoms. that represents a small percentage of the total number of cells that we have for

people. making it possible it put the most people behind glass in the jail is the way that we knew we could protect them. the way we knew we could do that proportionately is to reduce the population. a network, our particular project has been with a goal to reduce the jail population by 1. we did that really quickly. that was because of covid. the number of 1044 was the goal, county jail four was a dil apri

dilapidated jail. these were the strategies used to tackle the reduction of the jail population. we have these things in the works and they were going on before covid hit. we just could accelerate things and kick them in high gear. the relationships were made across the criminal legal partners to do this and speed up case processing times. to speed up the case resolution time. to get people into treatment faster, that has been a challenge during covid because so many programs had had limited admissions because of covid. that's been a hard one. and data sharing which has also been mutual in this process.

we had all the specific strategies. the police department was willing to site people instead of booking them and bringing them into jail, they would site them in the field. there were fewer people around the shelter in place. the da had really accelerated charging decisions, that is at the same time that we had elected a new da not long after we had covid. those things worked together well to get people out of the jail more quickly if they were not going to be charged. zero dollar bail was instituted by the state court and that was temporary but it was a strategy to get people out quickly and not have to wait for the bail

schedule and people to raise bail. following that was a longer standing decision that came down from the california supreme court. this is the humphrey ruling. they did in the rule that it was illegal but they did rule that for mr. humphrey who was charged a 325,000-dollar bail for some sort of shoplifting situation, he was homeless and improffer i.

we have finally crossed the halfway threshold in the jail in terms of people who are vaccinated. we have a constant turn, as you know. when i say 70% of our patients are here seven days or less. we only have the two dose option, we were discharging people after one dose if that. people need a little bit of time to settle down and figure out what's happening and do they trust us. we're asking them to get a vaccine that lots of people don't trust and they don't know

us and the therapeutic relationship you have with your doctor, now you have this different doctor in the jail, if you ever had one to begin with. we continue to do that. we've done about 25% of our doses have been j and j. as people are done, over 1200 doses total delivered. about 450 people who were vaccinated had left custody. that means more protection for the community. it's a win win for everybody and breaking it down by race, ethnicity is the next slide. initially just as we see in the

city, saw a disproportionate number of our black african american patients who were not taking the vaccine in the jail. as well as latin x. we brought in people from the community to talk to incarcerated people. we had videos and presentations. the sheriff's department, the deputies were helpful in helping make the decision. we've seen a good response in vulnerable communities as we've learned from recent presentations, the unvaccinated populations is disproportionately 24 to 35 year

olds and that's who is in the jail. we're well vaccinated in the city, about 20 percent of the jail is non san francisco residents. only about 10% come in with a self report of having been vaccinated. we've still have a very vulnerable population that comes in everyday. when we try to verify the vaccines, maybe 60% tell us they are vaccinated. here is the location, the vaccination i got, i got them on these dates, sometimes we can't find them. 10% have been vaccinated. we still have a very high risk pool of incarcerated people. now you're looking as a

requirement to report vaccination status, the sheriff's department so far they are 50% unreported. only 30% are vaccinated. fortunately with a mandate that will change. just to show you where we are, this is covid cases in the jail over time starting, i believe that was may 2020 and the black arrow is where we are now, mirroring the city. if there's a surge in the city, there's a surge in the jail. that's the way it works. seeing this now is concerning to

me. we definitely had had an uptick in the jail. it's the concern around transmission. the final slide about where we are with delta. i've may the point that having unvaccinated people like we do in the jail makes us vulnerable. as we reopen the jail to schools and family visits these are more people who are potentially going to bring in virus to the jail. incarcerated people need access to these things. people have been living there for a year and haven't had had school or a contact visit with family. that's really hard.

the assets are that we continue to have require testing, require vaccination, and we continue to have a reduced population. the very last slide is just an acknowledgement of all the people -- not all of the people. some of the people that really helped us and me through this very difficult time and process to figure out who and where and where to go and who to talk to and who can hook me up with this. twenty four hour testing and answering my calls. the hospital and contract tracing has been amazing. the partnering and working

withing the sheriff's department. all the people that are unnamed but who are the employees of jail health. thank you and i'm happy to take any questions. >> thank you, doctor. can i just under score again, i know we've talked about the relative success san francisco has had in respond to go the covid 19 pandemic. the successful efforts to control out breaks. just to look at this slide again and see there are no covid deaths, no hospitalizations and no in jail transmissions. that's an extraordinary accomplishment. i join you in acknowledging the sheriff for their role in working closely with you to ensure that everything was in

place to make this happen. very grateful for your work and thank you for this presentation. i will now i see that commissioner christian has a question for you. >> thank you dr. prat so much for this presentation. it's so rich and in depth and stunning to see how successful the prevention effort has been in the jail and i know that you and rightly so pointed out the partners to work on keeping the population down and keep everyone in the jail as safe as possible. i want to emphasize how critical you were in the effort in making that happen. please don't underestimate how clear and insistent and emphatic

dr. prat was at the beginning of this pandemic an throughout that the population must be decreased in order to protect the lives and safety of everyone that was forced to be there and the people who also work there. we owe you an enormous debt of gratitude. i just want to make sure -- i want to say that it can't be overestimated the importance of you being in the position and you having done and said and demanded what you did. that's not what we're talking about today in this segment but i also want to talk about how your presentation and the numbers you show us, how clear it makes it. the centrality of an effective treatment and mental health

resources and they are in the community. how critical that is to the overall health of the community and also decreasing the number of people who end up incarcerated or arrested. the disparity between the population of people who are incarcerated and who are arrested will never go away unless we are effective in creating relevant treatment. i want to thank you so much for

that. i do have a question, perhaps dr. baba might answer it. the focus that the department has now on vaccinating unhoused people, i know that there's always been a focus on that. what does that look like now given the relationship to people -- the population of people who disproportionately end up disproportionately in the jails.

>> we are faster currently at identifying in house people because of whole person care and how that works and the shared priority list. we are slower, i think, at having identified people because of covid for really long term or even permanent housing options coming out of the jail. we can get a hotel here or there. if you have covid, we can get you housed for a longer period of time. we're all waiting to see the money coming for all these different housing options and the focus that we're putting both on unhoused and the

complete revamping of our behavioral health services for -- especially for the vulnerable people who anne up in the jail. i think we're poised on making in house population. having community crisis response instead of the cop coming out is go to go have a significant impact, i predict because nobody wants even cops, they don't want to bring these people to the jail. everybody knows this is the right place but what do we do. now we have something to do. we have a way to connect people more quickly and efficiently with treatment. these things will lead to a consistently lower jail population.

>> the systems being built around substance abuse. having our jail population be a central part of that. it is something that was written in intentionally. we are looking at it very intentionally on how we ensure we can this isn't to prevent people from needing to go to jail. they have a therapeutic partner to talk to about their issueses. issues.for the vaccine efforts,e are all interconnected and the work that dr. prat is do inning doing inthe jails to get people

vaccinated whether we work with the community. also an integrated care system. i work with our community partners and hsh as well as academic partners have all become a way that we encircle this population to try to make sure they are getting the the access to care that they need. the vaccine as well as other health care issues that come up. >> thank you. i believe, i don't see anymore commissioner questions or comens. comments. i do.

mr. chow. >> she deserves all the credit she got. even though she is concerned. i think we need to give her credit that she has gotten as far as she has. i think it's important to note that the city puts lives first. jr health is actually a service that we perform for the departments. it shows the city's resources, the direction from the mayor all the way down to dr. co lfax and the services rendered by our

employees are dedicated to seeing san francisco and those under our charge are as healthy as they can be. we're here to prevent covid as announced by the mayor. i think this is another example of the extraordinary, i guess as you recall the structure of our health department to really look at people first and that we have the backing of the city which we're really grateful for that. thank you. >> thank you commissioner chow. i do not see any other comments. are there any public comepts.

comments. >> there's no one on the line for public comment. >> the next item on the agenda is for the land acknowledgement. >> hi. good afternoon commissioners, i want to introduce the land acknowledgement system. i'm with the office of policy an planning. i'm happy to present this draft resolution for your consideration in preparation of the next meeting on august third.

>> on the second page the third line down. it should say now therefore be it resolved. i will correct those two things. >> thank you.

>> i wanted to partner with some organizations that we have had the privilege to work with to put forth this resolution. the american indian culture district, they were instrumental in helping us draft the language and work with the american indian community as well. the land acknowledgement is a

respectful acknowledgement between the indigenous people and the people who live on their land, make sure that they are respected in the work that we do. we're really looking forward to this being a meaningful first step to develop an ongoing relationship with them. this summarizes some of the resolutions that have been approved formally or in the process of being drafted and adopted by the other san francisco agencies. on the left have been adopted. and on the right need adopting

including the san francisco health commission. this is also part of the city wide racial equity action plan. as a part of b ph's doctor under

the board's communication and actions was to pass a health commission this year. it would be around the ancestral home land. so with that, the process to draft this resolution started in march took initiative to draft the resolution. including april and june office of planning.

it became a process and in those conversations. the rest of the time line overall is that today's introduction and at the next meeting in august we're looking forward to that meeting getting your votes on adoption. there's two components before you today. it's been supported and approved by the community. it includes an acknowledgement that the original peoples in san francisco an the city and county of san francisco respectively. the community sat on their territory and formed an active community presently and continue

to contribute to the richness of the bay area region. an acknowledgement that the native [indiscernible]. americae included in the discussions government wide. this land acknowledgement statement is an initial statement in cultivating a more meaningful relationship that we support. it implements the land acknowledgement in all our public meetings. the slide before you shows the pending acknowledgement statement itself if implemented that was passed previously by

the commissions and very similar to the one the board of supervisors will be reading. and i want to acknowledge -- [indiscernible]. we're lacking forward to also feedback from the health commission and your thoughts on this. with that, i would like to hand it off to some of our community leaders to speak on this. the folks from the community, can you unmute yourself and if you would like to make comments about the acknowledgement process. >> thank you.

hello commissioners, appreciate the the invitation to come and just to see you an just to share with you a little -- i'll be brief. by the way, greg had an emergency about 15 minutes ago. he is not going to make it. i did not see director susie here. perhaps she is in the list. i thank the commission for the care and patience in commissioning this furlough. it was a slow and very deliberate process as opposed to an expedited process where you check the box and move on. i'm grateful for that. thanks mark and patrick for their assistance throughout this entire process. thank you both very much. we hope that this land acknowledgement will lead to heightened attention to

indigenous people in san francisco city and county and their enhanced well being. that's the goal of this, not just to get an acknowledgement for ourselves. it would be as patrick shared again to try to attract a little more attention to the health care needs of indigenous people. thank you for hearing that. i'm happy to take any questions. i'm hoping that she was able to show up. i want to make sure patrick we give her an opportunity to speak if she is here. >> unfortunately she is not here. if she pops up, i'm happy to hand it over to her to speak. >> what would be next in terms of process. would it be reading the

resolution. gentleman resolutions are not often read. >> i know that the resolution has received onspot review from all the commissions. if we could move to comments and questions. i also wanted to acknowledge the work of our community partners and everybody who was involved in the drafting of this resolution. i wanted to acknowledge one of our commissioners susan christian who for many years served on the human rights commission. perhaps we can move onto what is next. >> i just want to say to the community leaders, thank you so much for engaging with us the

way that you have and for being such amazing partners in this process. i know that i'm not alone in looking forward to growing the relationship with the community leaders and determining how the ways in which we can and will better serve the native populations in the city. i did want to make certain, it's been reviewed by you, i want to make sure that our ininstruction instructionfor the pronunciatioe ramayatush.

>> he says ramatush. the m-y is the definite ramaytush. >> i had a little interruption here at home. i'm back now. not only will this land acknowledgement be read at the beginning of every meeting to acknowledge the link they have had to this land. and respect to all american indians. more into the passing of a great leader in the community early this year who was a great leader with the friendship house who also reminds us of our obligation to serve the

community and substance abuse treatment to the american indian community and others. it's a great privilege to have this and we'll be taking action on it at our next meeting. i wanted to give it over to our commissioners who had had questions or comments. >> thank you, president. thank you patrick an mark for bringing this to us and to the community leaders who have worked with you in crafting this. i think it's an exciting thing for us to be doing. i only wish there was more that we could do to make it known that this is something that is important to us. so important that we're going to be reading this statement ahead of every meeting as a sign of

acknowledgement an respect. and that this is something that should be done in perpetuity. i wanted to at least verbally acknowledge the important marking of this and total support. >> thank you commissioner. commissioner chow. >> i also want to thank staff for the work they have done in order to help draft this resolution. i did look on the website from the -- i can't pronounce it, i guess.

we have done so many things and many of us in the past either as one block of people to another block have even within and prior to the bible had slaves and taken advantage of others and didn't consider humanity. i think this does. i think that it's well

warranted. i'm really struck by this map of the tribal area and the large numbers. it taught me a lot more about the heritage of the american indians. i did sit on a commission which was called an advisory board at the time. the state said they weren't go to go create more commissions. that actually looked at racial inequities. one of them was in regards to american inyans. indians. there i learned about the plight of the american indians in the united states. the broken and unratified treaty. the movement of people and buying of lands at very poor pricing again tells us that there's a lot that we should

acknowledge as being a problem in the past and that we should manufacture forward in the future. in moving forward in the future what i would like to have added to the resolve is a second resolve at the commission next meeting, i don't have the exact wording but what i would like it to say is something to the effect that the department will in fact continue to improve our approach to the american indians and their needs that are here in san francisco and that's under our purview. prior to that i think we should have a whereas if we can to try to demonstrate what health issues we've been trying to reach for the american inyan population.

indian population. i think there has been some out reach. their views and needs are not consistently reflected or included in the government planning or discussion. that's the fourth plan of the summary of the exponents. compo. we took the second part with the land acknowledgement as a step. we have not consistently as a government taken their needs into consideration. i would lake to put in any examples that we may have had in the department. that there be a second resolve to work forward with the community to try to address their health needs. that's just a request i would like to suggest that we enhance

the resolution for our consideration in our next meeting. >> thank you, commissioner chow. we look forward to formally considering that amendment at our next meeting which is august third. i see some hands up. >> thank you for your leadership in carrying forward this important work while you were on the human rights commission. i know much of this originated with the human rights commission along with the mayor and our own racial equity action plan developed here in the department. >> thank you. i certainly valued the work that we did with the human rights

commission. while i was privileged to be a member of that body. i whole heartedly support commissioner chows desire that we as a commission and as a public health department state our commitment to the native community and document the history of the poor treatment that is inadequate of the genocide and the lack of the concern for the health and well being of the community. i wonder if in addition to flagging those is one of the

things we might consider but further flag it by what the commission will do and laying out the history specifically and clearly. the history of the treatment here in what has become a city an county of san francisco. i'm not certain what the community's desire is with respect to having a specific land acknowledgement and then i don't know that the -- and to the extent this is focused on being the land acknowledgement, i wouldn't want the important statements that commissioner chow raised to be consumed into a document that did not highlight the meaning of the resolution. i think that's something i'm interested in the other commissioner's thoughts about

that but also the community leader's thoughts about that. >> thank you. >> i notified y'all that the public health committee had very similar thoughts to you. we included health issues and health equity. the community asked to separate those out and keep the land acknowledgement as a pure land acknowledgement, if you recall. there's a resolution that names the issues you are talking

about. the dph is continuing to work with the community and possibly look at funning an understand funni at funding. it can include the specifics that you're asking for. that's still in process. you gave pretty specific direction to us that the land acknowledgement that it's more sacred to hold as its own. please let me know if i've misstated anything. >> that's excellent. my understanding of the land acknowledgement is that the statement is a unit in it of itself. we try to make some fine distinctions because lots of groups want to add onto the land

acknowledgement. i think there should be a separation between the language we would use versus a commitment or something that becomes policy for an organization. we wanted to make sure that the land acknowledgement statement was something very separate in it of itself. any language that was more policy oriented that might be addressed and changed and altered in the future was kept separate from the land acknowledgement. that said, there are some groups that do add resolutions but they effectively have made a commitment to doing things, they are broad commitments and not specific in detail. they don't become and don't sound like policy that would

guide funding and action by groups per say. they are very general commitments. those we think are okay. when it comes to something being more formal and policy, we want those separated out. because this land acknowledgement is for us in the sense it's an acknowledgement for the indigenous peoples. the attachments will be for the indigenous communities in its entirety. it's always been our policy to keep those distinctions. thank you all for hearing that. >> thank you.

dr. benet is on the line is would like to make a comment. >> thank you. hello. that second commitment that is larger and sounds like policy, making sure that our staff keeping that community and all these other groups in line.

i think they do fit together and we will make them fit together in the way we discussed them, they will be done one after the other. part of what's the delay that we want to follow the pattern that we did with the pacific islander groups and make it a community led process. it's a process that we are invited to. what kinds of health priorities the community would like to know about, set, address. those things are taking time for the community to bring together. once they've done that they will invite us to that process and we'll incorporate those things. >> thank you for that clarification. do we have any other commentses

comments orquestions from commi. >> i do want to make a comment, if i may. i recognize the value of having the acknowledgement separate and to be that policy, i think also that the policy being developed by dr. benet is extremely important. put in the next steps that a commission or board is going to do. i respect that. i think then that there are several ways of doing that that allow us to remind that -- we

don't want to disrupt what the community wants. it's an important acknowledgement. these are within our resolution that we are going to address

health issues. not just that they were ignored but they will be addressed. whether it be put in the resolution or a further policy. either is fine with me. i do think we should address that. >> thank you, commissioner chow. we can continue this discussion where we're leeing up to the next meeting where we're taking actions that are being proposed. i don't see any public comment. i believe we can move onto the next item. please give our best and look forward to engaging with them in the future.

we will see you at our next meeting on august third. >> thank you commissioners. >> thank you very much. our next item is an epic update from the department of public health chief officer mr. rapin. >> good afternoon. it's my pleasure to bring you my quarterly update on the project. i want to recognize the growing list of co-contributors. without them my presentations to you would be much less informative. my appreciation to all of them.

here are the talking points. i'll try to move quickly as i know we have some other items on our agenda. at the end we'll spend a few minutes talking about what direction we're headed with epic which is turning our focus to car coordination. there's a number of forces driving us this way. we believe we have some powerful tools within the epic toolbox to help us achieve those goals. let's start with a take home message. it's in three parts. the first part is epic was our covid multi tool. basically it did so many things for us. i will share a summary of those for new a few minutes. the second part of our take home message is that we remain on

budget and i have a brief update for you in a little bit. thirdly and to the point i was just making, epic helps us bring people an services together. we think about electronic health records as a place to bring information together. we want to be in a position to bring information to many of people who are influencing the health whether it be the determinants of people that we serve. we're in the getting better phase. our pandemic response slowed some of our work down. we're beginning to pick up some of the items on our optimization list. we're resuming our regular schedule with regard to epic

implementations. we'll talk about where we are an where we've been with epic waive 2b and 2c. and three. happy to talk to but epic wave four as well. let's talk about how it played a role. i narrowed it down it this word cloud. there's five or six slides to tray to summarize everything that the epic platform help desk worked through. the summary here is powerful. everything is starting with putting in travel screening. that was the first thing we were concerned about. preparing for search capacity and make sure we could immediately flip and have more

in patient beds. it's all about the people and physical parts. we have this electronic health record platform. we need to flip and make the the electronic part of our world ready.

it becomes obvious to see that our goal of achieving health equity to ensure we're doing our best across the city and county of san francisco to ensure those who need vaccine the most the most vaccine. you can see where the darker

blue areas are. we continue to provide so much effort especially during the surge that we're experiencing in right now. we'll switch gears to finances. we talked about our best budget projection through the end of the epic contract period. we mentioned that our projection was a positive variant of three quarters of a million dollars. we're in a slightly better position with suggested positive interest variant of over a million dollars. happy to take questions about how we get there. just a quick refresher on what we're looking at. when you look at the rows from top to bottom. you are seeing what we propose and our budget. what we thought we would be spending on epic. the second row is what our

actuals look like. the rows after that is a positive outlook forward which is our actual spend through our projected spend. our project contingency has not been touched but sits there to be used later on. the second column of numbers. this is our crystal ball. we've really spent a lot of time refining it. can you see that the original estimated budget is much less than what we anticipate the spend to be. when you take our carry forward balance from the actuals to today or through june 30th of this year combined with the project contingency in place.

i want to talk about where we are and where we've been and what the future holds. some very recent activities. our ambulatory pharmacy. that's the out patient pharmacy platform in epic. we implemented that in may of this year, it represents the consolidation of three stand alone out patient pharmacy systems. they are all in epic which now allows, the complete integration with the pharmacy service with all the other clinical services and a lot more robust back and forth communication as well as ease of ordering because we don't have to have an external

integration to those legacy systems that we've now decommissioned. we welcomed the first of three population health division clinics. we're live with the tb clinic and more it come. we recently brought the placement and utilization management teams into epic using our care management platform called compass rose. our most recent implementation which is planning on how to it secure occupational health records, we are live with occupational health as well. events that are upcoming. as a quick reminder as a result of our response to the pandemic, we split implementation wave two

into three pieces. we're in 2c which is the final components of implementation wave two. the remaining two clinics. city clinic and the aitc are on deck. we're really excited and motivated now more than ever to get jail house services fully into the fold just because of the focus that we are working towards to provide the electronic manifestation of whole person care in epic which includes all of the experiences experiences,the health experienr patients have. our sobering center. the maternal child and

adolescent division it's a number of different programs combined into one group. we're interested in getting all of that information into our big collective. we completed an rfp an steps right now to have integrated video visits with epic. i shared with your commission once or twice that when shelter in place took hold we took emergency step it bring video visible capability. this is our long term solution where the video experience is fully integrated into epic. that will improve the experience for the patient and the provider. finally, i think you have heard of the changes occurring in medical through the cal aim program. in care management and in lieu

of services. we expect to be able to accomplish a lot of that care coordination work using the compass rose care coordination module. i mentioned wave three and four. these are a little further out on the calendar. wanted to make sure you could see the major activities we expect there. we're just starting our discovery and due diligence work with the department of behavioral services to assess what is possible based on initial planses from several yearses ago on working on a transition into the epic environment in the next couple of years. wave four is implementing the epic beaker and laboratory. this is really good governance. the leaders of the different

laboratory programs together with our governance body came together and realized off good product demonstrations and discussions that folks were comfortable with moving forward. the beaker program is in the budget. we have decided that a few years from now, we expect to actually implement that. that would result in the decommissioning of three current laboratory systems. in their place we would just have the one integrated beaker laboratory information system. somewhat analogous to the ambulatory pharmacy implementation that went live this spring. we always try to get the voice of the patient and the provider in our discussions. as we start to look at how epic

can bring people and services together. we note some comments here from some primary care physicians about how we're taking advantage of information that is generated in our whole person integrated care summary which i'm going to show you a pick of here in a ina moam. moment. we're bringing all the people into the same frame. that was something that was not achievable when we had multiple systems. it is achievable now. we're taking a dive into the pool and i'll show you that in a minute. we are using internal

communication to already deal a with a number of issues that fit squarely in the social determinants of health such as housing and transportation.

you have a follow-up appointment a month from now but what's going on in between. that's what focusing on the social determinants of health is all about. it's about getting more continuous feedback about what's going on. in order to do that, we have to bring more people and service providers into the mix. you can also see on the far right utilization. this particular patient has been to the emergency department over 700 times in the last year.

this is cumulative information from every hospital that's participating in care equality or ehealth exchange where we receive identity matched information from health care encounters that our patients are having in other places. here we see it in its more raw form telling us exactly what is going on. in this case, we have a very high utilization of health care services. we're really excited about building upon this. this is live and active today. to wrap up, we're really focusing on ensuring one source of truth. this is helping us live up to

that to effectively match wup ively match up oneperson with ar records across many health care organizations. collaborating an bringing groups in some cases on paper and other platform into epic. enhancing how we handle social services support. i think the future is bright for what we can do an the technology can be a big enabler. last but not least, we keep oiling the machine. what that meanses is that in the midst of the pandemic and all of these implementations. we have to keep epic healthy. we've been doing that. by doing that it means that there's almost no delay in us

being able to take advantage of new capabilitieses that the cape software can handle. how we were able to set up a vaccination clinic on an i pad. we were able to immediately plan and take that new software because we were ready for t. for it.that's not always the ca. being ready for it and what the team does on a monthly and quarterly basis is making a difference in the background. it's clearly something that is very technical and not worth getting into great detail about, it's helping us continue to advance an grow. with that, i will had leave you with this sentiment and i'm happy to take your questions.

>> commissioners do we have questionses. >> i just wanted to say this work is extraordinary in a meeting that we have heard about so much exceptionalism. epic is like this giant software product. it takes a team like yours. you said epic is indispensable, i think you all are indispensable. to see what you have done here to get all of these departmentses quickly and immediately and all the social determinants. it takes a team to see the potential. you have seen the potential. i can't say under about what this team has accomplished and

under budget by a million dollars. i really look forward to seeing the various ways continue. this is way beyond any of my expectations. the impact it will have on the health community is remarkable. i'm greatly appreciate active. >> those are very general ows gs comments. >> thank you. i associate myself with everything commissioner green said. >> thank you. all right. we can move onto our next item which is a discussion of the dph 2019 and 2020 report. we have max from the office of policy and planning. did i pronounce your name

correctly? >> max gara. i'm loading up the presentation. good evening commissioners. my name is max. i'm a health planner with the office of policy and planning. i'm here to announce the final draft of the annual fiscal report. thank you for your feedback in the finance and planning committee. your feedback have been incorporated into this draft t. it provides a general summary.

the report provides in depth reviews of both the covid 19 response by the department as well as the department's behavioral health transformation efforts. the report opens with a message from our director of health. the message highlights the priority issues during the past year including dph's covid 19 response, systemic racism and police brutality. continue transformation over the crisis. the director's message is followed by a message from the

director. the message highlights the health inequities in response to police brutality. both these provide activities discussed in the report. for the next set of sections provide an overview of functions and service as cross the department. they start by introducing the department's two divisions and rolls them out to san franciscanss. the next section reviews dph's true north and the pillars by an organizational chart. the last introductory section focuses on the health commission. an overview of the structure and function of the commission along with bios for each commissioner. as part of the racial equity action plan, this year's report

presents demographic information on the commissioners. this information will be continued to be collected in the reports. the largest section of the report presentses the three feature stories that show case some of the highest profile cases given the scale of these efforts these are longer than those of previous reports. the second feature establishes the department of health equity in the department. an in depth review of the response of covid 19.

the future highlightses case investigation contact tracing alternative housing efforts and providing information and guidance. this section provides key indicators on the impact of covid 19 through the fiscal year and capture the scope of the entire response. the next major section of the report focuses on data starting with dph's budget. spend tours, revenue, and budgets. $28 million that was to add funning. behavioral health treatment and recovery beds. the san francisco health data on visits, patient demographics, an pair types across the major systems of care. the report ends with an overview

of the service sites and contractors. a map of the primary care and service sites have been updated to reflect patient changes. lastly, the report includes additional dph resources such as where to get health coverage and community organizations and san francisco's covid 19 response. for next year's report we're planning to provide a much fuller review and planning to have a report ready by the fall. at this time i'm happy to take any questions or comments #-z #-z. comments.thank you for your tim. >> thank you. i really want to commend the department and you for a well

written document. mine is really only a small correction on page 28 where you actually repeat the two resolutions. i'm not sure what the right titles are but you probably want to correct that. otherwise thank you for a very comprehensive report. so much has happened this year, i guess we had forgotten that the fiscal year actually ended a year ago. in the meantime so much more has been done which was really illuminated in today's meeting but thank you very much. >> thank you. >> any other questions or comments? i echo his sentiments.

thanks to you for an excellently written report. thanks to the finance and planning committee to review and partner on development as well. next item is for discussion. our next item is community and public health committee updates. >> thank you very much, our community was presented with an excellent presentation from the environmental health growth which was the regulatory branch of dph which was 150 employees

and a 100 million-dollar budget. their covid work where many of their employees at covid command that what their function was within covid was to enforce health orders such as sro inspections et cetera that were part of the health order. the two parts that they focused on was the prevention and education on implementation of the health orders. the second part was enforcement. where we needed to look at compliance and they had 8200 compliance inspections.

and 27 percent of those, they worked with the departments to assist with their work during the the pandemic. they presented to us was the children's environmental health promotion program. it has been in the department for 30 years. it was most interesting that the focus -- many focuses but the primary focus is lead abatement in the city. it's focused on indoor paint. what is in 2020, 21, the

assessment for lead was remote and within the remote environmental assessment 140 families were visited. they will now do you the inspections in person on site for those environments. a number of paint companies, san francisco will elect $21 million for the settlement. now it's called the fix lead and fast. that's the name of the project.

they are prioritizing the 2020 to 2026, prioritizing homes built prior to 1950. i'll close with kids under the age of six. section eight housing and other environments. i also go to the lead abatement. within these departments that are -- the issue with lead for

all those living within the environment. that was a presentation to our committee today. thank you. >> thank you. seeing no people on the public line, do we have any questions or questions for commissioner? if not we'll good to other business. we'll still with commissioner and she will give us an update on the san francisco general hospital foundation. >> i am the representative. i had asked to meredith and the staff to give a presentation about the project at the

hospital, the building project that was wonderfully presented to us and your question was what about the money? what's going on and what's happening? this is what -- in just a couple of minutes, i wanted to bring back to all of you. i think it's important to look at this information. that one in eight san franciscans receive care at vsfgh and what is also not on this slide but -- it is, over a 500,000 patients we're seeing within the system during the pandemic. it was a very big and operating system that as you can see the

emergency room medical and psychiatric emergency visits seventy five thousand in the last year. babies born an at the height of covid 19 receive 5% of the cases were treated at the hospital. administered over 135,000 covid 19 vaccines. as you can see, it's a very very busy place. a lynch pin of our dph system. i wanted to just reiterate for your information the presentation i asked for what the building needs are and what is within this project that is going forward. you can see the number of

clinics and i wanted them to be listed. as you can see it's a broad spectrum of of clinics within this system. there's a short fall of $202,000. this is the next slide of what the goal is and what your questions were.

my name is doctor ellen moffett, i am an assistant medical examiner for the city and county of san francisco. i perform autopsy, review medical records and write reports. also integrate other sorts of testing data to determine cause and manner of death. i have been here at this facility since i moved here in november, and previous to that at the old facility. i was worried when we moved here that because this building is so much larger that i wouldn't see people every day. i would miss my personal interactions with the other employees, but that hasn't been the case. this building is very nice. we have lovely autopsy tables and i do get to go upstairs and

down stairs several times a day to see everyone else i work with. we have a bond like any other group of employees that work for a specific agency in san francisco. we work closely on each case to determine the best cause of death, and we also interact with family members of the diseased. that brings us closer together also. >> i am an investigator two at the office of the chief until examiner in san francisco. as an investigator here i investigate all manners of death that come through our jurisdiction. i go to the field interview police officers, detectives, family members, physicians, anyone who might be involved with the death. additionally i take any property with the deceased individual and take care and custody of that. i maintain the chain and custody for court purposes if that becomes an issue later and notify next of kin and make any

additional follow up phone callsness with that particular death. i am dealing with people at the worst possible time in their lives delivering the worst news they could get. i work with the family to help them through the grieving process. >> i am ricky moore, a clerk at the san francisco medical examiner's office. i assist the pathology and toxicology and investigative team around work close with the families, loved ones and funeral establishment. >> i started at the old facility. the building was old, vintage. we had issues with plumbing and things like that. i had a tiny desk. i feet very happy to be here in the new digs where i actually have room to do my work. >> i am sue pairing, the

toxicologist supervisor. we test for alcohol, drugs and poisons and biological substances. i oversee all of the lab operations. the forensic operation here we perform the toxicology testing for the human performance and the case in the city of san francisco. we collect evidence at the scene. a woman was killed after a robbery homicide, and the dna collected from the zip ties she was bound with ended up being a cold hit to the suspect. that was the only investigative link collecting the scene to the suspect. it is nice to get the feedback. we do a lot of work and you don't hear the result. once in a while you heard it had an impact on somebody. you can bring justice to what happened. we are able to take what we due

to the next level. many of our counterparts in other states, cities or countries don't have the resources and don't have the beautiful building and the equipmentness to really advance what we are doing. >> sometimes we go to court. whoever is on call may be called out of the office to go to various portions of the city to investigate suspicious deaths. we do whatever we can to get our job done. >> when we think that a case has a natural cause of death and it turns out to be another natural cause of death. unexpected findings are fun. >> i have a prior background in law enforcement. i was a police officer for 8 years. i handled homicides and suicides. i had been around death investigation type scenes.

as a police officer we only handled minimal components then it was turned over to the coroner or the detective division. i am intrigued with those types of calls. i wondered why someone died. i have an extremely supportive family. older children say, mom, how was your day. i can give minor details and i have an amazing spouse always willing to listen to any and all details of my day. without that it would be really hard to deal with the negative components of this job. >> being i am a native of san francisco and grew up in the community. i come across that a lot where i may know a loved one coming from the back way or a loved one seeking answers for their deceased. there are a lot of cases where i may feel affected by it.

if from is a child involved or things like that. i try to not bring it home and not let it affect me. when i tell people i work at the medical examiners office. what do you do? the autopsy? i deal with the enough and -- with the administrative and the families. >> most of the time work here is very enjoyable. >> after i started working with dead people, i had just gotten married and one night i woke up in a cold sweat. i thought there was somebody dead? my bed. i rolled over and poked the body. sure enough, it was my husband who grumbled and went back to sleep. this job does have lingering effects. in terms of why did you want to go into this? i loved science growing up but i

didn't want to be a doctor and didn't want to be a pharmacist. the more i learned about forensics how interested i was of the perfect combination between applied science and criminal justice. if you are interested in finding out the facts and truth seeking to find out what happened, anybody interested in that has a place in this field. >> being a woman we just need to go for it and don't let anyone fail you, you can't be. >> with regard to this position in comparison to crime dramas out there, i would say there might be some minor correlations. let's face it, we aren't hollywood, we are real world. yes we collect evidence. we want to preserve that. we are not scanning fingerprints in the field like a hollywood

television show. >> families say thank you for what you do, for me that is extremely fulfilling. somebody has to do my job. if i can make a situation that is really negative for someone more positive, then i feel like i am doing the right thing for the city of san francisco. we are celebrating the glorious grand opening of the chinese rec center. ♪ 1951, 60 years ago, our first kids began to play in the chinese wrecks center -- rec center.

>> i was 10 years old at the time. i spent just about my whole life here. >> i came here to learn dancing. by we came -- >> we had a good time. made a lot of friends here. crisises part of the 2008 clean neighborhood park fund, and this is so important to our families. for many people who live in chinatown, this is their backyard. this is where many people come to congregate, and we are so happy to be able to deliver this project on time and under budget. >> a reason we all agreed to name this memorex center is because it is part of the history of i hear -- to name this rec center, is because it is part of the history of san francisco. >> they took off from logan

airport, and the call of duty was to alert american airlines that her plane was hijacked, and she stayed on the phone prior to the crash into the no. 9 world trade center. >> i would like to claim today the center and the naming of it. [applause] >> kmer i actually challenged me to a little bit of a ping pong -- the mayor actually challenge me to a little bit of a ping- pong, so i accept your challenge. ♪ >> it is an amazing spot. it is a state of the art center.

>> is beautiful. rights i would like to come here and join them >> july 28th, 2021 and the time is 5:00. this meeting is being held by webex, pursuant to the governor executive orders declaring the existence of a local emergency. during the covid-19 emergency, the regular meeting room at city hall is closed and meetings will convene remotely. you may