it you know i'm a tiny girl but makes me feel good for sure. >> the sad thing the building is sold i'm renegotiating my lease the neighborhood wants us to be here with that said, this is a very difficult business it is a constant struggle to maintain freshness and deal with what we have to everyday it is a very high labor of business but something i'm proud of if you want to get a job at affordable housing done nasal you need a good attitude and the jobs on the bottom you take care of all the produce and the fish and computer ferry terminal and work your way up employing people with a passion for this and empowering them to learn

>> president bernal:i call the committee to order. secretary, will you call the roll. >> clerk: [roll call]

>> president bernal: thank you, everyone. and it is the privilege of the health commission to acknowledge that we are on the san francisco health commission acknowledges that we are on the unceded ancestral homeland of the ramaytush ohlone, who are the original inhabitants of the san francisco peninsula. as the indigenous stewards of this land, and in accordance with their traditions, the ramaytush ohlone have never ceded, lost, nor forgotten their responsibilities as the caretakers of this place, as well as for all peoples who reside in their traditional territory. as guests, we recognize that we benefit from living and working on their traditional homeland. we wish to pay our respects by acknowledging the ancestors, elders, and relatives of the ramaytush ohlone community and

by affirming their sovereign rights as first peoples. >> clerk:thank you, commissioner. commissioner bernal asked me to call up the items because we're going to change the order a little bit. for everyone to know that we're going to move up item 9, 10 and 11 before items 7 -- sorry -- 6 and 7. so moving forward, item 2, we've got d.p.h. employee recognition awards and first we have commissioner green. >> vice-president green: yes, well, i am so honored to be able to acknowledge the covid task force neighborhood vaccine team your work is spectacular. the neighborhood vaccine team has been working diligently with various community partners to bring covid-19 vaccine directly to the neighborhoods and communities most impacted by the pandemic. this includes those with the

highest burden of disease as well as with the highest economic impact. the staff working on the neighborhood vaccine team come from a variety of city departments, and the d.p.h. divisions. in close partnership with the community-based organizations, this team tirelessly worked to integrate and co-locate covid-19 testing services and to provide health education as well as community support services such as food assistance, supplying cleaning and protective equipment, and other invaluable resources. since january 24, 2021, first day of operations at the 24th and capp street community vaccine site, the neighborhood vaccination team has launched and operated eight community-based sites in the mission, bayview hunters point, visitation valley, excelsior and the tenderloin neighborhoods. between january and june 2021, they had 272 vaccine clinic events. the neighborhood vaccination

team and their community partners implemented 272 vaccine clinic events which supported 39,1021 individuals who lived, worked, learned or went to san francisco to get vaccinated against covid-19. the team's efforts could not have succeeded without the deep and trusting relationships that the site lead staff have developed at each of their individual neighborhood vaccination sites. and their ongoing advocacy for community partners and residents. as disaster workers, all of the staff on the neighborhood vaccination team, have left their regular positions, and put all of their hearts and minds towards supporting the most vulnerable san franciscans in accessing culturally responsive and linguistically important services and information, the team has gone above and beyond their call of duty to ensure that sites were operating to the highest standards, continuously improving the quality of services and responding to the

shifting community needs. this team exemplifies best practices and partnership building and cultural and community responsiveness, health education, and public health. it's my honor to introduce marina spiegel to read the names of the team members and make remarks regarding their impactful, incredible work. >> thank you so much, commissioner green and the rest of the commissioners. it is truly an honor to be here on behalf of our team. it is a team that has started as really small and mighty with drn getting this team off the ground in partnership with the task force at 24th and capp. since i shared that information with the commissioners, we've actually opened up two additional sites for a total of 10 sites. and through november and the end of november we have vaccinated

over 66,000 san francisco residents. so it's a tremendous, tremendous feat done by our team. and i just wanted to recognize, again, our fearless leaders from the very beginning, dr. jonathan toques, and dr. hernandez, and emily ravinald, and our operations, and as well as a leader in our team niema crown, and all of our vaccination site leads, alexis mendez, and lucia aranando, who those who might not be on the call because he's in the community, and david lavak, and [reading names] and phil dell cruise. it's been an honor to work with folks from the task collector office, from the library

department, from our election office. and seeing how everybody has cared for the community and contributed to these great successes. this week we're administering as many as 3,000 doses of vaccine, boosters and pediatric doses across our sites. and, again, it is truly an honor to work alongside the individuals that have been there and the vaccine team as part of the covid response team. so thank you so much for your recognition. and for taking a moment to speak and share about the successes of the team. >> president bernal: let's give everyone a round of applause on this team. thank you. all right, next up is commissioner guillermo.

i will unmute you. you're un-muted, commissioner. >> commissioner guillermo: thank you, mark. and i'm really happy to be able to read and present this award to the covid task force logistic supply unit. various members of this team have been working in the covid response since january 2021. all while maintaining the hospital and the supply chain regular operations. their work in the logistics section in the covid response only intensified as each month passed, and continues to expand daily given the monumental task to complete and mitigating the current surge. people in this unit have stretched themselves in ways they probably did not know that was possible, all the while supporting one another through transitions, staffing challenges, shutdowns, demobilization and four surges. the team members had innovative

systems to manage the millions of unit of p.p.e. and other non-scarce supplies distributed across san francisco each week. they truly are the unsung heroes of emergency response. this team has saved thousands of lives. i'll now introduce dave to read the names of this team and make some comments about their work. >> thank you, commissioner. i am honored and humbled to receive this award today. i am equally humbled to work with such a brilliant team. some of whom have been angt actd since the birth of what was then called the d.o.c. they took a manual process, or a manual processes and transitioned into what it is today. their tireless work has gone unnoticed and the team has been responsible for the prompt and the safe delivery of p.p.e. and

other supplies. and just beyond really, ensuring that we have everything that is needed -- that was needed for the pandemic at every stage. i have the most appreciation for solomon and david, william, patrick for their dedication during this pandemic. i appreciate you so much. and this award should be hung high because you all deserve it thank you so much. >> clerk: thank you, let's give everyone a round of applause. thank you, daisy. next up is commissioner bernal. >> president bernal: yes, thank you so much, and i'll provide this recognition on behalf of myself and commissioners cecilia chung. thank you so much to dr. susan buckbinder for nominating bridge h.i.v. within the population health division at d.p.h., in addition to continuing to

conduct from her groundbreaking h.i.v. prevention research as part of the local and global efforts during the covid pandemic on h.i.v. vaccines, pre-exposure, and other strategies to prevent h.i.v. infections, the bridge h.i.v. team took on recruiting, enrolling and retaining 256 study volunteers into a covid vaccine trial, the largest group enrolled in the bay area. of these, 81% were people of color. this hard work to ensure adequate representation of underrepresented groups is a testament to the team's commitment to diversity and to the well-being of our study volunteers. this truly took teamwork and the development of a new website in english and spanish, which wecanbeatcovid.org, and recruiting in the midst of the pandemic, diverse study volunteers, to enrolling participants and having clean

and accurate data systems for tracking results. the team enabled the local community members to contribute to the global covid vaccine effort, and we are so grateful to them and proud of their work dr. hyman scott will read the names of the team members and make remarks regarding their work. thank you, dr. scott. >> thank you so much for presenting this award to bridge h.i.v., and i'm honored to accept that award on behalf of the entire team here. and as was mentioned there was a strong emphasis on health equity in our response to the covid-19 pandemic. as has been our response to the h.i.v. pandemic as well. and i think, you know, the focus on engaging communities and being a resource within the community for information was something else that i think that the team really exemplified, being available to answer a lot of the questions that came up around vaccines, particularly when there were side effects being reported in the press with

lots of misinformation. accompanying them our team did a lot of work with our study participants. so i am honored to accept this award on behalf of the team, which includes albert lou, alphonso diaz, april garcia, gilliume malloy, and emily shafer, and josé carlos, known as garza. and [reading names] nicole walker, and sabrina davaro, and susan buckbinder, and william juárez. so we're honored to accept this award and i thank the commission. >> clerk: let's give this team a round of applause. thank you, dr. scott. >> president bernal: thank you, dr. scott, and thanks to who

both presented and nominated these extraordinary teams for this recognition today. it's really a highlight of every commission meeting for all of us. so thank you, not only for the work that you do, but for being with us today. >> clerk: all right, so item 3 is a resolution making findings to allow teleconferenced meetings under california government code section 54953 [e], this is the same resolution that is passed each month for you to continue to have remote meetings. the resolution is put before you. >> president bernal: thank you, secretary morewitz. we are required to adopt this to continue meeting virtually. and so you do have the resolution before you. do we have a motion to approve? >> i make a motion to approve this resolution. >> second.

>> president bernal: secretary morewitz, any picture comment on this item? >> clerk: folks on the line, if you would like to make comment on item 3, please press star 3, so we can recognize you. star 3. commissioners, just to remind you that the hands for public comment is in the dark black, so i have to stare at the screen to make sure that i don't miss anyone. i see no public comment. so i'll do a roll call vote. [roll call vote] great. the item passes. we can now move on to item 4, which is a resolution addressing health disparities of the local american indian communities. commissioners, i would like to lead the draft resolution. is that okay?

>> president bernal: yes. >> clerk: whereas the health commission acknowledges the disproportionate health disparities faced by american indians and native alaska an communities such as shorter life expectancy and higher rates of diabetes, heart disease, aids, premature death, domestic violence and other violence exposure, stress-related illness such as high blood pressure, depression and homelessness and suicide, as well as morbidity and mortality due to the covid-19 pandemic. and, whereas, the health commission acknowledges that american indians and native alaskans may face barriers including unstable or lack of housing, food insecurity, and limited access to culturally sensitive health care services. and, whereas, the health commission acknowledges that the existing american indians and native alaskan health data had gaps characterized by a lack of selection on the american indian and underreporting on the american indian and native

alaskan health indicators, rendering data insufficient to fully identify the disproportionate health disparities faced by the american indian and native alaskan communities. and, whereas, the health commission acknowledges the resources directed to the american indians and alaskan native organizations have not been proportionally to the disparity of the health problems in the community, and the human rights commission reported in 2007 named discrimination by omission, issues of concern for native americans in san francisco. and detailing the ways in which american indian community have erasure and exclusion in san francisco and recommendations for improved outcomes and process which was guided by members of the local american indian and native alaskan community in trials. now be it resolved that the health commission recommends the san francisco department of public health to establish meaningful and ongoing partnerships with local american

indian and native alaskan organizations, community leaders, and community and tribal members to identify and to understand their public health needs and to develop a set of public health priorities. and be it further resolve that the health commission recommends the san francisco department of public thoalt have accurate and disaggregated american indian and native alaskans' health data and health impacts in public reporting when possible, and be it further resolved that the health commission directs the san francisco department of public health to add a footnote to any presentation or report that includes race and/or ethnicity data, for specific communities to ensure that no community is invisible due to its size or small data sets. and that the health committee work with local american indians and native and alaskan native organizations and community and tribal members to identify the recommendations to address these health disparities, including updates to the health commission

within six months on this process and a summary report in one year. >> president bernal: thank you. secretary. >> clerk: i had a bit of history to go with this. if it's all right. >> president bernal: please, go ahead. >> clerk: so as part -- commissioners, if you recall and the members of the public, as part of the part of the development of the ramaytush ohlone resolution back earlier this year, several commissioners asked for health disparity data to be included in that resolution. and the ramaytush ohlone elders requested that that land acknowledgement resolution stand alone as a permanent policy and that anything else that might shift or change to be put in another resolution or an additional resolution. so after you paul pass the land acknowledgement resolution in august of this year, dr. bennett, who is the director of the office of health equity and began to work in earnest

with this, the american indian and the native alaskan communities here on the draft. and we received the last draft that is before you in october. and so the community has vetted and given input and really helped to craft what you see before you. dr. bennett is here today to answer questions and to make comments as we move along. and after you all talk a little bit, there are five leaders and elders who are here to make comment as well as part of the presentation. >> president bernal: thank you, secretary morewitz. before we go in, before we continue, um, with dr. bennett, i would also just like to acknowledge the american indian community elders and leaders who are joining us. i thank them for their presence it's our privilege to be spending time with you today. thank you for working closely with dr. bennett and secretary

morewitz on this resolution. and we look forward to hearing from you more. i'd like to acknowledge dr. bennett and offer her the opportunity to speak or to make introductions. >> hi. nice to see everyone. so, i will say very little because i want to hear from the community and if there's anything else to say, i will say it after them. i appreciate that we're making steps forward to do some reparation on what is owed as well. >> president bernal: thank you. >> i'm not sure who is speaking first. >> clerk: i introduce the first speakers, commissioners? >> president bernal: please. >> clerk: so sharia souza will begin and if each can introduce the next person that would be wonderful. >> thank you. good evening, everyone, i am

sharia, and i'm an executive director with the american indian cultural district. you know, for us this was as mark mentioned initially started out as a further resolve section as part of the ramaytush ohlone resolution. but as we really looked into it and we really started looking around the website, particularly your vulnerable assessments and your racial equity outreach and engagement and where that budgeting and that funding was exposed, it became extremely evident that no matter how much you hear in the media or how much you see, you know, on the news about american indians having the highest covid rates, that our community was being left out. i looked back specifically at the cultural competence plan updates around 2010 and 2016. i believe that it was 2010 or 2016, one of the two, that the american indian data fell off or fluctuated. we were 1.1% of the population

depending what you read. and this is really concerning, given, you know, that there's been a long history of folks like native n american health association and the friendship center that have worked with the department of public health and received funding from the department of public health and have been doing advocacy for a very long time. especially as the city shifted into a racial equity lens. i wanted to bring that to your attention and around the data points that your vulnerable populations which is 1.4% of the budget is actually navigated towards american indians, whereas, if we look at our black and latinx, we have 24% of the budget allocated towards them, even though american indians have the highest rates of h.i.v. and aids in san francisco. we are 17 times more likely to be homeless than any other population. i recently found by looking at counts if you were to re-house every american indian in san francisco, you would increase

our population by 10%. when we came to the city and we started coming together as an organizations that came to the city, and have been gathering as a cultural district, in the friendship, and the cultural center, a lot of other organizations that i haven't mentioned, is that what we really found is just a big dikrepsancy in the data that is happening in the city and really finding our voice to stand up and to advocate as a collective so i just wanted to express and to highlight the importance of establishing those partnerships with american indians to correct these mistakes so we can have funding that is proportionate -- sorry -- that is equitable in relation to the impacts that are happening to american indians. the highest homeless rates and the highest employment rate and the second-to-lowest income rate, but if you look at how the budget is allocated towards american indians and look at the engagement and you go back and look at your own diverse city and engagement assessments, it's

almost completely very minimally touching on american indians. i will have one more example. i went through the -- the vulnerable populations engagement assessment and i the american indians came up four to six times. and latinx came up and they haven't been getting much more diverse. so this is a really, you know, strong discussion on the future of engagement and how you intend to engage with the communities and the people on this call that have been doing this much longer than i have and how we're going to come together and take this seriously and work to really combat this. and we say racial equity and advocacy injustice and how we can bring those resources and those fundings to the american indian people. so with that i want to say thank you and i want to call on the folks that have been doing this work, and really hear from them and hear what they have to say.

so next i'll go ahead and call on dalile. thank you for your time. >> clerk: thank you. >> good afternoon, good evening, can you all hear me okay? >> clerk: yes. >> all right. well, good evening, friends and family. i am born and raised in the bay area. i am currently the contact and compliance manager for the association of american indians on behalf of the friendship trust association of american indians and its consortium, i would like to thank the health commission and dr. bennett and her team at the department of public health for prioritizing, addressing the american indians, native alaskan health disparities and taking action to coordinate data on health indicators and committing to communities need assessments for natives across san francisco. the friendship house is a residential treatment facility located in the heart of the

mission district. and serving our american indian relatives from the bay area as well as tribes from across the u.s. the rare resource, we recognize the value of medical, psychiatric and community health data that we track on vulnerable populations dealing with substance and mental health issues. we say that the barriers are from fragmentation so the indian health city and the city and county and kaiser data are unrelated and where there's an underrepresentation and immovability of the health status of our american indians and alaskan natives. in partnership with many native led organizations present today, we are constructing village s.f the village s.f., i'm smiling because this project means a loa six-floor social service and cultural hub that will be a holistic and informed response to the needs of the san francisco native people.

the village will offer medical, dental and behavioral health services, supportive housing for graduates of our recovery program, and a workforce development program that includes food and medicine program, and a youth center featuring a digital media program. and a cultural center that includes services for our elders. as we continue planning programs for the village, it is essential that we have accessible data for our community. each of the programs will have their own data and we may not have the same data, but our concern is how the data that we report to health services is not reported to the department of public health. there needs to be a process of our conversations, a dialogue, to create day-to-day analysis. data sharing and the information that we have about the community needs, and the disparities are reflected more accurately. there needs to be an ongoing process in place that helps us to track and share data. finally, we recognize the

importance of culturally informed care. and residential substance abuse care. and we encourage the commission to continue to support the best practice programs that foster culturally resiliency in the american indian and alaskan native communities. thank you. i would like to pass it on to my brother, anthony. >> good evening, everybody. my name is anthony, and i am the director of community wellness at the native american health center. the committee wellness department is an intersection of cultural, conditional, ceremonial ways of the native americans, to ensure that our programming has those elements completely vested into the work that we do and to the grants

that we manage here at the health center. i wanted to make a quick detour here, just a tad, and i know that we're on limited time, but there is a staff meeting and a story of tragedy and triumph that is occurring in cities across the country and particularly in san francisco. and that is the renaissance of urban american indian life. in 1953, there was an act called the relocation act that attempts attempteradicate american indiay shipping them off to places across the country. as my sister was already talking about, that those relatives that made their way to this city came and trekked and in this brave way, to bring their families and

to find a path for their success in these cities. what they found when they got here was a lot of challenges, whether they were in the communities and in the neighborhoods that they lived in, but also in systematic struggles that they faced by not having, you know, access to childcare, access to healthy food and rental assistance and housing programs, culturally sensitive programming to meet their needs. that reality has continued to come on since 1953, here to present day. however, grassroots organizers started their own programs and understanding that those in need were drastically -- were needed in order for our community members to sustain. that is, you know, the tragedy of those issues that our

community members have faced and the success and the triumph that they are still here. i have an auntie who left from utah at 18 years old and came out here like a nurse in that program. her family is still here today. where she now has grandchildren that run around in the bay area and it's a beautiful thing to see, you know, that not only is she still here, but they're thriving. and with us being able to get funding at a level that is needed for these programs and in san francisco, will not only sustain, but ensure that the generations to come will thrive and become a major, major part in the community and the city of san francisco. our relatives that live in the city and contribute to the greatness of that wonderful, beautiful city across the bay. so i want to say thank you all for your support and ensuring

that these organizations get the support that they need and, again, thank you all very much. i will pass this mic over to -- who do we have here -- april. thank you all. >> thank you, anthony. i just want to first say thank you dr. bennett, thanks to the health commission, for allowing us to be here today. i am april mcgill and i'm a member of the brown belly indian tribe. i have lived here in san francisco for over 20 years and i have worked for friendship house and the native american health center and i currently hold the position as a director of community partnerships and projects and with the american indian cultural center. and one of the co-founders of the american indian cultural center. and we have all played a crucial

part in the wellness of the american indian community here in san francisco. we recently lost one of our leaders, helen wakazu, who carried this advocacy for generations to make sure that our families have had health care and traditional healing services. the health center and friendship house have always held -- been this cultural hub for our community. and with a loss of the american indian cultural center, and that's why it's so important to have the cultural center because we're able to provide traditional healing services for our community be and they are part of our wellness and part of making sure that our people are staying connected to who they are as american indian people. you know, we have one of the highest rates of suicide among our native youth nationally. and it's really important for our youth to be able to be

provided services for both mental and behavioral health. you know, we need more funding for these types of services. this goes back to one-on-one therapy, i guess you could say, in the western world. which would be these -- with traditional healers, through talking circles and we need to make sure that we have this funding for our youth. you know, we have one of the highest -- california, actually, is number five in the nation of having the highest missing and murdered indigenous women. and san francisco, right here, we have -- we're in the top 10 nationally as cities that have the highest of missing and murdered indigenous women. and these are young girls that are being trafficked. and that are runaways and that have had issues with mental health services and so we need

the support and we need to be included in conversations and we need to make sure that the data that is being collected is not only coming from our organization, but also coming from the city and the county and that they're including us and these need assessments. it's crucial for our communities to make sure that they feel safe from covid and they have access to vaccinations and that you're funding health care facilities. i want to share that this year that they worked hard to make sure that we were providing food for our families weekly, delivering food to our native families throughout san francisco. and these collaborations are done with the rec and health center and the friendship, and the cultural district. so we all are working together. we have seven native organizations right here in san

francisco. and we all provide services and we ask that you continue to bring us into these conversations and think about our communities when you are thinking about these health disparities. thank you. and i will pass it over to the executive director lee. my boss. >> april, thank you. [speaking indigenous language] hello, my name is virginia, and i'm a member of the uroch tribe and with the california consortium for indian health. and we work on behalf of the 10 health services, and urban association organizations, which is two of our organizations find their homes in the bay area and specifically san francisco. i am honored to do the work on behalf of leaders like these. san francisco is also home to our founding office in presidio

i want to thank the commission and dr. bennett for your work and just underscore how important accurate and timely data is for vulnerable communities like american indians. you know, i was a part of what was known as the california tribal epidemiology center and about 15 years ago we produced two publications that showed racial classification deeply impacted american indians and alaskans in both hospitalization and death data. that when an american indian person goes into a public or a private hospital, we are racially misclassified as white, or hispanic, black or another race. or if we are categorized correctly as being american indian, we are indicated as being a multirace and most often saw in an "other" category. when it comes to death certificates, we are literally born indian and dying white.

that means when our mothers fill out our birth certificates they indicate us as american indian and when a funeral director does our death certificates they indicate our race as white or something else. this has devastating impacts, you can imagine, when you are trying to look at the health of a people and how to address issues and problems if you don't know that you have a problem, there's not much that you can do to address it or fix it. i think that the key solution is that you're hearing from leaders who do know our strengths, we know what we're doing well, we know where we need more support to continue to do those things. we also know the issues of our community better than anyone else. so when we speak out and in the data we never assume that it means that the problem just isn't there. we assume that we're not counted and we're hidden in an other or multirace category that we are categorized for historical reasons and the missionization

of california and the relocation of so many american indians into our urban areas. i want to appreciate the land acknowledgement first and foremost, that san francisco is the indigenous homeland of the ohlone people and those who come to visit are visitors. and so when i think about the community needs assessment, i look forward to the continued partnership from our organizations, and the friendship house and native american health center as being trusted partners and allies. and being able to develop need assessments to speak to the true needs of the community. and then, you know, i think that we measure resilience and we measure strength in ways that sometimes the western world doesn't always look at the same things that we look at. and so having the opportunity to have primary voice, to have primary voice and authorship of reports, to be able to look at things in a very culturally specific way is really important. for example, i work with the state of california about five years ago to look at the health of american indian babies and i quickly found out that the state

of california wasn't counting any american indian babies that were born to american indian fathers. they only counted indian babies if the mother was american indian. you can understand that has cultural implications but also very clear data implications and minimizes our communities in ways that we wouldn't know if we didn't have the statistician really digging through the data to determine what was happening and how we were undercounted. i could give a number of really specific epidemiologic examples of how to do data better. we could look at culturally specific indicators in ways that we might not already be looking so i think that there's a number of solution when's we think about culturally specific and culturally tailored and voices and solutions that come from the community are always going to be more successful than not. so i don't want to take up more time than allocated here this evening. but i want to thank you again for offering us a moment of your time to really talk about the needs related to the community

needs assessment, to community building and funding organizations that are directly serving the american indian population in san francisco. >> clerk: well, thank you very much, and to anthony guzman and sharia, and thank you for mentioning helen. i had the privilege to work with her on a number of occasions over the years and her passing earlier this year was a great loss, not only to the american indian community, but to all of san francisco. and the many people that she served in those lives that she touched. so thank you, thank you so much for that. before we go into commissioner comments or questions on the resolution, now is our opportunity to hear from the members of the public and the public comment. secretary morewitz.

>> clerk: sure. folks on the line, if you would like to make public comment on this item, item 4, please press star 3, so we can recognize you star 3. i do not see any hands, commissioners. >> president bernal: all right, thank you, secretary morewitz. commissioners, well, we'll move to questions and comments from all of you. i will just start by saying that we are so grateful for the partnership of the american indian community. our best and our most important work here at sfpdh is done in partnership with the community. and your insights and your input and letting us know what we can be doing better will only improve the health, not only of the american indian community, but of all san franciscans. so we're very grateful for your partnership. commissioners, do we have any comments or questions, understanding that this item is

being introduced at today's commission meeting and it will be voting on this resolution at our next meeting which is january 4th. is that right -- yeah, january 4th. >> clerk: there's a meeting in between but it's the laguna honda annual meeting. >> president bernal: thank you, secretary morewitz. i see commissioner green, vice president green. >> vice-president green: i just want to thank you all for you educating us. we all hear about the health service in places like south dakota and some of the things that have been in the news and some of the heinous things going on with abuse from staff in hospitals and so forth, but to hear the detail that could be, and the information that could help to us do a better job for our local community and to set an example for communities around the country is absolutely invaluable. so i wanted to just voice my gratitude at these meetings to learn so much about the needs of the community and to hear from

our community partners, it is absolutely critical. hopefully we can be as supportive as possible to really advance all of the concerns you have and to bring into focus some of the injustices that you have articulated today, so i'm grateful for your comments and for you sharing this information with us. >> president bernal: thank you, vice president green. commissioner chow. >> commissioner chow: thank you, president bernal. and you will note that my hand does work now. i did want to thank the commission for moving the agenda forward to create a program for the american indian and native alaskans in san francisco. when we were asked to acknowledge the presence and the

rights of american indians, many of us had felt that it was also important to really recognize that it is the health department and as the health commission that we should be addressing its needs in a much more visible manner. i recall funding friendship house, of course, for many years, but i have actually not recognized that -- until being reminded again -- remembering that it was also for our american indian -- sorry -- residents. i also think that this is a fine example, again, of us trying to take the issue of health equity and being able to bring it down to the level of those different communities that need it, and, mr. morewitz writing on the

[indiscernible] or a resolution, i think that particularly it is important that we have now -- rather than merely in our asian resolutions pointed out that it was necessary to disaggregate data, to really ask the department to disaggregate or let us know when data is not there for our different populations. so that we would not forget them. and so i want to particularly encourage the community to really work with the department i know that often and we've seen historically in working with our african-american community, that there is mistrust and the bureaucracy is so large. the department is so enormous that one might feel that they're not being heard. but it is also important to come together in whatever diverse

gatherings that you all have from the communities to work together, not as a special agenda, but to find the one that works for all of -- for all of the people within the american indian and alaskan community. i know that is hard to do for a lot of people who are strong advocates of something. i have watched this historically in our department, where we have struggled with various community organizations. and we would find that in all good faith, one or another organization would feel that they had the answers. i think that the ability to actually look at the whole and see where one can be as part of that whole, will lead to success in working with the department.

i think that the commission has taken a very strong stance, as has the city, that we must address diversity and inequities. i think that it is now up to the communities, including yours, to bring that to fruition by actually presenting clearly as you have today your needs and then work with the department to address those in a meaningful fashion. i think that dr. bennett is an excellent leader on our side to do that. and i really commend her for really understanding all of the different communities. i think that you have a great opportunity. and we look forward to our report in six months that we are making progress to work on the problems you are all facing and to come up with solutions for them or at least attempts to

create the answers to your problems. so thank you very much. and i appreciate everybody that has really worked on this and helped to bring the american indian and the native alaskan issues to the fore for our department. >> president bernal: thank you, commissioner chow. we'll go back to public comment because we do see one hand raised on the public line. secretary morewitz. >> clerk: person on the line, for each agenda item, the members of the public will have an opportunity to make comments for up to two minutes. it is designed to have input and feedback from individuals in the community, but it does not allow in back and forth conversations with commissioners. the commissioners do consider the comments when discussing items and making requests to dph. each individual is allowed one

opportunity to speak per agenda item and you cannot return more than once. i put two minutes on the clock and the person on the line, i just un-muted you. can you let us know that you are there. >> caller: i am here. >> clerk: great. also i'm starting two minutes and you have the clock. when it buzzes know that your time is up. >> caller: thank you to the commission for my two-minute comment. i am from the san francisco department of health. and this is everything which constitutes lawful direct and constructive notice to you personally and to all of your subordinates. a new -- and your successor, and your agents. the purpose of this notice is to make you aware of violations of law and allow you the due process rights to correct them and take your actions to the limits placed upon you by the

california state institution and the constitution for the united states of america. in regard to any and all covid-19 policies, orders or mandates -- such as guidelines for physical -- >> clerk: okay, i'm going to stop you for a second. so the comments that you are making doesn't sound like it pertains to the item that we're on, and, unfortunately, there's very rigid rules around public comment for items. so can you clarify if you are commenting on the american indian and native alaskans? caller? >> caller: it is relevant because it is also affects them as a people of the united states of america, it affects them, as well as everybody else. >> clerk: okay, go ahead. >> caller: so, to continue, i was saying in regards to any and all covid-19 policies, orders or mandates have physical distancing, masking, testing,

tracking, status forms of vaccination and others, there is no actual law that has been passed by the state or federal legislature that requires me and others to comply or compels me and others to consent to the violations of my natural and unalienable protected rights. and in the cases, are as follows -- the constitution is the ruling law of the land, and the law that is [indiscernible] is null and void. and it is over all other laws and it should be enforced in favor of him. and expressly designated beneficiary. the orders may or for the agent or officer for a city or county or state or department, are not law. and public policy cannot violate the rights of the people.

>> clerk: thank you for your comment. commissioner bernal, and commissioner guillermo has his hand up, so that you know. >> president bernal: yes, thank you, secretary morewitz. commissioner guillermo. >> clerk: give me one second. there you go, commissioner guillermo. >> commissioner guillermo: okay, great, great, thank you, president bernal. i wish that my connection was working so that i could see you all on screen, but i want to just support and endorse the comments that have been made so far by my fellow commissioners. and to thank the community that has testified today for your passionate advocacy around the policies, procedures and operational -- the operations that the department can put into place in order to promote the

issues and the concerns that are contained within the draft resolution and beyond. just i want to be able to say that this is something that i have -- a connection with. in terms of particularly around the data issues that are of concern and that have been articulated. when i was heading the asian pacific health quorum during a period of time when the health care form issues were first raised in the clinton administration, i had the honor of working very closely with james crouch, the california rural indian health board, in traveling around the state trying to work with others to educate communities that had

been traditionally marginalized in terms of health policy and health data. and health access. and in that, had a great deal of education myself. on the native american issues. and indian country issues, the social determinants of health that we all talk about now have shown up clearly and historically in native american communities way before we were able to put together a -- sort of an articulation and call -- call the social determinants of health concept. we were living the issues and the conditions and the effects of that for generations. and so i am proud to be able to

be a member of this commission in support of the concerns raised, the issues that have long been ignored, and, again, express deep support for the resolution. >> president bernal: thank you, commissioner guillermo. i speak with the commission when i say that we're all in agreement with you. before we move on to our next item, i'd like to recognize director of health, dr. grant colfax. >> thank you, president bernal, and i will be brief. i wanted to just thank the speakers for their comments. and to acknowledge the work that went -- that has gone into this resolution. and express my commitment as the director of the department to take actions once the resolution

is passed by the commission to realize many of the issues that have been brought forward today so actions speak a lot louder than words. and i just want to be clear that i take this extremely seriously and will work with dr. bennett and the multiple other people across dph to ensure that there's a true partnership that continues. and that the rules of the resolution are realized. thank you. >> president bernal: thank you, director colfax. you speak for all of us in that regard. so thank you very much. so we look forward during our january 4th meeting to see members of the community back with us, special thanks again to sharai souza and anthony guzman and virginia hedrick for joining us today and for your leadership in the community and for engaging so constructively with

the department of public health, also great thanks to dr. ioanna bennett for your work within the department to address disparities in health in san francisco for our american indian and native alaskan communities and many others. i believe that we are ready to move on to our next item. thank you again. the approval of the minutes? >> clerk: yes, i wanted to say a personal thank you to all of the speakers and thank you for taking time to share with us today. >> president bernal: secretary morewitz i was remiss in not acknowledging you for your leadership in drafting this resolution and for organizing today's -- today's testimony. thank you. >> clerk: it's a pleasure. item 5 is the approval of minutes, the november 16, 2021 meeting. >> president bernal: you have the minutes from november 16th of the health commission.

if there are no amendments, do we have a motion to approve? >> i move to approve. >> second. >> president bernal: thank you. >> clerk: i'll start with the roll call vote. [roll call vote] >> i thought that we needed public comment. >> clerk: you are correct. i apologize. folks on the line, if you would like to make a comment on item 5, which is the approval of the minute, please press star 3, and raise your hand. again, i apologize. i see no hands. so shall we proceed with the vote, commissioner chow can you say your vote again. [roll call vote] again, my apologies to everyone for that. so the minutes pass. >> president bernal: secretary

morewitz, are we now skipping to item 9? >> clerk: actually 8 for general public comment. >> president bernal: thank you. >> clerk: as noted, we will get to the director's report and the covid update after the next few items but right now we're on general public comment. so folks on the line if you would like to make a comment on something that is not on the agenda, please press star 3 to raise your hand. we will give you a few seconds to show up. commissioners, okay, great, i see a hand. i have something to read before we go. at this time, the members of the public may address the commission on items within the subject matter jurisdiction of the commission, but are not on this meeting agenda. each member of the public may address the commission for two minutes and the brown act forbids the commission from taking action or discussing any items not appearing on the posted agenda, including those raised during public comment. all right, person on the line --

all right, i have put two minutes on the clock and let us know that you are there. >> caller: hi, my name is novia, and i have worked for san francisco department of public health for over 17 years. and i am currently on admin leave because i do not comply with the city vaccine mandate policy. the mandate allows us to submit the religious or the medical exemptions to request for accommodations and i have submitted my religious exemptions because i believe god created us with the supports that we need in our immune system and i do not need to pollute my body with the vaccine, yet my exemption was denied and i was threatened for termination because i did not meet the minimal requirements for my job. why can't the city accommodate me? i have been able to work 100% remote all of this time with no impact on my work quality. i had the yearly papers to prove

it. if the vaccine is required as a requirement for my work, and since i won't be able to remove the vaccine from my body when i'm off work, then i require to be paid 24 hours a day for 365 days a week. 365 days a year. sorry. so far there's not a single city employee who has submitted their religious or medical exemption that have been approved. why is that? it seems to me that the city and the county of san francisco is not following the law and do not care about the law. you are so objective, and to inject as many people that you can with fear and coercion and by way of termination. this is wrong and unlawful. and i strongly suggest that the removal of the vaccine mandate. thank you. >> clerk: thank you for your comments. we have another caller. caller, you're unmuted and let us know that you are there.

>> caller: hello. my name is robert geller and i have worked for dph behavioral health for 23 years, collecting to pay for medical health and substance abuse services for residents. i have received 23 years of perfect compliance, and for everything that dph asked of me but because i have not had the mandate, you have cut my hours 40% and threatening to fire me. my manager says that it would be, quote, a disaster to lose me. and what a poor decision, business decision, it would be considering the money that youingly spend training my replacement for the $1,000 that you just spent on my training and the member that you will lose by walking out the door. you are all guilty of misappropriating taxpayer funds the main reason that i will not get the shot is because i have chron's disease and it put me in the hospital for three lines and i have barely eaten and

infusions and i am on the monoclonal and it's getting better. and there's adverse events, if you don't know about it you should not be in this commission. there were 289 reports of vaccine triggering or activating crohn's disease, most submitted by clinicians. it is clearly detrimental to some people with chron's. how could i jeopardize the progress that i have made, to force me to get shot is torture and to force someone like me to get the shot to keep my job is sadistic. yet despite my position and i have been turned down, and restricted by narrow criteria. dr. colfax or any m.d.s here will you issue me a medical exemption so i one of your best and loyal workers can keep my job and continue to feed my family? it's only fair at

robert.geller@dph.org. that is g-e-l-l-e-r. thank you. >> clerk: we have another comment. person on the line, let us that you are there. >> caller: hi, my name is lilliana dell arosa and i'm a coordinator with the bihaif youral health services and have been with the department of public health for 8 1/2 years. i was brought to this work because of my commitment to improving health and wellness. and equity for our san francisco beneficiaries like many of you that can relate. on november 1st, due to a pending religious exemption, i was put on administrative leave although i have not yet received a determination, i am feeling discouraged because i know that hundreds, if not all of the religious exemptions have been denied. i am asking you all to please reconsider your policies around vaccine mandates and accommodating religious exemptions. i am asking you to stand by the first amendment and to title 7

by upholding the right to religious accommodations. the current policies will not only hurt me, my 3-year-old daughter, my husband, my family, my livelihood, but also our beneficiaries. i manage regulatory mandated performance improvement projects and regulatory mandated audits and reviews. and our medi-cal beneficiaries will suffer if i am fired. so please reconsider your policies and your processes and stand by the first amendment and title 7 by upholding the rights to religious accommodations. thank you all for your time. >> clerk: thank you for your comments. i see one other hand. okay, caller, let us know that you are there. >> caller: yes, can you hear me? >> clerk: yes, you have two minutes. >> caller: great, thank you.

on november 3rd, 2021, [indiscernible] about dangers of covid-19 injections and crime of those who mandating of those vaccines. i wonder if any of you had an opportunity to listen to this debate, because unfortunately none of the media showed up, none of the government people showed up, none of the people that they created those mandates showed up. now i will encourage you, all of you, to go to that debate and if you don't have the link to the debate, i will be gladly to provide this. you can email me at my email which is

brightfutureofcalifornia@g mail.com and i will provide. it is very important for you to see this because you have created those mandates for people working for your company, and you don't even know what is really going on with it. number two, the f.d.a. approved this vaccination, so-called vaccination, which is not a vaccination. it took them 108 days and yet asking right now for this disclosure of 500 pages per month, disclose that information of what is in those vaccinations. i would encourage you to read at least those 500 pages because it will take 55 years for that information to be available for the public usage. and i think that i'm very close to my time. email me to brightfutureof

california, and i will give you information. >> clerk: that is the last hand that i see. >> president bernal: thank you, secretary morewitz. i know that we are now changing orders to guide us through our next items. >> clerk: sure, so the next item is proposed changes to calculation of the management reserve and we have jen louie, the cfo. >> i'm the chief financial officer. i am pleased to be bringing forward this item regarding an update on our reserve. -- our management reserve. and so by way of background, commissioners may recall section 12.6, and it may look familiar to you because this is an item that i include as part of our

quarterly financial report. at the end, i'm discussing the d.p.h. management reserve. but the reserve was established under the annual appropriation and ordinance that authorizes the controller to defer to us the revenue of surplus transfer payments and other revenues to offset the future reductions and audit reductions associated with funding allocations for health services. this provision was adopted by the board of supervisors to help to smooth the revenues due to things such as policy changes which may affect our revenue projections and unpredictable timing of payments. as commissioners may recognize from some of our financials, that there are times when we are anticipating payments and sometimes they're accelerated and are received in fiscal year earlier than expected. the and the management reserve is used to really to help us be able to just smooth out and to

meet the budget expectations of our revenues. the current calculation of the revenue is really around identifying significant revenue risks due to potential policy changes, including medi-cal programs and federal funding programs. so, for instance, there was a proposal by the federal government to eliminate the hospitals where approximately $50 million to us, and there's also been changes being -- such as the equity pool formula when medi-cal and it's been able to also to have us look at things such as delay and implementation of the drug medi-cal program as the state was standing it up. we also used reserve again to -- to recognize unpredictable -- for the unpredictable timing of the payments. at this time there's no current

on the amount of the reserve and just sort of looking back at the last several years. i think that the reserve had a high of $150 million to $170 million, and a low of $60 million to $80 million over the last several years. the proposed change before you is to maintain the reserve, but calculate it on a base of the percentage of the budgeted medi-cal, medicare patient revenues, rather than identifying potential adverse events. the advantage of this is that it really simplifies the calculation. at times it can be challenging to figure out how real the risk might be. we know that there are proposals out there but how likely they are to come to fruition and at times the larger policy changes, it can be difficult to actually identify, to associate a dollar amount with the potential impact. this also establishes the third criteria with deposits and withdrawals can be made and with

having a general reserve will allow us to buffer against general variability, which is becoming increasingly more prevalent under a value-based payment structure with continued policy changes in that direction. so as you know that value-based payments, we could be paid based on performance and at times there could be a percentage of our revenues that we do achieve or don't achieve. it becomes a lot less predictable, than a cost system, where we know exactly our volumes of services and we put the costs associated. if our volumes are lower but our expenditures are lower so there's a natural off-setting adjustment there. with value-based payments, this is continuing to -- there's a shift towards more increased variability within our revenues finally, this calculation will create a more stable and predictable reserve.

and the proposed level of reserve is 5% of the budgeted revenues from medi-cal and medicare patient revenues, and the intergovernmental payment transfer match for all divisions that are approved to your budget. so if we were to implement this, the calculation would look like this, where we look at a total of $1.1 million of net revenues through these three programs, of a total of $2.2 over two years and a 5% reserve would be $113 million. to define how we actually do deposits and 50% of the balance is by the comptroller up to 59% lower. and if lower it can be adjusted down to reflect the updated revenue.

withdrawals can be made when dph's revenues and the quarterly reports are below budget and the reserves are released to balance the shortfall. consistent with the rainy day policy for the city, up to 50% of the reserve can be used in any given year but the withdrawal should not go over the revenue deficit. and as with any reserve, the mayor and the board may choose to appropriate this through a budget or the supplemental appropriation process as part of the city charter. and we will also continue to use the reserve to address the timely payments and this is really managing of a timing issue to meet our budgeted goals. the withdraws would be made in the year that the revenue was appropriated or expected and the deposits could be in excess of the 5% calculations. so those are the changes proposed and the management

reserve and i'm happy to answer any questions. >> president bernal: before we go to commissioner questions and comments, do we have public comments. >> clerk: if you would like to make public comment on this item, this item only at this time, which is the proposed changes to calculation of dph management reserve, please press star 3. your comments must relate to this item. i do not see any hands, commissioners. >> president bernal: thank you, secretary morewitz. commissioners, this is an action item and approval is requested. do we have any questions or comments from commissioners before we entertain a motion to approve? i see a hand from commissioner chow. >> commissioner chow: thank you, president bernal, and thank you ms. louie for -- when i also -- i support the change in policy

as it's much clearer. and certainly easier to manage and i remember a time when we didn't have any reserves. and so anything is better than none but this is better than all of the mechinations that we used before, which is to justify why there's a reserve. as we get our quarterly reports, is that reserve showing up as a balancing act, or is this for your cash flow questions when you have a deficit, for example, or we're running short? how would that work? >> great, that's a great question. so the reserve will actually show outside of our operating financials, right. because this will be -- this will be fund balance held by the controller's office and all of our transactions will be -- we will work closely with the

controller's office to do. so we won't actually -- i will report on the value of the balance, continue to do so as we have in every quarterly financial. and then i will show a calculation of any deposits and withdrawals made based off of our current projections for the year. but it would not show up as a surplus. it's held in reserve in a separate account by the controller's office outside of the dph operations. >> commissioner chow: right, so in follow-up then on each of the specifics for each of the divisions, those are going to continue and then we'll see an overall picture of the reserves, is that what is happening? >> yes, there would be a summary at the end and, you know, and that balance is not reported is part of any of our operating balances. >> commissioner chow: okay, all right, i understand. so it's like using it as cash to keep everything going. but we are holding each of the

divisions to the budget itself, not that they would rely upon reserves to adjust their deficit? is that correct? >> i'm sorry, could you repeat that again? >> commissioner chow: so i was just saying was that the reserves are reported separately by each section and department, and they are held to their budget. and they won't be using that in our reports to balance the budget, because in essence, otherwise, it would always balance. >> in theory, yes. so what we would do, for instance, in a case where we would need to reserve, let's say that we had a billion dollars budgeted but we actually will come in at $990 million, so we're $10 million short of our budgeted target. and at that point our financials will show that $10 million loss and then below that we'll have a calculation showing withdrawals

approved by the controller from the reserve to keep dph balanced and on target in terms of its revenue budget. >> commissioner chow: so, no, thank you then. actually, the use of the reserve will be much more transparent to us. thank you. >> exactly. >> commissioner chow: so i have no other questions and i will certainly support this. >> president bernal: thank you, commissioner chow. seeing no other questions or comments from commissioners, do we have a motion to approve these proposed changes to the calculation of dph revenue management reserve? >> i so move. >> second. >> president bernal: secretary morewitz would you please call the roll. >> clerk: yes. [roll call vote] >> did we already call for public comment?

>> clerk: yes, we did. [roll call vote] the item passes. >> president bernal: great thank to jen louie for your presentation. >> thank you. >> clerk: and the next item is a presentation, fiscal year 2020-2021 fourth quarter and fy21-22 first quarter financial reports. >> so i am bringing both the fourth quarter and the first quarter report. the timing of presenting both of these reports really reflects all of the work that really takes to really completely close the fiscal year at year-end. i will note that the controller has not entirely completed their process so there may be some slight adjustments moving forward, but they are going through with their process with the auditors when we expect them to be completed probably in the

month of january. but the report that we bring forward to you is likely what we would expect from the controller at year end. i just wanted to note that i'm bringing two quarterly financial reports to you. and while they are consecutive quarters, there are some key differences that makes a challenge to try to compare the variances that you see from one quarter to the next. or merely you can do that for the second and the third quarter, but because these two financial reports straddle two fiscal years with two different budget assumptions, that's not possible. and so as you know, budgets are updated every year to reflect things such as inflationary costs and these are triggered by labor contracts, as well as professional services contracts, that are updated every year. we have often new initiatives in the budget as well as updated revenue projections. so in general, you know, you will always just see --

hopefully it will be an increase in expenditures and revenues going forward every year, so it's a little bit hard to look at the fourth quarter report and then look at a first quarter report, and sort of draw a perfect trend line because the operations and the spending plan has been updated slightly. what makes this -- these two fiscal years even more challenging is that some of the work that we've been doing with the controller's office, and as part of the year-end close, which realigned the covid costs and revenues into fiscal year 2020-2021, and the funds where they shifted from a special revenue fund into operations. as well as realigning some of the disaster service worker costs to the public health division. this is a slightly unusual treatment and i will say that it's been sort of an unprecedented year for year-end adjustments. but these are the ones that the controller believes that will support transparency and clarity around our covid cost planning.

we also have a slight change to our reporting format, starting with fiscal year 2020-2022. and we had a project line to be more consistent with the city's fund structure of operating funds and obtaining funds to represent the operating budget. we report on the overall to the bottom line as the same but we separate it as you will see in the bottom line operating and the multi-year projects. in general because multi-year projects are continuing projects, we tend to not report variances because any variances just continue to get rollover into the following year. most of the multi-year projects we have are related to capital projects. all right, so moving on to the fourth quarter financial, this -- as i mentioned before, this report reflects several adjustments directed by the controller's office and the reporting guidelines. two significant changes with realignment of $66.67 million of

relief funds into the operating fund. it had $44.5 million of revenue that was put into non-operating funds and $22.8 million to align with our plan, and primarily within our operations. and in addition it also realigns salary and fringe benefits within the operating -- within the operating budgets to match actuals for disaster service workers. and so these are the salary and personnel costs that were existing dph employees as service workers and they will -- and these costs continue to be recorded in the public health division as they have for the last several quarters. however, this realignment balances out. (please stand by)

with the revenue surplus 4.3 million, the surplus of 800,000, we're looking at a

positive variant of 85 million. then when we also take into consideration the defer -- the release of a deferred revenue related to the disproportionate share of the hospital, which we also recognize before -- again, this is a release from the d.p.h. revenue reserve. this is 51.7 of good news that we're contributing to the general fund. then when we consider an offset of the management reserve, which is 50% of the total revenue increase that would -- the revenue surplus we seen, it's 136.7 million. i will note that there is 44.6, which is slightly over 50%. the reason for this is part of the order of operations, which the controller's office needs. over the last several months, we continue to update our reports,

working to determine our fund balance. at some point the controller's office needed to make a decision on how much deposits into the reserve so they can continue to do their year end close. at one point, we did have a revenue projection that was slightly higher, which resulted -- which calculated into a 50% reserve of 44.6. there were some minor adjustments following that add -- deposit. they did feel that the change was minimal and recommended that given we're under the 5% threshold, we just maintain the deposit as is, rather than delay the year-end close process. >> so within the division, going through the public health administration division has some

positive revenue variances, primarily to the administrative activities, as well as prior year settlements and adjustments in the fee revenue. within san francisco general, they have a net positive of 75 million of net patient revenues. this is in part due to better than expected performance as some commissioners may recall as part of our budgets process, we did assume with all of the unknowns, with covid that many of our services at zuckerberg san francisco general primary care and behavioral health, would reduce productivity as a result of shelter-in-place requirements where people may not be accessing services as they would have normally. you know, we did see some losses in the spring of 2020, but it looks like our revenues did

actually -- and our productivity did increase due to part of the covid patients that we had there, results in the increase. this is offset by the quality incentive program, which has been shifted. this is a bit conference indicated but it's a shift in the recognition of the payment due to the merger of this program into prime, which delayed -- which one ran on a fiscal year and one on a calendar year. to better align our budgets process, we're not recognizing, we're shifting the recognition of the payment five or six months to make sure our projection aligns. this is a one time shift and we

would not expect to see the shortfall moving forward. slight drop with an increase in medi-cal revenue, including administrative activity, hospital quality, and the pharmacy. the expenditure sides, there are minimal variances, incluing some contract materials and supplies. at laguna, we're seeing positive variances on the revenue side. this is really related to an update to the medi-cal per diem rate. totaling 23.5 million and we have some minor fees related to parking that probably had been under budgeted historically. with behavioral health, we're

also seeing an increase in medi-cal. behavioral health was one of the areas where we seen there would be a drop in productivity, as well as revenues. so while there were some variances, we didn't see a lot of productivity as significant as we expected, so this is the better than budget achievement revenue. in addition, the state accelerated some of the reconciliation of settlements from prior years, and released 32 million back to d.p.h. with the final settlement of the cost reports. a slight uptick in the revenue and increase in the realignment allocated by the state. primary care, minor variances, and again the patient revenue is here, similar to zuckerberg and

behavioral health. we did see a one time reduction in revenues for fiscal year 2021 and so the good news is that our productivity was better than expected and there were increases in patient revenue to such. there are some minor variances and an uptick in capitation and patient revenues of 600,000 as well. health network. we're projecting similar to other quarters, $36.4 million shortfall. these shortfalls are related to the city auction funds and members of the finance committee are probably fairly familiar with this item as we just have finally worked with the city attorney and controller's office, and mayor's office and tax collector to determine a

process in which the city could recognize unclaimed city option disbursements. we are -- this item will be brought to the full commission in january for your approval. until then, it is a three year achievement process that we're proposing and at this point, until that process is completed, the city will not claim or recognize any of the revenues related to the option fund. you will continue to see the shortfall and i will be working with the mayor's office and controller's office to adjust this as part of our regular budget process that starts this month. finally population health, as we delay epic in some of its

clinics. there is also a reduced fee finding and license revenue, environmental health services. this is due to some of the staff being deployed to covid which would normally draw down increased fees and permits revenue. we also had a shift of revenue to align with in kind asset donation saying this was an adjustment requested by the controller shop. then to report on the management reserve, we discussed so with the calculation of a two year reserve, we had an existing balance of 59.4 with the additional deposit made by the controller's office. overall, there are just over 104 million of balance within the d.p.h. revenue management

reserve. this represents a 4.59% of our total two year budget, so just under that 5% jump. moving to the covid response budget, which we have been reporting on and continue to report on separately because it's a project outside of our regular operations, ordinarily we work with the controller's office to do a citywide report. because it's been delayed, we are providing a preliminary report to the commission at this point. there are a lot of changes, but this is where we land in terms of 265 with the revised budget that we received. we spent about 244 million of it. there is a surplus of 21.7 million. this is a surplus that was expected and part of the controller's nine month report

and it will be used and programed by the controller's and mayor's office to roll over in the following year to offset the cost of our proposed spending plan for the current year. so this is not a surprise. commissioner green had a question about some of these very large variances within the project, what do they really mean and i think that part, there are some savings delay due to the delay in implementation. these variances represent the dynamic nature of our response. as you known, we create a budget and we do the best we can in terms of the estimates. with operations, it's more linear. as the commissioners know, our covid response has been anything but linear and this is really just recognizing the agility of our response that we put towards

all of these branches. with that said, some of the surpluses are related to some savings, within medical services, some of the functions were supported by disaster service deployments, so we maintain that service model expected, but did not result in additional costs. vaccinations, similarly we had a high level of inlevel staffing support and they were deployed at the vaccine sites and we had slightly lower than expected costs at the sites. for the isolation and quarantine hotels, we did see two sites, but because of the response, we were supporting approximately five different sites at different points during the fiscal year. finally, adjustment by the controller's office. the personal protective

equipment budget, adjusted to reflect only p.p.e. distributed to end users by june 30th. so while we had a lot procured, it's not considered spent until it's actually been handed out. that was a lot. so i'm happy to answer any questions you have or i can move on to the first quarter of our intake questions there. >> secretary, are you okay with proceeding to the next report until we do questions? >> sure, because it's all part of one item. >> all right. >> good. >> you can proceed then. >> all right. now jumping into this quarter. at this point, we're really not projecting any significant variances within expenditures or revenues at this time.

these are preliminary figures based on three months of actuals and changes are possible over the course of the year. operating funds consistent with the covid-19 project. we are working with the controller with finalizing the reporting methodology to ensure consistency across all city departments, so i do not have a report ready for you at this point, but we should have one as part of the second quarter. so in terms of the first quarter report, again, there are some slight positive revenue projectives and projected surplus deficit and expenditures with this 9.7 million, they would deposit into the reserves. it would be 5.7 million.

we are seeing better better performances within the global payment plan. as you may remember from the fourth quarter report, we had shown a loss because we didn't achieve some of the cost reports due to the fact that the state has not settled. we could not recognize it, but we are seeing some of that trickle in this year and we're going to continue to update this number as the state completes its close out process. there is also a slight increase within the capitation revenue. a slight negative variance currently within salary benefit, as a whole within the department, i think we're considered above budget on salary infringe. at laguna, they're projecting a positive fringe variant, as well as the work orders related to

utilities, as well as workers' compensation, and we're working with those departments to understand what those drivers are this time. behavioral health is projecting a surplus. there is better than expected news related to 2,000 realignment and the slight increase in patient revenues. infringe benefits are expected to be slightly over budget. primary care, the patient revenues are short by 1.2 million and again, we had assumed a one time drop in some of our revenues as part of fiscal year 2021 and primary care. the assumption is that we would go back to normal revenues, for 2021-2022, so while we are not quite at normal, year over year, the patient revenues are still

increasing. expenditures, there is a projected salary benefit surplus at this point. with personnel cost, a negative variant of 1.2,600,000 -- respectively. we are continuing to look at the implementation and we're seeing a drop of revenue of roughly $2 million. with public health administration, a positive revenue surplus related to medi-cal administrative activities with a shortfall in personal health.

then bringing us to the management reserve, taking the assumption of the fourth quarter deposit, 4.9 million deposit would bring us to 108.9 in terms of our reserves, which is a 4.8% of our two year budgeted revenue. this is actually the prior, this is the first quarter report on there. that is all i have for you and i'm happy to answer any questions the commissioners may have. >> thank you. i do not see any commissioner questions or comments. and this is an item for discussion, is that correct? >> yes, and may i check public comment. >> yes, thank you. >> folks on the line, if you would like to make a comment about this item, the first quarter and first quarter

financial report, please press star 3. i see no hands commissioners. >> i see commissioners' hands. commissioner giraudo. >> i don't have a question but i wanted to thank you for the report. your memorandum that accompanied the budget really explains in clear terms the budget. i wanted to comment to say thank you for that presentation and understanding. it's very much appreciated. >> thank you so much for that feedback. i do appreciate that comment. it is my goal to be as transparent with a very complex dynamic set of issues involving our finances. >> i would like to associate myself with the comments of

commissioner giraudo as well. commissioner chow? >> thank you. thank you for again continuing to improve on the reports which are so transparent and i think gives us confidence in financial management. i had actually only a tentative question. i wouldn't sure in your summary, in the current point, it describes the fiscal year as 2021-2022 and then it says g.f. i was trying to figure out what g.f. was. >> it stands for general fund. we're always looking at our impact on the general fund, which is the general revenue that the city has opposed to general revenue funds which often has a lot of restrictions and the variances we tend to

comply with the requirements of those funds. >> oh, thank you. then i guessed correctly. the other question is more trying to understand the schedules that we were now going to be getting reports. i mean it's clear that right now you wanted to and did a very nice job in presenting the reserves and then showing in practice here what happens in the fourth quarter and the first quarter. so that's become clearer. at one time you were saying that the commission would receive reports twice a year and the budget committee, finance committee would receive it the other two quarters. i don't know if we were changing that. i'm not asking that we take any action here about that, but asking that we, for the coming

year, could work that out. i think you were so clear that it is, i guess a, if it's the commissioner level, we don't always have the time to be in detail and your fine presentation certainly, you know, discusses what has happened at the legislative committee. it was the ability to be able to look at some of the items more in depth. so i will leave it to our officers to work out what is a reasonable way to do it. another way might be that we want the high level recording at the full commission and perhaps have each of the sections, particularly either general and

laguna have more input -- at laguna, they present the budget but at general, we do not, leaving that to the finance committee. so that's asking how it was like to review the quarterly report. >> yeah, i'm pleased to come before the members of the commission and committee, as you see fit. i think historically we are supposed to bring the furtsz first and third quarter reports to the finance committee, and the second and fourth quarter reports to the full commission. quite frankly i think it's because the timing issue of when the first and fourth quarter reports are available. we just decided to have it as a single item rather than splitting it up between the finance committee and full commission.

i'm happy to do what works best for the commission. >> commissioners if i may, having the benefit of the history of this with jenny coming into this role during covid, exactly as jenny said, we determined to do 1st and 3rd as the committee, 2nd and 4th with the commissioner, we included the caveat that if there was significant new news or variances, then we thought warranted going to the full commission, we would bring those first and third to the commission. when covid hit, we heard nothing but significant news. we kind of startedering --

started ering on the side of the full commission and we had a deviation but now we're back to a more predictable schedule in terms of variances and also all these big changes in accounting that you just heard about that are related to covid. i think we, if it's the will of the commission, we would definitely get back to the regular schedule. >> yeah, i think that's an excellent explanation as to what is happening and certainly was not critical of the fact that we were able to see it as the full commission and if our officers or other commission members felt they wanted more, then i will leave that to them. i'm glad to hear we're talking about a more normal life and going to a schedule that greg

suggested and we had been following and seems to be working. >> thank you commissioner chow. i do not see any other hands up, so with that again, thank you jen, good to see you mr. wagner, and we can move on to our next item. >> thank you, i would like to also add, i would like to thank the finance team. this was an unprecedented year for the accounting team. the team really made every change and i think built the best budget report we can. i want to recognize and thank them for their work. >> commissioner, i just wanted to add my gratitude to jenny for her leadership.

she joined in her relatively new role and the work with the team. again, there are always a lot of moving parts in this and there are more than ever this past year and a half, almost two years now. thank you very much. the fact that it's so clear, it's incredibly complex and this makes it very clear and i appreciate that. thank you. >> thank you director. >> all right, the next item will be item 11 on the agenda. just a note, i put action, but this is a discussion only item. you will be voting on the january 4th meeting. just for clarification. >> thank you. we have greg wong, administrative analyst joining

us for this presentation. >> actually sir, it's item 11 not 12. >> okay, i'm sorry. >> again, my error. >> that's fine, thank you. then the next item will be delayed. so yes, veronica. >> thank you. >> the screen is yours. >> thank you secretary and the commissioners. thank you for the opportunity to be here today. i'm here to present proposed rules and regulations for refuse collection. if you can jump to the next slide. before i move to the presentation, i wanted to introduce myself and how we fit into the organization. we are representing the environmental health branch, which is under the department of

public health. i manage a host of different programs that is under the branch of environmental health and one of them is a solid waste program and the rules and regulations. it will be implemented by such program. next slide. before i go into the details and background of things, i want to make sure to clarify what is presented before you today are the rules and regulations for refuse collection, based on 1932, which is referenced as refuse ordinance. it's part of the san francisco article 6 and this addresses the portion of of the refuse ordinance that pertains to d.p.h.'s authority only, which is to license and the refuse

collector and permit throughout. please note that these rules and regulations is based on the current law, the refuse ordinance and this is a process that's really long overdue. it should have been done in 1932, which is way before our time and what we're here to do is what initiated this process is because we are in need of application for approval for new routes that have not -- that have been established as a result of a new development. we haven't had a new route that was open for application, so we haven't had the need. what i also want to clarify is this process that is proposed through rules and regulation does involve a contract process. it doesn't -- i mean that you

may be familiar -- if you're thinking about refuse collection and lot of jurisdictions, you may think about their competitive bidding process and contract negotiations and contract monitoring. this does not involve any contract. what we were tasked to do under the ordinance is to issue a license for the refuse collector an issue permits. so we haven't -- while the refuse regulation authorizes us to issue that, it does not mention anything about the competitive bidding process and hasn't been in practice. the regulations does not prohibit or require d.p.h. to institute contract process and

it's something that to be consistent with what has been in practice, we're implementing these rules that does not deviate from that and we want to also clarify that it is my understanding and as far as what we've been advised is that if there is an interest to include that competitive bidding process in may, it will have to go through further legal review, which may involve ordinance change. thank you. so to review the process, just to review the background of things, what you see here in the presentation are the 97 routes, collection routes that have been established in the 1932 refuse ordinance. what is highlighted in yellow is the permits, the routes that

were issued and what's highlighted in pink is to the census scavenger. you can see golden gate and the scavenger are part of the parent company, but they're recognized as a separate business entity. this permit, the date goes back to 1927. next slide. in 1992, in order to see refuse collection in areas not under the refuse ordinance, we wanted to address the federal facility, federal sites that are outlined in blue on the map and that includes pressido, job corp.,

treasure island, ggnra, and in order to address the permitting process there, the health commission adopted what is known as the federal facilities collection regulation. the regulation outlines the qualification of refuse collector and describes the refuse process and conditions in those specific areas. next slide. in 1999, we wanted to address -- so the city acquired treasure island as a transfer from a federal site to a property. in order to address that gap, the health commission adopted a refuse regulation to address the refuse service specific to that

area that is circled in red here. in addition to that, the health commission also adopted the revised federal facility regulation and that was just basically revised to clean up the language to be consistent with the proposed non-federal facilities regulation. with the regulation basically outlined the same permit process and conditions that were outlined in the 1992 regulation. next slide. so the current need is that currently the treasure island is still under the master lease and being hang -- managed by the sit city but it's undergoing a development by the private property. once it becomes occupied by a

private resident of a privately owned property, we will need to -- it should be regulated under the refuse ordinance. so there is a need for d.p.h. to have a process in place to license the refuse collector and the route the permit. the they are recognized as a 97a and 97b. we are in need of administrative process to issue route permits. from what we understand and this isn't for certain, is that we are anticipating residents to move into one of the developments in yerba buena so we want one of these processes

in place. next slide. so the proposed refuse collection will fulfill d.p.h.'s need by clarifying requirements of the refuse ordinance, so that am applicants can maintain the refuse license and route permits. it will also establish d.p.h.'s administrative procedures and outline the conditions of the license and the permit to ensure continuous regulatory compliance. next slide. so i wanted to go over the process and in a very high level. so basically the rules and regulation outlines the license for the refuse collector process and what would happen is an applicant would submit an application and d.p.h. will conduct an evaluation of the application package. within the first five days of

submission, they will have an opportunity to request for a meeting with us, to talk about any item on the application. once d.p.h. approves or deny application in that period, the applicant may request a hearing, should the application be denied. within ten days, the director will grant a license or deny license. the decision will become final. next slide. this outlines the route permit process, so once they obtain the license to become a licensed collector, the license can submit an application package for the permit. d.p.h. will evaluate the application process and they will have an opportunity within

the first five days to request for a meeting with us. after we make an evaluation of the package, within 30 days of that, we will have to set a public hearing and prepare a recommendation on the permit action. this will be -- so when we say public hearing, it will be a director's hearing. and basically, that's in place. the hearing officer for the director's hearing is an independent law judge that is hearing these on behalf of the director of public health. within the 30 days of setting that hearing, public hearing will be held and determination will become final in accordance with the procedures that is in place for the directors during

process. next slide. so i just wanted to go through the next steps on what has already been done. before this meeting today on november 29th, draft of the regulation were posted on the d.p.h. website for public comment. we asked the public comments to be submitted in writing to me, addressed to beronica slattengren or we provided our mailing address and it's to end on december 29th, unless there is any substantive changes based on these hearings. we are anticipating that there -- the health commission will be voting on this item january 4, 2022. at this time, i would like to

open this up for any questions you may have. >> before we go to any commissioner comments or questions, do we have public comment on this item? >> folks on the line, if you would like to make a comment on this item, item 11, please press star 3 and again your comments would relate to this item. star 3 to raise your hand. i do not see any hands commissioners. >> great, commissioner giraudo, is that a hand up or is leftover from the last item? okay, well i actually do have a few questions and i'm referring back to slide -- the one that is

on background and authorities. do i understand based on your comments as of d.p.h. is bound by ordinance, set by the board of supervisors way back in 1927 and we have a contract, or a license that was awarded 89 years ago in 1932. is that correct? >> so, just to clarify, the 1932 refuse ordinance is under the charter. it's voted by san francisco, so it was on a ballot and then it was voted by san francisco. this only addresses a portion of the refuse ordinance, but also it has other authority that is given to other city agencies for rates and such. >> got it. so maybe just a series of quick questions here. >> sure. >> so this is all coming about because we are having residents

moving in to the neighborhood in san francisco and they require to have their refuse, their trash, recycling, composting, all taken away. >> that's correct. currently to the development going on, at this time those in the development, no one is allowed to occupy that. that is to change in 2022. once they move in, then it will trigger this need for a refuse license and permit. >> and this is a two step process. the first is to issue a license. well, the first process is licensing. >> that's correct. >> of a contract, of a contract or collector and then the second step is to approve permits for specific new routes. i'm from minnesota, i say that

word strange. >> just to make a collection, there is no contracts involved. this is the really complicated topic to wrap our heads around and it's unique to san francisco. when you think about refuse collection in other jurisdiction, there is usually a franchise agreement involved. that hasn't been the case in san francisco. the 1932 refuse ordinance basically authorizes license to the collector and issues a permit for the individual routes. that's been in place since then. we never -- unless there is a need, a showing of need, there hasn't been any new collector and that the permit was offered for the occupied routes. >> and then with this process,

would it be open to new collector license applicants or are we limited to the existing collector licensing? >> we are opening this -- this will be open to any entity that is proposing to operate. so, we are not limiting this to just the current holder of the license, which i mentioned are the two companies. while they have an option to apply for the permit, as well as an existing license holder, we are providing options for other entities to apply for this license. >> okay, so then in this two step process, it's the license -- whatever license exists would be newly licensed through this process, then it would be a matter of awarding the permits for the new routes

and that would be awarded to whatever licensees exist at that point. >> correct, so it's open for any of the current license holder. should we approve a new licensee, then they would also have the opportunity to apply for such permit. >> okay, so the only existing licensees as you mentioned are golden gate and sunset scavenger. >> that's correct. >> and then just confirming what you said, these are the rules under which d.p.h. must operate and the only way to broaden them or provide more flexibility with regards to competitive bidding or other things, would potentially through an ordinance change through the board of supervisors. >> my understanding is that it does require a legal review as far as what steps need to be taken. i think one of the options may

be to change and amend the ordinance, but it will need to go through a further legal review. >> okay, thank you for really helping to clearly establish the parameters in which the department is bound to operate here. thank you for answering my questions. i have -- i see vice president green. >> this is very complicated and you have done an excellent job. thank you so much for explaining all this. i guess my question would be a follow up from what president bernal had said, how can the commission help support a change in the ordinance so that this can reflect more of the types of contracting we're use to, where it's not only competitive bidding, but also a re-evaluation of contracts in a period of time with performance metrics. i wonder if you can maybe give us a little bit more elaboration on what legal review would mean and how long such a process would take. >> thank you for that question.

i actually can't answer that question. i want to defer this question to our deputy city attorney, who is also present in this meeting, valerie lopez. >> good evening commissioners. the 1932 ordinance was adopted by voter approval. so in the event there is any type of change or proposed change, that would have to go back to the voter for approval. >> what would the timeframe be on that? >> it would be something that needs to be put on a ballot that would drive the deadline before something would be placed on a ballot. >> so is it possible that given the soon-to-be occupied treasure island housing, although i know not all of it will be complete, would it be possible to have an ordinance change before occupancy or is this something that would take time? if there were such an ordinance

change, what would the next step be in terms of other bidders that might want to come into proposal or apply for the position. an ordinance change can't happen before occupancy? >> to answer your first question, it will require voter approval, so that would need to be drafted and put on a ballot in some type of election and be approved by the voters all before the tenants occupy in 2022. i don't think that's likely given that we're already in december. my apologies. what is your second question? >> at what point, if an ordinance change were to be voted, would there be energy to

move forward once the routes are assigned or what would be a way that we could somehow make this potentially more reflective of the way the contracteds are structured. >> i think it would be dependent on what changes there are for the voters. if there are specific changes that outline the next steps, i assume that would dictate what the next steps would be. i'm sorry, i know that's not specific enough to answer your question, but it would depend on what the proposal is. >> are we -- is it appropriate or is there an encouragement for other companies to enter into this process? are there limits as we move forward, at least apply for

licensure. >> that's an excellent question. i will defer the question to beronica. i know she's been working with another city office to engage those folks. i will defer to her to give you the details. >> thank you valerie and thank you for the question commissioner. in an effort to get the word out that there is a new proposed rule and regulation, we're reaching out to different businesses and the city

stakeholders. it would include the administrative office, san francisco department of environment and the planning department, so they can comment on the process, but also to relay this information and distribute accordingly. we have made that effort and our plan is to also gather the stakeholders so we can strategize as to how we can make a property notice of these permits, these new permits that we're soliciting applications for. that's our next step and we're still in the process of planning that. >> thank you so much for the answers. given the soon-to-be occupancy, is there time to accomplish all

the things you just enumerated? >> that's an excellent point. it is very challenging. we have a very small timeframe. we're trying our best. we're also in the holiday season as well, so we're doing our best to get the word out there so at least we're giving out the opportunity for all the -- any impact to businesses to know about this and at the same time we're in parallel, we have to plan out some sort of a game plan so we can make sure that the notice of application is reaching all those partners. so we're doing our best. >> thank you, thank you so much for those really thorough answers. it's hard to understand but you made it very clear. thank you. >> thank you. >> before i go to commissioner chow, i had a quick follow up to vice president green's question for either ms. lopez.

if i understand it correctly, the awarding of the permits is limited to existing licensees and whoever is licensed at that point, is that correct? >> that's correct. >> and in length of time or provisional, or probationary or anything like that? >> thank you for that question. at this time, that is an internal discussion we need to have and will take that comment into consideration as well. those details have not been worked out yet.

>> thank you very much. commissioner chow? >> i want to follow up on president bernal's question for a moment. in the proposed rules and regulations, it would seem to me that something about time limits that would be appropriate and so if this is suppose to be the draft final that we're suppose to be taxing, within the next two weeks, it would sound like you would take into consideration whether to put a time limit. that's something we would expect to see in the final draft, i guess. >> thank you for that comment. if that's your comment that you would like to see, then we would definitely consider that and i would have to defer to our city

attorney to see if that's a substantive change. then we would need to review what the next steps would be. i don't know if valerie has anything to add on to that. >> sure, yes. thank you for your comment. as you know, d.p.h. has this draft out to the public and they're soliciting comments from the public and various other city stakeholders. they may have to then reissue the regulations for another 30 days, presumably public comment period to give the public notice. so we should know more once we get the comments from the public. your comment is noted and we'll

take it into consideration. >> since i don't know what the other commissions are thinking of, almost everything we do has time limits. >> yeah, thank you for that comment. we are in recognition of that and that is something we were exploring to address through a policy level instead of outlining in rules and regulation, but we will take that into consideration. >> okay, so my initial question was trying to understand this mechanism. we don't do the contracting, but we're going to recognize a refuse collector license. as i understand it, you're willing to accept a number of people who don't have contracts with the city to do that. so what happens if you in fact

award that to give the collector license to east bay or something. i don't know what the name of the units out there. an east bay collection, because this is right by the east bay, let's say. so, then they of course will then be part of a permit process to look for a route. you will issue a route. so, then what happens? i mean how -- why do, you know, it's not so much why, but that already sounds like it opens the process, versus what role does the fact that we don't actually issue the contract has? because if we're going through this and someone doesn't issue the contract, then i'm not sure we're going to get a lot of

bidders. >> so, thank you for that comment and question. just to clarify, i want to make sure that there is an understanding that there is no contract involved and there is no existing contract in place for refuse collection in the city and county of san francisco. so, we've always been authorized to issue the license for the collector and permit for the route and we never in practice have issued a contract, nor the other city agencies have issued the contract for the refuse collector. so i don't know if i quite understand if i can answer your question then because there is no contract involved. >> all you have to do is say east bay as a valid contractor,

collector. east bay then applies for the, i don't know the name. they apply for it and they say you're qualified. you have 10 trucks and you guys have a good area to dump these off and the trucks meet. then what do we do? nothing? i mean they just come and collect the garbage and everything. >> so, if we can go back to the slide nine, so that outlines the process for the permit. so, every license holder, what we refer to as licensee has the opportunity to submit the application package and the application consists of a number of things and we verify the showing of need, the finance responsibility, the operational competency and should there be multiple applicants for this

route, we will basically have an evaluation criteria, where we will be scoring based on the information that they provided and the facts that were provided to us and make a recommendation, which then will be deferred to the minister law judge who hears the hearing, who oversees the hearing process and they will make the determination as to who will be awarded that permit. >> okay, so i'm at the point where you awarded the permit. then they go off and do the work? then as you said, you don't necessarily have a time limit to the permit. who watches whether or not the work is done correctly and likely deal with so many other things. we go down to fisherman wharf and make sure the environment is clear, that the people are covering where the fishes are

and so forth. if they don't, then they're in violation. so, if we issued a license, it seems to me that says, we warn that you can have this route because you do certain things for it. so, within that process, who then says they really did collect the way they said they were going to do it? >> i'm sorry, what was the last part of the question? >> so the key question is who then says they're really doing what they said they're going to do. >> so there is a compliance aspect of this and that is outlined in chapter 9 of this rules and regulations. once they are permitted, they're being regulated under our solid waste program and there is additional process that is outside the scope of this, but we basically have to license the

vehicles that they operate and we have an inspection process. the rules and regulation also outlines the conditions of the permit, so we verify they're meeting these conditions and there is also a routine permit review process so that we can ensure they are maintaining the integrity of what is outlined in the -- they're meeting the compliance elements of this permit. >> well, that's very good. is that retroactive or is all -- are all the other routes grandfathered in without having to add that? >> the other routes are being regulated as such so they have all of their vehicles have been licensed and we inspect those trucks. whatever the conditions that we

clarify under rules and regulation will be applied to the existing permit holders and license collectors. >> okay, all right. thank you. >> thank you. >> all right, commissioners any additional questions before we move on to our next item? thank you both so much for leading us through a very complicated process and answering our questions and we look forward to seeing you at our next meeting, our next december meeting, secretary? >> it will be the january 4th meeting in 2022. >> okay, so we will see you in 2022, if not before. >> thank you, i just want to express my gratitude for this opportunity and i also want to thank valerie for representing us here today and i want to also acknowledge our leadership for

supporting us and guiding us and the program staff for working really hard on this project. thank you very much. >> thank them for us as well. commissioner chow, with your permission, may we move to item 13 and 14? items 13 and 14 are the finance and planning committee update and the consent calendar. >> sure, i'll try to be brief and really sum up, if the other commissioners want to ask questions, i'll let that happen. i'll give you a high level. i want to thank commissioner -- well, all the commissioners who did participate and that includes commissioner chung who was actually under the weather with a lot of different activities she had to do.

she has recently become appointed to a non-governmental agency that meets on geneva time. so, let me first say that as you know the contracts report are renewal contracts and what they are entailing this year, this meeting, is that i broke them into several items. one is that the positive resource center is really the emergency financial assistance to the underserved and this is a renewal of that contract and is using some carry forward funds also. that's number one on the contracts report. number two on the contracts report is really a series of registries. the registry for physical

therapy and other actuarys are for as needed. there is a nursing registry and you seen that before where we hired, we have about 3 or 4 contracts for hiring nurses as registry because we don't have enough or we had a need for additional coverage. the cross country staffing, contract carries first an amount that goes back to correcting the first two years of the contract. this was a five year contract but the board of supervisors approved two years.

the funding is short for that and as we discussed at the commission, at the committee meeting, the issue of increasing cost of medical personnel, especially nursing is a concern. this is a real concern in which we not only had to use more, but we had to pay more. i think that's something that resonates with all of us. this will now add two more years, so that's why the total looks so big. it adds two more years at the new rates. the other group of registry are four others, medical services, norcal, medical, rx relief and health. each are as needed pharmacists. about 50% of the pharmacy services, we don't have filled

slots and they have to come in for that. the other 50% are the additional coverage needed when people are away or you know, are assigned to covid, et cetera. of two of those contracts, they have an increased ceiling related to the fact that they are used the most. the others actually have the same ceiling that was in the previous contract, which is 3.7 million and the first two are up to 7 million because they are used the most. there is a third contract -- i mean there is a third type of contract that is behavioral services. this is to extend their contract for 18 months while preparing an r.f.p. new contracts are -- and this is

for the expertise in -- i was going to say leading, but the process for the department and it's a contract that also combines the previous -- there were two companies and roma has become a part of it. now it's a single contract with moss adams. we did discuss a program that the commission will see that i'll let you get that briefing, but basically its achievement process for our san francisco program. it's for our city option

insurance program, where employers have put money in. these people have not used the money and three years later, the money lies dormant. this is a process to move it over into the city and use it by the city after three years. they will go more into detail. so i think they'll be able to give a comprehensive discussion of it and recommendation on our part is that it does make sense. on an emerging basis, the commission -- the committee felt that it would be worth it for the commission to look at the issue of recruitment, retention,

and costs of rising costs of medical personnel and would leave that to the office and staff to see how best to do that since the increasing costs will be continuing with us. so we do recommend an approval of all the contract reports and new contracts. >> thank you commissioner chow. secretary, do we have any public comment on item 13, the committee update, finance and planning committee update. >> folks on the line, if you would like to make a comment on the finance and committee update that you just heard, please press star 3. this means your comments relate to that item. no hands commissioners. >> seeing none, we can move on to the next item, which is the consent calendar, which was just

reported by commissioner chow. commissioner chow, do you have anything to add before we move to motion on the consent calendar? >> no, i would move the consent calendar. >> do we have a second? >> second. >> any public comment secretary? seeing none, we can move. >> sorry, i was saying it out loud but i was on mute. if you would like to comment on the consent calendar, please press star 3. now we're good. i can do a roll call vote. >> commissioner guillermo. >> yes. >> commissioner giraudo. >> yes. >> commissioner green. >> yes. >> commissioner chow.

>> yes. >> all the items pass.

>> we did have this percent fully vaccinated, which i think is so important as we continue to head into the high holidays, the winter season. compared to where we were last year, we're in a much better position, but we're going to need to emphasize on getting

vaccinated and continue to watch and be flexible, responsible, and resillient. so i will stop -- resilient. so i will stop there and take any questions from the commissioners. >> before we go to the commissioners, do we have any public comment? >> members of the public who would like to make public comment, press star, three to raise your hand. star, three. make sure we give you a few extra seconds to raise your hand. i don't see any hands, commissioners. >> commissioner green? >> i guess i had two questions. we saw a lot of feedback from individuals really eager to get

the booster. how wonderful that so many people want to lineup, but i wonder what we might do to educate individuals where they can go to get vaccinated, and then if it turns out that [indiscernible] how we will be able to trace test rates, so

i'm wondering how we plan on participating, and obviously, just food for thought that i was particularly curious about the advice that you might give the public on identifying locations for boosters? >> well, thank you, commissioner green, and in terms of our booster outreach and work, we've been really focusing on the communities that are most vulnerable and hardest hit by covid-19, so our neighborhood sites, our pop-up sites, and if people have a health system that they are a member of, when encouraging people to go there, they can certainly see the hours of our site and certainly drop into our sites. nobody's turned away unless we obviously just run out of

booster shot. i agree the pharmacy piece is confusing. this is a national -- they are national, for the most part, national chains. not all of them, but the vast majority, so our efforts to get our systems refined and more clear have not so far been successful, but i have experience where a pharmacy has been listed at drop-in and then trying to work with a person to go drop in and then finding out that they haven't been drop-in. it is a challenge right now, given the demand for boosters.

in term i would say to either make an appointment or drop in, it may be frustrating in some circumstances. i think the second question was with regard to the home testing and case rates. we're actually in [indiscernible] either people who are negative reporting that they're negative than people who actually test positive,

we're only getting the positive results because if people are negative, they're less likely to be concerned and less likely to report. i think also as we hopefully continue to see -- i don't want to be concrete here, but i think we will see case rates be a less metric for us to follow than the case rates, although because of vaccines, such high vaccine rates in the city, the elevation of case rates -- the correlation between elevation of case rates to the elevation of hospital rates, that that

ratio has changed because the vaccines are so effective in preventing hospitalization. that means that actually watching case rates in to the level that we have may become less important in the future, and the question, then, is what is the additional value with the challenges that i just described around the accuracy of reporting home test kit rates, what is the value of getting that information? so i've asked the data team to get you that and we'll be coming back with recommendations. >> okay. well, thank you so much for that. >> thank you, vice president green, and director colfax. if we could back up for just a second, secretary moritz has let us know that there is one person on the line for public

comment. >> [indiscernible]. >> [indiscernible] and i'm a nurse working at the san francisco general. okay. so i have a few comments. number one, the covid-19 recovery rate for adults and all population is above 95%. we are talking about absolute rate of recovery. absolute, not recovery. so 95% is without the vaccine

[indiscernible]. >> can you please mute the background noise? there's background noise. can you please mute it? [indiscernible]. >> your time is going. just keep talking. you've got 30 seconds. >> [indiscernible]. the recovery rate is above 95%, absolute recovery, and there's

[indiscernible]. >> please mute your background noise. we can't hear you. >> yeah, just keep talking, please. [indiscernible] . >> thank you. your time is up. >> thank you, caller, and thank you for your comments. >> dr. colfax, i have a comment about your report. in san francisco, we have both public health surveillance resources and resources through

our partners like ucsf, for genome sequencing, and we are better situated than any other region in the country, so i think that deserves to be reiterated, so thank you for pointing that out. i would just ask, as part of your report, what are the best steps that san franciscans can take to protect themselves from covid and particularly the omicron variant? >> well, i think if you haven't been vaccinated, get fully vaccinated. get those doses. if you've been fully vaccinated, you will have six months from the mrna or two

months from the johnson & johnson vaccine to get a booster, so that's very important. and then, you can go to our d.p.h. website, but wearing masks in -- as recommended by the d.p.h. and in certain inside settings will be really key, and then augmenting those efforts with testing again. people can find guidance on our website how to lessen the risks using those additional tools. so boosters and additional testing, especially masking and testing and when you're around crowds for the holidays and during any significant holiday travel, as well.

so where we were last year, there certainly still is risk in terms of covid transmission during this holiday season. i think that people need to understand [indiscernible] that if and when they're comfortable, to gather with people because that's so important for so many of us, our health and wellness. so it's a balance here, and that's the message that we want -- the messages that we're sending in terms of risk reduction and then making a decision in terms of what you're comfortable doing for the holidays. >> great. thank you, director colfax. seeing no other comments or

questions, unless vice president green, is your hand still up? no? we will skip back later to our agenda, other business. commissioners, are there any other business? public comment. >> if you'd like to make public comment on other business, please press star, three now. >> okay. seeing no public comment, adjournment. >> i move to adjourn. >> i will do a roll call vote. [roll call] >> all right. thank you, everyone. >> thank you. thank you to d.p.h. >> thank you, good night. >> -- and the people of san

francisco for everything you do to keep us healthy and safe.