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. >> it is being held virtually

november 18, 2021 to order. maybe have the announcements about the meeting. >> clerk: thank you president follansbee. are remote viewing will be held on our web ask online platform public comments will be available for call in. sfgov tv is reporting the meeting and it will be posted later this afternoon or tomorrow morning. we encourage everyone to use ouronline platform webx to participate in the meeting today . >> president: go ahead and do the roll call, item number two. >> clerk: item number one is called the orderwhich happened that 1:02 and agenda item 2 is roll call . [roll call] president

follansbee, we havea quorum. >> president: we can go to agenda item number three . >> clerk: agenda item number three is resolution allowing teleconference meetings under thecalifornia government code section 54953 , this is an action item. >> president: i think the items are the documents attached are outlined in necessity of this resolution to continue to hold virtual meetings for ourselves and subcommittees for the next 30 days. is there any discussion from board members? >> this is randy scott and i move that we accept the resolution as distributed with the accompanyingnote .

>> second. >> president: it'smoved and seconded . we like to openthis up for public comment . >> clerk: thank you president follansbee, i will be reading theinstructions . public comments will be available for each item on his agenda and each speaker will be allowed three minutes to comment unless the board president deems the time limit during the meeting. past comments will be made during the agenda item and asa reminder call her my may have questions . there is no obligation to answer or engage in dialogue. you are encouraged to state your name clearly although when you're three minutes have ended i will thank you for your comments and the moderator will unmute the next caller. this meeting is available online using our platform, sfgov tv is recording the meeting and it willbe available on ourwebsite . opportunity to speak are

available by dialing the number on thescreen , 415-655-0001. again, 415-655-0001 . when prompted use access code 2484 226 5616. again, 2484 226 5616. then press pound and pound again. dialá3 to be added to the queue. when the system as it said your line has been muted it is your time to speak. for those already on hold please wait until the system indicates you have been on muted. i will be moderating todayand will check to see if there are any callers who wish to comment on this agenda item . we have zero colors on the line right now. if you have for anyone who is listening in if you

specificallwant to enter the public comment queue at this time you must dialá3 to join the public comment for this agenda item. wait another five seconds and close public comment for any agenda item . there are still callers dialing in . and it is the same,we have zero colors on the line right now and with that we can close public comment . >> president: moved and seconded weaccept the resolution with thecoming documents . all those in favor signify by saying aye . it passes unanimously. thank you very much. agenda item number four. >> clerk: agenda item number for approval of modifications

ofthe meeting set forth below. this is an action item .>> president: any additions, corrections or modifications of the minutes of theseptember night regular meeting of the health service board ? hearing nine, any comments or corrections to the meetings of the number from fourth board governancesubcommittee meeting ? hearing non-i will entertain a motion. >> randy is muted. >> president: [laughter] do you accept these minutes? >> i'm sorry, go right ahead. i was doing that, sorry.

but please, someone else wants to do it, that's fine. >> i move that we accept the minutes. >> i second. >> president: moved and seconded and we accept the meetings of the regular house servicemeeting of september night and subcommittee meeting of november 4 . any additional comments from boardmembers ? if notwe will open this up for public comment . no additional comments, would you open it up for public comment. >> clerk: thank you president follansbee. public comments will be available for each item on this agenda. the speaker will be allowed three minutes unless the board presidentinitiates time limits . all public comments will be made regarding theagenda item

presented . callers may ask questions but there's no obligation toanswer or engage in dialogue . you are encouraged to state your name clearlyalthough you may remain anonymous . you will be placed back on you and i will unmute the next caller. it is available online through our webx platform and sfgovtv is recording the meeting which will be available on our website opportunities to speak are available by filing 415-655-0001 . again, 415-655-0001. when prompted use access code 2484 226 5616. again, 2484 226 5616. then press pound and pound again. you will attend the public comment call line and press start 3. when the system indicates your line has been

unmuted this isyour time to see . for those on hold wait until the system indicates you have been onmuted . i will take a moment tocheck if there are any callers who wish to comment on this agenda item . >> we have zero colors on the line.>> as a reminder to all colors you must dialáthree to be added to the public comment queue for thisagenda item . we will wait five moreseconds to see if anyone wants to join . there is still no colors in the public comment queue. hearing no colors public comment is closed. >> president: so all board members in favor of accepting the minutes of the regular health service board meeting and of the governmen

subcommittee five by saying aye . opposed . thank you, it passesunanimously . moving on to the next agenda item, >> clerk: agenda item 5 is general public comment for members of the public to comment on any matters in the board jurisdiction including anythingnot on the agenda or replacing a matter on further agendas . i will read our instructions. public comments will be available for each item on the agenda and he will be allowed three minutes to comment unless the board deems time limits to be germane to themeeting. as a reminder a caller may ask questions of the body but there is no obligation to answer . when i welcome you you areurged to state your name clearly although you may remain anonymous . when three minutes have ended i will thank you for your

comments and i will unmute the next caller. let me slow down a little. live remote viewing is available online using the webx platform. sfgov tv is recording and it will be posted on our website opportunities to speak are available by dialing thenumber . the dial in number is 415-655-0001 . again, 415-655-0001. when prompted use access code 2484 226 5616. again, 2484 226 5616. then press pound and pound again. you will enter as an attendee on the call line and i'll are three to beadded to the public comment queue . when the system says your line has been unmuted thisis your turn to speak . wait until the system indicates you have been unmuted. i will check to see ifthere are any callers who wish to comment

on this agenda item . we have zero colors on the phone line and zero colors have entered the queue at this time. as a reminder all colors on the line must dial á3 if you want to join. we will waitfive more seconds and close public comment for this agenda item . there are still no colors in the public comment queue at this time.hearing no colors public comment is now closed. >> president: canwe move to agenda item number six ? >> clerk: agenda item 6 is presidents reportand discussion . >> president: thank you very much. i posted a briefdocument . number one i want to thank all the board members for completing their rotavirus

training as mandated by the department of public health . also i would like to let everyone know including the public regarding the department of public health robust website go to sf dph.org and look for the coronavirustax here . it's up-to-date and i find it incrediblyaccurate . it helps deal with a lot of the myths. i added a link to a kaiser family foundation website looking at a survey of common myths and surprisingly almost 80 percent of people either bought into one of the surveyed myths when they surveyed 1000 people either didn't know the actual answer or bought into misunderstandings about this covidpandemic which is a shocking number . not so shocking given the amount of misinformation.

as board members and asked staff in the health service system and veof course the city and county of san francisco as well as citizens to keep up-to-date on all the developments which are changing rapidly. i just want to make a comment that we spend a lot of time looking at social determinants of health and health disparities. i am logging into the washington post live discussions on a variety of issues and had a very interesting one onaging . one of the titles was they treat me like i'm old and stupid. i think anyone over the age of maybe 50 but certainly over the age of 65 has similar experiences if not through their healthcare system but through other opportunities in the public so i just had the issue of ageism to the item that we as members of the

health board and members will keep monitoring as we look at our own programs that we offer so with that i've given links on ageism and aging from the national institute of health as well and withthat i'll conclude my report . anyquestions or comments from board members ? >> i like to say i onthought th was a good thing to point out about ageism. i've heard many people say i feel like i'm invisible, i hear people say that and it is true. they don't really know what they're talking about so i definitely think that's something that we should keep in mind so thank you for pointing that out. >> i want to second those comments as well because i found that very true and i

really appreciate the fact that doctor tran five to include ageism in there so in spite of the fact that i feel like we're in the majoritythese days . but perhaps not. thank you so much it's very important . >> i would add that doctor tran five to suggest we have a number of resources as well here in san francisco and we are quite fortunate in that regard and there are a number of active agencies providing a range of services. both telephonically as well as social centers and so forth to reach out to the bullet points and one organization called prime time in our city.

so thank you for your efforts and i think it's something we have to keep in front of us not only as for retiree members but also mfor the activeemployees well .sometimes those issues will arise in the workplace and people need to be sensitive to that as well . >> i have a comment, i think i understand about these resources and that's great that a lot of people don't know about them. they don't know even how they can reach those things so i don't know how we could help with that. they don't even use internet sometimesso it's hard to get that information out there . >> i worked with a number of community agencies in my own district and i find it hard to find out information in my own district 11 and in my neighborhood. we have a couple of organizations out here that are

senior focused and are trying to go door to door and actually trying to contact those seniors directly leaving something in the mailbox for knocking on their door trying to engage them but you bring up a very important point because i think a lot of things are isolated and they really have no clue that services are there or how to access them. i see lines of people on certain days and then i realize there must be there food distribution at my crocker amazon park but i never had any information with regard to the fact that you're in senior food distribution but certain groups to and if they're connected to certain organizations and families within the neighborhood they get that information. it's a problem generally speaking in the city and i'm not sure our board really can contribute to that .

i think it's being handled at the board and also at other community organization levels . maybe randy has more insight into that with his connections, i'm not sure. >> i would only add you're quite right.t.sometimes the target population doesn't have access to the internet and so forth . periodically the chronicle does put a section in on adult and seniorservices and availability . i think they had one within the last quarter as a special section of thechronicle . and there are other ways that you have the department of, they just changed their name in thelast round of the charter . i called the department of aging services and is not that

anymore but here in the city there is also that department and they ntoo have a website an outreach programs so they are for seniors. on with a nonprofit but i don't want to give any single advocacy for one ,nonprofit or another but there are at least services are available for religious organizations in the city also have outreach within their own congregations and communities as well. so there are a lot of different points if you will for accessing and everyone is trying to do outreach, many of theseorganizations trying to do outreach . >> a lot of our own atretirees receive email or have email so sometimes the internet doesn't work. they might have dan iphone but

they don'textend it. that's one of the challenges i think . >> president: i think what we'd like to do is openthis up for public comment . >> clerk: i'll be pulling up ourinstructions . public comments will be available for agenda items and each speaker will be allowed three minutes to comment unless the board deems time limits during the meeting. all public comments are to be made can concerning the public item to be adopted. they may make questions of the public body but there is no recommendation toengage . when i welcome you you are encouraged to state your name although you may remain anonymous .

when you're three minutes are up you will be placed on mute and the moderator will unmute the next caller. the meeting is available online by using webx. sfgov tv will berecording and it will be posted on their website public comment opportunities are available by dialing 415-655-0001 . again, 415-655-0001. when prompted use access code 2484 226 5616. again, 2484 226 5616. then press pound and pound again. dialá3 to be added.when the symptom message says yourline has been muted it is your time to speak . for those already online wait until the systemindicates you have been unmute it . i will check to see if there are any colors wish to comment.

we have zero colors on the phone line. zero colors have entered the public comment you at thistime. you can dialáthree now to be able to join the public comments you for this agenda item. we will wait five more seconds and close public comment for this agenda item . there is still no colors on th public comment you at this time . hearing no colors comment is close. >> president: wecan move on to agenda item number seven . >> agenda item number seven is the board report, a discussion item. it will be presented by executive director ham. >> good afternoon commissioners.

during this last discussion i want to put my directors report for a onmoment. one of the last lines in that debt is from our well-being department and particularly on slide 49 we, we're putting our toe in the water with ageism and talking about connectedness for our retired population. we know that isolation is one of the biggest perspectives of health so that's one area we recognize that it is not a one-stop shop for everybody. there's lots of limitations but there's also a wealth of resources. and i said maybe we can listen to the exchange about the relative importance of social services networks. and helping people with their health and i wanted to bear that inmind .

later in the board meeting when we talk about population healt efforts that are underway . so scrolling back up to the beginningof the report , the transport story continues as of november 1, all city employees that are working are vaccinated. there's a very complex process occurring for those who have chosen not to comply with that state regulation . but with that date, we began our transition back to pre-pandemic patterns here at hss so we're all getting used to commuting to work, going to lunch. it's a little hard but for the most part i think people are really welcoming that in office

practices. we are under a mask mandate and that's ongoing. we also have i just want to encourage everyone that it is not an employment requirement this time but it is a public comfort recommendation so for those that should be getting boosters which is pretty much almost anybody, ulplease encourage you to do so already. we also in my report included the numbers that we have received. i must congratulate you on a tremendous idamount of work by the consolidated information so that they know who is in their perfume has received a vaccine but the data is not complete. we recognize the challenges of

getting that complete but there's been tremendous effort in that regard and that is excellent work on your part. on top of an ongoing vaccination program in terms of patients of covid which fortunately we had few of insan francisco. moving on to open enrollment another big successful year . we had a full report from the team in december l. calling out in particular the work of art medications team. i believe it's 24 webinars and i think we learned a lot our members learned a lot . disposition was excellent and i do believe one of the factors that reduced the call volume on a year-to-year basis if you recall that. so that's a good thing that we were able to anticipate providing information to help

people make their decisions each year. and it includes a new plan so we put that elaltogether and it was a pretty arduous effort and the team responded and did an excellent job so let's have that at our meeting next month. the board of supervisors under supervisor chan had a letter of inquiry about some time standards for mental health visits. we responded to that letter and participated in a hearing. the dilemma that we are all faced with is that there is a shortage of mental health workers . the new law that's going to into effect in july of next year has set a standard for follow-up visits so that

information is not yet available but we're all lookin forward tothat . there's i mean, almost everywhere we go there's a discussion about mental health. it's the biggest topic of the year right now so as we move forward, we're all learning a lot together about how we talk aboutmental health . how we measure arand we're very good eain our business about looking at cost but we need to go beyond quality and outcomes and process improves that but it's not the only part of the story so we wanted to work with all our partners to help plan professional organizations and they have a lot to say about this. the voluntary accrediting agencies like c hq which looks at these measures and others all are intensely looking at ways that we can enhance mental

health services andprovide better outcomes . but it is booming at this poin , more demand and the measures are flagging at this point. our racial equity plan update is included in your packet with celebrations of native americansand veterans . we also have on the agenda today a formal request for a formal questions to the board for blackout period d. not recognizing that could have should have thatoccurred last month. will be doing that action item shortly . we are progressing with the help lawsuit so i wrote in my report there has been a report monitor and we have ereceived our notice. we don't know reyet how much money may be coming towards us.

there's all these weight period that we have to send out to see who's missing and they have concernsit may slow down the process. continuing to monitor that . we did just yesterday complete our rfi discussions about the medicare advantage projects. we're approaching all the information and providing more to the board at its next meeting. i want to personally thank and recognize michael visconti for leading us through an arduous process and i want to thank commissioner scott for setting aside significant amountsof

time for being part of the process . the personnel, i do want to recognize that we have been working like crazy. it comes in fits and starts and i'm looking here tomake sure i get the names correct . we have marcel calvin hudson, kenny leon, john mom, they all started in september and november . and we are busily recruiting other commissioners that have come over. so gthat personnel, we keep our department of human resources personnel officers quite busy which are competent so we're very happy to be successfully working together. i think that finance information will go forward on

the agenda itemstoday . and i think that's it. the only other thing on the well-being i wanted to mention is they do an amazing job like everybody else, pretty much everything virtually they become a production house. and they've done na great job and it's culminated in a well-being at work award ceremony virtually last week and we were able to get the mayor to participate which we've been working towards for sometime . so that was really a great moment for the well-being from our current mayor. >>. [please stand by] so i want to congratulate the team and all the work that they've done for everyone in

the department. it's just an amazing awards ceremony, and i think to have the mayor recognize it, the department has done an amazing job during the pandemic, and it's on top of their regular job, so i just want to recognize the mayor for her blessings on that. happy to take any questions. >> questions or comments from the board? >> abbie, could you just refresh my memory, how much positions are in your department total? >> i think it's around 54. >> 54? >> yeah [indiscernible]. >> okay. for some reason, i thought it was, like, 58 or something like that, but that's fine. and you have how many vacancies at this time?

>> two or three. >> thank you. >> yeah, we just have steady people leave the organization for whatever reason. last month, we had a >> the hears you had and it was for actives only. so i do hope to follow. and make sure there's one for retirees also. >> from the hhs perspective we're concerned about mental health for all our employees. and have a particular interest in active employees. >> any other comments? thank you very much. thank you for the report. i think we'll go ahead and open this up for public comment.

>> thank you. i'll explain our instructions. public comment is available for each item. each person will have three minutes. all public comment concerning the agenda item and there's no need to interact with the caller and when you're minutes have ended you will be placed on mute and sf gov tv will post it the video and the dial in number is

14-655-0001. one prompted use access code 248422 5616 and press pound and pound again. you'll enter the meeting as an attendee and dialing star 3 to be added to the public comment queue. when the system message says your line has been unmuted this is your time to speak. for those already on hold please wait until the system indicates you have been unmuted. i'll check to see if there's callers this agenda i'm. i reminder to all callers on the line you must dial star 3 now if you want to join public comment for this specific agenda item. we'll wait five seconds and then close public comment for this agenda item.

there's still no callers in the public comment queue at this time. hearing no callers, the item is closed. >> thank you very much. director if we can move on to agenda item number 8. >> this is agenda item 8 blackout period notification an action item and the director will introduce this. >> commissioners, i would like to reintroduce the blackout period notice that is for the period commencing in september through june of 2022 that coincides with our recent benefit process. and pursuant to the board's own policy. it is required that you accept this notice. >> thank you very much. any discussion from board

members. >> move acceptance of the notice. >> i second. >> thank you very much. moved and second and we accept the blackout notice through june 20, 2022. we'll open this up for public comment. >> thank you. i'll display our instructions and read them aloud. public comment will be available for each item. each caller will be given three minutes and as a reminder the caller may ask questions of the policy body but there's no obligation to engage with the caller. when i welcome you on the call you may state your name or remain anonymous. when your three minutes have ended you'll be placed back on mute and i'll unmute the next caller. you can use our webex platform.

sf gov tv is recording the meeting and i dial in at 415-655-0001. you'll enter the meet as an attendee on the public comment call line and dial star 3 to be added to the queue. when the system message says you have been unmuted this is your time to speak. for those already on hold wait until the system indicates have you been unmute. i'll now check to see if there's any callers who wish to comment on this agenda item.

we have one caller. a reminder to all callers on the line, you must dial star 3 if you want to join the public comment for this specific agenda item. we'll wait five more seconds and then close public comment for this agenda item. there's still no callers in the public comment queue at this tile. hearing no calls, public comment is now closed. >> thank you, very much. we'll move to agenda item number 9. >> thank you. agenda item 9 the financial reporting as of september 30,2021 and a discussion item. >> thank you. can you advance the next slide? >> yes. is that coming through? >> yes, a little choppy but it

will suffice. good afternoon, president and board members. this is the chief financial officer for health services system. today i'll be discussing the report out on the san francisco health service system financial as of the end of september 30, 2021. that's the first three months of this current fiscal year. the details in terms of my write-up is on the memo available on in your packet as well as available to the public on our website. so i'll just highlight a couple key items of my report. the first quick note is that the financial year end audit has been completed. that is for the period of fiscal year 2020 through 2021 ending

june 30, 2021. we will have another action item following this one with regards to that but there's a couple key notes on the financial audit. this is the second year we've done 100% environment audit with our new auditors. we were able to start our audit process earlier in the year than waiting for the close of the fiscal year to start producing documentation and the like and probably resulted in a more efficient process and use of everyone's time. the scheduled completion date for our audit was typically the last part of october. we actually finished october 13. we finished ahead of time. more to follow on that. as i stated in the past, the

financials for which sfhhs are fund two sources. one is the general administrator fund which is primarily funded through the city and then there's the employee benefits which is funding all benefits our employees and retirees enjoy. with regard to the general fund administrative budget through september 30, 2021, we are product -- predicting three months in the fiscal year there's a surplus of $60,000. we for this budget we managed to have no surplus or shortfalls. the current projection shows we may have a net reduction or slight decrease of $84,000 but is this only through the first

three months. we obviously manage the budget. i do want to note this is november as part of our normal general fund budget cycle the mayor's office will be issuing the budget instructions for s.f. hsf some time in late december not sure exactly what our board meeting which is scheduled for december 9 so we'll have that information available to the board in january. with regard to the employee benefits trust, currently we are forecasting projecting a slight decrease of $2.2 million to end the year with a fund balance of $123.7 million. most of our surplus or shortfall

comes from the flows of our funds. we estimate that should remain relatively flat. currently we are projecting there's a slight decrease of $125,000 but this still early on. a large contributor to the funds is the expected rebates from our farm rebates. as of this time there's been none received. with regard to other sources of revenue for the trust, performance guarantees are typically a small portion year over over date we received $21,000 and in terms of interest with none resourced year -- received and the subset of the

trust fund we're projecting a net balance of [indiscernible]. i'll be happy to entertain any questions you have. >> we'll open it up the item for questions from board members. any questions or comments? it's a detailed report i appreciate that. it helps the perspective on all these different aspects of our financials. >> i was indicating i had no comments and i thank larry and his team for what they're doing month in and month out and reporting to us in this summary

fashion with the detailed reports as well. >> i'd also like to thank a big larry for his help on the sub-commitee. his input was extremely valuable. this used to be a topic of great concern for many years for those of us on the board and we see now we're doing better financially and i want to confirm it's early with regard to forecasting either and it's usually true at the end of the year -- is that accurate? >> that's correct. that's regard to the general fund. >> great, thank you.

>> willing to open it up for public comment. >> with regard to the active dental and are we good that gets balanced every year since one year we may have a shortfall and then it's adjusted because the way it's set up it takes a year's cycle it true up? >> it's more of a good discussion to have as we look at the setting and to stabilize the future rate over a period of time and those are presented as we set the rates down and with actives there's been some surpluses.

>> thank you very much. >> now, if there's no further comments or questions, we'll open it up for public comment. >> thank you. public comment will be available for each item on the agenda. each speaker will be given three minutes unless the board president deems different time limits and there's no need to engage in dialogue or answer the caller. when you're three minutes are over you'll be placed on mute.

sf gov tv is recording the dial number is 415-655-0001. when prompted use access code 24842265616 then press star 3 for those already on hold continue to wait until the system indicates you have been unmuted. i will now check to see if there are any callers in the public comment queue at this time. we have zero callers at this time. a reminder to all callers, you must press star 3 to be added to

the public comment for this specific agenda item. we'll wait five more seconds and then close public comment for the agenda item. there's still no public comment callers and it's now closed. >> thank you, we'll now end this item and move to i believe agenda item number 10 on the agenda which is an action item. >> yes. agenda item number 10 the annual statement and auditor's report. this is an action item. larry, cfo will introduce this and you'll have a guest speaker. >> i have a slide to queue up. thank you commissioner and president and fellow

commissioners and the board. i'm the chief financial officer for san francisco health system. we're introducing you to the independent auditing firm and auditors have looked at and audited our financial statements as well as our internal management of the employee benefits trust fund. with us is the auditor who led this effort. this is the second year ngo has conducted the audit. we have done this virtually and following the presentation i would recommend that the board accept the auditor's report. with that i'll hand it over to -- before i do that, i do want to make a couple acknowledgements. as i mentioned in the previous

agenda item this is our second audit and that's a bit of a challenge to do and i want to acknowledge a number of folks who helped support the board by providing information and our finance department has been hear longer than i have and there's others who report to mitchell craig for provide heap of information to support all the samples that our auditor have to pull and so on. and lastly i want to thank those who produced a lot of the contracts rating information that are the paper that binds

the organization. so with that, i'd like to turn it over. thank you. >> i'm a director with ngo and serve as the general service partner on our audit of the financial statements of the health service system. >> do you have anything to present? >> let me check if i do. >> thank you, everyone for being patient. >> i can share my screen.

if there's a way to expand it just a little bit. >> commissioners, is that big enough? >> wow. >> i made it too big. the scope of our audit is only over the employee benefits trust fund and doesn't include the general administrative fund. and as a result of our audit we

issued three reports, two of which are contained in the financial statement and a second report title the report to the board of the directors. due to our special audit status we have to provide a report to the board that contain a summary or wrap up, if you will, of the audit. and that's what we'll go through right now. and all the information they provide to us it's a lot of documentation provided and challenges that we were able to

work on and issued our report a week ahead of schedule. we issued and we're happy to report we issued an unmodified statement. that report is found in the first pages of the audit financial statement right after the table of contents. now, the financial statement report and there's a report we're required to include with

government auditing standards. that adds an additional level of work part of our audit. what this is is reporting back to the board of our consideration of internal controls over the financial statements the organization has in place and also on any compliance with laws, regulations and contracts and that could affect the amount in the financial statement and disclosures. so we're happy to report under the internal control section we don't have any we didn't identify any deficiencies in internal control that are required to be reported and also didn't find any laws or regulations that would materially affect the amount of this financial statement.

>> i notice you made a statement that isn't a part of the slide you said you found no control deficienies and i thing for matter of report that review of auditing standards covers both and suggest that may want to be included in your -- >> thank you for that. >> responsibilities of independent auditor and

management is responsible to prepare and prent the financial statements in accordance with the principles of what we call u.s. gaps and they're also responsible for designing, implementing and maintaining effective internal controls over the financial reporting and then communicating any matter of interest. as an independent auditor we're required to plan and perform our audit with wa we call reasonable [indiscernible] and they're free of misstatement and we don't give 100% assurance and we don't look at or audit every single transaction that went into the amount but provide a high level of assurance and are comfortable

the amounts are not materially misstated. and we're required to express an opinion whether the statement prepared in accordance with the financial reporting framework. >> then, they're required to perform communication and professional standards or certain matters we have to communicate to those in the case of the board and the first one on here we didn't have corrected materials, misstatements or any corrected audited statement and

the record we brought in doing our work were fairly accurate. we didn't have to have any adjustment in the financial statement. as far as the presentation of the financial statements and the disclosures, there were no admissions. everything was presented this were no misleading financial statements. this year there were no [indiscernible] we didn't have difficulties in performing the audit which is provided in the information and answering a lot

of our questions we didn't have agreements with management how to report anything in the financial statement. as far as where management didn't consult with any other accounting firms and there were no subsequent events. from the balancing date up to our report date didn't warranted dlsh to be -- disclosure for add the in the report. last time i went over there's a couple significant what we call estimates where it requires management to make estimates with certain disclosures and the estimates are best guess at the time of what the balance should

be and future experience could differ from those the main estimates in the financial statements and also in the non-disclosures you'll see the estimated refer for claims on medical prescription drugs and dental claims. and this is significant because management has to have an opportunity and based on historical makeup they have to estimate what the reserve is and so what we do is we actually retain and rehire a consulting actuary an expert in the health care claims area and rereviews

rereviews -- review the same data and with all the claim loss and enrollment numbers could prepare an estimate using the data and compare it to reasonably similar amounts and conclude the estimates are reasonable so we were able to conclude that and didn't have significant differences ha our specialist came up with. with that, i'll be happy to answer any questions. >> i'll open up the discussion for questions and thank you for

the report i found incredibly comprehensive and illuminating for items i'd forgotten over the course of my six years on the board now. so again, thank you very much. >> thank you. on the summary page of other matters and again i recognize this is fate at this point but i think it would have been helpful to have added the note this there were no significant discrepancies or what have you in the form. absent that narrative, someone reading this will be able to conclude there were no matters to report so forth and so on.

i recognize it's the process but it would be helpful to post this where the explanations can be added it would have been helpful. again, i'd like to thank you for the thorough ness of your report and the rigor in which you undertook this on and also would like to commend the team and those who supported him in bringing this to such a terrific and we hope continued expected outcome going in the future. again, thank you, larry, to you and your team for your work. >> i'd like to second what

commissioner scott said. i was on the board a number of years ago and it was very upsetting. it's good to have a report and it's very important and some of us are still sitting on pins and needles to the issues. we haven't had them some time now and i want to thank larry and his staff and the director for making sure we don't have the it issues going forward but it's helpful to have the comment added. thank you.

>> we call that out specifically. >> i'llico what the other commissioners have said not to drag it out any further. >> i'm glad you brought up issue number 4 because i couldn't find it for the conclusion. any other comments or questions from board members? hearing none i'll entertain a motion to accept the report of the auditor through october 13, 2021. >> i move we accept the report as presented with accommodation to larry, chief financial

officer and his team and those who supported and provided input to him to complete this audit successfully. >> second. >> it's been moved and seconded we accept it through october 13, 2021. hearing no further comments or questions, we'll open this up for public comment holly. >> thank you, president. i'll pull up our visual instructions. i'll read those allowed. public comment will be available for each item on the agenda and each speaker will have three minutes unless new time limits are deemed during the meeting and as a reminder a caller may ask questions policy body but there's no obligation to answer or engage in dialogue with the caller. when i welcome you on the call

you're encouraged to state your name but you may remain anonymous. when you're three minutes have ended you'll be placed back on mute and i will unmute the next caller. live remote viewing is available online loving the webex platform. sf gov tv is recording the meeting. the dial in number is 415-65-00001. when prompted use access code 24842265616. then press pound and pound again. you'll enter the meeting as an attendee on the public comment call line and dial star 3 to be added to the public comment queue. when the system message says your line has in unmuted this is

your time to speak. for those on hold continue to wait until the system indicates you have been unmuted. i'll check to see if there's callers who wish to comment on the agenda item. you must press star 3 to speak on this agenda item. there's still no callers at this time. hearing none no callers, public comment is now closed. >> thank you very much. call for a vote to accept the ngo audit report from financial

services through october 13, 2021. all in favor? any opposition? thank you. it passed unanimously with special accommodation. thank you very much. i'll entertain feedback from the board members. it's been two months since we've had to sit this long but are members willing to continue for the next presentation as well? >> yes. i would put the condition after the next presentation we entertain a hygiene break. >> that's okay. we'll call for agenda item number 11. >> thank you. this is agenda item number 11.

an education and s.f. hsf update and discussion item and presented by s.f. hsf health plan. >> thank you. let me pull up the slide. good afternoon, commissioners. i'm a senior health planner and i'll be giving an update on population health strategy. it looks at social

determinesate -- determinates of health. and for our agenda today i'll start by giving background and context to the population health and switch over and go to our approach and strategy and look at the work to date. and finally close the presentation and look ahead. the aims of this presentation are to serve as continued education and update to the board and to encourage discussion questions on the topic of population and social health. as i said broadly, population health is defined as the health outcome of a group of individuals including the distribution of such outcomes within the groups. the definition attributes health outcomes to the domains of individual health behavior and health care or what we think of as going to the doctor. this model has led to many features that we're familiar with today including focus on patient safety and critical quality and disease and care management such adds smoke

cessation and diabetes reduction programs. within the last several years there's been a growing focus on environmental factors that influence outcomes at an individual life span. this expanding definition of population health acknowledges that health is more than traditional and a shift towards a whole person perspective. this expanding inclusion coupled with the covid-19 pandemic and the growing adoption of digital health technology has led to a crowded discourse. may be encountering terms such as sboh and social determinates and social need and risk just to name a few and conversations about innovative technologies and health solution. all to say the eco system is changing rapidly and the roles and expectations of those who purchase, pay for and provide health care are also chachangin.

and between posting the materials and presentation i added the additional small graphic on the bottom left that may not be on your version. finally we approach our work recognizing the need to build strategy that address complex relationships between individual characteristics like age, race, gender, identity, sexual orientation with social systems. to close out the background in context, i wanted to highlight how key health care players are coming together in the evolving landscape i've described. a few of these examples include health plans and providers partnering and sometimes referred to as health advocates and navigators. and community-based organizations implementing technology to track referral

follow-up and employers contracting with digital health companies to meet the dynamic employee needs. regulatory bodies like state government extending data standards and collection and finally mental health becoming a major topic across all sectors. so now we're going switch gears and talk about our approach and strategy. in developing our approach we centered ourselves around two key questions, what are we going do about it and what is around our sphere and the system can take many years to see outcomes and can feel like boiling the ocean, change is possible at the micro and macro level through partnerships and resource investment. finally, we've begun organizing ourselves with two perspectives in mind. one is what we can do in

partnership with our health plan partners and the second is what we can do from an employer perspective within services, hsf and the city provides. and we're having key conversations to strengthen data partnerships and diving deep within data to understand gaps and priorities. over the next slides i'll briefly highlight the work streams highlighted in red with our audit and our database and the plan. one of our early activities was to analyze the large amounts of data and we acknowledge we're getting robust utilization in population health data but it wasn't easy to do a comparison

across the population and we worked towards creative prioritization of actionable data. in conjunction with the audit we used our data warehouse to identify areas of focus where population experiences higher cost and evidence in disparity. many areas were present. in the table displayed you see presence broken down by race and ethnicity groups and employee workforce. for each measure the average represents the value of one and each group is displayed relative to the average. for instance, a ratio of two means the group has twice the presence as employee workforce average. it is important to note our city workforce is not proportionately distributed by race and the

average rate is where we have more employees. many despairs on the screen including low prevalence of conditions for black and filipino employees are consistent with what is observed across the united states. there's much work to be done and to bring this back much of the health care system is through the extended focus an social and environmental influence. putting together the learns from the first two examples or the large amounts of data and disparities in health outcomes, the last example is an update on our standard measurement project and begin addressing the issues and in alignment with purchaser group coalition our goal is to

gather stratified data endorsed by the national committee for quality assurance. through this we'll strengthen our ability to make the comparison and work in partnership to begin closing gaps in care quality. and this represents the perspective of what s.f. hsf can do from a purchasing perspective. we're hoping to engage and develop internal strategies from an employer's perspective shown on the right. in summary, purchaser, pair and

provider roles include whole person systems and perspective. s.f. hsf is also strategizing the influence in the space and our efforts including data reporting and engaging steering groups and pilots and building an internal strategy and will continue to provide update with reports and presentations. thank you. >> thank you pose fascinating questions and it seems to me we're starting to do a first dive into this. am i correct? a lot of these issues wen when

you start to factor in environmental issues environmental from the workplace and residents. the question i have is can you tell us how you see this in the complex and intensity. >> definitely. and and with the environment each is a whole other system and from that perspective where we started working with health care on getting the accurate data so we may not necessarily be ready to talk about the environment and where people are physically living geographically but how that works into our strategy but i guess our first steps are really finding those areas of

data and care quality and health care we can lean into. >> even in cardio vascular disease and diabetes the higher risk groups higher than the 1.0 getting their care and if they're getting their residents and whether they're getting care within a small radius. >> are we assuming most people live in san francisco and no

matter what color you are you're all at the same environment at work so i don't know how that would vary. and with behavior, anxiety and depression were the highest in one group and then the lowest in the hypertension and i always thought these two things probably go together and didn't think there was any surprise most the asians were the lowest in all categories except diabetes which there you go with the white race. i don't hear anybody talking about diet and exercise which i find to be primary. no matter where you are, like i saw great meals on burners. nobody had much of a kitchen or anything in china. it isn't always about -- it's your habits and that needs to be impressed on people. your diet and your exercise.

maybe even cooking something for yourself instead of going to mcdonalds. and the fast food stuff been a big problem like in every part of the country, really. some people say it's cheaper but in my experience it's not cheaper from my days of trying to cook and stuff and mcdonalds is not really cheap. you can buy chicken and rice and potatoes would be much cheaper. it looks like diet and exercise to me and i don't see this mentioned in here. >> thank you for your question and comments. i think we're trying to let the data tell the story. i think anecdotally we have experiences we think what folks

are doing and eating but we want the data speak and we are looking to the public health groups and focus on diet. i think i know ucsf maybe in the last few year has done a study on the asian diets with diabetes and we're trying to find evidence of what can work in certain populatios and looking if they can be rolled out and a larger scale. we want to start by gathering the data and letting that tell the story. >> i don't think the white rice is a surprise. i heard that many years ago when we were talking about diabetes. white rice is one of the big problems. i don't know why that would be a big surprise to anybody. some of these it seems they're

making into something more than it is especially when there's a population all employed by the city and county of san francisco and salaries are the same depending what category you're in and it isn't as though you can work next to somebody in the same building an he's getting more than you are. if you're in a category at least you have disparities here. >> those are good points and a lot of the social determinates is leading to the context of an individual away from the things you may be able to say on the surface level and though two employees could be paid the same amount, one may travel two hours and one may be 10 minutes away or someone may be supporting a multi-generational household

with grandparents and kids and the households are stretched thinner. the industry of health care is take on the task of expanding the definition of traditional health from just going to the doctor to understanding the social, emotional perspectives of each individual. >> that's true. >> and asian population are scoring the lowest on most of these of anybody except for diabetes. you have to look at the whole picture. >> i appreciate the comments. >> i'd like to go back to to the slide and ask questions. what are we going to do bit and

what's our sphere of influence ? that's where the process began over a year ago. i think you've been here a year or more or two years and we've begun to talk about this in our health system strategy and this may be an issue, data will help us define it and then we'll be able to come up with what are interventions would be, things that may relate to our well being program and so forth. and what i will hope that will evolve out of this and i think the fact that you have this overview today of where you are and initially where you're willing to go is to seed seed s

time line for the collection of issues or what have you and that to me would help to inform us as a board as to this is where we are and where we're going or this is where we have been and where we are and where we're going and have broad themes or the issues in some of the data charts you've presented today. i'm suggesting along with the overview, you give some thought going forward to the time line. this is going in my view have to be the next waive of -- the next input to a larger board strategy. so i think what you've done here

is give a high level overview of what you've done today is fine but you need to also tie it to some larger time line both informational and actionable items that may evolve out of it but thank you for what you've done. >> thank you. >> i totally agree. i want to point out to all the board members who may be listening, some basic issues around commute times for all employees. probably different quite widely and i suspect a large proportion that contract with us for health plans do not live within walking distance of their main place of employment or easy commute as well. activity level of their employment, which position more sedentary and which encourage or

mandate levels of activity that may address some of the issues as well including mental health and also environmental issues. i remember a former member who worked for i believe the police department, the training field out in mission bay was actually con tam -- contaminated with nuclear waste after the late 1945 time and the possible health issues there. so not all are within conditions of employment. environment issues are the same for our employees the four agencies as well. these require deep dives to look for trends to begin to address

as you point out our areas of influence and health service system and as a board. any comments from other board members? >> i have some questions. i would also like to see if possible a breakdown between the over 65 or retirees and active. because i think i'm assume ith has everybody lumped in and want us to look at what is within our sphere of influence and what are we going to do about it and we need to know a little more and i don't know to what extent you can break down any of these populations with regard to

classification but we have everybody else in essence an awesome worker but we also have people who do field work which medical staff and some of our other people and a number of other not to mention break down police and fire and looking at what statistics on that and the breakdown as a percentage and i look at african americans and filipinos as having the highest diabetes and highest in the asian population. it was african american and filipinos. and as we look at the various conditions i think we also need to take a look at the

classification and i think you can generalize them in those categories and you can always look at which ones are which but a lot of are systemic and does the city know which classifications have different kinds of activities? also with regard to active retirees. we need to see all of that and i realize that extends your work. you and your team and that's a huge ask, a huge request i don't think we can approach solutions and answer the question what we can do bit and what is within our service unless we know more about the activities the jobs

present and also the commuting. when i started with the city we were required to be city residents in order to work with the city. that changed in the mid '70s. now many more of our active employees are commuting from outside and i think one or two hour commute from across the east is telling with regard to health impact. i hope we take into consideration the minor categories the smaller categories a breakdown that will help answer these questions and thank you, this is a very telling report and i have some

very very serious concerns with regard to especially the reports on the african-american health and that whole line is almost 100% in bold and higher numbers and it has me very very concerned as well as the fact that our filipino population which is significant and city employees, there's some indication and asian, american, african, filipinos, we have to look at that with everybody else and we need a breakdown as soon as possible. thank you. >> did you have another comment or question? >> not really, i said enough. just trying to get their people

to change their diet and do exercise but you still have to go back to the diet and exercise no matter what color you are. >> can you show the health cares and healthy determinates? i want to acknowledge commissioner, i believe you're talking about healthy behaviors and so we do recognize that that is a significant part of your health. i just want you to know that you're seeing it here. those efforts continue to encourage people to eat healthy diets and get proper exercise and all the good behaviors.

the other thing i wanted to acknowledge is about connecting to strategy and very much was part of our strategic planning efforts in 2018 we begin to develop the ability to think about population health and social determines. and we were predicting the future. i also hope this gives inside into all of the information you see in the media and press about equity. there are issues and i'm covering them in a sensitive and respectful way that helps people is a big challenge but i'll tell you what's changed in my career, a, we're talking about it.

that just hasn't happened in the 40 years i've been around health care. i think there's a tremendous amount of sincere good efforts happening and trying to find different ways of working and recognizing the social determines. i also want to encourage our partners are in the game with us and wanting to help us all help our members get their highest health state. when we did the rfp, we outlined that we wanted to be able to work with plans on a common measurement set and this is where derek's role has been key to helping us figure out what that means. so we're work together this year to define that common measurement set there's lots of limitations what we can and

cannot get through claims data and what we can and cannot do to associate with job classifications or meet regularly with department of human resources these days to look to where we can work together and so this is the year we're establishing the standards and determining what that baseline data is. we haven't wide -- quite finish had yet and what we do is by next year is have the baseline and have another year's data and begin to set improvement goals. and we're used to setting lofty targets and said targets of the ideal state of where we want to be and what we all know is these

things take time. what we'll be wrestle with is what the attainment goals are which are different than a target. it recognizes continuous improvement and the ability to move forward in a space where there's less clear answers than there are questions. so that's what we plan on doing and then by the third year once we've got the baseline, we set attainment goals and the third year we should see incremental improvement. that's the plan. we see the million all coming together to do very innovative things already so i think this is very exciting and timely work. it jumpses to mentally where i was going when i said we had this strategic plan set in a

direction and need to in our next strategic planning effort talk about what it is we're going to do. even at a high level, have descriptors about year one and two and three would be helpful in them to this report. see what i'm saying? we're kind of clear we started out in this strategic cycle and as we go to the next, this is where we're trying to go broadly and i think it will be helpful. >> i think it this board meeting for me since we're develop plan to refresh our strategic plan forward three issues, ageism, gerontology, mental health and occupation health. hose for sure are on the tarmac

and more to come. >> thank you. thank you for the work you've done on this. >> i want to point out as a board we've already dealt with our concerns over lack of utilization of dental benefits. we've addressed and are concerned over vaccination rates and these issues are very complicated which include trust in the service we provide as well as information and education. it's a big challenge but we have identified small aspects of all this that part of this overlapping slides of health outcomes that shows determine nate -- determinates and for people to use them and not shy

from the services we are providing and thank you for that. >> if anyone has questions or comments i'll open it up for public comment. >> thank you. i'll upload the slide with instructions. i'll be reading them allowed. public comment will be available for each item s agenda. each speaker will be allowed three minutes to comments in length unless the board president deems new time limits and all comments are for the agenda item present. a caller may ask question of the policy body but there's no obligation to answer or engage. you're encouraged to state your name clearly but you may remain

anonymous. when your three minutes have ended you'll be placed on mute and i'll unmute the next caller. live remote viewing is available using the webex platform. sf gov tv is recording the meeting and opportunities are available by dialing the number on the screen, the number is 415-655-0001. when prompted use access coze 24842265616. press pound and pound again and dial star 3 to be added to the public comment queue. when the system says your line has been unmuted it is your time to speak. for those on headline continue to wait until the system indicates have been unmuted. i'll now check for callers to

wish to comment on this agenda item. you must dial star 3 now if you want to join public comment nor specific agenda item. we'll wait five seconds and then close public comment for this agenda item. there's still no callers in the public comment queue at this time. hearing no callers, public comment is now closed. >> thank you very much. this closes agenda item 11 and per request, the board members i would like to take a 10-minute break. we'll resume at approximately 3:04.

>> thank you, mr. president. >> president. >> present. >> commissioner. >> present. >> commissioner. >> present. >> commissioner. >> here. present. >> thank you. we have a quorum. >> great, thank you. now we can move to agenda item number 12 you introduced i think being presented by the committee chair commissioner scott. >> thank you. i wanted to it noted we are taking two actions and the board

valuation and we have been doing this for about six plus years and made fo modifications and they reflect the scope and responsibility of the board. the document was attached to the meeting materials as well as the time line. it should be noted at the time line calls for the distribution of the develop evaluation to board members on the 19th of november which is tomorrow. and we have approximately three weeks to complete the self-evaluation and there will be prompts from our board secretary during that time reminding us of the deadline. this process last year was very

ably support the board secretary and were told this will be the case this year as well. that's the first document and first process. the next is the evaluation of the execive -- executive director and the time line will start after our next board meeting mid-december and be concluded in early march. the evaluation form we're proposing would remain the same. again, there was a slight adjustment in some of the wording made last year and as we discussed as a committee we saw no need to make further changes in either of the documents for the reviews and evaluations. and with that i'm going to entertain a motion for the adoption of the recommendation to approve the initiation of the

board evaluation and executive director performance evaluation with the accompanying time lines. >> i move exactly what you said. >> all right. >> thank you. is there a second? >> second. >> it's been moved. thank you, commissioner. >> with that i'm willing to open it up for any board discussion on the item. hearing none and seeing no hands raised we're now ready to go to public comment. holly. >> thank you, commissioner scott. public comment will be available

for each item on this agenda. each speaker will be allowed to comment for three minutes unless the president deems new time limits. all comments are for the agenda item presented. a caller may ask a question but there's no obligation to engage with the caller. when your three minutes have ended i'll thank you for your comment, place you back on mute and unmute the next caller. live remote viewing is available using the webex , sf gov tv is recording the meeting and will be posted on our website. opportunities to speak during the public comment by dialing 415-655-0001. when prompted use access code

24842265616. utility enter the meeting as an attendee and press star 3 to be added to the queue. when the line says you have been unmuted this is your time to speak. for those already on hold, continue to wait until the system indicates you have been unmuted. i will now check to see if there are callers who wish to comment on the agenda item. >> i'm realizing i did not post the information. i'm hoping people did hear. we have zero callers entered the public comment queue. a reminder to callers you must enter the queue to make public

comment. there are no callers in the public comment queue at this time. hearing no callers, public comment is now closed. >> thank you very much board secretary. so we're now ready to vote on the motion as stated regarding the self-evaluation process and time lines for year 2021. all in favor of the motion will signify by saying aye. >> aye. >> all opposed? it passes unanimously. we're now ready for item number 13. >> thank you, commissioner scott. agenda item 13 is to initiative governance policies with the review process and time line.

this is an action item and will be presented by the chair. >> this process began back in 2015 with a really review of the terms of the governance policies of this board and which were adopted as you see back in 2007. there was a period of time between 2007 and 2015 where we didn't actually go through this process. that was one of the issues that we felt as a board when we got to this point we needed to put this on a regular schedule. so we have tried to look at and amend review and amend the terms of reference in the governance policies about every three

years. however, if there are regulatory or other city charter issues or other state laws that require or federal laws that require us as a board to do something differently, obviously we would response to that and wait to incorporate those requirements. but on a routine basis we tried to put this review on a three-year schedule. so this particular item authorizes the governance committee to do a review and bring the recommendations back to the board in january of next year. and a date would be december 2. we would be doing a page by page or section by section review of the terms of governance and also

during this period of time the board council and would be reviewing these policies to assure we are indeed complying with regulations or requirements that are currently not present in the document to be sure that's up to date as well. so this is what this item provides for and i'm ready to entertain a motion on this particular item. does anyone want to offer that motion? >> so moved. >> all right. it's been moved we initiative the governance policy in terms of reference of review for 2022 with the accompanying time line. is there a second? >> second.

>> moved and seconded. is there any discussion? seeing none, we will now go to public comment. i'll be calling up or visual instructions for public comment and reading them allowed. public comment will be available and each speaker will have three minutes unless the president deems new time. public comments are to be made regarding the agenda item present. as a reminder the caller may ask questions but there's no obligation to engage with the caller. when welcome you on the call you are encouraged to state your name but you may remain anonymous and then you'll be placed on mute at the end of your time and live viewing is

available on webex platform and you can dial in with 415-655-0001. when prompted use access code 24842265616. then press pound and pound again. you'll enter as an attendee and press star 3 to be added to the queue. for those on hold until the system indicates have been unmute. i'll check to see if there's callers who wish to comment on this agenda item. we have one caller on the phone line. zero callers have entered the speaking line. you must dial star 3 now to be

added to the public comment queue for this specific agenda item. we'll wait five seconds and then close public comment for this agenda item. there's still no callers in the queue at this time. commissioner scott, hearing no calls, public comment is now closed. >> thank you. woe need to vote regarding the review of the policy in materials of reference for 2022 and the accompanying time line. all in favor signify by saying aye. those opposed? the ayes have it and it is passed unanimously. with that, mr. president, i turn the meeting back over and chair back over to you. >> thank you very much for the work and the work of the sub-commitee. and we'll now go to agenda item

14. >> thank you. agenda item 14, reports and updates from health plan representatives. this is a discussion item. >> hi, commissioners. i'm from kaiser permanente. how are you today? i wanted to provide an update on union activities and strike activities taking place today in northwestern california and i'll talk about the details about that. there's been a lot of activity over the past several weeks. you've probably seen some of that on the news and the good news is we recently reached successful agreements with dozens of unions representing more than 6,000 employees. that was late-breaking news this week and were able to also reach

an agreement with the professionals and have new three-year contracts so there was not a strike that went into place monday morning for northern california for pharmacists and the alliance of unions represent about 50,000 kaiser permanente employees and we reached successful agreements predominantly a southern california based unions did want you to know that as well. we are continuing to bargain with local 39 operating engineers. they have been on strike since september 18. many have been aware of that. we have not reached an agreement but we are are bargaining in good faith and hope to reach an agreement there. what you may have seen on the news and if you're a kaiser permanente member you probably received information on there's several unions that submitted

sympathy strike notices in support and the operating engineers have that have been on strike since september 18. the unions on strike today are fdiuuhw local 20 which is klin cal lab scientists, optometrists, occupational therapists, many of those positions and medical secretary and office staff. they're on strike today. will be back to work tomorrow. we also received a sympathy strike notice from the california nurses association for tomorrow friday, november 19. it's a one-day strike. for all those unions i just talked about it's important to note we're not in bargaining with these unions and have you current contracts so these are sympathy strikes. we continue to garbage with the

unions that represent our mental health professionals and they have also announced a one-day strike for tomorrow, friday, november 19. today and tomorrow are the strike notices except for local 39 that has been on strike since september 18 and again that's about 600 operating engineers. important to know for kaiser permanente members we've been thoroughly prepared and brought in contingent workers. we have physicians and experienced clinical managers and staff there to support this work. we very rescheduled many non-urgent medical appointments and procedures for today and tomorrow or converted them so it was a combination of both of those. much of that work was done ahead of time to make sure we didn't have last-minute cancellations. we tried it make sure that our

members were affected as little as possible. some out-patient pharmacies are closed today and tomorrow and in the event of an urgent prescription need we haved plans with retail pharmacies and have others open so we're working with members to make sure they get any prescriptions that are needed. the pharmacists are not on strike but some of the workers in the pharmacies are on strike today. this continues to evolve. our emergency departments are open. we are fully prepared to handle this but we wanted to make sure you understood what was happening today and tomorrow and that we continue to bargain with these unions and hope to come to agreement very soon. so we apologies for any disruptions but it looks like we'll be close to back to normal by saturday. >> thank you.

i have a question. thank you very much. so does that mean first of all, i am a kaiser member. the mail order pharmacy worked well and the message came out in plenty of time to re-order. in terms of covid vaccination clinics and i have to commend as well the mechanism for members to get their series whether it's the booster or first two, are those closed today and tomorrow? did you have to interrupt the vaccine process? >> i believe all of those are still open. i know that we were attempting to keep it open. it's very important everyone continue to get their boosters. it was a priority. and we did have continue gen workers coming in. i believe they're all open if some were closed it would be just a few. >> okay. thank you. >> yep.

any other questions for kaiser permanente? >> thank you very much. it is confusing because the notice i got suggested actually it was a sympathy protest but not a strike but you're saying a strike so they were not showing up for work? >> there's many moving pieces but yes, today and tomorrow were strikes and protests as well. >> my misinformation was corrected. thank you. any other health plan representatives? hearing none, we'll open this up for public comment. >> thank you.

public comment will be available for each item on the agenda. each speaker will be allowed three minutes to comment in length unless there's new time lines during the meeting and any comments as a reminder a caller my aquestion but there's to obligation to answer or engage with the caller. when i welcome you you're encouraged to state your name but you may remain anonymous. when you're three minutes are ended you'll be placed back on mute and remote viewing is available using the webex platform and sf gov tv with recording the meeting and opportunities to speak are available by dialing 415-655-0001. when prompted use access code

24842265616. then press pound and pound again. you'll then enter the meeting as an attendee on the call line and dial star 3 to be added to the public comment queue. when the system message says you have been unmuted it's your time to speak. for those already on hold, continue to wait this will the system indicates have been unmute. i'll check to see if there's callers who wish to comment on the agenda item. we have one caller on the phone line. zero callers have specifically entered the comment queue at this time. must dial star 3 now to speak on this item. we'll wait five seconds and then close the public comment. hearing no further callers, public comment is now closed. >> thank you, this closes item

number 14 before i junior adjourn -- adjourn i want to thank holly for the virtual meeting and she's taken on more responsibility as some of the support has been intermittent and also i.t. for the city of san francisco for managing to help me meetings move smoothly as they do and the meeting is adjourned one hour before our scheduled adjournment time. >> duly noted and thank you.

>> one more statement.

we are the one. that is our first single that we made. that is our opinion. >> i can't argue with you. >> you are responsible please do not know his exact. [♪♪♪] [♪♪♪] [♪♪♪] >> i had a break when i was on a major label for my musical career. i took a seven year break. and then i came back. i worked in the library for a long time. when i started working the san francisco history centre, i

noticed they had the hippie collection. i thought, if they have a hippie collection, they really need to have a punk collection as well. so i talked to the city archivist who is my boss. she was very interested. one of the things that i wanted to get to the library was the avengers collection. this is definitely a valuable poster. because it is petty bone. it has that weird look because it was framed. it had something acid on it and something not acid framing it. we had to bring all of this stuff that had been piling up in my life here and make sure that the important parts of it got archived. it wasn't a big stretch for them to start collecting in the area of punk. we have a lot of great photos and flyers from that area and that. that i could donate myself. from they're, i decided, you know, why not pursue other

people and other bands and get them to donate as well? the historic moments in san francisco, punk history, is the sex pistols concert which was at winterland. [♪♪♪] it brought all of the punks on the web -- west coast to san francisco to see this show. the sex pistols played the east coast and then they play texas and a few places in the south and then they came directly to san francisco. they skipped l.a. and they skipped most of the media centres. san francisco was really the biggest show for them pick it was their biggest show ever. their tour manager was interested in managing the adventures, my band. we were asked to open to support the pistols way to that show. and the nuns were also asked to open the show. it was certainly the biggest crowd that we had ever played to. it was kind of terrifying but it did bring people all the way from vancouver, tee seattle, portland, san diego, all up and down the coast, and l.a.,

obviously. to san francisco to see this show. there are a lot of people who say that after they saw this show they thought they would start their own band. it was a great jumping off point for a lot of west coast punk. it was also, the pistols' last show. in a way, it was the end of one era of punk and the beginning of a new one. the city of san francisco didn't necessarily support punk rock. [♪♪♪] >> last, but certainly not least is a jell-o be opera. they are the punk rock candidate of the lead singer called the dead kennedys. >> if we are blaming anybody in san francisco, we will just blame the dead kennedys. >> there you go. >> we had situations where concerts were cancelled due to flyers, obscene flyers that the city was thought -- that he

thought was obscene that had been put up. the city of san francisco has come around to embrace it's musicians. when they have the centennial for city hall, they brought in all kinds of local musicians and i got to perform at that. that was, at -- in a way, and appreciation from the city of san francisco for the musical legends. i feel like a lot of people in san francisco don't realize what resources there are at the library. we had a film series, the s.f. punk film series that i put together. it was nearly sold out every single night. people were so appreciative that someone was bringing this for them. it is free. everything in the library is free. >> it it is also a film producer who has a film coming out. maybe in 2018 about crime. what is the title of it? >> it is called san francisco first and only rock 'n' roll movie. crime, 1978. [laughter] >> when i first went to the art

institute before the adventures were formed in 77, i was going to be a painter. i did not know i would turn into a punk singer. i got back into painting and i mostly do portraiture and figurative painting. one of the things about this job here is i discovered some great resources for images for my painting. i was looking through these mug shot books that we have here that are from the 1920s. i did a whole series of a mug shot paintings from those books. they are in the san francisco history centre's s.f. police department records. there are so many different things that the library provides for san franciscans that i feel like a lot of people are like, oh, i don't have a library card. i've never been there. they need to come down and check it out and find out what we have. the people who are hiding stuff in their sellers and wondering

what to do with these old photos or old junk, whether it is hippie stuff or punk stuff, or stuff from their grandparents, if they bring it here to us, we can preserve it and archive it and make it available to the public in the future.