. >> president bernal: let's begin by calling the roll. secretary morewitz. >> secretary: [roll call]

>> president bernal: we will now move to reading the ramaytush ohlone land acknowledgement. i'd like to welcome commissioner cecilia chung to offer the acknowledgement. >> commissioner: thank you, president bernal. 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 the 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 the living and working on their traditional homeland. we wish to pay our respects by acknowledging the ancestors, elders, and relatives of the

ramaytush ohlone community and by affirming their sovereign rights as first peoples. >> president bernal: thank you, secretary morewitz. our next item is approval of the minutes from december 21, 2021, meetings. do we have a motion to approve? >> secretary: if i may, commissioner chow asked me to make an amendment. he made an amendment and i sent it to you all now. and he asked me to change the statement. officers stated that the term of to date is being used to

receipt primary of vaccination and a booster. >> commissioner: seconded. >> president bernal: do we have any public comment? >> secretary: there's no one on the line. welcome commissioner guillermo. can you give us your vote as well? [roll call] >> secretary: the minutes are approved. thank you. >> president bernal: the next item is the director's report.

director of health dr. grant colfax. >> director: hi. good afternoon, commissioners. i will provide the covid-19 update after this report. there are e did tails in the director's report. i also wanted to point your attention to an exciting development with regard to the opening of the tenderloin linkage center that happened today, the 1170 market street. i was able to visit this morning it's very impressive to see what we've put together in a short amount of time. the number of people that have already been referred for behavioral health treatment and medical care, it's well on its

way to becoming a one stop shop. i just wanted to thank dr. andy tenner and dr. hillary cunins who really helped on the d.p.h. side in partnership with the department of emergency management. excuse me, director mary ellen carol. so i just wanted to let you know that that has opened this morning and, again, it will continue to evolve, but certainly a good start this morning. and then, i'm happy to answer any specific questions around the rather detailed covid information that's provided in the report and/or i can go to the update and answer any questions after that. thank you. commissioner president, you're on mute. >> president bernal: i see no one on the comment line, so commissioners, with your agreement, we can move directly into the covid-19 update.

director of health dr. grant colfax. >> director: thank you, president bernal, commissioners. i'm happy to have a further discussion. next slide just to emphasize, we continue to be in the most severe surge. yet, this is our case rate, 192 per 100,000 far above our prior surge of 42.8 this last winter and this certainly reflects our u.s. trends shown here in the insert. next slide. with regard to our testing and positivity rate. there are a couple of points i'd like to make on this slide. one is testing has been a huge challenge with regard to access to testing and turn around times. a huge challenge across the

country and certainly at the state and local level. do note however that compared to where we were in late november doing just about 3,400 tests average a day across the city, we are now well above that through three and four fold above that and within the d.p.h. side of the large providers, d.p.h. is providing well over a majority of the testing being done and our sites have expanded their capacity to 500% to 900% with regard to testing. the other piece is i want to emphasize the high positivity rate at 19.5%. however, you can also see this is leveling off to some degree. so this is potentially some early evidence that our cases are starting to peak and that would be consistent with what we're seeing across other bay area restrictions and what

we're hearing from new york as well. while this positivity rate were hitting the peak surge numbers now. next slide. so in terms of hospitalization, we have 229 individuals in the hospital as of january 13th. these data numbers. so far our medical surge in i.c.u. bed capacity remains relatively sustainable and we're obviously watching those hospital bed capacity numbers very carefully. i'd also say that given different estimates we're getting from the hospitals, they're about 30% to 50% of the

covid positive patients in the hospitals. they're primarily for noncovid related reasons. they still take up a hospital bed. so i want to emphasize that. it's also an added burden on the hospitals to take care of people with covid even if they're not sick from covid. so if you have somebody admitted for a curl reason that's in play a whole level of resources and staffing needs that would not otherwise be there and it's good people are not necessarily there for covid and test positive. that's good from a medical perspective. but there's still a substantial burden that i don't think is necessarily acknowledged in some of the reporting that has been done in that regard. next slide.

so this slide is looking at covid cases and hospitalizations percentages of our winter 2021 surge. so basically 100% here on the vertical axis represents for both cases and hospitalizations of those peak numbers. so remember it's 256 hospitalizations would be 100% on this y axis, a covid rate per 142,000 would be 100% on the y axis for cases and what you can see here is a remarkable difference in terms of how the case rate is so much higher relative to the hospitalization rate over time. so notice the distance between the case rate and hospitalization rate even compared to the winter surge in august of this year compared to what we're seeing now.

so this is really i think attributable to two main things, one is our high booster rate coverage, vaccination up to date coverage across the city as well as the fact that it does appear that omicron is substantially less vigilant in terms of causing severity of illness. but also note that the orange line in terms of hospitalizations as a percent of the winter 2021 is approaching 100% and this really reflects what we're seeing across the country. while the rates are not as directly related to the case rate in terms of hospitalizations because of such a high case rate, we are still getting an extreme burden on the health care system. the other thing i wanted the commission to also emphasize, i want to emphasize to the commission is that our health care staffing system continues to be severely strained. we have approximately 500 staff

out at zuckerberg and nearly 100 staff out at laguna honda hospital and that's continuing to strain our system. so far, the hardworking people of both hospitals have been able to manage. next slide. and then in terms of our vaccine administration, just to call your attention to a couple of key points here among all residents were 81% of this vaccine were completed and then on the booster side, on the far right, you'll see we're at 61% and at 80% among residents who are 75 and up is hovering above 35% who are eligible boosted and i wanted to share with commission in termses of the 5-11-year-olds, we're now at 75% of five to 11-year-olds have been received first dose

and i believe it's between 50% and 60% of 5 to 11-year-olds who have received two have completed their initial regimen of the vaccine. next slide. so in terms of booster recipients by age, 61% as i said and you can see that as people increase in age they're more likely to receive a booster. that's reflected in evolution in terms of how booster recommendations are rolled out and you'll see that numbers continue to increase even among the 18 to 34-year-olds that historically have been our lower vaccinated population demographic and then the 12 to 17-year-old is reflected the fact that they were eligible boosters recently. next slide. so this slide really summarizes our state of covid and i just wanted to take a moment to read

this through because it does represent both where we are, what we know and then some scenarios about where we may be going. we do know that omicron is far more infectious. it appears to be causing less severe disease. of the boosters in terms of preventing severe illness and death. our robust efforts has saved lives and it is also clear at this point that covid is here to stay. it has adapted to us and we need to adapt to it. what is likely in the near future is we believe the surge is peaking or will peak within the next one to two weeks followed by a hospital peak shortly thereafter. he also understand the supply of the test kits and treatments will improve dramatically. in terms of test kits, we are starting to finally receive the rapid test kits that we have been waiting for and distributing those both to our community partners providing them at certain testing sites and then also making sure that

key essential workers are receiving those to be able to test to come back to resume their vital functions. we believe that the treatment access will also dramatically improve. we know so well in preventing severe disease is in short supply across the country. in terms of plausible scenarios in the medium to long-term, once it has responded to boosters are targeted to shifts and variants. severe case rate remains manageable. we must also consider that more megasurges are plausible as the virus mutates to a more transmissible or possibly a more deadly variant. so we do need to make sure that

that is still a plausible scenario. and our ongoing response must be flexible and last to respond. focusing on the most vulnerable. maintain hospital capacity and preventing deaths. other constituencies for vaccine and testing and balance our covid response with multiple convenient health issues including behavioral health. thank you. >> president bernal: thank you, director colfax. do we have questions or comments from commissioners? commissioner giraudo. >> commissioner giraudo: thank you, dr. colfax, for the report. my question relates to the most -- one of the most recent health orders that are requiring the other health care

institutions in san francisco to be able to test other than sending their patients to sfdph sites. if in fact my understanding in one institution in order to have a test, you must have a doctor's order which is not what i assumed is accessibility and are they complying and are the hours not thursday from 2:00 to 4:00 with an appointment and a doctor's orders. of that's what i have. that's i guess my concern when i was really happy to see the health order requiring other participants to step up to the plate. >> director: thank you, commissioner.

i believe dr. susan hill is on the line and will provide you with an update and also to emphasize the mayor's order that was announced last week and places penalties on health care systems. so there are two different orders. one dr. hill will provide more updates and there's the mayor's orders for mott following the health order. dr. phillip are you able to provide an update to the commissioner. >> yes. thank you, director. and thank you, commissioner giraudo. today was the fist day for reporting data. so we will see what data they provide. we do understand that these are large organizations and there's a large amount of need and there may not be an immediate ability to satisfy all parts of the order. my intention is to see improvement on a rapid time

frame to see what steps they are taking. so we will ask for the data and the data will be focused on the emergency and urgent care side and the outpatient side. so not on inpatient testing which we are assuming they will be able to do, but it's to meet the need of their patients and the people that are covered in the outpatient world seeking testing. so i'm happy to come back and share with the commission how it is going, but the reporting will be on two days per week, tuesdays and fridays. so we anticipate that the first real day might be friday, but they will report to us. i have asked that they report to us, tell us what they're doing now as part of their planning and then we'll see the data over time and we expect to see this data improve and to hear what plans they have to make those improvements over time. >> commissioner giraudo: great. thank you very much.

>> president bernal: thank you, commissioner giraudo, and dr. phillips. i see commissioner chow. >> commissioner chow: thank you, dr. colfax, for the presentation although brief but very comprehensive. i thought it was a very good summary especially where the state of covid is. we can read everything in all the papers, but i think you've said it all well in one slide. i am wondering how well our school programs are moving along? i understand that we're handing out test kits, but there's been also some comments that it's not helpful or it is helpful and i'm not sure how either you or dr. phillip is viewing the partnership with sfusd in terms

of trying to assure the public that this is an appropriate way of testing. i mean, as you know, some jurisdictions have just dropped it and others have actually enforced it to even a higher degree. so i'm not sure how we're viewing our course at this point. >> director: thank you, commissioner chow, and i'll let dr. phillip add to more of what i'm about to say. we've been partnering with sfusd from are the beginning of the pandemic. we're continuing to provide them with guidance and technical assistance. we've also responded to their request with regards though providing test kits and masking and we have been very clear repeatedly that we believe at this time that the benefits of in-person child learning far outweigh the risk and ensuring that we are supporting the

schools with the again the technical assistance and guidance for potentially implementing such policies. i'll let dr. phillip add any additional context if i haven't covered this in a brief with it that satisfies your question, dr. chow. >> thank you, commissioner chow. yes. i agree with everything that director colfax has said. what i will add is this is a common challenge that people are grappling with across the bay area and the state. the very nature of the transmission dynamics of the omicron variant make it very challenging to do traditional contact tracing because of the speed with which it moves through. what i will say as dr. colfax says is we have daily with the school team and we have done

that for months throughout the pandemic. there are also the layers when we were doing and the schools were doing very extensive we've talked about many times including ventilation and masking in addition to that so while we are all seeing the challenges our sfusd colleagues

so it's been a close and ongoing partnership so children can stay in schools across the city. >> commissioner chow: thank you. so i'm thinking there's a question on the part of the teachers that the question has come up along with the health department. what's your take on that and a -- well, let me just stop there first. >> director: that decision was made in the leadership of the sfusd teachers to ensure that protocols are being sought in terms of best practices recommending that those practices explaining and supporting the district

whenever possible whether that be for the teaching staff or for the schirn. i think the other thing that i would emphasize is there's obviously understandably and appropriately a lot of emphasis on testing. we're also understanding the testing and boosting my concern is that in this surge in the emphasis on the testing with the burden of testing which again is appropriate. you know, if you have school aged children that are eligible for boosted for goodness sakes get them boosted as soon as possible. >> yeah. i certainly agree. in terms of contact tracing, it sounds like the overwhelming cases we are not doing as much, but do we think we're losing or

do we feel comfortable. >> wednesday night. came out with new guidance that recognizes the speed with which omicron transmits and it's unlikely, just because of the dynamics of the virus itself to have the traditional individual level contact tracing be able to identify people quickly enough within a classroom. so they've laid out an alternative which is called group tracing and basically that is saying that if there is a positive case in a classroom, we treat the entire classroom as potentially exposed and then attempt testing for that is what's recommended, testing. and if they stay in the classroom, continuing to learn unless they then develop a positive test. now there are challenges with both of these with the individual levels and contact tracing, if the amount of time

or school staff or others have to spend to identify contacts, but with the second approach, the challenge is testing and we're hopeful that testing will not continue to be as constrained as it is right now, but there are challenges on both sides of that which is i didn't as dr. colfax said the vaccination and the boosting for those eligible as well as ventilation, masking, all of these things are one of the layers that are needed in addition to testing and probably more important right now than these efforts in contact tracing. but we do continue to follow the state guidance. >> commissioner chow: thank you. my last question does relate to that state guidance and how well nursing staff and others working in the hospital are taking it. obviously it's elective and not necessary that the facility

take people back after five days if you're asymptomatic there would be covid positive people taking care of the sick. so has there been much discussion within the hospital community that you're aware of? or has there been even within our own hospitals some discussion as to whether we're going to follow the state guidance or be stricter? >> director: so, commissioner chow, i assure you there's been lots of discussions and i will turn it over to dr. earlic of san francisco zuckerberg hospital to give you an update on where those conversations stand. >> good afternoon commissioners. susan earlic. there has indeed been a lot of discussion about this topic at the hospital council which is

the regular group that makes up the ceos in the hospitals of the city. i would say all hospitals are experiencing this similar phenomenon and that is like we are not at all like in previous surges challenged with i.c.u. or ventilator capacity. it really is our medical surgical capacity both because patients are less sick, but also because we're all having a terrible time discharging patients and the reason that's true is because the places to which we discharge including skilled nursing facilities are having outbreaks and staffing challenges. so we are, you know, working as diligently as we can with skilled nursing facilities and others to take patients, but, you know, they are obviously following their own criteria and their own needs to keep

staff and patients safe. so it's just a real challenge right now especially as we are either at or nearing the peak of hospitalizations. >> commissioner chow: so you've not had reaction from either our patients or the nursing staff or are you following, you know, having people come back after a short period of time or is that voluntary? >> you're talking about the staff? our staffing at the hospital? yeah. so we -- our occupational health team has just done an outstanding job working with the you know changing state guidelines and we are following those guidelines for the most part, we're a little bit more conservative and now we have -- today we had 278 staff out

almost all of those folks actually have covid, so we've implemented the text to work guidance that allows us to bring people back faster than we did a few weeks ago when we were quarantining people for exposures up to 10 days. so we are following the state guidance. we are more conservative than the state guidance. we're not bringing people back to work, for example, who have covid. that is allowed and staffing shortages, but we are bringing people back to work safely and with testing. >> commissioner chow: thank you very much. and i appreciate all the responses and the clarity that you're providing us. and the work that you're doing for the entire city. so thank you. >> thank you very much. >> president bernal: thank you. i see no other commissioner comments. i would like to note today that

the federal government started making available free covid home tests and starting today people with visit www.covidtests.gov to order free, at-home tests from the government. every home is available to order those. they're completely free and orders usually ship in seven to twelve days through the postal service. www.covidtests.gov. i had to be especially disciplined for that. all right. seeing no other questions or comments and no one on the comment line, thank you, director colfax, we can move on to the next item which is general public comment. seeing nobody on the line, we can move on to the item after that which is the first hearing on the fiscal year 2022, 2023

and fiscal year 2023-24d.p.h. budget. we have jenny louie, the chief financial officer of d.p.h. >> hello. >> it looks good on our end. >> yeah. >> does it still look good on your end. >> good evening, commissioners. the chief financial officer. i'm pleased to bring i'm going

to go over the 5 year financial budget and then discuss our department goals and areas of focus for the up coming budget cycle. so this is a reminder for the commissioners. d.p.h. has a budget of $2.8 million. you can see here how the expenditures are broken up by division: we have ambulatory care. and our population health division here as well as public health administration which is basically our operation function within the department.

about more than 50% of our budget is and just sort of based on the space of the pie chart, that really is the lion's share of the expenditures we have overall, we continue to leverage general fund. what this graph shows is we have in the blue that's leveraged by each department. we have general fund layereded on top of it. we continue to offer 65% and require general fund subs tea of 35% in our base.

35% is $2.8 billion it's quite significant and so the 22-23 budget includes almost a billion dollars of general fund. 971.2%. the percent of general fund has been fairly consistent but we've usually been clocking in around that 30% to 36%. it's been fairly consistent. but this is a number we're watching very closely because percentage changes can mean significant requirements and additional general funds. in terms of our current salary projections, administrative code section 3.3 requires a report on this.

our hearings, and we're projected to be fully expended this year with hiring the second half of this year. our quarterly financial report of the health commission will continue to update you on these projections and we will continue to work aggressively to hire permanent staff and filling vacancies to support hospital operations, covid response and behavioral health expansion. in terms of the five-year financial projection, i had some questions about this. this is the city's five-year financial projections and so it includes d.p.h. and all other city departments including m.t.a., the public utilities commission, um services agency. so this projection is done by the city in whole. resulting in a projected surplus this year. i'll just take a moment to

cause there. commissioner chow, i don't know if you can remember a time where the five-year financial objection has reflected, but it's certainly not been since i've been working on city budgets. and so it's a pretty incredible moment and we can talk and i'll go into a little bit more about how that is. there are some risk that could change this forecast, but the department's been instructed to not add new costs, but reprioritize some of our better core services. specifically in the numbers of the controller's report, what you see is revenue increases of $40 million increasing to

$323 million. when you compare this to the expected expenditure growth that they see, you know, it seems minimal in the first year and so it shows a surplus over the next two years, but after the two years, the deficit is expected to grow and overall between the two fiscal years, they're projecting $108 million surplus how the projections are calculated are really around known expenditures and revenues. it should not include any policy decisions, but it's really should the city stay the course, what do you revenues

look like. should the city stay the course on its current hiring operating cost, departmental costs, what would that look like and so this is policy decisions and we're looking forward to taking action. and this is what it would look like. we talked about the risks and uncertainties, but covid-19 and the public health response the pace of the recovery. there's market volatility that could impact the pension return. part of the significant rev knew increases that the city's seen is really around increased return on pensions on the rate of return of the pension assessment by the retirement system other state and local

ballot measures and numbers to the educational, it's a state of -- i'm blanking on this, but it's basically excess educational funds that have been returned to the state and it's always been a policy decision or is a potential policy decision for the state to change the formula in which we've calculated. the mayor's policy priorities are restoring vibrancy in san francisco including public safety and street conditions. the local economy is focusing on the return of residents towards office workers to downtown and public spaces. small businesses. reprioritizing existing funding to include more service delivery as well as accountability and equity in terms of how we provide programs. the budget instructions to the

department. no mandatory reductions, but they ask we do not increase our requests for general funds. asking the departments to get back to basics for existing budgets including core service delivery and focus on programs that produce meaningful and equitable results and just other instructions were nongeneral fund departments which does not apply to us. in terms of d.p.h. goals and areas of focus, there are four that we're looking at. these should be fairly familiar to the commissioners because they're very consistent with what we've had in years past or the last two years. first is the transitioning of covid task force functions into our operating division in continuing our investment and behavioral health in support of people experiencing homelessness. our operating functions and improving work force and health equity and implementing new

programs and benefits under cal aim. so just to dive into each of these a little bit more, currently, we are looking to transition our covid task force operations back into operations. so our first year, we had a city wide approach where the covid budget would manage across a central covid command and then in this current year, we have a task force with ndph and now rear looking at the ability to bring functions back to manage under regular operations as we really looked at these functions and so many of these functions we expect will be continued in one way or another. at this point, we would expect all of our existing branches

here would continue in some form or another in the proposed budget. our planning work will continue into the spring and our detailed spending plan will not be included as part of our february commission but will be brought forward later because our staff has been undeployed on the surge but i think that it is because we are bringing the functions back into operations, it will take much more time to plan and term the right level of service and i will also note that currently, there's no long term funding identified for covid. a reimbursement is currently set to expire in april. we know that there is additional funding put into the governor's budget for this. we understand at this time that there's no direct funding to counties for services, but it's

possible that they may be providing services so that we would scale back our response because it's being provided by the state. there's a lot of work that really needs to be done to evaluate the proposals in the governor's budget and evaluate other funded sources and that will be happening this spring. our secondary focus will be behavioral health services as well as services for people experiencing homelessness. first and mother foes we'll focus on implementing the prior year initiatives. i know you had asked for a specific time line on when this would be implemented and unfortunately a lot of staff members were focused on the opening of the tenderloin site this morning so i didn't quite capture it all, so i will circle back with you on

specific time lines and i believe dr. cunnin will be providing an update on behavioral health to the commission, but there are areas, you know, through that will take some time to do and it depends a little bit on the work and evaluating the work that bed capacity is one area where we'll be looking where we need to acquire facilities before they can become operational and so that we are working on acquisitions. i know we recently acquired one site on geary street, but i think there are multiple sites dph is evaluating currently. in terms of service in the streets, i know that we have six street crisis response

teams and established a plan. we've started to expand some of our behavioral health and street medicine work. i think some of the targeted mental health services work in progress with the additional hires we have with the office of coordinated care as well as additional hires for mental health service center expansion which is expected to start i believe this month and then the street overdose response team, i know we've split up at least one team here and would expect additional programs to roll out over the course of this year and next as well as permit supporting housing services at supportive housing sites. over the course of the year. in addition to the continued implementation, we will and we

-- as we implement these initiatives, we will identify additional initiatives if we identify gaps in services. so but and then we expect some increases in the mental health services but the funding is primarily one time and then also in terms of behavioral health programs, it's the first set of programs which i'll talk about a little bit later. most of them do have behavioral health built in. this area is really focusing on core operating functions to support service deliveries. our prior year budgets have really been focused on increasing service levels, but we have not had any investment in operation. if you think about the functions of central operations, it's, you know, our work is critical to ensuring the time line of implementation of successful programs and so one of the things we'll be

looking at is looking at the investments needed to function in terms of business and human resources, office of health equity. data information systems and facilities. and, if you think back to the pie chart where we showed our expenditures where contracts and staffing was the lions share of our department, i think these first two areas this was an area where we'll be looking most closely to make an investment, but all these areas will be considered as we bring forward budget initiatives. last but not least is cal aim. cal aim is the multi-year frame work that the state has developed for, you know, to implement a broad based delivery system and payment requirement across all of

medi-cal. they have begun implementation, but the whole cal aim implementation is supposed to take place in january. allocations are still being developed for most programs. in general, what we found is that the details aren't available until a few months before they expect to implement. what we believe will happen over the next 18 months which will affect the first year of the budget will be three new benefits and two new incentive programs that will be rolled out. okay. so the benefits program. the first one is enhanced care management. this is the first benefit to roll out under cal aim. it's comprehensive care management to address clinical

and nonclinical care needs. the first clients are transitioning from care and overall i understand we have about 150 referrals that we are doing and evaluating for involvement into the program. the second benefit is community support. this is formally referred to the state as in lieu of services. this program is expected to be implemented in july 2022 and beyond and this is medically appropriate and cost-effective alternatives to services under the state plan. the health plans can choose to add new benefits every six months and we're currently working on benefits for working services. in addition to housing navigation benefits as well. these first two programs,

enhanced care management and community care support are a continuation of the whole person care pilot and i believe commissioner green asked which -- what's better whole person care or cal aim? right now, it's a little too hard to tell. they're slightly different animals. whole person care was a five-year pilot. so we never had certainty in terms of the funding. i do think the enhanced management and represents an opportunity for long-term ongoing funding for programs that historically hasn't been covered by medi-cal. so i think it does represent an opportunity for counties and i think that all counties will be looking to see how these pilots -- how these programs will be rolled out and adjusted over

time. lastly, a plan for january 2023 is a benefit for justice-involved clients for pre and post relief benefits. what we understand is it would allow for medi-cal reimbursements and would encourage a facilitator referral linkage and key health services. at this time, we have no estimates of what the allocations may have looked like, but it's one that we will be watching closely over the spring. in addition to the ongoing benefits, there are two time-limited multi-year programs that are focused on infrastructure incentives. the first is called to access

and transforming health. we expect details on this program sometime at the end of march or early april and the goals of the program are to provide infrastructure and financial support for the cal aim initiative. it also poses support on transitioning whole person care initiative. they're maintaining client support. there's a possibility we can apply for additional support. shared our care management or in lieu of community support services is insufficient. and lastly, this summer, we expect there to be additional details around justice involved services. the second program is behavioral health quality improvement program. we expect this to take place this month through june of 2024. it provides incentive for system changes and process

improvements for county mental health programs. and the goal is really to help counties prepare in terms of infrastructure for opportunities in cal aim to support billing, data, and collection exchanges. one of the key things that we will expect and that will be part of cal aim is payment reform and changing how we bill and, you know, looks at our clinical systems, our billing systems, and how our systems overall. we are currently developing a proposal for this program that i believe will be submitted at the end of this month. okay. with that, those are our goals and priorities. these are things we'll be working on in the next commission meeting. so at the next commission meeting, we'll be bringing forth a balancing plan that will include initiatives that looks at these goals and we

will request commission approvals and then as a reminder, our commission will not include covid-19 response as it will be developing from key stake holders. that is all i have for you. i'm happy to answer any questions the commission may have. >> president bernal: thank you, ms. louie. many thanks to you and your extraordinary team for your excellent work on the budget and thoughtfully presenting it to the commission. commissioners, do we have any questions or comments on the budget which we will be hearing again, additional information in our next meeting? commissioner guillermo. >> commissioner guillermo: thank you.

and thank you ms. louie for that comprehensive overview of the budget. we're really happy to hear that we have more resources than anticipated to work with and that they're going to be put to good use. i did have a question about the number three priority, the core operating functions. if you could tell us a little bit more about the right sizing of goals that you have and i know you mentioned that, you know, the contracts developed in all of that is something that is really important, but i had a question also about the data and information systems piece that you have listed there. the first question is is that data and information systems related to the public health function or is it related to the administrative functions for the department?

and if related to the administrative department or the administrative functioning, could you just describe that a little bit more? i just feel like, you know, those are areas that are very often needed for improvement, but get very little support when there are resources to actually be made available to things that seem quite mundane. so i was just sort of wondering if i'm sort of misreading this or misunderstanding how you're going to use these resources in that area. >> sure. i'm happy to talk about that. from business office to get a contract out the door to get a

whether we're on target and being held accountable. so the purpose of this area is really looking at recognizing that to talk a little bit more about some of the work that we're doing in the area. >> sure. hi commissioners.

so jenny really touched on a couple of pieces, but we're at a moment where we have significant growth, plus the strain of the covid response and we're really at a point where human resources and contracting are probably the bottleneck for the implementation and priorities and human resources hiring has been a big strain because we've got 150 new positions for mental health sf. we have about a00 positions for covid and so what we are trying

to do is right size our human resources function upward to be able to manage this. i'm sure you'll hear from dr. cunins next month about a lot of the hiring challenges which are the single highest priority. the other thing is providing services to our employees and that goes to being able to support employees would have challenging issues going on in the work place and it also goes to the retention of our employees and that is the most efficient and best way for us to maintain and grow our work

force. contract is another similar area. the growth and the volume and the complexity of contracts has outpaced our facilities we are behind getting the so that has to be putting that structure in place and the execution of it will be very much hand in hand with our programs and what they need to get implemented. there are a few things going on. we still do have the next phases of our clinical data systems to roll out.

for example, we're in the process now of planning for implementation of the behavioral health e.h.r. replacement project. that is largely funded through the epiproject. but there are pieces of that that need to happen as we roll out things like street crisis teams, we'll need to have a lot of work as part of the case management expansion to be collecting and using data and we are as one of our top four priorities under the lean strategic planning process that we did, we identified access to actionable data to one of the

top priorities. so that's going to be in behavioral health in our administrative system. so definitely a combination of the administrative and the direct program and services. the other thing we are trying to do is we have a historical pattern under investing in the basics meaning replacement of our equipment and infrastructure because those are not very exciting things to do. but we have tried to make an effort to put in place a sustainable funding source for replacement and upgrade of our systems overtime including the fact that we are now at the point where equipment and infrastructure that was bought and implemented in the opening of the new zuckerberg san

francisco general hospital is starting to reach the end of its life. and so what we're trying to do is create a financing model that will smooth out those investments over time and will be replacing our core infrastructure and allow us not too expensive that was a lot of talking, but this is really a lot of what you have heard and will continue to hear from a lot of staff in the department about the kind of growing pains and the bottlenecks in our ability to execute on some of these really kind of core administrative operatoring functions for the department.

>> thank you. >> commissioner guillermo: thank you. i just wanted to express support. often times when we have constrained resources, those kinds of things don't often see the light of day in terms of means versus the services we are obligated to provide don't get the attention that's needed and don't get the support and so i think this is a god time to invest so we don't end up having to worry about capital costs versus an ongoing budget that keeps these systems up to speed and current. so thank you for that details explanation.

>> president bernal: thank you, commissioner guillermo. vice president green. >> vice president green: thank you, as always for this really comprehensive background you've given us and all this work that's gone into this. i was a little bit confused about the cal aim program. i'm curious to know, it seems like when you look at all of the various sections here that it could have touched upon many of our divisions, but i had two questions. how much financial impact does this have when you look at our budget as a whole and it would be particularly vulnerable if we don't check all the boxes that they've listed here and i know in the past, there's been issues with keeping our underserved population registered in medi-cal and i'm curious to know on whether that would be a problem in our

ability to continue services but also pay for them when there's a lot of administrative involved and finally, what you touched on which is will we have the manpower to be able to execute all of this, but also what mr. wagner was talking about very recently as well. >> yeah. those are really great questions. i think in general with the exception of enhanced care management in lieu of services from what we can tell at this point, these are all new benefits from cal aim and under -- you know, and between us and the department of homelessness and supportive housing, we were able to draw down a significant portion of the whole person care dollars related to services which did include enhanced care management and the community's support.

the. it's a flip between a pilot program that had a mix of funding structures to a cap tated benefit where we're still finalizing the rates and the membership for that cap tated membership. and so i think that, you know, one of the big risks that you mentioned is really on eligibility and making sure people stayed enrolled in medi-cal and it's designed to counties to say what are the things you're going to need. how can we give you one-time multiyear funding over the next few years about this program to figure out how you're successful in the work that you do and i think a part of that is around eligibility. i think that there's other

areas around cal aim that we haven't seen before is and so they represent opportunities that we don't want to miss out on. and so i think that it's really about making sure we're positioning ourselves well, for the benefit as they roll out and understanding, you know, what the reals are but this new programming, it's a little unclear on what it would take and what we would need to be successful, but we're definitely looking at it. i would say we've struggled

with a lot of the details and so trying to roll out cal aim and so the details have not been coming out until sort before in a lot of counties and so i think a lot of things are up for interpretation. but i think these are some excited areas moving forward. >> can i jump in for one second? >> yes, please. >> i think that's a great question, commissioner green and i'd also say that it's a great opportunity to do some of the things we've needed to do as a system for a long time anyway. maybe individual bright spots within our system, but they don't necessarily talk to each other. same goes for some of our

community partners and this is a real opportunity to get on the same page and have a consistent approach to case management really throughout the safety net and then the other thing is i totally agree that i think people fill engine and out of medi-cal enrollment is problematic. we've worked closely with the pandemic to kind of ease a lot of the kind of time lines for patients, but the best part in my mind is we're working so closely with the health plan and i think it's going to help that situation in addition to the jail health services will enroll people, medi-cal before they discharge and hopefully that will improve and streamline their inmate to, you know, community dwelling,

medi-cal recipient a lot. but happy to talk about the commission meeting. >> vice president green: thank you so much. that would be interesting. i was delighted to see the jail because it's high time that happened. and lastly, where does this land in terms of our number of dollars that might be involved, what percentage? its having a hard time putting it in context. >> i think we're still evaluating the cal aim. which included a payment match so i think it was closer to about 17 or $18 million between the two departments. we are still trying to understand the level of enrollment and i hope to actually have updated requests

or an updated projection at our next meeting and i think that part of it as i understand is past funding was to help bridge the gap for us as we enroll clients, but, again, the details of that program will likely not be rolled out until march or april. but i hope to have anger consumption for ens hansoned care management. >> vice president green: thank you so much. >> president bernal: thank you. commissioner giraudo had a question. >> commissioner giraudo: i did. i was concerned about the right sizing looking at the infrastructures and she did ask

the question already and then my only other comment was to again, thank jenny for the very readable and i just want to again say thank you for how you're conveying this information to us. it's very much appreciated. >> you're very welcome. >> president bernal: thank you. commissioner chow. >> commissioner chow: thank you. and i also want to complement mist louie on a clear presentation. the i expect and i'm hoping that we'll do as we did in the past, the detailed changes in the budget will allow us to

know the specifics and i am concerned as you were talking about the vagueness of the cal aim program without very commendable goals as to how one will price those and i guess we will see that at our next meetings. i am struck that this is one of the years we will have a surplus the department's been much better in terms of trying to even them out because of first the two-year budget program that the city adopted a few years ago and certainly with the help of mr. wagner, being able to create those reserves to avoid the ups and downs. nobody came to protest so far because you're not all talking about service cuts so that says a lot in terms of where we're

going and i fully support and i would have asked very similar questions about the core operating functions the fact that we finally are going to be able to fund you call it right sizing, a lot of people think that's down sizing. in this case, right sizing is up sizing. we're well aware there's been so many shortages in the administration and the work you're all doing all the way from the contract's office to everything that's being done with not just the shortage of people from the pandemic, but when you began with a shortage of people if i remember and they were always the first to be cut when there was a question. so i look forward to how you're going to right size and hoping our people can do the best work that they want to do and that

the city deserves. so that's actually my only comments and not asking any comments yet because i'll wait for the details in our next meeting. >> president bernal: thank you, commissioner chow. do i not see anyone on the public comment line. thank you again for your presentation. we always say the budget is a statement of our values and we look forward to hearing from you at our next meeting. all right. our next item is pardon me while i grab my agenda. we have mr. eric ralphin is the dph chief information officer. >> good afternoon president bernal, commissioners,

secretary colfax. thank you for providing an opportunity for a quarterly i.t. update. i know all of you have been accustomed to seeing me over the past two years. today, i'm going to switch it up a little bit. i'll have a brief update for you and then we will dive in to what mr. wagner referenced a few moments ago about working on how to achieve the most actionable to optimize our decision making across d.p.h.. but first a quick update. your commission has expressed some questions and concerns about how we make use of external medical records in the provision of occupational health services. and i wanted to bring up just an update for your commission and that we recently implemented some changes in the

epic platform to focus the availability of external medical records and when i say external medical records, i mean medical records we are receiving from other health care medical organizations where our employees receive their health care services. so we took some steps and have limited the amount of external categories that are reviewable in epic to just two and those two categories are allergies and immunizations. and that's important because both of those categories can be quite work related. just an example, if an employee had a latex energy and we were able to learn that, that can be very important from a safety perspective. immune stations, no better time than the present is a reminder about how important immunization records are. not all d.p.h. staff received

their covid vaccinations from d.p.h.. however, by being able to quiry, we can develop a complete report of immune stations for our staff and as we know, immune stations for covid as well as now a booster coming up on the horizon are required. so the occupational health record, if you are an occupational health provider, the only records you will see are immune stations and allergies. i wanted to make sure i would provide that for you. i will try and be brief. this is going to be a high level introduction into one of d.p.h.'s newly minted

projections. and i will get my screen up here for you okay. the two take-aways for our time together, one is that we have really learned the value of having the right information at the right time and the right setting and i'll talk about that in just a moment. and we are placing a strategic focus on utilizing actual knowledge to optimize data driven decisions. so the three blue boxes on the bottom row of this display highlight our strategic objectives including health outcomes for people in homelessness. achieving health equity with a focus on engaging our

community. and then finally the d.p.h. way to achieve actual knowledge any time anywhere. and that strategic objective will not only hopefully change how we go about ensuring we have actual knowledge available for all of our programs, but we also expect to be able to have direct impact on the three strategic objectives to the left in the blue boxes and i'll talk about that more in a minute as well. so we can't really get to actual knowledge without first recognizing how very important this data is in our work and the two most present activities where data has been and continues to play a huge role is our transformation and our pandemic response where we have taken the time to bring many systems to one to have

governance where we can shower that the work gets down done and the information we gather whether it's a report or dash board or something more advanced. it is linked with the priorities of the organization. so we've placed the patient client at the center of our work. we've captured data in a much more standardized way which makes it more available and usable and we actually now can perform some of our analytics work ourselves. i'm living proof that i can actually go into epic and get administrative dash board reports all by myself and i don't need to get any additional assistance. with regard to our pandemic response, something that's really important is that we have one source of truth because folks need to be able

to trust the data we're working with. instead of having my data, we have the data and that's what's committed the source in every single report and presentation that your commission has consumed as well as all of the other information sharing that's been accomplished over the last two years. and it's so important for us to be able to say that the decisions are based on the data. it's such a trust building activity. i mentioned that both our ehr transformation have a governance function that sits on top of the work so every one is a transparent activity where we're able to define standards and we're able to develop uses of the data that tie directly back to the objectives at hand. and last but not least, we've

learned that being responsive is a direct report. it means that the data does have to be actionable, ready, and available. and so in order for us to get to a place in actual knowledge, we need to make sure we have our data in order. those are evidence that we can get this done. it would be great to say that we could leave directly from having the data we need and immediately start applying and taking action to support all of our strategic objectives. what you're looking at here is a knowledge sandwich and the bread is high quality data on the left which means it's available and usable and meaning it's accurate and valid and complete. and on the right side, you have

the actions that we take, but we need to deal with the middle part of the sandwich which is the knowledge and the data. and when it becomes this knowledge and it becomes knowledge when it starts telling a story like a lot of our pandemic reporting especially where we've looked and used some advanced anal lit cal capabilities and modelling that we can start deriving a lot of insights and start getting ready to predict what we think might happen in the future based on the data, the powerful data we've had in the past. so the knowledge that we gain is where dph is going to focus a lot of effort the next few months which is the strategic action period. so what does it mean? i like to think of it in just three buckets.

people, process, and tools. with regard to people, it's understanding that dph has a rich cohort of staff who are analysts but we don't always bring all of that powerful talent together to increase our capacity to handle more knowledge work. much in the same way that you heard a little while ago talking about case management programs and trying to bring people together under the cal aim enhanced care management platforms. it's the same idea here. understanding where our talent is. making sure there's good development plans and being able to hopefully share the burden of working with all of the data so that we can bring it forward and let that

transformation happen and the data becomes a story. but it also means that we can become an army of analysts where everyone at dph who has questions can first learn before asking the question and say wait a minute. i know where i can get to the data and analyze what's going on. also ensuring that we develop more shelf serving. we have a process today which is the best practice called information governance. it's what allowed us to have standards and prioritize requests and and it also opens the door for us to dive into

more advanced analytics where we look forward to building our first predictive model in the epic system. and finally, tools. it's probably not a surprise to know that developing actual knowledge in large part is said by major changes we're making such as continuing to advance epic across dph whether that's the clinics in the population health division and the rest of the san francisco health network. as we continue advancing epic, we continue advancing data that's standardized and available which means we can work from an analytical perspective. we've spent a lot more time trying to bring the data together and now we're in a much better position to start feeding our process with knowledge from that data.

and last but not least, we have so much data in d.p.h., we've sort of outgrown the houses we store it in both physically as well as logically. we need to create a new data home for all of our dph information needs. a place where there's a good catalog of all the data that we have as well as a good description of definitions of what that data is and what it isn't and be able to create an analytical space for our analysts as well as for those of us who would try and hopefully succeed in self-service analytics. and i'll talk for a moment and provide a few tangible examples of how actionable knowledge any time anywhere is important for us in our other strategic objectives. i'll start with behavioral

health services and people experiencing homelessness. we are quite wired in already with the san francisco mental health program and part of that work is the creation of new data homes specifically for mhsf where we are bringing information together from all of the systems to provide a view of the experience that many of our patients and clients have and that is going to help us both when we're looking to see who may be eligible for our program, but also how are we keeping an eye on and supporting cal aim now that we're able to bring the information together that our patients and clients are experiencing that we're able to take more action as a result. from the equity standpoint especially with new work to

engage our community directly in a program where we'll be doing a lot more direct surveying across our different community neighborhoods is that we will need to be building out a new way to both gather and store and analyze this survey data and then begin to join that and analyze it in conjunction with the larger population trends that we're observing and so that leaves some exciting work we're going to be doing with dr. ben nit. and finally from a work force perspective. i think you heard a little while ago we're working hard on our administrative support functions and one air where we'll be quite focused is looking towards investing in a new system that helps us with not just data, but actually helping the work flow in human

resources so that work can be more transparent to a customer, let's say a hiring manager, but also so we can see when we can track but also a bottleneck process so we can work on the data and have us tell us the story and make continuous improvements and we struggle l today because we don't have one system that we can depend on that gives us all the information we need in h.r. so we're just getting started. so we've built our core team and i've neglected to share that it's akata is the acronym for achieving actionable knowledge any time, anywhere.

and we're quite excited to be able to start our journey on the dph way to achieve actual knowledge any time anywhere and it was really to hopefully wet your appetite in the future reports. i hope to bring you back some good feedback on how things are going. and i am happy to take your questions as always. >> president bernal: thank you mr. raffin for that presentation. we have commissioner chung. >> commissioner chung: thank you, mr. raffin for the presentation. at the end, you actually answered one of my questions is how you connect to the process. it seems like we have a lot of tools. and also trauma identified and

so my next question is about how do we actually, you know use that from the mental health perspective and also from outpatient standpoint to really look at whether or not we are responding in a meaningful way, you know, that's informed to patients' needs. >> i think the thing that i have observed most about my time over the last ten years or so in county health care is that there's often sort of a separation between behavioral health records and all the other health records that we have and most of that is not anything, there's no law that says that those records can't be brought together and shared. so it's been a really important

journey that we're on now and mental health san francisco is a great catalyst for the work to join that information together. so if you recall at epic, we have both the infection that we generate. we also have all the external health information that we receive about the clients and residents we satisfy in other health dare organizations and then we have data from the homelessness and supportive housing and we have the h.r. data and for the first time, we are really bringing that all together and so we have more of a longitudinal view of the experiences that our clients and patients are having and that's so important because a program like enhanced care management can succeed best when all of that information is available and so that those engagements, those actions that

can be taken can be formed by the knowledge of having a much more complete view of what's going on with the people we serve. >> that's really exciting. i have two more questions. so the next question i have is regarding, you know, like the human resource part that you mentioned earlier. so if this is used correctly, will this be able to help us predict, you know, staffing needs, you know, for different departments and especially, you know, for hospital staff? >> so that's something that modern human resources would do, but we would be on a path to collecting more data and we would understand trends a lot more and once we get proefficient at that, then you can envision being able to do a little more accurate

forecasting about what to expect whether it's when do -- when are people who are approaching retirement eligibility actually retire is a good example. and how long or how frequently our employees staying less than two years in their job to make it through probation nar period, but they don't stay for a long time. right now and even reports like that, we have to spend a long time. i know that our human resources team, it takes a long time to actually produce that because the information doesn't necessarily all live in one home. and that's where we want to get to. where all of that information can be used to do the very thing you're asking about. >> commissioner chung: and the last question i have is, you know, it's ambitious because it's anywhere, any time, you know knowledge anywhere, any time. and for us, you know, the

nature of this work, you know, we have a lot of ad hoc initiatives that happen, sometimes from the mayor's office, sometimes from the supervisors like what we have now in addition to covid, it's the tenderloin linkages. how fast can these initiatives be implemented like within this system? >> i want to make sure i'm clear about which system just in general? >> you mentioned data, but data is very general and it could be many different systems. so. >> so what we've learned and i think our pandemic response is a good example. and i had the honor of sitting down there in the department operation center during the first few months of our covid

response in 2020. and we started with very little information and so there was a lot of my data said this or my data said that and we knew immediately that if we could start focusing on providing a single source of truth and we could describe it well and put a governance program on top so we would be working on the most important information at any given time regardless of what it was for. it might have been for the mayor's office. it miebl for leadership. it might have been from one branch of the covid center versus another. but we learned that we could actually be very responsive and while we worked, we're working under a lot of i would say abnormally high pressure to get the work done, there's evidence, you know, that we know how to get it done. the question is how will we

make that come together across the whole of dph and that's what the strategic objective is about. i don't think -- we can't boil the ocean. we can't attack every area at one time, but the strategic objectives and these major programs that you heard a lot today from ms. louie and mr. wagner, these are the areas where we'll be focused. >> commissioner chung: so hopefully that will help us in saving dollars after these two years and also help with some of the high level positions so that director colfax's hair won't turn gray. so thank you. >> president bernal: all right. we have commissioner giraudo. >> commissioner giraudo: thank you. and thank you for your presentation: i'd like to just

extend commissioner chung's questions a little bit further. i think it would be really helpful if as you are implementing and gave us a couple of examples, if you could rom back for an update of the implementation of akata with really specific examples in walking us through the start let's say when you had referenced mental health sf, you referenced a homeless client just from start to conclusion. what did this system do and how did it then benefit not only the client, but let's say the

mental health sf program. i always like to see, you know, we've got theory to implementation and practicality with specific examples. so i would appreciate it if as you are rolling forward, if you would if commissioner bernal agrees and the commission to just come back with an update of examples of the excellent and wonderful work that i'd like to further understand the wonderful, you know, the challenge but the changes you're making as well. >> i'm happy to do that. >> commissioner giraudo: thank you. >> president bernal: commissioner guillermo. >> commissioner guillermo: thank you.

and thank you, mr. raffin for your presentation. this is very exciting to know that this vision is coming in the department and i imagine that you know, again, this is going to be a multiyear effort. of this is not something we can expect to see results from even within, you know, a nine to twelve month period. i guess it depends on the use case that you're going to be putting in place similar to the question that commissioner giraudo asked is, you know, what are these cases that we're going to be hearing about in terms of the implementation and the outcomes and then i had a little bit of a technical question that relates to that. given that you are trying to

find a central home for all of the data, clearly all of the major source of data is going to come from the epic systems, but there are lots of other places where data comes from and in terms of being about to make that data into actionable data, lots of a.p.i.s or interfaces that are going to have to be put in place and applications are going to have to be put in place in order to translate into actionable data and then to be made accessible to those who need that. it would be helpful at some point just because this is such a major initiative i think that is being ed and the potential benefit in terms of the health of, you know, the communities and the individual residents in san francisco that need this information and the providers that are going to be using them. it's so important that how this is going to work i think is

going to be really important for us to be able to kwiry about and be as transparent as we possibly can. data is something that people are very concerned about in termings of who uses it and, again, what are we going to expect in terms of, you know, the initial results of this. and so it's clear that, you know, my fellow commissioners are interested in the exciting nature of this, but i think there's going to be a need to understand the implementation and the execution chajss that are going to surround it and support what you need to do in order to get there. >> i completely agree and i think things will probably be lined up and phased.

there will be some work that's low hanging fruit where we've already started and there will be other work that will definitely take longer than a year to bring to life. but the nature of this lean process and using these a3 process improvement charters, one of the rationale behind it is it gets started

>> so the only information that if you are logged in as an occupational health staff member, the only external information you'll see. of course, you'll see any information is created in occupational health, but the only external information say from perhaps you received a vaccination from kaiser or a sutter facility, that information would show up on the same allergies, but beyond

that, the other concerns about other components of external medical records such as diagnosis or problems or any other types of diagnostic reports or diagnostic summaries or diagnoses, those are not viewable in occupational health. that was the major change that we implemented and i do believe to the second question that that is well aligned with the standard that osha uses for occupational health records which is that the records should be work related and immune stations and allergies are quite work related and that we are not exposing or making viewable any of the other records for our staff in

occupational health. >> commissioner chow: so we'll get to the second part then. as i understood it, there was a question and i don't think it only related to occupational health to people able to access records. was it only occupational health? >> i'm concerned about the staff member going in to get a vaccination and looking at the screen and seeing more of their medical record which is from external sources than they thought was appropriate and so that instance led to a lot more research and consideration about how to make the most work related information available in occupational health, but not the other information.

it was technically challenging to make that adjustment, but those changes are made as a result of that very concern. >> commissioner chow: okay. thank you. >> and, dr. chow, if i could add, this was done in response and targeted at the issue that we've been working on and it was raised at the health commission. and so i think this does subs at that point address those concerns. as part of our normal electronic health records process, they're still in exchange with other systems. however, that data won't be visible in the same way that it was that caused those concerns in the occupational health area physicians treating a patient

will still have access to that data shared unless the patient requests that the system not share their data. this will limit the easy visibility of that data that was the basis of the concerns that you heard. >> commissioner chow: thank you. and that's helped clarify also where the questions were coming from because they seemed much more general, but this certainly makes it much clearer in terms of your katra, that's quite a slogan really i think. i like that. and on that slide, i think that you have for dph strategic objectives. i'm wondering is that illustrative or is that

complete because it seems to me that improving health outcomes, for example shgts really reflects not just the homeless, but also those who are challenged with substance abuse or mental health and they're not necessarily homeless and there are a number of other strategic objectives from different areas is that justin meant to point out the important ones or are you going to point out the objectives you've made. >> i think trying to fit the language for the first one about improving health outcomes and that is clearly tide to behavioral health services just to clarify. those four strategic objectives are the ones where we have a focus and are using our lean strategic planning process to build plans. the good news is in a lot of

these areas where we build either we approve capabilities, it will likely have a positive effect across the programs and not just in one specific area. >> commissioner chow: okay. so thank you. that's a great explanation. these are the areas in which your department is looking that these are the high focus areas that you all want to really hit as you went through your a3s. >> yes. >> commissioner chow: well, i look forward to further updates and i think some of that for those of us that were looking at the community, public health committee in which there was really a much more extensive data on even tobacco and the

sales of tobacco or even with primary care. so we really do appreciate all the work you've been doing. this aggregate data which is so helpful. thank you. >> you're welcome. >> president bernal: thank you, commissioner chow. i believe that's it for commissioner comments or questions and there's nobody on the public line. thank you again, mr. raffin for coming to see us with your regular report and we look forward to the next one. >> i just want to thank mr. raffin and covid has

reinforced that data. so thank you. >> president bernal: thank you, director colfax. moving on to our next item and it is an action item. patient trust fund and to present, we have alex koskinen from the dph business office. >> hello, members of the commission. thank you for taking the time to hear our item. i'm from the vsfg accounting. and the zsfg maintains a patient trust fund for our mental health patients one mission is to provide a weekly $10 stiepenned for patients who

do not have any funds of their own. i believe this has gone back to at least the year 2000 and the purpose of the stiepen is really for equity and to prevent behavioral issues. some patients have their own funds deposited by friends and family or have their own personal funds from when they became residents and having some patients with their own funds to spend at the vending machines and it really caused behavioral issues. so our patient trust fund is regularly replenished to a level of $15,000 and we distribute about $200 a week. there are on average, 20 or so patient who is receive the

stiepen in the mhrc. so every year and a half, we need to replenish this fund. and the controller's office has interpreted that a new health commission approval is required for the next replenishment and replenishments going forward. so we'd like to memorial, we created this resolution and we'd like to memorialize your approval and you'd basically be approving us to replenish the patient trust fund to a level of $15,000 any time the trust fund depletes to a level of 2000 and the source would be the general hospital operating fund and this is in accordance with the city's admin code and with the concurrence of the

controller's office. i'd be happy to answer any questions. >> and if i may jump in. i believe the city attorney's office partnered on this. >> yes, big thank you to greg wong who really draft and modified by city attorneys. >> thank you. for that clarification. i also want to thank you, mr. koskine which is something we consider to be very important. so thank you for introducing that element of this program to us. commissioners, upon reviewing the resolution, this is an action item. do we have a motion to approve? >> commissioner: i so move.

>> commissioner: seconded. >> president bernal: okay. seeing no one on the public comment line, we can move to a roll call vote, secretary morewitz. >> secretary: [roll call] the resolution passes, thank you so much. >> president bernal: great. thank you. >> thank you. >> president bernal: our next item on the agenda which all i have a www.covidtests.gov to get your four free tests from the federal government. any other other business? >> commissioner: commissioner bernal, i'll just add that i already did that and the u.s. postal office already sent a confirmation like within minutes.

so it works. >> president bernal: great. thank you, commissioner giraudo, for being the test case. personal next is the health update back to commissioner giraudo. >> commissioner giraudo: thank you very much. we had fwochlt excellent presentations today. one the first one is the primary care as part of our health network the information that was presented today that we have clinics in all four quadrants of san francisco. there are four special youth clinics and they were explained to us including the clinics at balboa high, willy brown, and burton high school who are patients. there are 66,121 active

patients and within the last year, there were 240,000 encounters for both in-person and through telehealth. the presentation was also given on the covid test and vaccine very the we've had 16 sites over 20% of the san francisco population was vaccinated at the dph sites and this was not just the health network patients. it was overall population of san francisco. the amid a significant campaign outreach for vaccinations and made actually over 10,000 live outreach calls. the home bound vaccine program which was really stellar vaccinated over 300 people

within the city. the focus has been the southeast sector of san francisco where the covid rates are the highest in the black african american age five and up are the lowest percentage. and so this is where there is significant efforts to focus and address the disparities in this population. the priorities of the primary care group are as follows. an equity action plan, increased access to care, pop population health and support recovery and resilience in primary care teams. the presentation was excellent and answered all of our questions in a very timely manner. our second presentation was the

tobacco retail enforcement group. the permitting for tobacco gave us a history time line. the permitting began in 2004 and since 2004, there were seven more laws. the latest was 2019 which was no flavored tobacco to be sold and no sale of e cigarettes without the fda premarket approval and the only there are currently only three products that have been approved. the permit density which is one of the points of the law went from 923 permits, it's down to 621. the enforcement process for sales to persons under 21 is in place and they also have a

correction plan for first time violators. the labeling of flavored tobacco has been challenging and they are so aware of it and right on it and are partnering particularly with san francisco unified school district and community organizations on not only flavored tobacco which we do know that kids can just get whatever they want which is an issue, but that in their partnership with san francisco unified, they're putting together a very creative nonvaping campaign since that is the adolescent focus and who either know of vaping or are also vaping is quite high at

this particular time. so it was extremely informative on both areas with excellent work being done in both and they were very informative presentations to our committee. that's my report. >> president bernal: thank you, commissioner giraudo. any questions or comments for commissioner giraudo? hearing none. i see no one on the comment line. our next item, thank you, commissioner giraudo, is the joint conference committee report from the laguna honda hospital j.c.c. meeting of january 11th. commissioner guillermo, please. >> commissioner guillermo: thank you, president bernal. we did have a relatively brief j.c.c. meeting on the 11th and mostly consisted of in the executive team report and update on the covid surge and

its impact on laguna honda and it's the most positive report we have continued to be exemplary in protecting the residents there even though that there has been a sort of a bit of a surge among the staff that was reflected there but, again, among the residents, you know, the protective procedures and safety protocols that have been put in place in laguna honda have held up and so a minimal exposure there had reenstated a number of thing that is had been put in place when covid first hit laguna honda in terms of visitation and setting up a separate wing and other kinds of protocols and so hopefully that will hold through the peak of the surge

and that we again will be able to protect our work force in laguna honda residents to the extent that we had been able to do that well and beyond expectations to date. we also went through a regulatory affairs report for november and december and in closed session, we did review the med q.i., the pips report and approved the credentialing of and recredentialing of clinical staff there or physician staff there. and that's the extent of my report. as i said it was a relatively brief meeting and we dispatched that. >> president bernal: thank you, commissioner giraudo. and thank you also for reminding us of the effect iresponse at laguna honda which

is one of the nation's largest skilled nursing facilities as we saw. very tragic outbreaks in other parts of the country. so thank you for that. okay. our next item is our final item which is consideration of a motion to adjourn. >> commissioner: i'll move to adjourn it. >> president bernal: do we have a second? >> commissioner: second. >> secretary: i'll do a roll call vote. >> president bernal: thank you. >> secretary: [roll call] >> president bernal: thank you commissioners. thank you dph staff. thank you members of the

public. please stay healthy and safe and we will see you in just a few weeks.

>> we are right now in outer richmond in the last business area of this city. this area of merchants is in the most western part of san francisco, continue blocks down the street they're going to fall into the pacific ocean. two blocks over you're going to have golden gate park. there is japanese, chinese, hamburgers, italian, you don't have to cook. you can just walk up and down the street and you can get your cheese. i love it. but the a very multicultural place with people from everywhere. it's just a wonderful environment. i love the richmond district. >> and my wife and i own a café we have specialty coffee drinks, your typical lattes and mochas and cappuccinos, and for lunches, sandwiches and soup and

salad. made fresh to order. we have something for everybody >> my shop is in a very cool part of the city but that's one of the reasons why we provide such warm and generous treats, both physically and emotionally (♪♪) >> it's an old-fashioned general store. they have coffee. other than that what we sell is fishing equipment. go out and have a good time. >> one of my customers that has been coming here for years has always said this is my favorite store. when i get married i'm coming in your store. and then he in his wedding outfit and she in a beautiful dress came in here in between getting married at lands end and to the reception, unbelievable.

(♪♪) >> the new public health order that we're announcing will require san franciscans to remain at home with exceptions only for essential outings. >> when the pandemic first hit we kind of saw the writing on the walls that potentially the city is going to shut all businesses down. >> it was scary because it was such an unknown of how things were going to pan out. i honestly thought that this might be the end of our business. we're just a small business and we still need daily customers. >> i think that everybody was on edge.

nobody was untouched. it was very silent. >> as a business owner, you know, things don't just stop, right? you've still got your rent, and all of the overhead, it's still there. >> there's this underlying constant sense of dread and anxiety. it doesn't prevent you from going to work and doing your job, it doesn't stop you from doing your normal routine. what it does is just make you feel extra exhausted. >> so we began to reopen one year later, and we will emerge stronger, we will emerge better as a city, because we are still here and we stand in solidarity with one another. >> this place has definitely been an anchor for us, it's home for us, and, again, we are part

of this community and the community is part of us. >> one of the things that we strived for is making everyone in the community feel welcome and we have a sign that says "you're welcome." no matter who you are, no matter what your political views are, you're welcome here. and it's sort of the classic san francisco thing is that you work with folks. >> it is your duty to help everybody in san francisco. a city like no other, san francisco has been a beacon of hope, and an ally towards lgbtq equal rights. [♪♪]

>> known as the gay capital of america, san francisco has been at the forefront fighting gay civil rights for decades becoming a bedrock for the historical firsts. the first city with the first openly gay bar. the first pride parade. the first city to legalize gay marriage. the first place of the iconic gay pride flag. established to help cancel policy, programses, and initiatives to support trans and lgbtq communities in san

francisco. >> we've created an opportunity to have a seat at the table. where trans can be part of city government and create more civic engagement through our trans advisory committee which advises our office and the mayor's office. we've also worked to really address where there's gaps across services to see where we can address things like housing and homelessness, low income, access to small businesses and employment and education. so we really worked across the board as well as meeting overall policies. >> among the priorities, the office of transgender initiatives also works locally to track lgbtq across the country. >> especially our young trans kids and students. so we do a lot of work to make sure we're addressing and naming those anti-trans

policies and doing what we can to combat them. >> trans communities often have not been included at the policy levels at really any level whether that's local government, state government. we've always had to fend for ourselves and figure out how to care for our own communities. so an office like this can really show and become a model for the country on how to really help make sure that our entire community is served by the city and that we all get opportunities to participate because, in the end, our entire community is stronger. >> the pandemic underscored many of the inequities they experienced on a daily basis. nonetheless, this health crisis also highlighted the strength in the lgbtq and trans community. >> several of our team members were deployed as part of the work at the covid command

center and they did incredit able work there both in terms of navigation and shelter-in-place hotels to other team members who led equity and lgbtq inclusion work to make sure we had pop-up testing and information sites across the city as well as making sure that data collection was happening. we had statewide legislation that required that we collected information on sexual orientation and our team worked so closely with d.p.h. to make sure those questions were included at testing site but also throughout the whole network of care. part of the work i've had a privilege to be apart of was to work with o.t.i. and a community organization to work together to create a coalition that met monthly to make sure we worked together and coordinated as much as we could to lgbtq communities in the city. >> partnering with community organizations is key to the success of this office ensuring

lgbtq and gender nonconforming people have access to a wide range of services and places to go where they will be respected. o.t.i.'s trans advisory committee is committed to being that voice. >> the transgender advisory counsel is a group of amazing community leaders here in san francisco. i think we all come from all walks of life, very diverse, different backgrounds, different expertises, and i think it's just an amazing group of people that have a vision to make san francisco a true liberated city for transgender folks. >> being apart of the grou allows us to provide more information on the ground.

we're allowed to get. and prior to the pandemic, there's always been an issue around language barriers and education access and workforce development. now, of course, the city has been more invested in to make sure our community is thriving and making sure we are mobilizing. >> all of the supervisors along with mayor london breed know that there's still a lot to be done and like i said before, i'm just so happy to live in a city where they see trans folks and recognize us of human beings and know that we deserve to live with dignity and respect just like everybody else. >> being part of the trans initiative has been just a great privilege for me and i feel so lucky to have been able to serve for it for so far over three years. it's the only office of its kind and i think it's a big

opportunity for us to show the country or the world about things we can do when we really put a focus on transgender issues and transgender communities. and when you put transgender people in leadership positions. >> thank you, claire. and i just want to say to claire farly who is the leader of the office of transgender initiatives, she has really taken that role to a whole other level and is currently a grand marshal for this year's s.f. prize. so congratulations, claire. >> my dream is to really look at where we want san francisco to be in the future. how can we have a place where we have transliberation, quality, and inclusion, and equity across san francisco? and so when i look five years from now, ten years from now, i want us to make sure that we're continuing to lead the country in being the best that we can be. not only are we working to make

sure we have jobs and equal opportunity and pathways to education, employment, and advancement, but we're making sure we're taking care of our most impacted communities, our trans communities of color, trans women of color, and black trans women. and we're making sure we're addressing the barriers of the access to health care and mental health services and we're supporting our seniors who've done the work and really be able to age in place and have access to the services and resources they deserve. so there's so much more work to do, but we're really proud of the work that we've done so far. [♪♪]

>> the city has undertaken a pilot program to hook up private privately -- owned hotels. >> the community members say this is helpful for them especially for the seniors and families with kids from seniors

being able to connect with the family during the pandemic and too watch the news has been really helpful during this time where they are stuck inside and are not able to go outside. for families it is important to stay connected to go to school, to get connected so they can submit resumes to find jobs during the pandemic. [speaking foreign language] >> challenges that might seem for the fiber in chinatown is pretty congested. the fiber team found ways around that. they would have to do things such as overnight work in the manholes to get across through

busy intersections, and i think the last challenge is a lot of buildings we worked on were built in the early 1900s and they are not fitted with the typical infrastructure you would put in a new building. we overcame that with creative ideas, and we continue to connect more sites like this. >> high-speed internet has become a lifesaver in the modern era. i am delighted that we completed three buildings or in the process of completing two more. i want to thank our department of technology that has done this by themselves. it is not contracted out. it is done by city employees. i am proud and i want to take a moment to celebrate what we are doing.

>> what we're trying to approach is bringing more diversity to our food. it's not just the old european style food. we are seeing a lot of influences, and all of this is because of our students. all we ask is make it flavorful. [♪♪♪] >> we are the first two-year culinary hospitality school in the united states. the first year was 1936, and it was started by two graduates from cornell. i'm a graduate of this program, and very proud of that. so students can expect to learn under the three degrees.

culinary arts management degree, food service management degree, and hotel management degree. we're not a cooking school. even though we're not teaching you how to cook, we're teaching you how to manage, how to supervise employees, how to manage a hotel, and plus you're getting an associate of science degree. >> my name is vince, and i'm a faculty member of the hospitality arts and culinary school here in san francisco. this is my 11th year. the program is very, very rich in what this industry demands. cooking, health, safety, and sanitation issues are included in it. it's quite a complete program to prepare them for what's happening out in the real

world. >> the first time i heard about this program, i was working in a restaurant, and the sous chef had graduated from this program. he was very young to be a sous chef, and i want to be like him, basically, in the future. this program, it's awesome. >> it's another world when you're here. it's another world. you get to be who you are, a person get to be who they are. you get to explore different things, and then, you get to explore and they encourage you to bring your background to the kitchen, too. >> i've been in the program for about a year. two-year program, and i'm about halfway through. before, i was studying behavioral genetics and dance. i had few injuries, and i couldn't pursue the things that i needed to to dance, so i

pursued my other passion, cooking. when i stopped dance, i was deprived of my creative outlet, and cooking has been that for me, specifically pastry. >> the good thing is we have students everywhere from places like the ritz to -- >> we have kids from every area. >> facebook and google. >> kids from everywhere. >> they are all over the bay area, and they're thriving. >> my name is jeff, and i'm a coowner of nopa restaurant, nopalito restaurant in san francisco. i attended city college of san francisco, the culinary arts program, where it was called hotel and restaurant back then in the early 90's.

nopalito on broderick street, it's based on no specific region in mexico. all our masa is hand made. we cook our own corn in house. everything is pretty much hand made on a daily basis, so day and night, we're making hand made tortillas, carnitas, salsas. a lot of love put into this. [♪♪♪] >> used to be very easy to define casual dining, fine dining, quick service. now, it's shades of gray, and we're trying to define that experience through that spectrum of service. fine dining calls into white table cloths. the cafeteria is large production kitchen,

understanding vast production kitchens, the googles and the facebooks of the world that have those types of kitchens. and the ideas that change every year, again, it's the notion and the venue. >> one of the things i love about vince is one of our outlets is a concept restaurant, and he changes the concept every year to show students how to do a startup restaurant. it's been a pizzeria, a taco bar. it's been a mediterranean bar, it's been a noodle bar. people choose ccsf over other hospitality programs because the industry recognizes that we instill the work ethic. we, again, serve breakfast,

lunch, and dinner. other culinary hospitality programs may open two days a week for breakfast service. we're open for breakfast, lunch, and dinner five days a week. >> the menu's always interesting. they change it every semester, maybe more. there's always a good variety of foods. the preparation is always beautiful. the students are really sincere, and they work so hard here, and they're so proud of their work. >> i've had people coming in to town, and i, like, bring them here for a special treat, so it's more, like, not so much every day, but as often as i can for a special treat. >> when i have my interns in their final semester of the program go out in the industry, 80 to 90% of the students get hired in the industry, well above the industry average in

the culinary program. >> we do have internals continually coming into our restaurants from city college of san francisco, and most of the time that people doing internships with us realize this is what they want to do for a living. we hired many interns into employees from our restaurants. my partner is also a graduate of city college. >> so my goal is actually to travel and try to do some pastry in maybe italy or france, along those lines. i actually have developed a few connections through this program in italy, which i am excited to support. >> i'm thinking about going to go work on a cruise ship for about two, three year so i can save some money and then

hopefully venture out on my own. >> yeah, i want to go back to china. i want to bring something that i learned here, the french cooking, the western system, back to china. >> so we want them to have a full toolkit. we're trying to make them ready for the world out there. >> in august 2019 construction began on the new facility at 1995 evans avenue in bayview. it will house motorcycle police and department of forensic services division. both sfpd groups are in two buildings that need to be vacated. they will join the new

$183 million facility in late 2021. >> elements of the cfi and the traffic company are housed at the hall of justice, which has been determined to be seismically unfit. it is slated for demolition. in addition to that the forensic services crime lab is also slated for demolition. it was time and made sense to put these elements currently spread in different parts of the city together into a new facility. >> the project is located in the bayview area, in the area near estes creek. when san francisco was first formed and the streetcars were built back it was part of the bay. we had to move the building as close to the edge as possible on bedrock and solid elements piles down to make sure it was secure. >> it will be approximately

100,000 square feet, that includes 8,000 square feet for traffic company parking garage. >> the reason we needed too new building, this is inadequate for the current staffing needs and also our motor department. the officers need more room, secured parking. so the csi unit location is at the hall of justice, and the crime laboratory is located at building 60 sixty old hunters point shipyard. >> not co-located doesn't allow for easy exchange of information to occur. >> traffic division was started in 1909. they were motor officers. they used sidecars. officers who road by themselves without the sidecar were called solo. that is a common term for the

motorcycle officers. we have 45 officers assigned to the motorcycles. all parking at the new facility will be in one location. the current locker room with shared with other officers. it is not assigned to just traffic companies. there are two showers downstairs and up. both are gym and shop weres are old. it needs constant maintenance. >> forensic services provides five major types of testing. we develop fingerprints on substances and comparisons. there are firearms identification to deal with projectiles, bullets or cartridge casings from shootings. dna is looking at a whole an rare of evidence from -- array of evidence from dna to sexual assault to homicide.

we are also in the business of doing breath allyzer analysis for dui cases. we are resurrecting the gunshot residue testing to look for the presence of gunshot residue. lifespan is 50 years. >> it has been raised up high enough that if the bay starts to rise that building will operate. the facility is versus sustainable. if the lead gold highest. the lighting is led. gives them good lights and reduces energy use way down. water throughout the project we have low water use facilities. gardens outside, same thing, low water use for that. other things we have are green roofs on the project.

we have studies to make sure we have maximum daylight to bring it into the building. >> the new facility will not be open to the public. there will be a lobby. there will be a deconstruction motorcycle and have parts around. >> the dna labs will have a vestibule before you go to the space you are making sure the air is clean, people are coming in and you are not contaminating anything in the labs. >> test firing in the building you are generating lead and chemicals. we want to quickly remove that from the individuals who are working in that environment and ensure what we put in the air is not toxic. there are scrubbers in the air to ensure any air coming out is also at the cleanest standards. >> you will see that kind of at the site. it has three buildings on the

site. one is for the motorcycle parking, main building and back behind is a smaller building for evidence vehicles. there is a crime, crime scene. they are put into the secure facility that locks the cars down while they are examined. >> they could be vehicles involved in the shooting. there might be projectiles lodged in the vehicle, cartridge casings inside the vehicle, it could be a vehicle where a aggravated sexual occurred and there might be biological evidence, fingerprints, recovered merchandise from a potential robbery or other things. >> the greatest challenge on the project is meeting the scope requirements of the project given the superheated construction market we have been facing. i am proud to say we are delivering a project where we are on budget.

>> the front plaza on the corner will be inviting to the public. something that gives back to the public. the building sits off the edge. it helps it be protected. >> what we are looking for is an updated building, with facilities to meet our unit's needs. >> working with the san francisco police department is an honor and privilege. i am looking forward to seeing their faces as the police officers move to the new facility. >> it is a welcome change, a new surrounding that is free from all of the challenges that we face with being remote, and then the ability to offer new expanded services to the city and police department investigations unit. i can't wait until fall of 2021 when the building is finally ready to go and be occupied and the people can get into the

facility to serve them and serve the community. [♪♪♪] [♪♪♪] >> so i grew up in cambridge, massachusetts and i was very fortunate to meet my future wife, now my wife while we were both attending graduate school at m.i.t., studying urban planning. so this is her hometown. so, we fell in love and moved to her city. [♪♪♪] [♪♪♪] >> i was introduced to this part of town while working on a

campaign for gavin, who is running for mayor. i was one of the organizers out here and i met the people and i fell in love with them in the neighborhood. so it also was a place in the city that at the time that i could afford to buy a home and i wanted to own my own home. this is where we laid down our roots like many people in this neighborhood and we started our family and this is where we are going to be. i mean we are the part of san francisco. it's the two neighborhoods with the most children under the age of 18. everybody likes to talk about how san francisco is not family-friendly, there are not a lot of children and families. we have predominately single family homes. as i said, people move here to buy their first home, maybe with multiple family members or multiple families in the same home and they laid down their roots.

[♪♪♪] >> it's different because again, we have little small storefronts. we don't have light industrial space or space where you can build high-rises or large office buildings. so the tech boom will never hit our neighborhood in that way when it comes to jobs. >> turkey, cheddar, avocado, lettuce and mayo, and little bit of mustard. that's my usual. >> mike is the owner, born and bred in the neighborhood. he worked in the drugstore forever. he saved his money and opened up his own spot. we're always going to support home grown businesses and he spent generations living in this

part of town, focusing on the family, and the vibe is great and people feel at home. it's like a little community gathering spot. >> this is the part of the city with a small town feel. a lot of mom and pop businesses, a lot of family run businesses. there is a conversation on whether starbucks would come in. i think there are some people that would embrace that. i think there are others that would prefer that not to be. i think we moved beyond that conversation. i think where we are now, we really want to enhance and embrace and encourage the businesses and small businesses that we have here. in fact, it's more of a mom and pop style business. i think at the end of the day, what we're really trying to do is encourage and embrace the diversity and enhance that

diversity of businesses we already have. we're the only supervisor in the city that has a permanent district office. a lot of folks use cafes or use offices or different places, but i want out and was able to raise money and open up a spot that we could pay for. i'm very fortunate to have that. >> hi, good to see you. just wanted to say hi, hi to the owner, see how he's doing. everything okay? >> yeah. >> good. >> we spend the entire day in the district so we can talk to constituents and talk to small businesses. we put money in the budget so you guys could be out here. this is like a commercial corridor, so they focus on cleaning the streets and it made a significant impact as you can

see. what an improvement it has made to have you guys out here. >> for sure. >> we have a significantly diverse neighborhood and population. so i think that's the richness of the mission and it always has been. it's what made me fall in love with this neighborhood and why i love it so much.

>> good afternoon and welcome to the january 11, 2022, regular meeting of the san francisco board of supervisors. madam clerk, will you please call the roll. [ roll call ]