>> president bernal: meeting of the san francisco health commission for october 19, 2021. commissioner guillermo? >> commissioner guillermo: my computer keeps crashing. [ roll call ] >> president bernal: we'll go to the ramaytush ohlone land acknowledgement that will be read for this meeting by commissioner susan christian.

>> commissioner christian: the san francisco health commission knowledges that we are homeland of the ramaytush ohlone. for all people to reside in their traditional territory, as guests, we recognize that we benefit and living and working on their traditional homeland. we pay our respect by acknowledging the ancestors elders and relatives of the ramaytush ohlone and community and by affirming their sovereign rights as first people. >> clerk: next item is a new item at every meeting one that

commissioners enjoy very much. we have an opportunity to recognize some of the extraordinary work that members of the department, every single day. i would like to hand it over to commissioner giraudo. >> commissioner giraudo: thank you. this honor in recognitions for the employee. b.h.s. medical team pivoted to respond to the pandemic. the medical team helped guidance for b.h.s. they ensured all services had timely information regarding p.p.e., screenings and guidance for serve situation such as outreach, residential programs

and telehealth. they were involved in the planning operation for vaccinating all staff. they have outstanding project and administrative support who are not usually part of the b.h.s. medical team. this team took on these tasks on top of their usual duties. the group received feedback from the b.h.s. staff that the team has been invaluable. the team covered all necessary duties including maintaining spreadsheets for immunizations, providing immunizations and

covid testing. all this incredible work was done while the team was continuing to cover their pandemic job duties. we will now read the names of team members who made contributions. >> it's an honor to be here to recognize our team.

[ indiscernible ]

>> president bernal: let's give the team a round of applause. [ applause ] >> president bernal: next we have commissioner guillermo reading the next employee recognition. >> commissioner guillermo: thank you so much. this is little ironic i was having tech problems trying to get on to read this.

i really was excited to be asked to read this recognition. i have a little bit of background in working these kinds of things in healthcare setting. front line workers get lots of attention, lots of thanks and gratitude for getting us through and continuing to get us through this past year and a half with covid. really, without the i.t. digital and e.h.r. system, being able to be equal to the task and to do way more than has been asked. we would not have been exemplary in our response. i'm so happy to read this

recognition to the d.p.h., i.t. and epic team. they were involved in supporting the city and san francisco health network in the response to the pandemic. examples include search prep with covid testing and more recently vaccination efforts. the team pushed hard to ensure information technology was never a limiting factor month matter where the services were needed. it created solutions such as epic on ipads. epic teams worked with to ensure the digital was available in seven languages. epic teams took pride in making sure every vaccination given made to the system with the

required regulatory data elements, removing this burden from front line staff. all s.f. residents vaccination records are valuable to their primary healthcare provider. the epic teams worked with patient financial services to provide work flows to allow the city to recruit approximately two million in funds from insurance providers to pay for vaccinations. front line staff were able to focus on identifying a patient and administrative vaccine without worrying about finances. these funds helped support the department's continued mission. >> thank you. i like to recognize kevin

schindler. i believe you wore every single hat on this project. you always took it in your own hands to make sure we have what we needed including hand delivering some of that equipment around the city. natasha kumar. you led our ambulatory team and instrumental in the response for vaccination without your leadership and guidance of that team, i'm not sure that we would have as many around the city as we did. we know those sites were key in getting san francisco to our vaccination rate. rosana leone, owe you a debt of gratitude to making sure staff and hospitals were safe, patients had the opportunity to receive the treatment that they

needed and we were prepared for whatever scenario the pandemic might throw at us. edmond kung. none of those system work if there's not a computer or network for it to run on. i want to acknowledge everything you did to make sure that numerous locations around the city were prepared to communicate. each of you were selected because you are a leaders of i.t. teams. please make sure to take that recognition back to your team and pass that along to everyone who participated in making this a successful effort.

>> president bernal: thank you to the epic program director for bringing forward your team. it's our privilege to recognize them. it's my privilege to recognize on behalf of the commission the health at home mobile covid-19 vaccination team. health at home functions within the san francisco network to provide skilled nursing, physical rehabilitation, medical social worker and personal care to the network patients who were complex and confined to home. in early 2021, health at home staff recognized the hardship of leaving at home was reason of covid-19, there was those considered to be high risk for contracting covid-19. this exposed a large vaccination access gap for the entire homebound demographic within the network. with this assistance from the

primary care clinics, health at home administrative leadership and the vaccination team, support was provided to allow for this group of staff to offer extremely valuable service to our community most fragile residents, caregivers and loved ones. since february 22, 2021, health at home administered 476 covid vaccines at a rat of 6 -- rate of 6 to 12 per day. without this dedicated and caring team effort, many of our communities most vulnerable would not had access to the vaccine. lisa enders will now read the team member names and make a few

comments. >> hi. thank you so much. this is an honor. i want to recognize lot of the clinical staff at health at home for recognizing the need. they brought it to the leadership attention and able to come to fruition. i would like to thank without the program's developers, our nurse managers, our administrator and blake gregory who was the advisors that developed this program so we could be do the work that we were doing. there are two groups i like to recognize are the first grupp is the patient access team.

the lead for the patient access team is lisa kimberland. they worked tirelessly in office to reach out and call patients and try to schedule. i think they called each patient at least three times. some patients were reluctant in the beginning.

thank you so much to all of you. this team still going out doing -- still giving initial vaccinations at a slower rate. they are going out now administering shots. that number that was in my nomination has grown since then. thank you so much to this team. >> president bernal: thank you for bring forward your team for recognition. we're so proud of the work they are doing. we're happy to share this time with you and look forward to your continuing great work.

>> folks who were acknowledged, you're welcome to stay. it's great thing to have staff here during the meeting. don't feel like you're obligated to stay. please use your own judgment on that. thank you. >> i like to extend my gratitude to the teams. one of the things that's really wonderful about these awards, [ indiscernible ] i realized multiple people were wearing multiple hats. incredibly grateful for all the work that the department staff has done. it's really the team that has got us through covid. i want to show my gratitude and

appreciation. >> president bernal: next item which is approval of the minutes of the health commission from october 5th. do we have a motion to approve? >> i move to approve. >> president bernal: secretary morewitz do we have any comments? >> clerk: if you like to make public comment, please press star 3 so we can acknowledge. i don't see hands. may i do a roll call vote? >> president bernal: please. [roll call vote]

>> clerk: item passes. >> president bernal: we'll move on to our next item, which is the director's report. welcome dr. naveena bobba. >> thank you, president bernal. good afternoon commissioners. in terms of the director's report, lot of these items we'll be talking about in the presentation today. there's a couple of items that i wanted to specifically turn your attention to. one is the mandates that's coming out of the mayor's office that city contractors also must be vaccinated. that will take us back to the timeline. one thing to know about the department of public health lot of the health partners are doing the healthcare.

this won't be a huge impact. it's another step ensuring our city and our county increase our rates on vaccinations. the second item that i like to direct everyone's attention to is that our school team has been honored with an award at the california public health safety net institute award. this award has been in the past given to the team. we're pleased this team has been recognized. the team came together across community, across our grants, around the school themselves and subject matter experts to come up with school guidelines. that team, the information that they produced was really a benchmark for not only the city and county but also for the state and number of people that

worked on the local level ended up at the state and has more recommendations. due to the team's work, the number of schools that did open had very little outbreaks and transition during the winter surge i'm glad to sow they are recognized for that incredible work. the final thing i wanted to highlight was prevention week. i like to highlight the work that the department is doing around led prevention. our ceremonial health team has a child led prevention program to ensure that children are not exposed to led. over the last five years, they have outreach over 1000

families. they also proud lot of information to community members in different languages and this work has been critical to the department. really appreciate the work that they've done. i will stop there. lot of these items will be talked about with the covid updates. >> president bernal: thank you dr. bobba. >> clerk: anyone like to make public comment, please press star 3. >> president bernal: any questions or comments for dr. bobba? commissioner chow?

>> commissioner chow: thank you president bernal. i was interested and happy to hear of all the families being contacted under the child led prevention program, i'm wondering if we've had a decline in incidents of problems because we certainly have had a long history of working in this field. i'm hoping that it is even more successful and we have less led poisoning and led medical problems. do we know how effective we have been? >> my understanding is that there has been a decline in cases as time has gone by. we can get you the actual data, commissioner chow, to ensure

that is the case. as you said, this program has been ongoing and we're trying to address the environmental needs. it should be going down with time. that's the expectation. we can come back to you with the data. >> commissioner chow: thank you. will be nice to know the outcomes and how well we are doing. it's very important issue. especially for children. thank you. >> clerk: there are two peoples who had their hands up but in a different place. do you mind we go back to public comment? >> president bernal: thank you. >> clerk: i will unmute you one at a time. for each agenda item, members of the public will have an opportunity to make comments up to two minutes. the public comment process is dined -- designed to provide

input. the process does not allow questions to be answered in the meeting or members of the public to engage back-and-forth conversations with commissioners. commissioners do consider comments from member of public when making requests from the d.p.h. i will unmute the first person. caller, are you there? anyone there? second person. would like to make public comment? [ indiscernible ]

>> clerk: are you on item number 6? >> clerk: we're on item 4. i want to speak on item number 6. we're ready to go. >> president bernal: thank you secretary morewitz. next item is covid-19 update. again, back to dr. bobba. >> thank you again, the presentation will talk about the data and talk about vaccinations finish up with health orders and predicting where we're headed. as you can see, it peaked 35.6 and we've been on steady decline. we are at 7.7 cases per 100,000. that's great news top to compare the fact that our --

[ indiscernible ] in terms of deaths, you can see on the left side is deaths over time and total up to 51,000 deaths across the state. in san francisco, you can see. we had the most increase in deaths in our winter surge a slight increase with the delta surge. the reproductive number is 28.7. most of the areas is below one. that's probably due to measures that are happening. our hospitalizations continues

to decrease. we have 48 individuals in the hospital with 13 in icu. you can see that peak is nowhere near 256. it speaks to the effectiveness of vaccination and reducing the burden on hospitalizations. in terms of vaccination, overall in terms of population, 76% people have completed two doses.

last week, ewe sent out a press release -- [ indiscernible ] we do expect that population to get to 70%. in general, our vaccination team is doing lot of efforts with community partners to ensure that vaccination rates continue to increase. in terms of what we're headed with the vaccine, one of the things i wanted to talk about is our boosters. pfizer is currently booster gone through authorization. we'll talk about little bit who they are available to in the next slide. moderna and j&j are still going through the journey including they both gotten f.d.a. advisory committee authorization.

in terms of the second group that can get vaccinated is front line workers that interact with the public.

you are allowed to have your mask indoors. there has to be control to the setting in the facility. everybody has to be 100% fully vaccinated. that means there are no exemptions allowed. we have to ensure there's proper ventilation, there's not any outbreaks as well as no interaction with the public. indoor masking does remain in effect in settings outside. that includes retail stores, common areas, restaurants and bars where there's a lot of intermixing. i will say that even with this

mask mandate, there are going to be places where we have to mask based on california federal guidelines. this includes healthcare facilities, adult and senior care facilities on public transport and school and child care. in terms of looking ahead, our covid d.p.h. task force is looking at how to sustain our covid effort. also going back to our operations and current things our department continues with.

that is the last slide. i'm happy to take questions about our covid response. >> president bernal: thank you dr. bobba. secretary morewitz, do we have public comment? >> clerk: folks on the line if you like to make comment regarding item 5, please press star 3. this is item 5. no hands. >> president bernal: commissione rs any comments or questions. commissioner chow? >> commissioner chow: thank you.

it's a question dr. bobba mostly -- in santa cruz, they said as of september 30th, they lifted the mask mandates. are we going to see that california counties are all going to vary in their indoor mask mandate? >> santa cruz is not part of the initial mask mandates. they were separate from it. the other places that i know have indoor mask mandates, it's not a requirement through the state. l.a. is another place that required indoor mask mandates. it was great to see that number of counties agreed on these

metrics. santa cruz was separate. >> commissioner chow: thank you very much. >> president bernal: thank you. vice president green, do you have a question? >> vice president green: i do. i noticed that you didn't mention pregnant women in the list of groups. we're getting lot of questions. i'm wondering whether they fit in group one from your perspective? >> for boosters -- [ indiscernible ] >> vice president green: yes for the booster. many of the women are six months out. the questions are coming. >> i think they fit in that 18 to 49 category with underlying condition. pregnancy being condition that

puts somebody in high risk. the fact they are all high risk, that was another group we can work on ensuring they have that method they should get the vaccine booster. >> vice president green: there's so many different recommendations. i wanted to make sure that there's uniformity. it will be considered in an individual qualified to get a booster if they had pfizer original vaccine. >> president bernal: thank you. dr. bobba, i know that every time we relaxed our restrictions little bit, that is thanks to the great work of the department

of public health and cooperation of the people of san francisco. each time we've been able to relax the restrictions, we have seen little bit of bump in transmission and hospitalizations. do we anticipate that happening again? >> it's great question. one of the things we're contending with here is how much boosters will impact that bump. we do know there's waning immunity. it's something i think everybody is trying to figure out. i think that's why the booster information is so important especially as we shed into the winter months. there will be lot of gatherings and people will want to see their families. we can anticipate a little bump in cases. we can watch hospitalizations closely. >> president bernal: thank you.

are there any other questions or comments for dr. bobba? >> commissioner hirsch: i had one more. i noted that the vaccination rate for the white population is only 65%. are we also extending our efforts to also improve on that? >> yeah. i think we are definitely looking into the data and trying to determine exactly where that is. is it the age group or certain population. i think the other thing that we are seeing is very effective. you're seeing this across the city is vaccine mandates do work. they can be that last push to get some of the populations that have not been traditionally vaccinated to the vaccine table. specifically in our young adult population we're seeing that in 25 to 35-year-olds.

that may help getting the rates up. >> president bernal: seeing no other questions or comments, we can move to our next item, which is general public comment. secretary morewitz. >> clerk: if you like make a comment on item 6, please press star 3 now. this is general public comment. i see few hands. at this time, members of the public may address the commission on items of interest to the public that are within the subject matter jurisdiction of the commission. each member of the public may address the commission for up to two minutes. brown act forbids the commission from discussing items not posted on the agenda. each of you will have two minutes. i will start with the first one.

are you on the line? >> caller: hello. my name is jordan david. i'm the founder of the 30 right now coalition. i would like to talk about the -- [ indiscernible ] i've been getting lot of complaints that they are paying way too much in rent. there was a law passed late last year -- that law ended up getting funded but that funding -- [ indiscernible ] there's still some -- this is a crises. this is a lot of -- these are

lot of people with mental health. this is a very -- these elders. i'm concerned about the general lack of transparency in this department. i tried to contact the behavioral health. as well as every staff in the department of public health. we need to make sure this is funded. that no person is paying more than 30%. i yield my time. >> clerk: thank you. next caller, you got two minutes. >> caller: hi. good afternoon. i have a son who has a mental illness, mental disability. he lives on 9th street.

unfortunately, he's paying about 80% of his income to rent. he doesn't have a kitchen. so he can feed himself really well or save money. i really would like to see a change. i really don't understand why there's no change. if the federal government saying 30% because it's reasonable, it's humane, why d.p.h. is not following suit? i don't understand it. some of you can explain to me i would love to hear that. thank you very much. >> caller: there's one more person. >> clerk: the way webex works it's impossible to see who the folks is.

have you spoken before? caller, are you there? ite i'm putting two minutes on the clock for you. >> caller: i'm not speak for two months. i'm a long time resident of san francisco, been here for over 45 years. i believe that the 30% rent is absolutely what's necessary. i don't understand why it doesn't apply to the housing of d.p.h. i like to make sure that it's clear that they lost the public support for that >> clerk: those are all -- there's one more that just popped up.

>> caller: i'm also calling in support of 30 right now. i want to ask that d.p.h. and health commission commit to making sure that tenants living in supportive housing buildings are not paying more than 30% of their income and rent. >> clerk: that is the last hand. >> president bernal: thank you callers for your thoughtful comments. thank you secretary morewitz. next item, which is the department of public health behavioral health services update. we have dr. hillary kunis. >> thank you so much for having

us. it's my pleasure to present this update. commissioners, thank you for your question. i know some of you are able to review the slades. i will try to answer or address the question as i present for unanswered items, i'll be very happy to get back to you. for today's update, i'm hoping to review -- sharpen our goals and priorities and principles. i want to share with you our work to also sharpen our data and analytic approach.

as you have previously part of this presentation, some on our client's demographic characteristics and provide you with some key up days on new programming work we are doing to improve and transparency of our data including several dashboards the metrics we are using and update on hiring and workforce development. these are our fundamental pillars, goal, key priorities and guiding principles. as i settle into my time in san francisco and d.p.h., i want to share with you how we as a team are focusing the work of behavioral health services. our goal is to improve quality

of line reduce mortality of all people of san francisco and substance abuse issues. we are seeking to improve access and quality of mental health services and substance abuse treatment. we have some important key priorities which are to reach and treat people with behavioral health challenges to reduce overdose deaths which are epidemic and in order to reach and treat folks, we need to send them to behavioral health workforce. our goals is to achieve racial equity and outcomes. we must fill gaps in levels of care and we must use a proactive

and lower threshold approach. i think that all of these will be consistent what you have already heard just as we are working to sharpen and clarify those approaches. we are aiming to take a strong data-driven approach to measure and evaluate who we reach. this is very much a work in progress. we have been presenting all of you with data for many years and moving data to improve our services. it will really be key to knowing how and whether we are improving our current services.

this is a slide that's similar, trying to wrap this up as a high enough level that help us keep track of how we're doing in terms of people services. behavioral health services served about 20,000 people for

mental health treatment or substance use disorder treatment. additionally we provided early intervention services to more than 20,000 people which for a total of more than 100,000 individual services. this includes as you can see a variety of kind of services including crises debriefing, school-based programs and peer programs, vocational services and drop-in centers. the bulk is what we label population mental health promotion and wellness. there are about 1000 school-based services provided to school children.

we conducted nearly 1000 mental health consultation capacity building in schools that other programs and provided debriefings to more than 3000 people in san francisco. as you seen in the last presentation demographic breakdown of people. i wanted to highlight for you really a consistency who we're serving but to compare it to the san francisco population as a whole and what you see in the orange bar are characteristics of people serving. what you can see here is d.p.h.

services serve fewer san franciscans who identify as white or asian and acknowledging that is a very broad category. it is imperative that our services respond to who is walking in our doors but also make sure we are reaching people who may be in need but not walking in our doors. i wanted to turn now to some key updates from behavioral health in terms of programming and our data and how we are tracking our

new programming. i want to share among the many programs. i wanted to highlight just two of them. which has not dupont lot of discussion with the commissioners is pharmacy expansion. this is funded under prop c in order to -- -- in order to serve people better experiencing homelessness. we are expanding hours of pharmacy as well as some of the activities of the pharmacy. you can see them here. this is a really part of our expansion which we intend to expand access. on the right side you can see

that we identify our expanding or established office of coordinating chair. which will have a number of different functions including venal program services availability, more capacity in case management. we'll highlight that part of the office has been launched for people being seen by our street crises response team. i believe that i mentioned that last time i was here.

that is in place very excitingly. one thing i wanted to respond to that read by commissioner green is that in the coordinated care office as well as our other approaches we have been engaged in a program to address the needs of high utilizers. about 200 of them. we developed that shared priority population resulted in number of different lessons.

another example is the need for psychiatric [ indiscernible ] the example here that opened in valencia, you can see increased number of overnight guests. if you recall, valencia provides drop-in capacity as well as overnight capacity. you can see those 134 overnight admissions, day programs

participation nearly 800 as of october 9th. this is based on daily overnight capacity of 26. additionally, we are using this dashboard to trash sister central part of the work to expand residential care and treatment under mhsf. the dashboard is available online. it is updated monthly. you can see the length to the bottom of the screen. what we want to share with the commissioners and the public is progress meeting the goals of setting up more residential care and treatment in san francisco.

this distribution was informed by stakeholders but as well as optimization report conducted several years ago.

you can also see on the right bottom of your screen, the majority of calls were resolved in community. other --

[ indiscernible ] as of -- now, we are now providing services 24-7. this just came online recently from overnight five days a week to overnight seven days a week. we are excited about that. i want to respond before i leave mhsf work. i believe commissioner green asked about more information about i.c.m. as you will know, icm programs

are comprehensive treatment with care management and other services. it's available in outpatient mental health treatment settings. it's a vital part. however, we have known that there's a wait list. we have known that it needs to be a bottleneck in order to get people to the right level of care. we are aggressively working on this in a number of ways. one is under mhsf. we also know vacancies affects

the provider. we expect that some parts will be able to transitioned to a lower level of care that is intermediate in the since between outpatient and i.c.m. we are both working only capacity. as well as adding a higher level without losing the intensity and

fullness. i wanted to turn over response. that is very central to the work we're under taking at the department. there's been widespread media coverage. you can see the deep rise through 2019 and into 2020. this year, i need to see the reports on monthly reports online from the chief medical examiner office. we have seen from leveling off

of the monthly numbers. we don't have final numbers for obviously for 2021. the monthly numbers are lower they had been early in 2021 and late 2020. nonetheless, over the -- largest driver is opioids.

you can see that they fall in four categories. expansion and removal of barriers. account of you can see some of the initiatives to the tags.

i want to focus on workforce. [ indiscernible ] we are to reach people who experienced a nonfatal overdose. we know from the scientific literature these people are an elevated risk of the future of fatal overdose compared to others. it includes the paramedics and street medicine clinicians.

they provide intervention to reduce the risk of overdose. as we increase staffing and up to 24/7 coverage, we expect consistent follow-up within 72 hours of both non-fatal overdose in order to do the work of engagement and connecting people to ongoing life and concerns. similar to our street crises response team, we are using a dashboard to track our work.

you are seeing now an early iteration of our key performance including the number of calls that are handled. you can see that we respond to more calls that turn to be an actual overdose. we are offering treatment for opioid use. we are offering connections to care and in addition, what we are measuring right now is trying to accept a farm reduction supplies. we are getting high rates of

acceptance 139 of 183. we will be measuring and working on data system to describe connections to ongoing care. much of the work is happening on the streets more than half the time. sometimes our team are meeting people in the hospital as well as other places. i was very pleased to share the metrics and dashboards with you. we are working to refine key performance for across all the mental health and other work. i know that the commissioners had questions about what

specific metrics we will be defining. looking forward to sharing those with you. we see these metrics as key to meeting goals, to reducing health disparities and equity and how we implement services.

we identified 61 key new positions. our resource staff are working their hearts out to help us get those in the city. we are excited about the batch hiring process, which we have recently implemented with d.p.h., h.r. as well as the

city, department of human resources to expedite the hiring. this approach will enable hiring managers to more vital positions. i will just conclude with a workforce update. we are still early in our internship cycle. we are very exited that we have a new internship coordinator who's in the meeting already with our subcommittee. we now have a staff person who can help us implement the many workforce development projects we are doing.

we have previously discussed with commissioner giraudo and others the importance having updated and centralized website. we are ready to begin the website planning in november and we'll be on aggressive timeline to get that up and running. we launched a weekly -- [ indiscernible ] a new deadline is coming up. we are in the planning stages with another one of our internship opportunities. finally, we are working across the department to better map pathways that students of different levels of training can take to intern the department. to maximize and efficient use of

our resources. thank you. i'm happy to take questions. >> president bernal: thank you dr. kunis. do we have any public comment? >> clerk: i see one hand. we're on item 7. footlike make comment on item 7, please press star 3 to raise your hand. no hands. >> president bernal: commissione rs, any questions or comments

for dr. kunis. commissioner green? >> vice president green: thank you so much for the presentation and for the progress that has been made just in the short period of time. i think you structured and defining it together. i think it will create good outcomes. what i was wondering, when you might be able to share more granular metrics with us? i'm still impressed by the numbers we were told for example, about the wait times and intensive case managers, obviously we don't know even despite our efforts we'll be able to fill a position, what's the longevity of individuals in the positions might be. i'm wondering if you might share with us the top metrics beyond just rubrics you think will be the most important. what do you think will be the

easiest to achieve and what might be the greatest challenges. when you might be able to share that with us? >> the timeline i hope every time i come back to you, i will be able to show you new metrics that we're implementing. next time i present, i will have additional metrics to share with you both. i plan for the overall mhsf to share. i think applying the metrics is access. i think everyone is clear that this is the heist priority. as you know, there's different programs you need to measure that in different ways.

i.c.m. wait list is one of them. which i know we shared with all of you. which is extremely high priority. so high priority, vary ability and feasibility but time of entry. >> vice president green: what do you think the greatest challenges as you go forward

with the initiatives that we have? >> i think workforce and filling positions -- whether they are civil service position or c.b.o. positions. we are scrambling to hire what we know to be a relatively small pool of people. i think solve of the cost of living issues here are obviously special to this area. i think getting well trained people and creating opportunities that are desirable, is a central challenge.

>> vice president green: thank you so much for taking on those challenges. thank you so much to your team. i know they are really stretched thin. much appreciated. >> president bernal: commissione r christian? >> commissioner christian: thank you. thank you dr. kunis for this update and this presentation. it's extremely helpful to begin to be able to get concrete about

this work and see the progress and to see where we are still headed. i was appreciative of your answers to commissioner green's questions. i would imagine that with covid, even though things are much better for us now, that has been a huge impediment to the provision of beds and in particular who are coming out of jail. what kind of -- have you been able to make any progress given the barriers? in particular covid and funding and lack of physical capacity. where are things right now? is the wait time gotten any

shorter? >> i would have to get back to you about wait times. our beds and residential care treatment are filled, ranging from utilization between from 74%, which is in our specialty residential care, mostly

prenatal care. despite covid we have secured higher levels of care beds including treatment beds, including rehabilitative beds. that is terrific.

as part of the office coordinated care, we want to get at what you're asking about. our care and transition management team are specifically working with transition in order to keeping their connection to whether it's residential care or straight up housing. i want to flag that as just housing and supportive housing as a need. it's not only or exclusively as you all know the treatment. >> commissioner christian: you said you hired a director for street-based justice involved behavioral health. what can you tell us about that?

>> she is directing number different programs in her portfolio including the street crises response team. now director under dr. ail maeda who is directing street crises response team. dr. alameda directed other street-based work. we have our behavioral health homelessness team.

we're very excited that dr. alameda is now in a role permanently. we have director of street crises response team in addition. >> commissioner christian: good hire. the director of the street crises response team, can you share with us who their person is and that their background is? >> i'm stumbling on her last name. her first name is catherine. she comes from -- sorry, kathleen silk. she is wonderful. necessary trained in social work. she comes to us from a community-based provide we are a lot of experience with both folks experiencing homelessness

and crises. we are glad to have her. she is a wonderful addition. >> commissioner christian: thank you so much for this information. congratulations on the level of organization that you brought to this and that success you had so far, really looking forward to continued updates on a very regular basis. thank you for this work. >> i want to acknowledge so much of this was set in motion before arrived. there's an incredible team at d.p.h. who is making all of what we just discussed happen. >> president bernal: thank you dr. kunis. i don't see any other hands. i have a question, it's great news about dr. alameda.

if we are making news tonight about that. happy to have her. one, my question is more along the lines with a question that commissioner green asked with regard to hiring and personnel. with all of the critical work that's really getting up to speed right now in terms of mental health and crises response team and overdoses and all of the additional demands were placed on the department staff during the covid-19 pandemic. what is the impact, not just on the work that needs to be done but also on your current staff having these vacancies and they are needing to have to juggle multiple roles until those positions are filled. >> i'm trying to sugarcoat it. >> president bernal: please don't. >> it is hard and stressful.

that is the truth. like the covid response, and deployments to work on covid many people on the staff is holding multiple roles. my goal as leader of d.h.s. is to provide support and problem solving and cheerleading. i know that only goes so far. for a that reason, hiring more people on who can shoulder and run with the many things they are doing is really paramount. it is hard.

such a wonderful dedicated staff. i'm grateful to all of them and to all of h.r. who is helping us hiring staff. >> president bernal: thank you for not sugarcoating. commissioner is mindful all the challenges. >> talk about what role d.p.h. has or should have if it doesn't already have a role in this. education about public health, officially in the schools to deal with substance abuse

prevention and mental health wellness. i know that -- [ indiscernible ] i'm just wondering, i like to understand more where the department is on that and what kind of role the department is playing there. >> absolutely. prevention and early intervention, not that i've been speaking about it a lot. it's also a huge priority to think about ways we can promote wellness outside of clinical settings and for folks who may not ever have diagnosis of a serious mental illness or any

substance abuse challenges. we do that work. you found one of the slides that we do that is funded under mental health services act. some of it is in schools and in collaboration with school-aged children. we additionally received bloc grant dollars from the state and federal dollars to do prevention substance abuse disorders. one of the programs is called strengthening families. this has been an evidence-based approach to reduce rates of

substance use across self-substances and take plates in in schools. >> clerk: a hand was raised right after we called public comment. i got an e-mail from someone

saying she had computer issues. we have two comments. is it possible to go back and have that? >> president bernal: yes. >> clerk: i want to remind the folks, for each agenda item members of the public will have an opportunity to make a comment up to two minutes. the commissioners do consider comments from members of the public. i will unmute the first person. are you there? >> caller: hi. good afternoon. i'm so glad to hear dr. kunis explaining. really wishing good luck with your endeavors.

because it is a huge job. i, myself, experienced the whole process when my son became ill and there are two things that the really bothered me right now. one of them is the fact that when you list people who are seriously mentally ill, that will not listen to people who say here is place to live and here is the program. i don't know how you deal with that. these people walking in the streets and somebody who didn't take showers for weeks. what do you do with these kind of people? that's one issue. another issue is the fact that most mentally ill are processed through the -- [ indiscernible ] , not through hospital. there's no places where seriously mentally ill can be

healed. for example, in the east bay, they are trying to build a huge building in santa rita jail instead of building a hospital for these people. for me, it's like if you take the weakest link, will get everybody else in place. thank you. >> clerk: thank you for making the comment. next caller, you got two minutes. >> caller: hi. i had a question, i will trying to reformulate it as a comment. i really appreciate this excellent outline of the expanded services that are and will continue to be available to people experiencing behavioral health issues. i want to comment that there's a lot of confusion out in the community and among community-based organizations

about how to actually access these services for people that they are trying to help. there was recently member board of supervisors posting something saying now, you have to call 911. i heard there was an alternative number. i don't know what the number is or how it's publicized. i'm urging the commission on focus on the most practical aspects of implementation by making it clear to the public and community-based partners how we can actually get our patients these services. >> clerk: thank you. those are the only comments. >> president bernal: thank you secretary morewitz. we will move on to our next item, item number 8 for the discussion that is the annual

compliance training with margaret rykowski who is our chief integrity officer. >> good afternoon. i have two presentations for you this afternoon. one is our annual compliance training, which is a requirement for the governing body. i will move into the annual report for office of compliance and privacy affairs. these are the topics that i'll

be covering. we'll start with the overview of our program. the mission of d.p.h. compliance program is to ensure the integrity in d.p.h. business and clinical operations. we work very hard with our providers and all of our staff to integrate compliance into daily operation of d.p.h. a compliance program, it is a formal statement of a healthcare organization to prevent, respond to and report violations of las, government regulations and ethical rules. our program just follow the seven recommended elements of an compliance program that is put forth by the off of the inspector general. these are the seven elements. i'm going to go over these very briefly and show how they are incorporated in our program.

i'm the chief compliance officer for the department. i report to the chief operating officer, greg wagner. we have a d.p.h. compliance committee. membership is level. we also have compliance committees. they report up to this d.p.h. compliance committee. we do make periodic reports to d.p.h. compliance committee and to the health commission. we do have policies that are very specific to our compliance. it includes code of conduct. they are reviewed annually and updated as needed. we do have open lines of communication. d.p.h. maintains a hotline. anyone may call to report any

concerns. we also have private e-mail where individuals can e-mail any issues or concerns they might have. in addition, they will contact directly either one of the compliance officers or they'll contact me or deputy director. we do provide annual compliance training to online training module. we do periodic education as needed with documentation, coding, building, anything we kind of noticed that people need little bit more education. we'll provide that training. we also distribute newsletters we have a newsletter that's called "client matters" it focuses on a subject. for november, we'll have gifts. we usual have that once a year. we do get a lot of questions

from staff. for internal audit, we do conduct risk assessments and develop work plans and that includes audit schedules. we do a lot of auditing. we use to identify issues and provide to providers. we will conduct -- we also conduct reviews if we do get a concern that's brought to our attention. every issue that is brought to our attention, we will investigate thoroughly. if there is -- if we find it's substanceuated we'll to an

action plan. if we do have an over payment, we will return funds. we do notify oversight agencies such as california department of public health and the office of civil rights as needed. we work very closely with human resources and we ensure that we have standard disciplinary procedures in place. one thing that i wanted to mention standards are uniform regardless of status within d.p.h. we have very comprehensive code of conduct. that gives guide staff on how -- they conduct business practices in compliance appropriate

regulation. these are the top things are covered in our code of conduct. health commission responsibilities. the federal government believe that the governing body is ultimately responsible for compliance. with organization with rules and regulations down the line. these are some of the responsibilities that are the health commission. should be aware of the regulation and provision. you do have a lot of committees that you have.

this is some of the consequences of compliance violations. if we have compliance violations that are not addressed there could be ramifications. this is just a list. finally, our duty to report. we really stress with staff that if they see something, they need to say something. they need to report. this is our poster -- posted throughout d.p.h. so people know they can call. we have a hot line.

we have the e-mail. i know that was quick. that's the overview of our compliance. does anybody have any questions. >> president bernal: commissione rs, secretary morewitz, do we have anyone on the comment line? >> clerk: if you like to make comment on item 8. please press star 3. >> president bernal: any comments or questions before we go to the next item? i do not see hands. we can continue to the next

item. which is the fiscal year 2020 and 2021 office of compliance and privacy affairs annual report. for the office of compliance and privacy affairs known as ocpa, we are overseeing the department's privacy program, compliance program, data sharing and whistleblower investigations. this is an organizational chart. this is d.p.h. organizational chart. you can see that to the left. ocpa, we report directly to greg wagner who is the chief operating officer. this is corso organizational chart. if give you an idea of our staff and our program. i will go to the compliance

program. i did mention earlier, our program really ensures that d.p.h. and workforce conduct operations and activities with the highest integrity. we really work hard to integrate compliance in our daily operations. for the fiscal year 2021, we did have some disallowing of payback p.p.p. you can see the number on the screen. those were claims as a result of external and internal audits. we also had a financial penalty on the d.p.h. page. this was related to the non-compliance with the california department of public health states, operations manual for long-term care facilities. this was related to the issues at laguna honda. i have this slide just to show you, we have put forth an effort to reduce these overpayments.

if you can see where we were from fiscal year '17 to '18, we have made lot of progress. we're really working very hard to continue to get that down. we do lot of auditing. lot of corrective action plans. lot of monitoring. i think that's really has helped us achieve this lower number of repayment. at the beginning of every fiscal year, we do risk assessment. we will develop a work plan. thee are the top areas that we monitor for fiscal year 2021.

those are observation services. that is inpatient admission to acute care hospitals are generally payable under medicare part a. if they accept the patients to require hospital stay past midnight. we common that closely. you have to have medical records, documentation that supports that accuracy. for laguna honda, that's the minimum data set accuracy. that's a tool used to assess patients and develop their care plan. for population health, we looked at medicare provide enrollment ensuring that the providers that billing medicare were enrolled. the b43 program a federal program where you get a discount

on pharmaceuticals. we look at time and effort reporting. we're into our current fiscal year. just to give you a snapshot of the area that we're currently looking at on our work plan for this fiscal year. for behavioral health service, our compliance program is inshoring the mental health for integ. we do quite bit of didding.

whenever we have any errors, we do develop a corrective action plan and we do close monitoring. we really try owork with the providers so they can improve on the audit compliance. triannual audit. this is every three years the department conducts a review of each county's mental health plan. you can see that from 2017 and 2020, we actually did quite well in 2020. we had 59% decrease in number of claims. we were happy for that.

this shows where we were in fiscal year 2021. i know this is a little hard to see. there are lot of numbers. it gives year-to-year comparisons of the number of incidents and reportable breaches. for data sharing. corso overseeing the data sharing program for d.p.h. as part of its privacy program we did city. we did consultations, regarding

covid related data sharing. we worked with mattie and covid command center to determine appropriate identification of data ocpa investigating nine

additional complaints filed directly with d.p.h. we do have a hotline. we can get complaints that can come to our hotline or our e-mail or come to us directly via phone. we domain -- do maintain our hotlines. we received 622 calls on various matters. for our education and outreach, we do rerequire that all d.p.h. employees and partners complete our annual privacy and compliance training. we publish a monthly newsletter

and we have a quarterly for compliance call compliance matters. soph the training for our training, we updated to coronavirus training issue. we are working on enacting improvements.

we have developed a privacy. we did a privacy risk assessment and developed a privacy work plan. we'll be working on operationalizing brummetts identified in that assessment. commissioners that concludes my annual report for ocpa. >> president bernal: thank you. anyone on the comment line? >> clerk: there's no public comment. >> president bernal: commissione rs any questions or comments on this presentation? commissioner guillermo. >> commissioner guillermo: thank you very much for your report and training. i wanted to note that and congratulate you on the improvements that have been made. i know what it can be like

particularly on the repayment part of the work. how difficult it can be with both the state and the federal government in terms of all of the back-and-forth that needs to happen in order to make sure that we are not being unnecessarily tagged or fined or spending resources unnecessarily. i want to thank you for that attention. i wanted to note that. thank you very much for the work. >> thank you for the kind words.

>> president bernal: we associate ourselves with your comments. thank you margaret rykowski an your team. we are ready to move on to the next item, which is other business. do we have other business? seeing none, next item is the joint conference committee and other committee reports. we'll hear brief summary of the october 12th laguna honda hospital meeting. >> we had a relatively brief meeting. as usual, we had the executive team report sort of update on the going on. at laguna honda which is indicative to the committee of the jailing that's happening

with the management team. it's great to hear how though the work in such a dedicated fashion. we also heard the regulatory affairs report. it appears they are now getting back in the saddle to speak because they have made a number of unannounced visits back to the schedule. i guess they keep through the month of september at laguna honda we have no reports yet of what those unannounced visits have found. i know there's been some other activity there of late. we expect to see it activity ramp up in terms of things that either findings or reports that d.p.h. is going to be making with regard to laguna honda. we moved on to the facility

assessment which is done annually for long-term care facilities. the three areas that included in the facility assessment are resident population and the care needs based on their physical and cognitive disability. second are staffing and competency, the services that are provided. third, risk analysis for the system and resources in both the north and south towers as well as the hospital buildings which expand more than 500,000 square feet. we continue with the ranking with the primary diagnosis that we see over at laguna honda. i'll read off the first two or

three. the first is primary hypertension and the second is dysphagia and the third is interestingly, epilepsy. we want to make sure that given those are the top diagnosis that we have the appropriate care services in place for those types of diagnosis. there are a number of those. those are the top 10. with regard to staff competency, i wanted to share that there are a number of new training that have been implemented at laguna honda. there are 36 trainings that provide continued education and credit hours in addition to 24 new training that have been provided to staff. as i said, ramping up with that management team, making sure we're providing the best care and have the best staff in place in performing to the top of

their licenses. finally with regard to the actual physical plan, there has been a vulnerability assessment includes natural risks a 35%, technological risk at 28%, human risk at 26% and then hazmat at 19%. again, well documented well addressed. i feel really good about the assessment that occurred. that sums up my report. any questions, i'm happy to try to answer. >> president bernal: thank you, commissioners any questions for commissioner guillermo? seeing none.

we can move on to our next item which is adjournment. do we have a motion to adjourn? >> so move to adjourn the meeting. >> second. >> president bernal: roll call vote. [roll call vote] >> clerk: thank you. >> president bernal: thank you d.p.h. staff, thank you commissionerrings, thank you secretary morewitz for a great meeting. we'll see you in two weeks. good-bye. .

>> a lot of water heater in san francisco look like this may be yours doesn't too do you know it is the post earthquake problems we'll show you to brace our water heater hi, everybody i'm patrick director of quarter safety for the city and county of san francisco welcome to another

episode of stay safe today, we'll talk about bracing water heaters water heater failure is a leading problem with earthquake fires you have a a single source you'll have in our home. >> how are you. >> so what are we looking here. >> this is a water heater 3 weighs from 200 to nine hundred pound during an earthquake that weight will try to move sideways we need to secure is. >> we'll brace the water heater our model home in south of market we'll use a simple kit interest the hardware stores from $20 it the the clean up itself single thing to do what necessary look like. >> this is what you'll find in

our kit a inch and a half wide strap to attach to the wall around the water heater and so you want to compare this in some garages around the city and state which is called plumbers tape innovate as strong and we need to brace the water heater if you find this you'll want to replace it with a streetscaping kit. >> we've put blocking so that way we streetscape the water heater a nice fit it is important and important probation officer mention you need to move our water heater to strap is it talk about to a license plumber they'll come out with a firm once we streetscape those obviously we want to follow the manufactures instructions.

>> typically the instructions will require the strap one strap be installed to fit the top third of the water heater and the bottom on the bottom 1/3rd away from the controls if it is above a certain size 50 gallons a third train e streetscape in the middle of the water heater. >> a lot of time i see older water heaters on the ground obviously explain why this is required and the mr. chairman is required if you pa a water are hereto in the garage gas fumes can accommodate and the pilot light will ignite the fumes so you want to above the grouped level. >> so why not go ahead and he get started with the bracing. >> we're joined with peter from construction he'll help us

>> there you have it for not a lot of 340e7b in a short time we were able to reduce the risks as

you can see secure and even in a big rumble bell not going to come losses thank you for watching we'll give is one more big push as you can see with >> i personally love the mega jobs. i think they're a lot of fun. i like being part of a build that is bigger than myself and outlast me and make a mark on a landscape or industry. ♪♪♪ we do a lot of the big sexy jobs, the stacked towers, transit center, a lot of the note worthy projects. i'm second generation construction. my dad was in it and for me it

just felt right. i was about 16 when i first started drafting home plans for people and working my way through college. in college i became a project engineer on the job, replacing others who were there previously and took over for them. the transit center project is about a million square feet. the entire floor is for commuter buses to come in and drop off, there will be five and a half acre city park accessible to everyone. it has an amputheater and water marsh that will filter it through to use it for landscaping. bay area council is big here in the area, and they have a gender equity group. i love going to the workshops. it's where i met jessica. >> we hit it off, we were both

in the same field and the only two women in the same. >> through that friendship did we discover that our projects are interrelated. >> the projects provide the power from san jose to san francisco and end in the trans bay terminal where amanda was in charge of construction. >> without her project basically i have a fancy bus stop. she has headed up the women's network and i do, too. we have exchanged a lot of ideas on how to get groups to work together. it's been a good partnership for us. >> women can play leadership role in this field. >> i tell him that the schedule

is behind, his work is crappy. he starts dropping f-bombs and i say if you're going to talk to me like that, the meeting is over. so these are the challenges that we face over and over again. the reality, okay, but it is getting better i think. >> it has been great to bond with other women in the field. we lack diversity and so we have to support each other and change the culture a bit so more women see it as a great field that they can succeed in. >> what drew me in, i could use more of my mind than my body to get the work done. >> it's important for women to network with each other, especially in construction. the percentage of women and men in construction is so different. it's hard to feel a part of something and you feel alone. >> it's fun to play a leadership

role in an important project, this is important for the transportation of the entire peninsula. >> to have that person -- of women coming into construction, returning to construction from family leave and creating the network of women that can rely on each other. >> women are the main source of income in your household. show of hands. >> people are very charmed with the idea of the reverse role, that there's a dad at home instead of a mom. you won't have gender equity in the office until it's at home. >> whatever you do, be the best you can be. don't say i can't do it, you can excel and do whatever you want. just put your mind into it.

. >> president yee: of the 26 neighborhoods we have in west portal, it's probably the most unique in terms of a small little town. you can walk around here, and it feels different from the rest of san francisco. people know each other. they shop here, they drink wine here. what makes it different is not only the people that live here, but the businesses, and without all these establishments, you wouldn't know one neighborhood from the other.

el toreador is a unique restaurant. it's my favorite restaurant in san francisco, but when you look around, there's nowhere else that you'll see decorations like this, and it makes you feel like you're in a different world, which is very symbolic of west portal itself. >> well, the restaurant has been here since 1957, so we're going on 63 years in the neighborhood. my family came into it in 1987, with me coming in in 1988. >> my husband was a designer, and he knew a lot about art, and he loved color, so that's what inspired him to do the decorations. the few times we went to mexico, we tried to get as many

things as we can, and we'd bring it in. even though we don't have no space, we try to make more space for everything else. >> president yee: juan of the reasons we came up with the legacy business concept, man eel businesses were closing down for a variety of reasons. it was a reaction to trying to keep our older businesses continuing in the city, and i think we've had some success, and i think this restaurant itself is probably proof that it works. >> having the legacy business experience has helped us a lot, too because it makes it good for us because we have been in business so long and stayed here so long. >> we get to know people by name, and they bring their

children, so we get to know them, also. it's a great experience to get to know them. supervisor yee comes to eat at the restaurant, so he's a wonderful customer, and he's very loyal to us. >> president yee: my favorite dish is the chile rellenos. i almost never from the same things. my owner's son comes out, you want the same thing again? >> well, we are known for our mole, and we do three different types of mole. in the beginning, i wasn't too familiar with the whole legacy program, but san francisco, being committed to preserve a lot of the old-time businesses, it's important to preserve a

lot of the old time flavor of these neighborhoods, and in that capacity, it was great to be recognized by the city and county of san francisco. >> i've been here 40 years, and i hope it will be another 40 year >> we are right now in outer richmond in the last business area of this city. this area of merchants is in the most western part of san francisco, continue blocks down the street they're going to fall into the pacific ocean. two blocks over you're going to

have golden gate park. there is japanese, chinese, hamburgers, italian, you don't have to cook. you can just walk up and down the street and you can get your cheese. i love it. but the a very multicultural place with people from everywhere. it's just a wonderful environment. i love the richmond district. >> and my wife and i own a café we have specialty coffee drinks, your typical lattes and mochas and cappuccinos, and for lunches, sandwiches and soup and salad. made fresh to order. we have something for everybody >> my shop is in a very cool part of the city but that's one of the reasons why we provide such warm and generous treats, both physically and emotionally

(♪♪) >> it's an old-fashioned general store. they have coffee. other than that what we sell is fishing equipment. go out and have a good time. >> one of my customers that has been coming here for years has always said this is my favorite store. when i get married i'm coming in your store. and then he in his wedding outfit and she in a beautiful dress came in here in between getting married at lands end and to the reception, unbelievable. (♪♪) >> the new public health order that we're announcing will require san franciscans to

remain at home with exceptions only for essential outings. >> when the pandemic first hit we kind of saw the writing on the walls that potentially the city is going to shut all businesses down. >> it was scary because it was such an unknown of how things were going to pan out. i honestly thought that this might be the end of our business. we're just a small business and we still need daily customers. >> i think that everybody was on edge. nobody was untouched. it was very silent. >> as a business owner, you know, things don't just stop, right? you've still got your rent, and all of the overhead, it's still there. >> there's this underlying

constant sense of dread and anxiety. it doesn't prevent you from going to work and doing your job, it doesn't stop you from doing your normal routine. what it does is just make you feel extra exhausted. >> so we began to reopen one year later, and we will emerge stronger, we will emerge better as a city, because we are still here and we stand in solidarity with one another. >> this place has definitely been an anchor for us, it's home for us, and, again, we are part of this community and the community is part of us. >> one of the things that we strived for is making everyone in the community feel welcome and we have a sign that says "you're welcome." no matter who you are, no matter what your political views are, you're welcome here. and it's sort of the classic san francisco thing is that you work

with folks. >> it is your duty to help everybody in san francisco.