january 4th, 2022. welcome toern and our first order of business is to read the land acknowledgement. >> before we do that, commissioner, i'm going to call the role. commissioner bernal's on his way. [roll call] >> clerk: commissioner giraudo will read the land acknowledgement commissioner 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 rrlts of the ramaytush ohlone community and by affirming their sovereign rights as first peoples. >> thank you. >> commissioner: so the next item on the agenda is recognizing the disparjing. >> clerk: commissioners, this item was introduced to you on december 7th. today is your vote on the item.

i'll read the resolution. whereas the health commission acknowledges the disproportionate health disparities faced by the native americans and higher rates of diabetes, heart disease, aids, prema sure death, domestic violence, and other violence exposure. stress related illness and depression illness and suicide as well as a disproportionate morbidity and mortality due to the covid-19 pandemic. and whereas the health commission acknowledges that the native americans may face one or more systemic barriers including unstable or lack of housing, food insecurity and limit to access to culturally sensitive cultures. whereas the health commission acknowledges the health data contains significant data gaps on american indian and alaska

native race and underreporting on american indian and is a native carriers. rendering to fully identify the disproportionate health disparities and whereas the health commission recognizes it has not been proportional to based by the american native indian. the san francisco human rights commission published a report in 2011 titled discrimination by admission an issue for native americans in san francisco detailing the ways in which american indian communities experiencing disparities in san francisco. and process which was guided by members of the local ingd yan

ask meaningful ongoing partnerships alaska native organizations slash tribal members to identify and understand their public health needs and develop a set of public health priorities and be it further resolved, the health commission recommends the san francisco department of public health including accurate and african american health data and health impacts and public reporting where possible. and the health commission directs the san francisco department of health to add a footnote to any presentation or report that includes race and/or ethnicity presented to the health commission explaining a lack of data for specific communities to ensure no community experience is being visible and be it further resolved, the health commission directs the san francisco department of public health to work with local american indians and community tribal members to identify recommendations to address these health disparities

including presenting to the health commission within six months. >> thank you for reading the resolution. motion to approve an order before we go to public comment. >> director: yes, sir. >> president: do we have a motion? >> commissioner: motion to approve the resolution. >> commissioner: second. >> president: all right. can we go to public comment, again, star three. before we begin, i have something to read. for each agenda item, members of the public will have an opportunity to make comment for up to two minutes. the public comment process is designed for feedback. however, the process does not

allow questions to be answered in the meeting. the commissioners do consider comments for members of the public when discussing items and making a request to d.p.h. so we'll start with you, caller. i've put two minutes on the clock and please let us know that you're there. >> caller: hi. good evening everyone. excuse me. i'm the executive director or rfrlt american indian corporal district. and i just wanted to express my support for this item and just express the importance of this for the department of public health and the commissioners for their work. as many of you may or may not know, it's been highlighted in the reports for the last few years. lowest income rates in the city and unfortunately we haven't seen this requested in our policy changes with our different organizations

throughout the year. just wanted to call and stress the importance of this resolution and thank those that have stepped up and agreed to a significance of working on it and i hope this is a step in the right direction working with the native american organization and the funding distribution and the policies are also accurately including americans in their data. so i just wanted to say thank you. >> director: thank you so much for your comments. next caller, are you there. >> caller: hello. this is michael petrellis calling and regarding this item, the resolution addressing health disparities of the local american indian communities. i am calling in to speak in favor of this resolution and i hope this is resolution passes unanimously. >> thank you for your comments. next caller, please let us know

that you're there. >> hi, good afternoon. my name's mary travis ellen and i'm the advisory board president for the american indian cultural district. i'm calling to ask for your support in passing this resolution and not leave it just as words on paper. it is a commitment. it is a modern day promise and treaty that will commit this commission and san francisco to address all the health disparities that have occurred in the past. in the interest of equity, we have so many concerns that need to be addressed and have not been addressed by this city. so i'm asking for your support in favor of this resolution. thank you. >> director: thank you very much for your comments.

next caller, please let us know that you're there. april mcgill, are you there? >> caller: yes. good afternoon, commission. my name is april mcgill. i'm one of the cofounders of the american indian cultural district and i just wanted to also say thank you commission for supporting this resolution. it's really important to the american indian community to make sure that the health disparities that our people have been facing for decades is not forgotten and that we include those statistics in this work. i also would like to thank all of those organizations such as the california consortium for indian health, native american health, and just all the other

boards who've worked so hard to make sure they create visibility for the native american community. thank you very much and i appreciate all of your support. >> director: thank you for your comments. i believe we've got one more commissioners. please let us know that you're there. >> caller: i just want to thank the commission for your support on this resolution and equitable words of ms. mcgill in regards to really focusing on having accurate data for our community. so often, we're invisible or we have been termed what is the asterisk nation and so i just really appreciate the city and commission's attention to this matter so that we can work to improve the health of american indians and alaska natives in san francisco and really throughout the state.

thank you. >> director: thank you so much. commissioners, that is the last hand that i see. thank you all for your comments. >> president bernal: thank you, secretary morewitz. we will now go to commissioner comments. in developing this resolution. commissioner chung. >> commissioner chung: thank you, commissioner bernal. i believe i was absent from that meeting and i feel terrible that i wasn't there because the actual human rights commission report was doing my ten year as the health and human rights commission and i was one of the commissioners presided at the hearings for

the report. and so it is heartening for me to see that we are finally really like addressing some of the issues highlighted in the report especially around disparities. i've said before there were two american indian health organizations and, you know, because of funding and, you know, other reasons, you know, one of them had to close the door. so hopefully, you know, this would help prevent, you know, any of these kinds of situations ever happen again and to make sure that we give our support to the native communities. >> president bernal: thank you, commissioner chung. commissioner chow. >> commissioner chow: yes. thank you. i wanted to thank the native

american communities for coming together with the department to work out this resolution. i know at the time that we spoke about it that there was need to bring together community input and i think that we're very satisfied that this has occurred and we can look forward to our cooperative relationship in order to address these needs. it was interesting that yesterday, usa today on a national level carried another article on the native americans and the challenges they were facing not only with omicron, but overall in terms of indian health. and so i'm very pleased and privileged that this commission will be able to address this locally and i encourage the support of all of our commission. >> president bernal: thank you, commissioner chow.

commissioners, do we have any other questions or comments before we move to a roll call vote? all right. seeing none. of thank you to the members of our community working with secretary mark morewitz and your ongoing work with the department to ensure san francisco's american indian communities are supported and that their health is addressed by the work that is done here in the department. thank you also to director colfax and the leadership of the department for your work in this area and we can move on to a roll call vote. >> secretary: [roll call] all right. the item passes. thank you all. >> president bernal: the next

item is the approval of the minutes of the health commission meeting of december 7th, 2021. do we have a motion to approve? >> commissioner: so moved. >> commissioner: second. >> president bernal: any public comment? >> secretary: sure. folks on the line who would like to make a comment, please press star three now. please let us know you're there, caller. >> caller: hello. this is michael petrellis again and i want to discuss the minutes from december 21st and what's missing. while there is information about the latest developments with covid-19 and the variants, there's nothing in these minutes indicating that you all

discussed mailing everyone in san francisco both the home test and a so we can get better epidemiology and i think that san francisco which prides itself on being the first in so many public health issues

that's all i wish to say about the minutes from last month. >> secretary: thank you for your comments. >> president bernal: any other public comment? >> secretary: none that i see. >> president bernal: all right. we can then move to a roll call vote. >> secretary: all right. [roll call] the item passes. thank you. >> president bernal: all right. our next item on the agenda is our director's report. director of health, dr. grant colfax. >> director: thank you, president bernal. you have the director's report in front of you. there is quite a bit about covid and covid updates. so i encourage you to read that. i've also provided that in my covid update.

i do want to call your attention to another emergency issue that we are working hard on with other city departments. this is being led by the department of emergency management. but on december 23rd, the board of supervisors voted to approve mayor breed's state of emergency declaration in the tenderloin. this state of emergency focuses on the very high rates of drug overdose in the tenderloin and we are working under the leadership of the department of emergency management to do everything that we can do to mitigate and prevent as many deaths due to drug overdose as possible. this includes establishing a service center where people will be able to go to avail themselves of city services including behavioral health services, behavioral health treatment. the team is working very hard on that and we expect this to be up relatively soon.

this was announced today that the building was leased for this purpose. lots of work going on covid related and then also related to the very serious situation in the tenderloin. that's my director's report summary. i'm happy to take any questions from the commissioners. president bernal, you're on mute. >> president bernal: you're on, don't listen. no. i was on mute. secretary morewitz, before we go to questions is there any public comment on this item? >> secretary: i don't see any hands. i see no public comment. >> president bernal: okay. commissioners, any questions or

comments before we move into the covid-19 update? i don't see any. >> secretary: actually, i'm sorry. it looks like a caller put their hand down and back up. it looks like that person wants to speak. is that okay, president bernal? >> president bernal: yes. of course. >> secretary: please let us know if you're there, caller. >> caller: hi. it's michael petrellis again. so i am disappointed that dr. colfax, you are not raising the issue in your report about mailing everyone in san francisco a covid test. in washington, d.c., about a week and a half ago, mayor muriel bowser found city money to begin distributing covid-19 tests through public libraries,

recreational centers, and d.c. government buildings. while that is not what i would like to see here, it still is a terrific development for public health that the d.c. government is making the covid test so widely available for free and all of their government buildings. i think you should consider this, dr. colfax in addition to making the n95 masks available everywhere at san francisco government buildings and the home test. i don't think as year three of the covid pandemic begins here that we're in a good situation because there is no discussion at this point ability mailing the tests and making them more

widely available. thank you. >> secretary: that's the only public comment, commissioners. >> commissioners, any comments or questions before we move on to the covid-19 update. okay. i do not see anyone. so back to director of health, dr. grant colfax. >> director: thank you, commissioner. thank you, president bernal. and i think we'll go into the covid update with presentation as that comes up. thank you mckayla. so thank you, commissioners. let's just go right into the slide. we're having an unprecedented surge you can see here on the far right of the slide that

curve. it's basically a line going up with cases now approaching 100,000. we haven't seen the likes of this before and these are data looking at the data just over the next couple of days. i fully expect the number to go above 100. so we are in the midst of a surge like we've never seen before. the other thing that's important to emphasize is while our vaccines and particularly the boosters are extremely protective. the vaccines are not working as well as you can see from this slide, our case rates by vaccination status here, the vaccines and the boosters still are somewhat protective.

you can see our case rate here is 82.5 per 100,000 people who received our booster. 120,000 for people who received our initial series but are not up to date. in other words, have not received a booster and for unvaccinated, that rate remains even higher at 133.1 per 100,000 cases. the bottom line is unlike prior surgeries, we're going to see a lot more people who are fully vax -- who have received our initial series of vaccine and who are up to date on the vaccine and have received the booster. they are still at very high risk now for getting covid-19. the bottom line, however, is particularly people who receive a booster, the odds of being hospitalized due to covid-19 are tremendously reduced. so getting those -- that initial vaccine series into arms and getting that booster

is more important than ever before because as far as transmission is concerned, all san franciscans are at greater risk than ever before. so this is looking at our covid hospitalization numbers over the past two years. and you can see here that our -- i'm sorry over about the last year. starting in october of 2022. you can see our hospitalizations are on the far right. we have just over 100 people with covid-19 in the hospital. that is approaching our summer 2021 surge with delta and then still lower than our alpha surge. i also want to point out that that all important metric of hospital capacity, you can see here that we still have good hospital capacity in terms of number of beds across the city.

our i.c.u. capacity is 41.8% of beds are available. in remaining noni.c.u. capacities those so-called surgical beds are at 21.5%. at this time, our hospitals from a hospital bed standpoint are not in danger of being overwhelmed. i will say though as you probably read in the press and heard directly from others, we are having challenges with staffing levels to some degree and just to provide some examples, we've had over 250 staff out due to covid-19 infection related issues and at laguna honda hospital, we now have over 70 staff out. this is another challenge that we need to address as we continue to support our health care systems both within the health department and other health care systems across the

city. just one other point to make on the side on the far right with the omicron surge, there is a percentage of these cases in the hospital who are hospitalized primarily for other reasons, not covid related. so people coming to the hospital are tested and are covid positive versus people who come into the hospital specifically due to covid-19 related symptoms so based on the data from the zuckerberg hospital so i think this slide is also important to review with automotive of you. this is looking at our covid

hospital census on our case rate shown with the blue line and yaxis is the right. and i think what's important here is you see that oicron is not to the rate of hospitalizations at this time and that's really consistent with a couple of things. our wall of immunity for preventing most serious hospitalizations as well as 81% of san franciscos have received those first initial series of doses. now getting a booster, so up to date on their vaccination. and the other part of the equation here is that it appears that omicron is less likely to cause severe illness

compared to delta or alpha. at least what we saw with our winter surge last year, we are doing better related to the case rate overall. but still, we're going to have lots of people become infected and that's going to translate despite this wall of immunity and despite omicron is still going to result in a large number of hospitalizations due to covid-19. next slide. our test positivity has sharply increased consistent with our case rates here. you can see the number of testing seven-day average. we are at numbers that are

unprecedented. 17.1% if you just want to take a moment to provide you with additional testing data that are not fully realized on this side. that takes into account the holidays and i just want to assure the commission that on december 28th, we've reached our all-time high of testing in the city, across the city but not including over 12,000 tests being done in a single day and our four-day running average that excludes the holidays is now over 11,000 tests being done. d.p.h. is shouldering a large burden of the testing numbers here we've and we are working

with other health care systems to encourage them and require them to do more testing. just to remind the commission, the health officer had the health order that requires specifically health care systems to test their clientele of the request. we've received communication from other health care systems in the city where they are specifically sending their staff and patients to city sites to get tested and this is obviously concerned because we expect per health order require all health care systems to do their part during this unprecedented surge. next slide. in terms of vaccine administration, we again as i already mentioned 81% of the

population has completed those initial vaccine series of those eligible, we're at 85% and then our booster numbers still have a way to go here, but i will say we are in a much better place than any other jurisdiction i'm aware of. and you can see here among our residents 65 and over, those numbers are even higher at 75 and 76% respectively. i also just want to add, this is not on this slide, but among the 5 to 11-year-olds in terms of their vaccination status, we are at nearly 66% of 5 to 11-year-olds now having received one shot and nearly 50% of those 5 to 11-year-olds having received the initial, completed the initial series. next slide. and this is just looking at the

booster recipients by age. actually, we're at 55%. so this slide is slightly updated from the last slide. i apologize and i just want to emphasize every bit does count and you can see here by the age breakdown of people receiving a booster, this is reflected and this discrepancy in terms of the distribution of boosters by age is reflected to some degree by the fact that the boosters were recommended for people of older ages initially. so that's one of the reasons that number's so much higher among 65 and over. we've also been very focused on ensuring that we are reaching residents at high risk for the worst outcomes due to covid and that means focusing on often focusing on older resident including those in our skilled

nursing facilities residential care facilities for the elderly and other congregate settings where there are large numbers of older adults. next slide. so just in summary, omicron has replaced delta as the dominant variant. you'll recall in early december, we announced the first detection of omicron in the united states. clearly, omicron is far more transmissible than delta. so that is positive news, but there is reduced vaccine efficacy for transmission especially without boosting. we are having rapid increases in our numbers. our resident hospital number is increasing rapidly. omicron hospital severity at this time is tracking at about 33% of what we're seeing with similar rates with delta.

so, again, it appears to be less severe. this could change, but we are watching this very carefully. at this time, those protections correlate with the peak census that about 250 people in the hospital with covid by later this month. again, that's a testament. there are wide variation in those numbers, but that gives you ball park figure of where we are thinking we may end up and we're working with our health care systems watching that hospital capacity so carefully and, again, working to address potential staffing shortages and issues there. and then, again, i've said this many times already in this presentation, boosters are so important and increasing boosters now can have a significant impact even this month. there's reasonable scientific evidence that boosters start

working quickly after a receipt. so we're encouraging everyone who's eligible to get a booster as quickly as possible and we've been tweeting in real time on a regular basis where people can actually drop it and get boosters. we've expanded our booster availability within the health department and are working with other health care systems to support increasing booster availability as well. thank you, commissioners, that's my update. happy to take any additional questions. >> president bernal: thank you, director colfax. commissioners, before we go into comments or questions on this item, we need to go to public comment. >> secretary: anyone who would like to make public comment, press star three. caller, you're unmuted. please let us know that you're there. >> caller: hi. this is michael petrellis again. and the issue i am calling

about today is the lack of discussion from dr. colfax and the commissioners about mailing everyone in san francisco a home test for covid. we also need to discuss mailing everyone n95 masks. i don't believe in year three of covid we are going to see it under control if we do not make masks and tests widely available. and we need to follow the example of washington, d.c. where they've made the tests available for free and all

municipal government buildings. without widespread testing, i don't think we're going to get accurate epidemiology. and i think it is really worth it to spend the money to mail the masks and the tests everyone in san francisco. it really needs to be done if we're going to control this pandemic. thank you very much. >> secretary: thank you. >> president bernal: thank you, caller. commissioners, do we have any comments or questions for director colfax. i see vice president green. >> vice president green: first of all, i want to thank you so much and the team as well because you produce statistics in which the state of this pandemic is spreading to get these kinds of

up-to-the-minute. i think you deserve high praise for this kind of work and i know which gets to one of two questions i had and it really all relates to the whole question of staffing. i know you have a burden and responsibility to address the pandemic as well as the issues in the tenderloin. and i think coincidentally with that this is the first time during the pandemic where hospital stats have been decimated by the but also given this whole issue of staffing, are there specific statistics that will trigger things like a

remgts in other words, we're in a situation where there is a whole other element of work force issues that we haven't faced up until now in the pandemic. but i wonder if you can just comment in general how you're all holding it together. >> director: thank you, vice president green and i just want to acknowledge the team has worked extremely hard on this and the number of employees who've been activated to address the covid-19 pandemic were scheduled to go back to their other work december 31st and we had to delay that they're going back to that to their regular jobs because of this. in fact pulled a number of additional d.h.p. employees due to the covid-19 surge. so there's a lot of work in the department that unfortunately will continue to be delayed as we address this issue and i

think the commission is well aware of as the city is re-opened and so many other priorities that are not directly related to public health, other departments are working in so many other areas and that this work is now really even more entered at d.p.h. compared to when we had our covid command center where dph played a major role, but there were many other departments involved. just to assume the general context. i think the team is digging even deeper and working even harder. we have an incredit burglary group of leaders on the ground and i do want to focuses on our

congregate settings. all those issues are areas where we are focusing and it is forcing us to prioritize. right now according to staffing, we are in a reasonable place. we do have a number of challenges usual staffing rates, we're able to maintain those and as i think you know from the state, there's been new guidance about people returning to work after testing positive if they are asymptomatic and if they have a negative test five days after their initial positivity, again, provide their asymptomatic and have a negative test. so that's positive for us in terms of getting people back to work in a safe way. we are actively discussing with

the hospital council and watching the hospital bed capacity. i think one of the challenges that we have in the next few weeks in particular as you well know, commissioner green as a practicioner yourself, hospital consensus tends to go down a little bit during the holiday and that surge team is reviewing the metrics to ensure if there is evidence if we start to run out of hospital bed capacity that steps will be taken to voluntarily or otherwise decrease the elective surgeries across the systems in order to make sure that we have capacity to care for people who

are most at need. >> vice president green: thank you. is there a curriculum. this is one of the questions whether there is any calculus or any way you're viewing the percentage of people that are out with sick calls. >> director: yes. and i think for an example of this, i'll turn to our director of the health network just to share a little bit of detail in terms of how this is looking on a day-to-day basis. >> hi. it's rowland pickins. can you hear me?

>> director: yes. >> thank you, dr. colfax and i invite dr. earlich comments also. you're absolutely right, commissioner green. it is a hospital by hospital calculus but i think the common theme is that, you know, we have state ratios particularly in terms of staffing beds and so all the hospitals are relying upon that and to that extent will operate beds as long as we have the staff and, again, patient safety is the number one goal and so if a hospital were to be in the

situation where they thought they wouldn't be able to adequately staff beds, then we have our regional emergency management protocols where we go into the state and all the way up to the feds, we're able to request additional resources. so those maneuvers have been put on the table in terms of if we find ourselves in that position of some of those preliminary discussions have already begun to happen, but i'm happy to have susan earlich comment. >> sure. thank you. susan earlich executive of san francisco general. this is indeed a uniquely challenging time for us one is there's a time in the winter every year as people get sicker.

this year as dr. colfax mentioned, we're challenged a bit more because we have more staff out on leave because, you know, for various reasons. we have quite a number of staff out because they're either sick with covid. they have high risk exposure to somebody who's known to be covid positive and they're being managed by our occupational health system. and that number of people is approaching 300 right now just at csfg. so with that being said, we have incredibly resilient, persistent and creative teams and the way we're managing that is as follows. first of all, we have entered into a third level orange in our area so we are slightly reducing our common space surgeries. i won't say these are lesser procedures, but they are less

urgent than other procedures. and so our number of o.r.s are operating. instead of eight, we're operating seven in a flex room. and we are also reducing procedures in other parts that enables us to take staff in that area specifically in the pacu and rotate them to other places. for example, the pacu, we have some nurses who are qualified to work in the i.c.u.s. particularly impacted by staffing losses so those nurses can go and work in the i.c.u.s. so that's the kind of thing that we're doing. we are adhering to ratios by reducing the number of beds we have open. so in the emergency department, we don't open all of our beds because we can't staff them. we go on diversion more than we would like to. but we're doing other creative things, but like, you know, if we can open our surge units for a proportion of the day, we

will do that in order to augment flow and finally, there is new guidance coming from the cdc that allows people to get back to work faster and we're in the process of implementing that. we don't know exactly how many people that will impact, but any people we can get back to wow sooner, we will do that so we're in the process of starting that this week. i think that's how we're managing it. you know, we just have an amazing team. they're just doing a remarkable job taking care of people in the community. thank you. >> vice president green: thank you so much. do you think with this wonderful example of how you're managing, are other hospitals in the city following suit? >> you know, we are uniquely impacted with volume at this

time. and part of what we're doing is working as dr. colfax mentioned, we're working with the other hospital to see if we can reintroduce the idea of level loading. we did that as you recall back in the first surge. there was a covid unit that opened at st. francis. i'm not sure that we'll do exactly that, but we are exploring ideas for level loading where we need to. the other thing i didn't mention is we are converting as many to telehealth both in the specialty clinics and primary care and that also helps relieve staff to go and work in other areas like testing for example. >> vice president green: that is wonderful. thank you for this thorough answer. very much appreciated. >> appreciate your support. >> president bernal: thank you. commissioner giraudo.

>> commissioner giraudo: thank you. dr. colfax, in your report, you mentioned dr. phillips' concern that some of the health systems are not really doing their part for testing and are sending not only their employees but others who walk in the door, potential patients to be tested at the d.p.h. testing site. is there anything more that you can do or dr. phillips can do with this so-called concern to get the other health systems to do their part? is there any push or anything that can be done? >> yes. i'll let dr. phillips answer that. i will say we've been reaching out directly to other hospital

system leaders to ensure that they have insight into the situation to work with them to collectively problem solve around this issue. this so we're working with them but we're going to see unprecedented demand and quite frankly d.p.h. is carrying a huge burden here. however, whenever we can, but we are really calling upon

other health care systems to do their part different health care systems are a different change in that regard. others it's not clear at this time what their plans are to do that and i will turn it over to dr. phillip as our we have been in communication for some time that the order has been in place that they provide testing to their patients on request within 24 hours. so we recognize it's been a challenge during a so we have

some evidence. we're following up with a letter from the health officer reminding them of the health order and we do want to continue to work together in a. >> president bernal: all right. thank you, doctor. >> commissioner giraudo: thank you. because it was my own employees who needed testing. so just to note if there was any other push, but i understand it needs to be constructive. as much as possible. but thank you very much, dr. phillips.

>> president bernal: thank you, commissioner giraudo. commissioner chow. >> commissioner chow: yes. thank you, president bernal and dr. colfax for actually an amazing response to this rapid surge as you said. i was wondering if there was any forecast or a lot of forecast in the papers from maybe experience in other countries how we might feel in terms of and what you're playing for in terms of the length of this particular surge and i guess secondly, i am interested as i've been trying to read through the what we are actually asking for when we say fully vaccinated versus up to date vaccination. there are areas that are

requiring the booster for example. i think kind of in lieu of what's going to be started to implement that. so i just wanted to understand a little better and thirdly in regards to the schools and i know that has been a continued challenge and i'm glad to hear we're all working together to try to keep the schools in operation. it does talk about rapid testing. i think the concept of some people that we've heard about sending tests to homes only gives you one test or two at the most for each kid. here, we're talking about actually testing more frequently for example in schools. so i'm not sure how we are cooperating or working with the school district or encouraging them to be sure to follow the

guidelines. so those are my three questions. >> thank you, dr. chow, and i'm also going to ask our health officer and page director susan phillips, but just to go through a couple of your questions in terms of projecting about where this -- how this surge will go, obviously, this pandemic has humbled us on any future predictions about disease patterns. but i will say that most experts i've talked to looking at those international, national, and local situations believe based on increasingly based on data and to some degree on modelling to a lesser degree on speculation. this surge will be very steep

and fast because this is such an infectious virus it will go through populations very quickly. we've seen that in south africa for instance that may already be in the u.k. locally using the models by dr. maya peterson who you know we've been working with since the beginning of this pandemic. our projections show that locally our hospitalizations will peak sometime later this month, like this month followed by a relatively steep decline going into february. so, again, the actual data is still being generated obviously as we move into that future, but so far, the limited relatively is tracking with that projection. so it's a long answer.

but the point is it's going to be an intense surge that will peak relatively quickly and dissipate relatively quickly if those models hold. i did want to touch on the rapid testing question that you brought up and just to emphasize that we are working all possibilities for pulling out more testing kits. rapid testing kits, home testing kits as you know and we're doing everything we can to avail ourselves of an adequate supply of home testing kits to use in very specific situations to protect the most vulnerable. there's a national shortage. the supply chains are very irregular and in some ways

nonsense cal there are places where they receive home test kits in large numbers and there are other places where home test kits have not showed up. we have ordered tens of thousands of home which really is a week from now and that can shift by the hour two more weeks to three more weeks. we're also cautiously optimistic. we are literally purchasing these kits. we don't have any additional information on the 500 million test kits will be coming and how they'll be distributed. so we're working on three levels. one is we're talking to the state and working to see when

they may be able to and then again waiting on the state, on the federal it is a national shortage. we are ready to deploy these materials and there has been a lot of work with the school district both in terms of figuring out how to deploy rapid testing if and when it can be scaled up as well as additional testing. so i'm going to let dr. phillip answer that question. respond to that question. >> yeah. this is a top priority for all of us in this city at d.p.h. and sfusd and schools across the city and for families. so that is a key focus. we've put out our strong statements that despite the number of cases in omicron, the

previous efforts and preventtive measures in schools have allowed schools to be open during our prior surges and we believe that that can happen again. testing is a component of this, but so are masks and ventilation and all of the core prevention strategies for covid-19 and those have to continue. so the schools have their own testing contracts and they are positioned and situated to best work for their needs for their students if their families at sfusd in particular. the state is additionally sending rapid test kits and people may have heard of other jurisdictions and school counties that have distributed those kits. because of the recent severe winter weather throughout california, the state had announced that some of the supplies had been delayed and we are understanding that in san francisco those kits are arriving in the next day or so and will be distributed by

sfusd. they also have other opportunities for home test kits through the contracts that they have now. so we're continuing to work with school partners as we have done since the beginning of the pandemic. we have a school's team that's just focused on assisting schools as much as possible and that team continues to meet with and talk with not just sfusd, but all schools across the city. so that is what we have in place right now. we continue again to look for all opportunities to assist and continue to make sure that the city wide resources are also available and as we scale up testing, we know that will be to the benefit of students and families as well. i also wanted to ask a question about up-to-date vaccinations and what that means. this is a new term that we have in our most recent health order and rather than saying a person

is fully vaccinated, this is really an acknowledgement that now we're talking about are you up to date. so that means you've gotten your primary vaccine and that also gets tricky because just this week, we're hearing at the interval the boosters has decreased by the fda and cdc from six months to five months after an mrna vaccine. so that is what up-to-date means. we have not made that a requirement in most general settings. the exception to that is going to be in indoor megaevents which previous have been a 1,000 people or more in a venue and the state has revised its definition to be 500 people or more. in those settings starting on february 1st, everyone who attends will need to be up to

date on their vaccination and their staff as well. we also said in high risk settings, has been done since the beginning of the pandemic. nurses facilities all must be up to date on their vaccinations by february 1st, but that we are encouraging and urging people to do that as much as possible. >> this is a moving target. i understand the up to date definition now and i think dr. colfax and the entire department has been remarkable in one that we should be very pleased to be able to support. so thank you. >> thank you.

commissioner chow. commissioner guillermo. >> commissioner guillermo: thank you. and i really appreciate all of the answers to the questions so far and the thoroughness in the details. i appreciate that again in advance. one has to do with sort of a followup to rapid testing. knowing that there's a lack of availability of the home testing kits i'm wondering what impact that's going to have the data collection efforts around covid knowing that there are going to be more and more people who are just going to be self-testing at home and they won't be reported to the health department or to their provider and whether there's a sense of how impactful that lack of information is going to be and our ability to respond as a

city. and then the second question has to do with contact tracing knowing that it was difficult to do to begin with when we first were impacted by covid and the surges, but with omicron even more so and i'm just wondering if we have an update on the contact tracing efforts that have been put into place or whether there is, you know, with the difficulty is at this point given this surge and the state that we're in. >> director: thank you, commissioner guillermo. i will attempt to address the testing and rapid diagnosis questions. i'll let her provide an answer to that question. but going to the rapid test kits where people will be

testing and whether they test negative or positive, there's no formal way for them to record and there's no requirement. i think it really calls into focus the fact that going forward with the surge and like with future surges, we need to really focus on the number of people hospitalized to ensure that we're able to take care of the people who are most sick with covid-19. i think increasingly, the absolute numbers of covid-19 infections, the specific rate is less important than the change in that rate and whether that rate is going up with what i would call conventional testing. you know, a week or two weeks later. but those actual specific numbers are more matter more i

would say qualitatively than quantitatively going forward. as you see in the slides that i showed earlier, the rate of infection is high. the percentage of that is lower than we've seen before which is really good news. that being said, i mean, we have talks with the data team and to some extent the state, what are systems that could potentially be put into place. there are some counties that have piloted voluntary reporting of positive test results from home test kits. i think that that's a creative way of testing this but it also could adds additional challenges. if you only have people testing positive reportings of that don't have your rate because everybody is testing negative

would necessarily report in those situations. i think overall until we get many more and those should be leading indicators and should not in any way from trying to get as many of those home test kits out to people as quickly as possible particularly with regard to being used in a rapid diagnosis and also based on state and local guidelines being able to return back to work and other activities if you test negative. i hope that gives you the specificity to the answer you hope to receive. >> before we go to dr. phillips, just wondering

then again about messaging, you know, around the importance of testing overall versus testing when you have symptoms. and so that's something it's probably not a good around that messaging right now, but it is something that i think it would be important for us as the health department to be very aware of and to be prepared to communicate with the public around that issue. >> director: thank you, commissioner. the thank you for reinforcing that and we have reenforced the importance of testing. and obviously people who have symptoms. but also to test with regard to travel history to consider testing when people are going to be around particularly vulnerable populations or people who are unvaccinated and

those are recommendations that are on our website and we are reenforcing the recommendations of the state and cdc in those regards as well. dr. phillips, if you could answer commissioner guillermo's question about the contact tracing update. >> yeah. certainly. commissioner, thank you very much for the question. it is not feasible to contact all of those people and that indicates for some time with having hundreds of cases, but what we have done since the beginning of the pandemic and what we continue to do is try and optimize the information that we can provide to people so that they know how to isolate or quarantine safely. everyone does get an auto mated message and they are told, you know, if you need additional support in order to do isolation quarantine, they can

call our support center. we do continue to have a covid support group that are experts at telling people and giving people information about resources and about ways in which they can isolate and quarantine safely in their own homes and residences. so that is really the focus in trying to make sure that people know what is -- what we need to have them do and that they have people that they can talk to and ask questions of if needed as this comes up. but more and more, this is something that people are doing in their own homes or needing to do on their own with support and information about how to do that safely. >> thank you. i appreciate that. this is sort of a reminder for the public that there are resources on the department's website, you know, instructions, guidelines, you know, all kinds of things that people can go to versus going to other sources on the

internet that may not have good, accurate, scientific based information and so i appreciate that you've reminded us that we are on, you know, a number of the questions that we've been asked, that have been asked, that the department has definitive information with is up to date as possible and that there are resources for us. thank you. >> thank you. and we'll continue to make those as clear and accessible and remind people via social media and other ways so that will be front of mind for people as they need that information. thank you. >> president bernal: thank you, dr. phillips, commissioner guillermo, and director colfax. i do not see any other comments or questions from commissioners. i did want to just go back to your presentation, director colfax and acknowledge that you showed we've been through two

fall years and almost entering our third year and given this third peak that looks to be steeper than any. it's clear how much strain this has placed on the entire department to our program attic staff. our leadership and just want to acknowledge all of their hard work and everything they've been through over the past two years and just thank them for their perseverance and just acknowledge how hard they've been working and know that the commission stands fully behind them in support of them and of you and your team as well, director colfax. >> director: thank you, commissioner. thank you, commissioners. >> president bernal: all right. we're moving on to our next item which is general public comment. >> secretary: hi, folks on the line, anyone who would like to

make a comment. at this time, members of the public may address the commission on items of interest to the public that are within the subject matter jurisdiction of the commission that are not on this meeting agenda. the brown act forbids a commission from taking action or discussing any item not appearing on the posted agenda, including those items raised at public comment. >> caller: mark just said that this is general public comment for items that are not on the agenda and as you have heard me say previously during this meeting what's not on your agenda is making tests and n95 masks more widely available. i have not heard anything and it's not been on your agenda about mailing everyone in san

francisco a home testing kit. however, we're all going to be getting ballots in the mail and i just think it's very interesting that the politicians are taking elections as they should. but they need to expand their agenda and allocate to mail those tests to everyone in the city, especially in those areas where you're seeing the increases happening. you also need to start mailing the masks to everyone. i don't believe that there is a shortage comparable to the covid tests. so why aren't the masks being distributed at the libraries, at police stations, at fire stations. i think san francisco has to examine why you are not

discussing at this point the dawn of year three of this pandemic. you're not even discussing mailing the tests and the masks to folks or making them available at municipal buildings. i hope you have heard what i have said several times during this meeting and that you soon put these items on your future agendas. thank you. >> secretary: thank you for your comments. that's the only public comment that we have, commissioners personal thank you, caller. we will move on to our next item which is an action item, a resolution making findings to allow teleconference meetings under california government code section s4953e. as we've done every month now, the health commission considers passive resolution to give it and all of its sub committees including the jccs to meet

remotely for the next 30 days. so approval is requested on this. commissioners, you have seen this resolution before, so i think there's no need to read it through. do we have a motion to approve? >> commissioner: i move to approve the resolution. >> commissioner: i second. >> president bernal: secretary morewitz, do we have any public comment on this item? >> secretary: folks on the line please press star three now if you wish to make public comment. i see no hands, commissioners. roll call vote? >> president bernal: yes, please. >> secretary: [roll call] thank you. the item passes. >> president bernal: great. thank you, commissioners. our next item is an action

item. we have stella clou who is the dph manager of care. >> secretary: i believe jenn louie is also. >> we're establishing a process to address the backlog. this is a legal process consistent with california state law and this is all in conjunction with the city attorney, the mayor, controller, as well as the tax collector. i do want to reiterate that our

goal is always to maximize the use and we hope that our work on this process we're able to increase the number of active accounts. but the actual zones. this is a process of last resort. can't leave unclaimed funds in the program. with that, i'd like to turn it over to stella chou. >> it looks great. >> thank you. happy new year. my name is stella chou. so thank you for the

introduction. we will also touch base on information about the sf auction program as well as the in-treatment process. we'll look at what we need for the program. followed by we will be sharing our communication and our plan prior to our initial shipment in calendar year 2025. and after that, we will also provide a summary of program changes if the shipment policy is approved and implemented followed by our plan exit staff and the q&a section.

our objective today this sf city auction shipment policy has been approved by the health commission's finance and planning committee on december 7th. and today we are here to ask the commission to approve this and allow us to move forward with the implementation. the issue here is that the department's goal has been to ensure the program participants can maximize the use of the benefits. in june last year, the health commission approved the sf co to make the program easier for the employees to access. under that program approved by the health commission, we are implementing multiple projects to achieve our goals.

in addition to that, the program also has a backlog of accounts and contributions that have been inactive for multiple years. as a result, we're here to propose continuing this project under the sfco communication projects to improve the utilization of the project and we ask the health commission to approve when eligible to inactive program funds based on the state and the city's current shipment process. a little bit background on the city auction program. the board of supervisors in 2006 approved the health care

security ordnance which created the san francisco city program. launched the sf city auction program as one way for employers to meet the employers spending pilot we also contracted san francisco health plans to the program including managing the sf medical reimbursement account referred to as sf benefits and also managing the poor accounts where contributions are initially deposited before they move to the accounts. in june last year, the simplification program was approved to increase the utilization and employee

engagement through three mechanisms including the simplified wellness process. why all this again, they are under this project, they are all under way. this problem always has some level of account as the program grows. just to share with you what are we doing currently in terms of communication and knowledge and data projects. one of them is to renting our program website. we are also replacing our existing logo to increase employee trust in the program. we are also rewriting the all

employee materials to the 8th grade level. this is all under way and also learning from one of our pilots in 2021 call healthy airport pilot. we learned that the employers warranted highly influential in terms of optimized enrollment of the employees. so our plan is to further expand these employer pilots this year for employers that with large numbers of employees that have not set up their account. as part of this data project, we've also contracted with transunion to perform auto mated and searches for updated employee information. so what is the.

it can be transferred to the local agency after a period of three years. and the city can have such process already if managed through the treasurer and tax collector's office and it's governed by the state law as well. and in the last i would say year also, they've been meeting with the mayor's office, the controllers, city attorney, through draft policies to draft this policy in process to initiate a new fund in this program. why do we need to initiate? back in 2015, the health commission approved and deactivation policy for the sfmra and the activation policy

only deals with the this program will always have a fund. which at the end of the year will have so it's inevitable as

the account grows. we would like to propose this shipment policy to allow us to initiate the inactive funds totalling the state's shipment process managed by the treasurer and tax collector's office. and, again, the city has been implementing this shipment process for various programs. and because, you know, we established this program in 2008 and it's been 18 years. so we have an unusual large sum of money that's that has been inactive for over three years. so it's about $104 million

which we present about 7.6 of the total percentage ever. our future projections will be about $36 million annually which means that 90% of the employer contribution funds are going back to the employees. but we can do to a budget drop. next, i would like to share our plans before the initial shipment happens. our communication and outreach lan to further reach out to this next town. if this policy is approved by

the commissioners our plan is to stop the outreach plan in april april. so we will implement this policy starting in july and urge them to activate the account. and counting gym, the three year period required by law will start to kick in and during that three years, our plan is to conduct an additional and more consistent and targeted notification and outreach to the employer and employees and our detail of what plans need to be out in the next few months and after that, three years of that period, if it's still inactive after all these outreach

efforts, we will follow the state laws, we'll follow the city's shipment process and notify the city that the city will now issue the funds unless they, you know, within the statuary period which is within 45 to 60 days. we will also do any publications in the newspaper as required by law to make sure that we get that information out and that's when the fund will be instituted in the general fund. that's the time line we are seeing. so now let's look at a summary of changes if this policy is approved and implemented.

hoping for your contribution. once we implement this new policy, the city will hold all the employer contributions. as of today, the health plan pays all claims and other program costs directly and after the new policy is implemented instead of an. >> and lastly, we mentioned the two pool funds. we have an activation policy in place, but the unassigned pool accounts which was started in 2016 which would have no policy to address it's activated.

so we whether follow the same shipment process. if the department will continue to work with other city agencies and san francisco health plan to implement policies in the next few months and next in the again, starting in april, we will increase our outreach and community efforts from april to june and then throughout the three years. we will also need to implement the existing city policy within

the city program. and in order to enable the san francisco health plan like it does now. we will need to set up the new bank account and set up a process to do this day-to-day activities. and we will need to review all and notifying all employees. in the next few months, our plan is to come back to the health commissioners and and today as the health commission approves this policy to start

to implement shipment policy we also have alice from the finance department and we have the san francisco health plan representatives who are here to answer any questions you may have. as not requested, i will stop sharing so we can see our faces better. >> secretary: commissioners, i will check for public comment. first on the line, if you'd like to make a comment, please

press star 3 now. >> fishs, any questions or comments before we move on to the next item. commissioner green. >> vice president green: thank you for the elaboration of information. it helps clarify this a great. i'm wondering if you can answer a few questions that i have. from your answer, it sounds like the office of labor is responsible and i wonder if you can comment on two things. first of all, you know, how that will unfold as you produce these materials which should be much more understandable than they were in the past, how that will unfold and the other

question i have if you've apparently been using transunion for awhile. we still have $104 million that hasn't been claimed and if i read correctly, if someone contributes funds in 2008 and passed away in 2011, if you did find family members, it would be too late for them to tap into the funds. people may not have been as clear in the past and i'm wondering whether everyone has confidence that we're doing what we can to reach out. >> first, i will take the question on the office of labor standards enforcement and then i'll give the rest of the.

>> once this policy is approved by the to understand what changes we need to make and based on last year, we know that's critical if we want to further optimize the employee because that pilot is incredible. we have over 70% employees enrolled after the presentation. so that leaves some time to kind of let them learn from that. but, in our next update in a couple months, we're hoping in a few months, we've announced, we can provide you updates to your question about the olse and did that answer your question, commissioner green? >> vice president green: backward reaching question. >> yeah.

and then for the rest may i ask you to clarify? >> sure. thanks for the question. so yes, we use transunion which is a credit agency. but it's actually used for people where we have bad data and so that is used consistently to try and get because that's the last thing we want to see is the return mail, the vast volumes of return mail that we get. i think the bigger answer to your question though is there are thousands of employees that we actually have valid data for today that are not actually setting up their accounts. and so that's what stella is sort of talking about is that's really the problem is trying to reach them. it's very difficult in some cases and what you're seeing is like, you know, this accumulation of many years right of population, but from a

-- i think what you're trying to get at is what you're doing to try to make sure that people today know and will use their money and that has been we really have to start leveraging employer voice more because that's also been part of the logo change. it's like it didn't say the city and county of san francisco, so people just toss that kind of stuff. it's also a problem that you have large numbers of people in service and retail and entities that have termed through many jobs. so they don't even remember they have contributions from two jobs ago. so that is our challenge is really trying to reach those folks who are fairly disconnected, don't understand the programs that's a lot of simplification kind of changes and we have three years to reach them because what has happened in the current program, nothing has ever been permanent. so anyone month has ever found

out like in a future job or a past job they've had contributions can always call us and get all of their contributions restored so that has been the status quo up to today. in three years, if this policy is approved, that will no longer be the case. so what we have to do in between now and three years is really try to increase that level of engagement to those employees and try and leverage more employers. it's very difficult. you know, most of the people whose funds would be in danger come from very large employers. you know, macy's, target, starbucks, they're churning through thousands of employees and so that will just be a challenge that we are going to try and find the secret sauce to. >> vice president green: thank you. that's a huge undertaking and i really appreciate the degree of challenge here. i guess the last question i

have is whether any thought as this money goes back to the general fund if the d.p.h. itself has had shortfalls whether there would be any ability to look at this money whether it might help fill our back needs as well in just general. >> thank you for the question. i will pass this question to jenny lee to address. >> yeah. this is a great question. as a technical matter, it falls to the city's general funds as those fund balances are subject to the appropriation of the mayor and the board like any other funds that we may have, and so this is a conversation i think that will take place over the next several years, like what will happen with the funds that we wanted to separate the use of the funds and just the actual implementation of this policy which is just the policy we need to have for that small percentage of unclaims that we

do have and i think there's a separate conversation about how this fund could be appropriated for it. >> vice president green: thanks so much. >> commissioner: sure. if i could also just add, i think the city fund is also our largest funder. so the determination about how those funds would be used as a technical matter is one thing, but we are always working really closely and working very hard to establish and build that relationship with the mayor's office and whether it

goes to it's going to be that process and relationship that we worked to build through, the pujt and vice versa one way or the other. >> president bernal: all right. seeing no further comments or questions, i believe we can move on to the next item. >> secretary: i apologize. that was an action item. >> president bernal: s apologies. okay. so before we i know this is

coming forward does the finance committee i'm glad we were able to bring it to the full commission for some additional insight and questions and information. so i'll move to approve. >> commissioner: second. >> all right. secretary morewitz, do we have any public comment? >> secretary: we already asked for public comment so i'll take the roll. [roll call] great. the item passes. >> president bernal: okay. on to our next item which is the resolution recommending that funds claimed for the san

francisco achievement option be used in san francisco. back to stella cho. >> secretary: and this item will be deferred. so we'll look at that in the future. >> president bernal: thank you. our next item is the 2016 public health and safety quarterly bond update. we have a number of team members. >> give me one second. i apologize you should see your button any second. >> good evening, commissioners. i'm going to go briskly through a presentation, but we will have time at the end of the presentation for questions.

basically, it's going to be myself to the director's office and joe chen from public works and then ucsf from the campus architect and roesha can speak to the research building. with that, joey, you're going to share the slide deck. >> thank you. it should show up any second.

>> the last time we came before you was june 17th. we've moved some of the data. we didn't eliminate any data, but we've moved some of the more detailed data to the appendixes. if there are questions that relate to that, we can always go to that. >> can you see my slide deck? >> yes. >> okay. so before i start, i'm going to address two questions that came from commissioner green because she alwayses and the most appropriate questions and so -- and i'll paraphrase, commissioner. the questions evolve around what sort of lessons have we

learned since we started doing some of the 2016 rojs and what are our biggest challenges. i think some of the lessons that we've learned relate to slide 9 and the presentation and i kind of categorized them into four areas. one is we've learned technically to simplify the bidding documents and take out all the allowances and the reason you put in allowances is because you're not quite sure the quantity of the so when a subcontractor sees that, they put a lot of risk in the dollars. the second thing that we've learned is we have to do more

site exploratorization. so before we get into construction, we have a better idea of what we're dealing with and i think part of the problem is we've made a lot of people reluctant because of the perceiveded work level. the third thing is we've asked our in some cases, we got no bid on some of the projects or one bid and when that happens, the price goes up 30 to 40% because there's no competition. so we started that dialog and conversation with our general contractor to increase that effort. the fourth thing is actually do

early demolition of certain projects so we can understand all the unforeseen conditions like we're doing with psych emergency services. so those four things are kind of the categories i would lend myself to say are the strategies around lessons learned. i think our biggest challenge continues to be the budgetary impacts. the factory shutdowns are affecting everyone floeblly. this diagram shows you the top is the global disruption to supply chain because they can't get into dock to unload their goods because there's no

trucking or they're piling up the containers. the slide to the far left is an actual slide that was used in 60 minutes so the supply has shrunk, the demand increased and the cost went up dramatically. so these are some of the challenges that we see that are almost outside our control, but we're trying to look at maybe using more local materials that aren't contingent on shipping or materials that are the

reason is we're only tracking the first two bond sales. the first sale was between three of the departments that's fire. the third was solely ours for d.p.h.. next slide. so this is a financial picture of zuckerberg. the take away here is in june, we projected a higher amount of budget for zuckerberg, but between conversations with mr. wagner and staff because of the clinics were so close to

being shovel ready, what we need is a decision to transfer approximately $18 million from the zuckerberg over to the clinics to make sure they kept their momentum going and as a result, it was done a couple months ago and then both castro division, that's the reason we moved that money temporarily. if you look down on footnote five, second collum, we're able to secure 11.4 million in a 2020 bond in november to help zuckerberg out. next slide. these are the community clinics. it's cast trudeau, mission, and

southeast. if you can tag in. it's second to the last you'll see those high percentages. that's the reason we didn't want to move the money because we didn't want to slow down the project. so we moved those moneys there. we were able to finish vaccines as i said and get into pretty deep construction in the other two clinics. why don't you go from here from six to eleven. >> sure. thank you, mark. good evening, commissioners. this next slide just shows the bid prices for each of the six projects as compared to the 2016 budget, the city those estimates. this table was updated from the last presentation, june. the two additional projects that have now proceeded into

the original phase. so much of the higher prices that we're seeing for the projects can be directly correlated to much of the covid-19 impacts that mark discussed earlier as well as some of the cost drivers that were discussed at the last meeting. i do want to spend a few minutes to discuss project four. because of the huge delta the city's cost assessment, we recognize that we need to address this project differently than the other five projects. so the team is working together with the contractor and as well as with the design team and d.p.h. to identify engineering ideas and scope reduction concepts that were currently valuing last meeting in june.

since the last meeting. the clear cost driver one, mark discussed this earlier, supply chain issues had just gotten worse in the last six months which is leading to higher costs overall on projects. additionally on cost driver four, that was the covid-19 health order cost impacts. right now on any contractor and subcontractor are now required to show proof of vaccination. so we are starting to see some trade labor resource impacts as now all contractors have sufficient staff that's fully vaccinated. therefore, they're not allowed to work on the vsfg campus. so we're monitoring this issue as the time progresses. so this one i'll skip.

mark went through that earlier as well as slide number nine. i'm happy to report there's some good news after many months of delay on the rehab, rehabilitation project. this project has now achieved completion in november 2021. this is for the project because the start of the analysis were contingent on the completion of the project. and the rehab department can now move into a new space so

all these projects are inner linked and connected. by the end of this month, we will have all the projects constructed. the department of public health lab early demo. the clinical laboratory track replacement. and for the next eight projects some of which i discussed earlier the general contractor which will be used to deliver the next eight projects. these projects include the seismic upgrade building 89 specialties and this method was chosen primarily within one

occupied building with an overlapping schedule. we're also tracking two projects that have been we are expecting plan review for these two projects through the end of 2022. and just on the last slide. i have an update on the community health update project. the construction progress is going well. we are approximately complete. the contractor will then be mobilized and d.p.h. will relocate from the existing

health center. once the building's occupied, the contract will return with an overall project completion by the end of 2022. i'm also happy to report on this project, we've received permanent power from pg&e back in november of last year which typically is typical for any project because this allows the contractors to start elevator mendecino health center is the first health center to be completed. with patients being seen in a new space on october 15th. it's approximately 7,500

complete with a target completion date of 2022 and the project is currently focused on interior finishes as well as sign improvement. so at this point, we turn it back to mark and he can give you a brief update on the research and academic building project. >> yeah. so the xaekd building is going well to a little over this data is sort of december data it's around 60% completion, but it's really taking shape there on campus and we're collaborating with the u.c.s.f. team on the roadway that divides existing building and the research building and we're using it collaboratively, the oj problem

there is with pg&e. so at this point, if we can open it up for questions, commissioners any questions. before we do that, secretary morewitz, do we have any questions? >> secretary: there's no one on the line, commissioner. >> president bernal: thank you. commissioners, any questions or comments. commissioner chow. >> commissioner chow: yes. i was looking through this program schedule and i think briefly, mark, could you describe how far our projects are in terms of being behind or being ahead? >> commissioner chow, can i have joe address that since he's been collaborating with the general contractor and

their scheduling far more than i have. joe. >> yeah. sure. obviously right now, we have two projects that are nearing completion. those are the sixh surge space and the rehabilitation project. so those are probably the closest -- currently in construction that will be done shortly. those have been different for different reasons due to unforeseen condition, hazmat. the schedule has been pushed out for those reasons and probably has also identified code issues that need to be addressed as part of the project so we had to deal with those. so currently under the more recent projects, we just

started the and fiber reinforce wrapping to strengthen the column. so it's a multitude of schedules depending on which project we look at, you know, the longest so at least these active projects, it's about three years. we also have other projects in the pipeline we talked about earlier. the main scope, those will be planned review through the end of 2022 maybe as typically we're looking at those adds one

to maybe two years. >> commissioner chow: so in summary from your finances, are we on target and have found enough money to complete all the projects for instance with what we had to do? >> to be completely transparent, we don't really know right now. there's two unknowns. one is we haven't appropriated any interest money although we were able to get our hands on a little over 23 million from the various sources. so we're also looking at some of the budgetary gaps that we have in the building, because if you recall in 2015 and 2016, a former health director garcia and mr. wagner and i had

advocated for more money to the tune of 535 million for the 2016 bond. we were in competition with sfmta and affordable hows and so from the beginning, we knew we didn't have enough to do everything that we knew there were dishss for. so we're looking for any kind of funding so source the 2016 bonds. >> commissioner chow: so, can we get i gunshot in the future, your next report, a continuation of discussion as to where we are with these? i'm just reminded of when we had to drop a building over at laguna in a and it's kind of

history repeating itself, increasing cost of supplies in that case and here we have shortages of supplies, increasing bids and as we know an inpopulation factor right now. so i think from the standpoint of the commission, we should understand the financial imp indications of all this sooner rather than later. >> absolutely. and we're going to be diligent around working with the foundation and also we're advocating and we've got place holders next year, 2023 and i think greg, correct me if i'm not wrong in 2028, we're on like a five year cycle to bridge the gap. both at the clinic level and at the campus. >> commissioner chow: thank

you. commissioners, any other questions or comments. all right. thank you and your team. >> thank you. >> president bernal: okay. our next item is the report from the finance and planning committee. commissioner chung. >> commissioner chung: thank you commissioner personal. and the finance and planning committee met before the commission meeting today and we had one contract report and three new contracts to consider. the contract reports include one contract extension for

positive resource center and also, you know, like an extension for covid response for institute familiar as far as like, you know, one contract, technically new contract just to extend the previous contract for another year until june 30th, 2022, due to the rfp for a new contract. and the three adds needed support services for mental health sf and all these items have been added to the consent calendars for you to consider.

>> president bernal: that leads us directly into our consent calendar. back to commissioner chung. >> commissioner chung: as i mentioned earlier, all the items have been added to the consent calendar and we recommend the approval of all the contracts. >> president bernal: great. commissioners, any comments or questions before we have a motion to approve? or is there a motion to

approve? >> secretary: i'll do a roll call vote. [roll call] okay. great. thank you. the item passes. all the items pass. >> president bernal: excellent. all right, moving on to our next item which is other business. commissioners, do we have any other business? >> president bernal: okay. seeing none. we'll move to our next item. we'll hear an update from

commissioner chow from the december 28th, 2021,j.c.c. meeting. commissioner chow. >> commissioner chow: thank you, president bernal. the joint conference committee met and we did the regulatory affairs report, human resources report and the medical staff report and in the human resources report, we did report that we were beginning to find more nursing of course, you heard about the existing nursing shortage and this is bringing on new resources to help fill difficult positions and this is one of the first times i think we heard we were making progress on things like i.c.u. and such other very highly sought specialists throughout the country.

we also then received the medical staff report which included an extent of the discussion of the largest department which is the department of medicine and all the work that they are doing as part of the report, we also then updated the department of medicine rules and regulations and emergency department standardized procedures which are used by the anon positions very extensive position which are very well done which we did pass votes on your behalf. the committee also discussed the presentation care strategy. in order to to be able to

capture more timely fashion and is ask so we're looking forward to seeing how this measures patient satisfaction which was right after a patient leaves and also then how well our satisfaction is proceeding in terms of their goal which is really the one measurement is how well do you want to recommend working here so that in our closed and that concludes my report.

>> president bernal: thank you, secretary morewitz. thank you, commissioner chow. do we have any questions or comments for other commissioners? okay. seeing none. we'll move on to our next item which is a consideration of a motion to adjourn. do we have a motion to adjourn? >> commissioner: i move to adjourn. >> commissioner: i second. >> president bernal: all right. >> secretary: a roll call vote. [roll call] take care everyone. >> president bernal: thanks all. >> commissioner: thank you commissioners. >> president bernal: thank you director colfax. thank you, team. >> commissioner: happy new year everyone.

>> we have private and public gardens throughout the garden tour. all of the gardens are volunteers. the only requirement is you're willing to show your garden for a day. so we have gardens that vary from all stages of development and all gardens, family gardens, private gardens, some of them as small as postage stamps and others pretty expansive. it's a variety -- all of the world is represented in our gardens here in the portola. >> i have been coming to the portola garden tour for the past seven or eight years ever since i learned about it because it is the most important event of the neighborhood, and the reason it is so important is because it

links this neighborhood back to its history. in the early 1800s the portola was farmland. the region's flowers were grown in this neighborhood. if you wanted flowers anywhere future bay area, you would come to this area to get them. in the past decade, the area has tried to reclaim its roots as the garden district. one of the ways it has done that is through the portola garden tour, where neighbors open their gardens open their gardens to people of san francisco so they can share that history. >> when i started meeting with the neighbors and seeing their gardens, i came up with this idea that it would be a great idea to fundraise.

we started doing this as a fund-raiser. since we established it, we awarded 23 scholarships and six work projects for the students. >> the scholarship programs that we have developed in association with the portola is just a win-win-win situation all around. >> the scholarship program is important because it helps people to be able to tin in their situation and afford to take classes. >> i was not sure how i would stay in san francisco. it is so expensive here. i prayed so i would receive enough so i could stay in san francisco and finish my school, which is fantastic, because i don't know where else i would have gone to finish. >> the scholarships make the difference between students being able to stay here in the city and take classes and having to go somewhere else.

[♪♪♪] [♪♪♪] >> you come into someone's home and it's they're private and personal space. it's all about them and really their garden and in the city and urban environment, the garden is the extension of their indoor environment, their outdoor living room. >> why are you here at this garden core? it's amazing and i volunteer here every year. this is fantastic. it's a beautiful day. you walk around and look at gardens. you meet people that love gardens. it's fantastic. >> the portola garden tour is the last saturday in september every year. mark your calendars every year. you can see us on the website

>> when i first started painting it was difficult to get my foot in the door and contractors and mostly men would have a bad attitude towards me or not want to answer my questions or not include me and after you prove yourself, which i have done, i don't face that obstacle as much anymore. ♪♪♪ my name is nita riccardi, i'm a painter for the city of san francisco and i have my own business as a painting contractor since 1994 called winning colors. my mother was kind of resistant. none of my brothers were painter. i went to college to be a chiropractor and i couldn't imagine being in an office all day. i dropped out of college to

become a painter. >> we have been friends for about 15-20 years. we both decided that maybe i could work for her and so she hired me as a painter. she was always very kind. i wasn't actually a painter when she hired me and that was pretty cool but gave me an opportunity to learn the trade with her company. i went on to different job opportunities but we stayed friends. the division that i work for with san francisco was looking for a painter and so i suggested to my supervisor maybe we can give nita a shot. >> the painting i do for the city is primarily maintenance painting and i take care of anything from pipes on the roof to maintaining the walls and beautifying the bathrooms and graffiti removal. the work i do for myself is different because i'm not actually a painter. i'm a painting contractor which

is a little different. during the construction boom in the late 80s i started doing new construction and then when i moved to san francisco, i went to san francisco state and became fascinated with the architecture and got my contractor's licence and started painting victorians and kind of gravitated towards them. my first project that i did was a 92 room here in the mission. it was the first sro. i'm proud of that and it was challenging because it was occupied and i got interior and exterior and i thought it would take about six weeks to do it and it took me a whole year. >> nita makes the city more beautiful and one of the things that makes her such a great contractor, she has a magical touch around looking at a project and bringing it to its

fullest fruition. sometimes her ideas to me might seem a little whacky. i might be like that is a little crazy. but if you just let her do her thing, she is going to do something incredible, something amazing and that will have a lot of pop in it. and she's really talented at that. >> ultimately it depends on what the customer wants. sometimes they just want to be understated or blend in and other times they let me decide and then all the doors are open and they want me to create. they hire me to do something beautiful and i do. and that's when work is really fun. i get to be creative and express what i want. paint a really happy house or something elegant or dignified. >> it's really cool to watch what she does. not only that, coming up as a woman, you know what i mean, and we're going back to the 80s with

it. where the world wasn't so liberal. it was tough, especially being lgbtq, right, she had a lot of friction amongst trades and a lot of people weren't nice to her, a lot of people didn't give her her due respect. and one of the things amazing about nita, she would never quit. >> after you prove yourself, which i have done, i don't face that obstacle as much anymore. i'd like to be a mentor to other women also. i have always wanted to do that. they may not want to go to school but there's other options. there's trades. i encourage women to apply for my company, i'd be willing to train and happy to do that. there's a shortage of other women painters. for any women who want to get into a trade or painting career, just start with an

apprenticeship or if you want to do your own business, you have to get involved and find a mentor and surround yourself with other people that are going to encourage you to move forward and inspire you and support you and you can't give up. >> we've had a lot of history, nita and i. we've been friends and we have been enemies and we've had conflicts and we always gravitate towards each other with a sense of loyalty that maybe family would have. we just care about each other. >> many of the street corners in all the districts in san francisco, there will be a painting job i have completed and it will be a beautiful paint job. it will be smooth and gold leaf and just wow. and you can't put it down. when i first started, it was hard to get employees to listen to me and go along -- but now, i have a lot of respect.

good afternoon everyone. thank you for joining us here today. i'm san francisco mayor london breed and i'm joined today by supervisor matt haney as well as the director of the department of emergency management mary ellen carol. the department of public health behavioral health director dr. hillary kunis and we are also joined by our police chief bill scott. i am here with our various leaders in san francisco to

officially declare a state of emergency in the tenderloin community of the city and county of san francisco. we know that there have been a number of challenges that have happened in this community and have persisted over the years. but if we take a step back, when this pandemic first hit san francisco, of course, we immediately in light of what we knew was inevitable declared a state of emergency to deal with the global pandemic of covid-19 and, in fact, what we saw over the last almost two years was san francisco step up, remove the bureaucratic layers and the opticals that get in the way of actually being effective and collaborating with our various city agencies and what we were able to do to deal with the

pandemic was extraordinary. we are one of the densest cities in the country and with less than 700 people who lost their lives throughout the entire pandemic, we saw one of the lowest death rates of any other major city in the u.s. and san francisco not just because we acted quickly and shut down early, it's because we had the ability to move quickly and set up our various locations including a covid command center embedded equity into our response to help deal with challenges all over the city. but the sad reality is when we look at the loss of life in the pandemic which every lost life is tragic, we had over 700 people alone die due to a drug

overdose last year in san francisco. we have over 600 and counting this year. when we look at the conditions on our streets, it is really unfortunate, it's sad, it's heart breaking, and i must say, what doesn't get publicized enough is the fact that not only do we say and we are a compassionate city, the amount of money that we spend on services to help people struggling with mental illness, substance use disorders, programs. our street overdose team, our wellness team. additional resources for narcan. the additional organizations

that assist us with those struggling with addiction and mental illness. the significant increase in number of behavioral health beds in our system. a mental health sf, we've done a lot of work to try and turn things around because we know that suffering from those things are not easy. it is not just about homelessness. it's about addiction. it's about the fact that there is clearly in the tenderloin community with the conditions of not just the streets, but the people living there and the people suffering that we are in a crisis and we need to respond accordingly. it's not just about our police response to make sure that when people cross that line and commit crimes, we hold them

accountable. it's about getting people the help that they need and being able to do so quickly. i've said this time and time again, if you don't know what it's like to experience an addiction and i hope to god you never find out, we have to meet people where they are. we can't wait for something to be set up. we have to move quickly. we can't wait until something goes through a layered process. we have to move quickly. too many people are dying in this city. too many people are sprawled out all over our streets. and now we have a plan to address it. a robust, aggressive plan to address it.

earlier this week, i made it clear that there are going to be a number of things that this city is going to do to address public safety and part of that is a police response. part of that is accountability. part of that is making sure that we are consistent, but the other part is being aggressive about getting people into services and support and not allowing what has happened on our streets to continue. not only the fact that people who are suffering from these things are randomly committing acts of violence towards people who are just walking down the street not to mention the number of shootings and stabbings and other things that are happening randomly in this community, but also the high number of people who are dying from fentanyl overdoses.

so leading this effort to address this emergency will be mary ellen carol and the work that we have in place after our assessment will allow us the ability through this emergency declaration to move quickly, to move fast, to change the conditions specifically of the tenderloin community. this is necessary in order to see a difference, in order to reverse some of the deaths from overdoses and the assaults and attacks and other things happening in this community. so, at this time, i want to

introduce someone who's been advocating for resources and let's be clear, this city spends more money on when people walk down the streets of san francisco, they should feel

safe. they shouldn't have to see someone sticking a needle in various part officer their body laying out on the streets and wondering what can i do to help them. they shouldn't be spit on. we have to have an honest conversation about people who suffer from mental illness and substance use disorder and that crosses a line and impacts other peoples' ability to feel safe in our city, addressing those challenges, understanding what people are suffering through and meeting them where they are. and i'd like to introduce supervisor matt haney of district 6 to say a few words.

>> supervisor haney: i want to thank the mayor for her focus for her urgency and courage in today's announcement. the tenderloin is a community of residents who want and deserve safety, who want and deserve health and who want to survive. they need help. and this is a statement of the urgency that help is on the way. our city came together over the last few years and through everything we had to confront a deadly epidemic. and because of those actions of the people who are standing up here, we save lives. and we have to do that again. the overdose epidemic is taking the lives of nearly two people a day in our city. most of those people in the

tenderloin are south of market and mostly fentanyl. and if we are going to stop the epidemic, if we are going to save lives. we are going to once again throw everything we have at it. we need resources. we need coordination. we need tracking and we need it now. we cannot wait to take action. every day that we wait, anything that is getting our way to move slower, may cost lives. and this is something that we know we can do. decades ago, there was another epidemic that we faced which was hiv and aids. and this city came together we led the way and we saved lives. and so even though this is an epidemic that's not only

affecting our city and the tentder loin, it's a national epidemic. we have to demonstrate through commitment and compassion not only looking the other way, but confronting the problem. i think if there's anything we've demonstrated over the last year and a half under mayor breed's leadership that we can absolutely do this. but it takes us treating it like the emergency and the crisis it is and that's what we're doing today. thank you, mayor breed also as a resident of the coo at the scale of the problem we're facing and you have my full support and partnership. and i want to thank chief carol

and director scott and chief kunis for your partnership on it. i want to introduce the person who is going to lead this effort through the covid-19 pandemic bringing together resources, bringing together staff. unprecedented focus and speed to confront a pandemic. we have to do it again with this deadly epidemic of drug overdose. so i want to welcome up now director caroll. >> director: thank you, mayor breed, and thank you, supervisor haney. in emergencies, people need resources immediately and not months from now. an emergency declaration allows san francisco to cut through the red tape, to obtain the contracts, the resources and the personnel that we need to address the crisis conditions in the tenderloin. we only have to look at our

covid response to see how an emergency declaration allowed us to quickly lease hotels, hire critical staff and establish testing and vaccines. if you remember, when we did that declaration, there is a lot of questions about why we were doing a declaration so early before we even had a case in san francisco. it is because we knew the lead time that we needed and we knew how important it was to have the ability to conduct those resources. that's what it's about. this includes speeding up the establishment of a linkage center that once activated. the site will connect individuals in crisis to resources like substance use treatment, counseling, and medical care. to date, we have conducted neighborhood assessments, community stakeholder

engagement. we've coordinated interventions, and helped people in crisis connect to social services. i just want to reiterate that the emergency declaration is really about removing obstacles so that we can go in and conduct the work we need to do to help the residents of the tenderloin. our goal is to get those services coordinated as quickly as we can in order to alleviate the overall suffering that people are experiencing in the neighborhood. thank you very much. i'll turn it back to you. >> so, with that, are there any questions? >> question: the chronicle was told two months ago, if you

declare it an emergency, it could practically allow -- not practically allow, but you can do anything [inaudible] today. what does this mean in two months? >> can you go back to the first question? >> question: [inaudible] >> so the challenge we have with our conservetorship process is we wait until someone is 51/50 which is a 72-hour hold before we can implement a course of action which goes through a lengthy court process. from my perspective, it's not strong enough to be as effective as we would like it to be and i think that's why we have to use our alternative of not giving people any option when they are struggling with addiction and have challenges with mental health. we have to take them somewhere.

so either that somewhere is going to be san francisco general depending on their condition or that somewhere is going to be a location that we will set up as a result of this emergency declaration and the goal is to not let anyone stay out in the streets and not give them an option and to enforce many of our various laws that are on the books including sit lie and camping and sleeping and other things. so we're going to be a lot more aggressive with implementing existing laws on the books in order to get people off the streets and unfortunately the conservatorship does not work as effectively as is it should. >> question: and why the change in two months? if we did declare an opioid crisis that we would not be able to do anything that we're not doing now. so i'm wondering what's is

changed in two months? >> what's changed is at that time we were working with the department of public health and the city attorney's office to understand how we can get more creative on declaring a state of emergency because the problem we were having is technically under some of of 0 our various laws, it wasn't in terms of what was put forward and what was suggested, it wasn't something that technically we could use legally as a basis. so we had hunkered down, got creative and workeded with our attorneys to figure out a way. even at that time, it was a crisis. this is not something that just all of sudden happened. we were able to find a way which we needed in order to address it and so that's what we did.

>> question: mayor, do you think this declaration will save lives? >> my hope is that it will save lives. people laid out on the streets, we don't know if they're dead or alive. the ability for our street wellness teams to do checks, but most important, that person probably needs to be monitored and so part of our process is removing them from that location and moving them inside to a location where we have the kinds of folks that can monitor, that can provide resources, but more importantly, we're not here to judge. we're here to say, we're here, we're paying attention, we don't want you to die and so we're going to do everything we can to support you but we've got to they you off the streets. >> question: a public defender said that expanding police presence is going to be harmful to people who are already overpoliced and it cuts the promise you made in the wake of the george floyd murder death.

what is your response to that? >> answer: it doesn't. you see significant investments in programs including commitment to the african american community for $60 million a year ongoing. and so you tell that to the families who i met with who are in tears from the attacks and telling me that they want the police there. telling me that they call the police and they want them to show up. the families and the people who live there, has anyone from the public defender's office or anyone else had a conversation with these families who feel uncomfortable walking their kids down the street. so have the public defender give them a call and see what they want and they need to protect their lives and their children. everyone in theory can is talk about all the policies they want around no police and defund the police and all of these other things, but at the

end of the day, if someone beat your kid like that 11-year-old girl, who are you going to call to protect you? and that's the point of this. we have worked very hard in this city to turn things around with the challenges that have existed historically in the police department of san francisco and i'm very proud and confident in bill scott and his leadership and the various trainings, anti-bias trainings, the new recruits which have made the department more and more diverse and understanding of various communities, making sure that we're sensitive to the need and we're not creating these barriers to those who in the past have historically had challenges with the police. we have people who want a relationship. businesses in the tenderloin who want a relationship and treat their police officers with kindness and respect, the same with the police officers towards them. so folks can say what they want

about all of this going back on your word this and that, but at the end of the day, the people in this community are not safe and it is not fair and it's not right. and part of the response to this is definitely police officers. >> question: [ indiscernible ] >> answer: and they're deployed in the tenderloin too. but let me just be clear and the chief can talk about that. this declaration of emergency is more so about making sure that we are dealing with our public health crisis on the streets and part of it separately from that is definitely a significant increase on our police response. so, if you want, i can bring

chief scott up if you have a question. yes. >> thank you, mayor. everything that was said today only enhances our ability to do our jobs. enforcement, we have to enforce. we have to arrest drug dealers. a lot of what people complain about are the street conditions, open air injections of whatever is being injected in peoples' arms and toes and those things have to be addressed. the other side of that is our officer has said time and time again, let's have a system where we can get the social workers involved and that's exactly what this does at the front end so we can go and do the things that the public wants us to do. arrest people that are hurting people. stop the open air drug uses. stop some of the craziness

that's going on on our streets and that's what most of us came on this job to do and this only enhances our ability to do that because our officers will work in partnership with the health department and social services so they don't have to do that. we know to treat people with dignity and respect. we came on this job to be cops and this will only enhance that and the deployment that's already been increased. and i want to echo that in my comments that the mayor said. thanks to the mayor and the support of her budget office than any other community by far year to date. all this needs to come together. we will continue to invest in the tenderloin, our officers have worked a lot of hours and they don't mind doing that, but they want good outcomes. so when we enforce, we want

consequences when the evidence is there. we need to support so they're not doing social work. we understand we have to treat people well and do the job the way we have expected. and we need the support. the emergency declaration and my professional opinion will give us that support right now. so thank you. >> question: mayor breed, you mention an intention to move people to a place they need to be monitored. can you expand on where they will be moved to? >> answer: yes. mary ellen caroll can answer that. >> yes. so we made reference to a linkage center and we will have people who are experiencing

substance abuse disorder, they can link up with the department of public health resources. they can link with community based organization resources and treatment. we can find out where they are in the housing system if they need housing and we can also meet them where they are with some basic hygiene, food. we really want people to -- this is really intended to be a warm intervention with people to engage people. i think i can tell you personally and i think a lot of people feel frustrated with the lack of intervention and the lack of ways to intervene with people who are suffering on the street. and so this is a place that we can pull people in and get them warm, get them dry. get them fed and have them connected to all of the many services and resources that the

city has. >> question: [ indiscernible ] >> answer: yes. it is voluntary. people can come in on their own. people will also be given choices. so there is a push pull. our intention is to be more pull than push, but there will be and as the chief has talked about, there may be instances where people have a choice. you know, you're doing something illegal, something that's harmful in the neighborhood in this situation. we have this option for you to go here and we're hopeful that people are going to take us up on that option as much as possible.

>> chair borden: please call the roll. [ roll call ] you have a quorum. >> chair borden: next item. >> clerk: announcement of prohibition of sound producing devices during the meeting. we have no announcements. item 4, approval of minutes forever the december 7, regular meeting. >> chair borden: is there any additions at this time? seeing none, we'll open up public comment. are there