>> tuesday february 15th, 2022 and would you please call the roll. [roll call] >> thank you. now it's my privilege to read the ramaytush oholone land acknowledgment. the san francisco health commission acknowledges we're unceded ancestorial homeland of

the ramaytush oholone who are the original inhabitants of the san francisco peninsula and the indigenous stewards of the land and in accordance of their traditions the ramaytush oholone have never ceded, lost or forgotten their responsibilities as the care takers of this place and as well as for all people who reside in they are traditional territory as guests, we recognize we benefit from living in a working on their traditional homeland. we wish to pay our respected by acknowledging the ancestors and elders and of the ramaytush oholone and their rights as first peoples. before we go into the next item which is dph employee recognition awards i would like just to acknowledge commissioner ed chow, dr. ed chow upon his reappointment to the san francisco health commission by mayor london breed and his swearing-in last week and i had

the privilege and join him as he was swearing-in and commissioner chow has amassed an incredible amount of knowledge about the san francisco department of public-health of all san franciscans as many years as the commission has been in existence when i became president of the commission, his advice and council was incredibly valuable particularly when we began dealing with the covid-19 pandemic and he continues to be such an asset to all of us everyday. thank you commissioner chow for continuing to serve for stepping up and continuing to serve and i want to express my thanks to mayor breed for continuing to serve with you in all this year

to work on behalf of the city and public-health and with my fellow commissioners all of whom have been really so dedicated to the issue of health in the city. i've not had one opportunity with the colleagues to question the colleague's own integrity and the desire to have and always better department and i'm hoping that i can continue to tribute to that and again, i really want to express my thanks to the mayor and of course, to the entire commission for everything that they have done in support of listening to me rant and rave once in a while. but also, to really continue to work and it's wonderful to have so many people really dedicated

community. thank you. >> actually, i also want to thank dr. coalfax and the fact that i was able to have the opportunity with our fellow commissioners, several of you who are part of that to actually do the screening and i recommend this is a work of the commission to think on behalf of the people's of san francisco and certainly not reason to and it's something we had unexpected and it has been i think not a -- i would say a very effective director of health hoping to lead our city and into through covid and into what we hope would be the end game of this

panned. i want today that opportunity also to express my thanks to dr. coal fax for his work. thank you commissioner chow and we look forward and the next item ask the again da is the dph employer recognition awards and i understand before we go into giving the awards that dr. haligonians hammer director of the san francisco network would like to say a few swords. dr. hammer. >> thank you, president bernal and thank you members of the health commission. it's a huge pleasure and really an honor to nominate a number of our ambulatory care and

harkening back to last fall when you recognized teams in the department which had served the city and county of san francisco and assisting children in that city wide covid response you recognized ambulatory care and and today you recognize the extraordinary work of dream work ambulatory care teams. before we recognize the first team, i just wanted to say that it's really been an honor and one of the most humbleing and meaningful parts of my 30-year career in public-health to be part of dph's response during the pandemic and especially to be able to support the many, many teams throughout ambulatory care who exemplify what it means to be a public servant and part of a public-health emergency response. the teams we're recognizing today and in march distinguish themselves in notable ways which we'll hear about today but i

really would like to celebrate the work of all the super heroes throughout ambulatory care to preserve the health and well-being of all san franciscans and particularly those patients, families, and communities we serve in the health network. so, thank you for this opportunity to recognize our team. >> thank you dr. hammer for the first award, i will give the floor to vice president lori green. >> well thank you and it's my great plaintiff to celebrate the work of the jail health services exemplary of the amazing dedications and accomplishment during this pandemic of one of our critical, critical divisions. so the jam house services charge is to protect the health and well-being of people in custody in our san francisco jails.

throughout the covid-19 pandemic, which has ravaged residential facilities including jails and prison, our jailhouse services has led the effort to protect those most vulnerable san francisco from contracting, spreading and getting sick from covid-19. their work saved thousands of lives during this last two years incarcerated individuals are among the populations that hospitalsization and death in most parts of the country and during the 202 to 2021 fiscal year, and the normal census in the jails and crowded living conditions and maintaining preventative measures like social distancing and great risk of transmission and decisive

public-health measures were taken. true advocacy, collaboration with other dph sections and city agencies as well as developing and implement new clinical protocols jailhouse services fulfilled the charges the health and there was key measures. first, to work for the sheriff department, jailhouse services was able to test and isolate all people on intake to the jails in order to protect others in the million and masking in enforced to the ex at the present time possible. jailhouse services staff took over the complex task of contact tracing for people who tested positive and thus were able to quickly identify all at risk people before they were able to

be in close contact with others. through all these measures, san francisco had low number of people test positive while they were in custody. of these there were no hospitalizations or deaths and until delta hit, no transmission of the virus between people in custody. again, given the high-risk setting in the jails, it's a remarkable achievement to prevent and of these jailhouse services team. >> thank you so much, commissioner green. yeah, i'll just add to this that the jailhouse team over the last year and has really been an ongoing lesson in how to use

clinical protocols and advocacy and really a whole person approach to insure that being able in custody in the city and doesn't also mean an unacceptable increase and risk of being infected by a potentially deadly virus. they did an incredible job of the leaders nationally in their work they did during the covid pandemic and i just want to expect my deepest gratitude to the jailhouse team. thank you. >> let's give this team a round of applause, everyone. >> can you walk us through the awards? >> sure, the next award is a

southeast heath center team. >> i'm pleased also and very honored to be able to present this award to the southeast health center. which has a decade's long history of responding to the health needs of the bayview and hunters point community. early in 2020 as san francisco was hit with the first wave of the covid pandemic, southeast health center was called upon to expand clinical operations in order to provide access to health services for its patients and the broader bayview point. it opened its second site at southeast in march of 2020 only one month after mayor breed declared a state of emergency in san francisco. within weeks dph only field care clinics opened as an alternate place of care for people who needed easy access to urgent medical services in their own neighborhood.

field care clinic also served diverting many people needing urgent and not acute medical care services during periods of covid surgeries when demand for hospital care was high. throughout the pandemic, southeast health center has distinguished itself for standing up to covid related health services testing and field care site and vaccinations and meant to give residents the bayview neighborhoods barrier free access to essential healthcare. the southeast health center chamber provided 55,000 covid vaccines and conducted 28,000 covid tests. under their leadership with medical director keith cidel and the leadership team of eileen rule and costly, owens and glen smith, southeast has kept its doors open for 5,000 primary care patients. children, pregnant women, elders and families. who rely on the health center for the urgent and routine

healthcare needs. one of 14 primary care health centers in the san francisco health network southeast health center was an early leader in our network wide efforts to reduce disparities and inaccess and that were impact bid covid and we will make comment on the work of this team. >> what an honor. thank you, commissioner. i'm always inspired when i walk in the doors of southeast health center and i invite all of you and we're doing more in-person visiting if you haven't already to take a tour of southeast health center. southeast, as you heard, it

stayed to its early commitment and san francisco city wide response. they stood up our second alternate testing site and the first field clerk we are hoping to do a ribbon cutting to move into the brand new building that we're building in southeast health center later this year and i hope that we'll be able to celebrate in-person with dr. cidel and his team and the community advocates who made that a reality as well as our

amazing staff at southeast health center so, so this is really a beautiful recognition for all the work that they've done. >> thank you, southeast. health center. the next award will be read by commissioner chow and a primary care leadership team.

primary care set up the first alternative testing site in early march of 2020. through surges and two years of on going stresses, on the public-health system the san francisco health network has provided almost 300,000 doses of covid vaccines and conducted over 100,000 tests. for which primary care also provided telephone results and reporting and that part is one of the most difficult. the feat of maintaining this and our patients and to protect and

promote the health of all san franciscans and at this point, we'll have dr. haligonians hammer make comments. >> thank you so much, commissioner chow. it's great to hear you make that and you really understand the work of primary care and it's near and dear to your heart so we so appreciate that. as well as primary care leadership team really stepped

up right from the beginning to take an active engaged, innovative creative role in the city's covid response. they engage early as parts of the doc took on important roles and quickly were able to operationalize new, think about cal services for people impacted by the pandemic. their approach is not just anything we did and they used our brand new electronic health record which has done on-line just months before covid hit and really used that to show us where we needed to pull these new services reach people who were impacted by the pandemic. i just want to add to the

commission to add my deepest gratitude to the primary care leadership team and all the teams that they oversee who when our clinics and various critical programs throughout the department. thank you primary leadership team. that concludes the awards for this meter. i believe. >> i want to add my admiration, appreciation and congratulations to the jail health services southeast health center and primary care teams and incredible work and i also wanted to take a moment to express admiration for dr. hammer's leadership particularly over these last two years and she's supported the teams and

she's shown extraordinary fortitude of this multiple challenges and these awards concentrated on the earlier days and i want to rewind the commission that dr. hammer and her team have been managed the delta surge and the omicron surge where people who had been going back to the covid for us to do the work and then also, with the tenderloin emergency declaration and another emergency in the city ambulatory care has contributed to our work there in remarkable ways so i want today salute the work of the team and the team members and dr. hammer's leadership in the department. thank you. >> thank you director colfax and

we have an action item, the approval of the minutes of the health commission meeting of february 1st, 2022. commissioners you have the minutes before you and after reviewing them do we have a motion to approve? >> so i so move. >> i second. >> before you vote and before we take public comment on this i want to note the directions that i sent you via e-mail so that we're all clear and it's posted on-line. there's two corrections, one under item 2 the approval of the minutes i'll read what the amended language says. commissioner chow requested that the word in quotes "policy" replace" measure" on page 7, 4 paragraph. the dhp is using policy a bit more conservative than the cdc or cdph guidances and the other direction is on page 11, under item 11 it was a commissioner

with noname and he as a conflict with chinese hospital and sustaining from the vote because the february 2022 contracts report included a chinese hospital contract modifications. is it ok if i go to public comment? please press star 3. your comments should just be about the minutes. for each agenda item, members will have an opportunity to make comment for two minutes. the public comment press will invite input and feedback however the process does not allow questions to be answered in the meeting or for members of the public to engage in back and fourth conversation with

commissioners. caller you have two minutes. >> this is patrick shaw and i know mr. morowitz said you would just public comment on every agenda item. you did not do so on item number 2 and so my comment is about item number 2. as far as dr. chow reappointment to the health commission i'm disappointed that supervisor connie chance proposed charter change has been temporarily taken off the june election is it dr. chow has

served on the health commission for 33 years and it's time for a leadership change and dr. chow should step down and allow other community voices. >> i believe that was the only caller. we can go to a vote. all right, i will do a roll call vote. [roll call vote] thank you the amended minutes pass. >> great, thank you secretary. the director's report.

dr. colfax. >> thank you president bernal and good afternoon health commissioners and director of health and i have a few things to highlight and happy to answer any questions and first dr. chow thank you for your clients and congratulations on your reappointment and one item i have here to highlight in your tenure on the commission, i don't know if this has happened before and i'm just proud to say that we have hired over 100 behavioral health workers and fill the gaps in our behavioral health system dr. the leadership of dr. hilary cun inns under the tenderloin emergency declaration. these are 200 positions just last week we announced we reached half of that goal and they include behavior health clinicians, pharmacists, health workers and others who will continue to build our our programs so a great progress in

that regard. and dr. cunnins will provide an update on behavioral health later in this session. there are a number of updates with regard to covid-19 that i will provide more details when i go through the slide update right after this and there are black hit months just to call your attention to that item and finally we're in the process of transitioning our website to ss.gov and that's the last item there and we will be redirect or visitors from our web page and i want to thank the communications team for working on that and we'll see a.

>> press star 3 so we can recognize you and caller, i will unmute you. hi, caller, i have two minutes on the clock. let us know that you are there. >> this is patrick (inaudible). >> you've got two minutes. >> thank you. on july 6th, 2020 i sent records request for out of county discharge data on september 16th, 2020, dph claimed epic does not track out of county discharges and -- >> i'm going to interrupt you.

is this about the director report that the director? >> this is about the director in the director's report and i want you to restart my clock, sir. >> ok. >> to continue about dr. colfax on may fifth, 2021, i filed a sunshine complaint over the fail your to pro those records on july 6th, 2021, epic systems media relations department asserted discharge data is contained in structure database field in epics patient throw module and on instructing

dph to provide the records on february 7th, dph did a 180° u-turn changing its tune. >> i want to finish -- on february 7th, dph changed its tune saying that the out of county discharge data is in an epic but quote-unquote free form text fields that it cannot

export and that's crazy. on february 14th, dph has been lying to me all alone. dr. colfax you must make your it staff. >> thank you for your comment, caller. that's the only public comment, commissioners. >> any questions or comments before we move into the covid-19 update? all right. seeing none we can move into the covid-19 update again. dr. grant colfax, director of health. >> >> thank you, president bernal

and commissioners, i will provide a brief update on happy to answer any quiz and next slide, please. acknowledging this is really the work on the san francisco has done collectively including and especially or community partners and leaders and you can see that having gotten through the worse of the omicron surge we're still coming down but in terms of our numbers but you can see that san francisco has the lowest death rate per 100,000 population at 86.9 and the second highest population percent that is completed initial series compared to comparable jurisdictions with miami dade

just slightly higher and really important in terms of our booster rates, we have compared to california and certainly united states over all, much larger percent of our population that is up-to-date on their vaccinations so just provide a little broader context for the commission here. in terms of our case rate for 100 this is showed on the broader side and this is the national trends and we're reflecting very much at this point that sharp increase in the omicron surge shown on the far-right of the insert and the far-right of the slide over here and you can see that we peaked at 270 cases per 100,000 and we've seen a sharp decline in those cases to a rate of 40 per 100,000 which is really good news and thankfully because of our high booster rate in particular, and our completion it put a huge stress on the

communities in our city and over all, we've done much better than most other jurisdictions with regard to getting through the worse of this surge. next slide. their highly effective in reducing the risk of hospitalization and death. next slide.

we peaked at 286 people if san francisco hospitals with covid-19 we are now down to 177 so as we see in the prior surges these numbers are coming down and a few weeks after our case rate peaked. this slide is 65% of all residents have received the booster. you will see that over 80 in our residents of age over 65 and over 75 and then among the five to 11-year-olds, i wanted to just present the data that we are at three quarters where we received one dose and two-thirds of completed the initial series and these rates again are much higher than the state or national average. we obviously still have significant numbers to increase

here with regards to that percentage compared to our percentage over all and the percent per week who are getting the vaccines in that age group has slowed and as we did with the other age groups we're working with key stakeholders, community partners and you're ourmedical systems to get that percentage up higher. you see that numbers here by the other age groups, to some degree reflecting when those age groups were eligible and for boosters according to the cdc recommendations and we have availability of boosters now in the city and at last check, people are able to basically walk into sites offering boosters including our

pharmacies in the city and receive boosters the same or next day so wide available and we'll continue to stress the importance of this. and the importance much everything being up-to-date on their vaccinations who is eligible even with our case rates coming down, we want everyone to get boosted if they're eligible. next slide. there have been a number of health order changes that have been announced in dr. seuss an silva and our health officer is available to answer questions but just a couple of key points going forward is that on wednesday february 16th, the sate will lift the indoor mask requirement for people who are vaccinated and we will for the most part lift that universal masking requirement for most indoor settings in alignment with the state and it's very important to stress individuals over the age of two will still not required to wear masks in

all indoor settings and that in high-risk indoor settings, masks will be required by the state and therefore the health and also that people can continue to chose to wear face covers around others and that we ask everybody to respect people's individual choices to wear a mask to protect their health. we will continue san francisco will continue to require proof of vaccinations or a negative test where food and drink is consumed. someone who is unvaccinated may show prove of a recent negative covid test and entry without proof of vaccination is no longer limited to those with a medical or religious exemption and they have to have a recent negative covid-19 test to enter. patrons attending large indoor events are required to show proof of being up-to-date on vaccinations and have a recent negative pch test within two days or a verified antigen test one day of attendance and the

definition of a mega event now changed to 1,000 which was previously 500 to align with the state. so, those are details that reflect the fact that with our high vaccination rate, and our case numbers coming down, we're not -- there's not an on-off switch about an endemic state and we're not going to keep our guard down with regards to continuing to promote the vaccinations and continuing to promote testing and the layering of other protective strategies in the high-risk and vulnerable settings but i do think this is really evidence of the progress that we've made over the last two years and again happy to take any additional questions .>> let me check public comment. i see a hand already. folks on the line, if you would make comment on the item, the

covid report, the update to item 5 press star 3 so we can recognize you. it should be about the covid-19 update. >> caller: this is patrick again. >> please, go. >> i'm patrick shaw and i want to dispute the case numbers are coming down to the point where you should be suspending wearing masks indoors that decision is premature, there have been 118,751 covid infections reported on dph's website since this start of the pandemic and 55% of those 64,663 have

occurred since december 1 which coincides with the omicron variant coming along that 55% of cases have happened in a two and a half month period which represents only 11% of the number of months since the pandemic first started. i want to dispute that the hospitalization case numbers are coming down and recently as january 12th, which was just a month ago and we were at the same point of 175 hospitalizations and the report that there's 177.

>> thank you, caller. do you have questions or comments for director colfax? >> i have one more related covid update and our health officer and acting population health da vis director dr. susan phillips has after selection process interview process, in

this new permanent position so i just wanted to take a moment to congratulate her and acknowledge her leadership during these past two years in particular in many of. >> our next item is general public comment.

at the time, members of the public may adjust the commission on items of interest to the public within the subject matter. caller, please let us know that you are there. >> caller: it's patrick minette shaw. >> i'm starting the clock you have two minutes. >> caller: thank you. i'm continuing my remarks on epic. they confirmed the $164 million

epic database did store data in structured not pre formed text fields and as dph falsely claimed a week ago on february 7th. epic there's a distinct field ff a name of a patient and therefore, if the city does not equal san francisco, it's an out of count tie discharge. they must dph to comply with the task forces first order of communication for the discharge data for the multiple. for the out of county discharge for periods of time i've requested specifically directing

dph chief information officer eric rapman and the chief officer dr. nada and dph's epic program director to have the it staff write an ad hoc query in the patient throw module to select only san franciscans who were discharged out of county to any city, not named, san francisco, dph must stop its lying and the health commission. >> thank you caller for your comments. that was the only public comment question. thank you caller. our next item is an action item and it's a resolution adopting a new regulation to license rev

you collections and permit designated rev use collection routes within the city and county of san francisco and for this presentation we have veronica slattengrin the health inspector with dph environmental health services population health division. [please stand by]

>> we clash >> to provide more transparency to the permit application process, we opened an application period where we would announce the application period on our website and provide them with all the instructions that apply. in addition to that, we have had a preapplication question and

answers section that would be held before the permit application period. what that entails is an e-question session, as well as an option of pre-application conference. also added to the permit application process a public hearing option, which means within 15 days of the first publication of notice of completed application, they would have the option to request for a public hearing. we also shortened the license permit application, license and permit application processing time, which i will be going over in more detail on the next slide. we added section where we would consult with the other agenies for license and permit applications. we added some additional grounds

for license and permit denial. next slide. this is the process timeline for both the license and permit application process which is distinct from what was presented last time. there is now an opportunity for you to apply for license and permit at the same time. we also shortened the license period from 40 days to 20 days, so once the application -- and that's the maximum of 40 days to 20 days and not including when we added the option for appeal to the board of appeals. just to go over the license application in more detail, once applicants submit the license application to d.p.h., we would evaluate the application and make the determination within 15 days of the seat and if the license is approved, d.p.h. will

notify the applicant within five days and issue the license. if the license is not approved, we would notify the applicant within five days of the determination and with the reasons for license denial. for the permit application process, the timeframe shortened from potentially from being up to 90 days to 50 to 55 days. so that process d.p.h. will open an application period and host an e-question and session which means once we make the announcement and let them know what the permit period is, we will also hold an equestion session where they have an opportunity to e-mail a question, any question regarding the application process and we will post the question, as well as the response on our website and that will be accessible to

everyone. once applicants submit the permit application to d.p.h., d. p.h. will determine the completeness of the application within 15 days and once the application is completed, d.p.h. will evaluate -- make an evaluation of the completed application within 30 days to make a decision to approve the permit. during that 30 day period, public hearing may be requested and i also want to -- i'm sorry, i'm going to backtrack a little bit. if the application is not complete, then the applicant will have five days to have an opportunity to look at the deficiencies in five days and then we will evaluate the

application within 30 days and if the permit is approved, d.p.h. will issue the route permit to the applicant. if it's not approved, we will notify the applicant of the denial. for all the steps after we make the determination to approve the license or the permit, they all have an opportunity to appeal the request for review for the director's decision with the board of appeals within 15 days of the decision. next slide. upon adoption of this regulation, we will be posting license applications on our ss d.p.h. website and around late march or early april, we will announce the early application period and post the equestion session. thank you. i can take any questions at this

time. >> i'll check to see if there is public comment. folks on the line, if you would like to make a comment on item 7, please press star 3 now so we can acknowledge you. star 3. commissioners, there are no public comment requests. i will read the revised resolution, there were changes made since friday. i will read the language so you know what you will be voting on. whereas the disposal initiative ordinance in 1932 as amends requires those collecting refuge in the city of san francisco. it also requires collectors to obtain permit from the director of public health to allow them to collect refuge on certain cities and counties in san francisco. in 1999, the san francisco

health commission amended the adoption and governs refuge collection under the management and control of the city. development of private residences on treasure island will result in properties under the amended -- i'm sorry, that have not been previously licensed or permitted under the amended 1992 collection permit regulation or the 1999 federal facility collection regulation and the health commission will provide for the orderly refuge collection permit for different routes in the city and county of san francisco. therefore, be it resolved, the san francisco health commission

approves, and permit contained -- sorry, collection routes in the city and county of san francisco, which shall will known as the 2022 refuge collection and be it further resolved the regulation is not intended to impact the authority of the director of public health to issue licenses and permits under the 1992 or 1999 regulations as applicable. thank you. >> thank you secretary. i see a hand from commissioner chow. >> sorry, i figured the resolution -- i just wanted to clarify and thank you for the flowchart, which was very clear. the only part i was unclear about is where it says that under the application of public hearing can be asked for, who

actually can ask for that? then, how does that fit in to this timeframe and then extend beyond the public hearing or the public hearing itself within the same timeframe, within the framework. >> thank you for that question. anyone can ask for a public hearing, which includes the applicant or any members of the public who would wish to request for public hearing. it would happen within the 30 days. it will be requested within 30 days of the evaluation period. i would like to go back and look at how long they would have.

it would need to be set within 30 days of the time set. i believe that it would be requested within the 30 days while making the evaluation and public hearing would occur within the 30 days of the request. >> now that sounds like on the 29th day i ask for a hearing,

the hearing would have to be completed within your 30 day period or there is another 30 day period that extends from the public hearing. that was my only question of clarification. >> what was the question again? >> if i have 30 days to make an appeal for a public hearing, does the hearing then fit within the 30 day process or is there another 30 days after the request for the public hearing for holding the public hearing? so basically in that case it would possibly delay the application by 30 days.

>> let me go back and correct myself. you would have 15 days to request for the hearing, within the 30 days of evaluation, and public hearing is 30 days -- within the 30 days of the request and the final decision must be made within 30 days of the hearing. >> oh, okay. thank you very much. >> yeah. sorry about that. >> thank you. commissioners any other questions or comments on this item before we entertain a

motion to approve the resolution? okay, i do not see any hands raised. do we have a motion to approve? >> moved. >> second. >> all right. commissioner giraudo. >> yes. >> commissioner chung. >> yes. >> commissioner green. >> question. >> commissioner bernal. >> yes. i want to thank the city attorney's office for guiding us through the process of adopting this new regulation and also to commissioners for their thoughtful review and feedback on the resolution.

okay, our next item is item 8 for discussion, the behavior of health services update and dr. hillary of the director of behavioral health services will be here to offer her presentation. >> good afternoon everyone. it's a pleasure to be here. i am delighted to present this update on the division of behavioral health services. i also wanted to acknowledge that i'm joined by dr. angelica and she will be presenting specifically on the street crisis response teamwork, which is embedded in this larger presentation. next slide. so for today's update, i wanted to share with you information in the following that you can see in the outline, some new leadership, which is really

exciting, information about the tenderloin initiative work on our metrics, update on hiring, and information on workforce development and equity. next slide. first, let me just share what i'm anticipating going forward about the population that our behavioral health services are caring for in our own systems of care. you have already seen these data in fiscal year 2021, behavioral health services treated about 20,000 people on mental health treatment. behavioral health services provided prevention and early intervention services to more than 20,000 people, including in services such as crisis

debriefing, school based programs, p.r. programs, vocational services and drop in centers. what you can see in the chart in front of you is for last fiscal year. again, this is data that the commission has seen before, reflecting a breakdown of that 20,000 which i just shared with you by age group around mental health. as you can see on the top part of the chart, and for substance use disorder on the bottom of the chart. what i'm now sharing with you and thought i would do this going forward is to give you a year-to-date look at who we are serving with a lag time that accounts for data getting put into our systems. so for the first two quarters or six months of this current

fizz -- fiscal year, we cared for approximately 2,500 young people, approximately 11,000 adults and older adults, that's for mental health treatment, and on the bottom part of that chart, so far in the first two quarters of fiscal year 2022, we have cared for approximately 36 people in specialty substance use disorder treatment. i'll keep updating the commission with this as the year rolls forward with each successful update. next slide. let me turn to some updates with behavioral health. first of all, we're very excited to share with you some key leadership roles. we're catching up.

many of the commissioners know jessica brown, who is officially appointed as the combined office of equity and workforce development, as well as the mental health services act work, joining these two offices together. kelly kirkpatrick is the director for operations for mhhf. and after a hiatus, she is joining in a new role as director of systems of care of all of the age groups reporting up through him. he will expand our capacity and work to improve quality and manage the systems of care. really just hot off the press, heather who has previously been the director of our transitional age youth system of care has accepted a new role as director

of office of coordinated care, which as you likely recall is one of the key programs under mhsh. so we're proud of all these people are joining the team officially. next slide. i wanted -- i know that i am guessing all of you have been reading and hearing about the tenderloin emergency initiative. as you heard from dr. colfax at the top of the meeting, the decoration has enabled us to do a number of things. first, mayor breed declared an official state of emergency in the tenderloin in the second part of december and this was ratified by the board of supervisors on december 24th. this declaration allows for emergency operations to address

the overdose crisis, the epidemic of overdose deaths, which is concentrated in the tenderloin, in our city. it promotes and facilitates cross city collaboration and our public health goals are to reduce overdose deaths, reduce public drug use, and link people to health and social services. so far we have launched a linkage center, which is currently operating 12 hour as day, and we are working across the city to conduct regular outreach with city partners. what is not on this slide and i'll come to again later is the emergency declaration has also facilitated our hiring and you heard from dr. colfax about our accomplishment of hiring 100 new behavioral health workers since

the decoration with our goal of hiring 100 more by the end of march. the screen shot that you see also is from the sf.gov web page. on this page you can read the guide and the plan and you can see the link right in front of you. we are also posting on a weekly basis metrics of specific accomplishments and targets we are undertaking to serve the people of the tenderloin. next slide. here's the hiring. i think i already did the punch line. the hiring plan would enable us to provide direct care to the residents of the tenderloin and beyond, as well as accelerate the launch of the new mhsf domain. about 90 of the 200 we are planning to hire by the end of

march lack a civil service list and could not be hired without an emergency authorization such as this. however, we are undertaking a great number of procedures that hasten some of the hiring work and some of the gaps in time in hiring procedures. this will enable us to reduce the backlog and fill vacancies, as well as supporting us to implement with our h.r. colleagues a number of process changes. next slide. here in this slide, you can see where we were just a couple weeks ago. these are vacancies and hiring status. you can see the positions are spread is amongst adults and older adults, youth and

families, office of coordinated care program development data oversight and administration, which is among other things that allows us to do the important contracting work and distribution of resources to community partners. some of these resources sit outside the d.p.h., but within integrated care. so far we have onboard the 84, but as i just indicated, the slide is already out of date and we're at 100 right now with a large number more in progress. i want to focus on the office of coordinated care implementation process. this is the cornerstone for how

we are intending to tackle some of the most important ways i think we can strengthening behavioral healthcare. now with a leader in place, with hiring expedited, we will soon be on track to launch the office of coordinated care fully. so far, the goal of the occ as i believe you all know already is to ensure equitable and well coordinated access to behavioral healthcare, seeing the transition systems and levels of care and centralized care coordination for priority populations, including people experiencing homelessness. so far we have set up an operational center for the office of coordinated care at 1360 mission, that happened in the late fall. some staff have moved over to

that site, incluing some members of our behavioral health access lines and access programs, as well as increasing occ staff. we have in the behavioral health access center, we implemented new and improved phone systems for our behavioral health access line. these systems will allow us to do better tracking, quality assurance around calls, and know how and whether we're meeting demand. what is coming soon is the behavioral access center staff will be expanding hours from 45 to 69 hours per week, to provide increased assessment and linkage to services in the evening hours and weekends. in terms of our care coordination services, as you all have heard already, the

street crisis response team has a dedicated follow up team, the occ team that launched last spring. we just launched our next team called the bridge and engagement services or best team. stage one as launched and it's part of an enhanced care management services. we're receiving referral from the health plan and there -- they will be assigned to a coordination team. we're continuing our hiring and by the end of march, we are expanding that service that is being offered by the bes team focused on people leaving hospital in order to best connect them to care. finally as part of the office of coordinated care, we have an eligible team and they are going

to be moving -- or they have moved to the occ operational center uniting these important access functions, not entirely but in great part, under one roof. next slide. a very important new service we have launched, which really focuses on low thresholds, low barrier care for people with mental health issues, substance abuse issues, experiencing homelessness. i know you have seen a version of these data previously. this is data from inception last may through most of january. the service has seen a total of 201 overnight admissions, more than 1,000 day program participants, and just as a note, the total overnight

capacity is about 26. it had some dips and you can see them in there, that was constrained by covid. the majority of these guests reside in the mission, which is what the center was designed to do to increase access for folks with mental health or substance abuse challenges and experiencing homelessness in and around the area. next slide. another way we are measuring progress is as you have already seen is our dashboard. it's available online. i know the files were distributed to you ahead of time commissioners, so the link is at the right bottom of the slide. this is a way you all and i can

sort of measure progress to what is open and where things are at and stages of planning. in addition to hummingbird, which is at the top of the dashboard and at full capacity should be at 30 guests, once we get past the latest covid surge. additionally i'll mention that we have opened our 12 month rehabilitative boarding care, which has the capacity for serving 20 clients and our treatment beds with capacity up to 31 clients. we are working on the other programs, including rise, which you can see at the top of the right column, which is slated to open later this spring. i'm sorry for the small letters. i see some of you peering at my screen. apologies. next slide.

let's talk about the street crisis response team. >> thank you so much. good evening commissioners. now we're giving a brief update on the street crisis. i'll relate this to a law enforcement response. these are calls triaged to 9-1-1 as mentally disturbed persons, but there is not a weapon involved. each team including three members, in partnership with the fire department, including a community paramedic, a behavioral health clinician, and pair who provide deescalation and support to individuals.

of course we know that providing intervention at a crisis does not end there, but we need to provide ongoing support to individuals to prevent the risk of a future crisis occurring and as we said previously, we have dedicated capacity through the office of coordinated care that provides services. i'll talk more about it in just a moment. next slide please. so this is data through december of this year and we provide a monthly dashboard that gets posted on our web page, just to highlight a couple of quick updates, to say that we have six teams that are fully operational that provide citywide 24/7 coverage to respond to these 9-1-1 calls. as i mentioned, our office of coordinated care team launched in april, we are not fully staffed for that team and we moved to coverage seven days a week to provide that for individuals.

our goal is to provide follow up as close to the crisis contact as possible. so a couple of quick highlights to note. this includes specific data from the month of december, as well as commutative data since the program started in november. our goal of course is to defer all of these calls away from a law enforcement response. since the program started, we were able to divert 61% of those calls. we are moving towards all of the calls being responded to. more to come on that. just a note, every single one of these calls that are responded to represents a clear response from a non-law enforcement entity. the average response time has been consistent. in december, it was 16 minutes, but cumulatively 15 minutes, and that's where we hovered. most of our calls come through

9-1-1 dispatch, but our teams are also trained to identify behavioral health crisis in the community and will respond when they see them instead of waiting for a call to come in. we take special requests from the police department, if they see someone that will benefit from our services. in terms of outcomes for individuals at the time of crisis, most individuals are able to be deescalated and supported to remain in the community where they feel most comfortable. this is consistent with what we seen in other jurisdictions. 15% of individuals have been transported to hospitals for hospital reasons. 14% of individuals have been transported to a behavioral health setting, including detox programs, urgent care, hummingbird, just to name a few. 5% of the calls were psychiatric

care needed to be initiated. in terms of follow up support, we were able to follow up with 63% of individuals, which is a great outcome and again we hope to increase that. of course, many of the individuals that we are working with are experiencing homelessness. so it's part of our goal to transition people to other settings, where they can have their needs met. looking forward, i'll also note that we have a seventh team that has been funded that we're looking to implement in june or july this year, so we can respond to more of these calls. i believe the last time i was here, we also spoke about our move to the emergency medical dispatch protocols. currently we are responding through police dispatch and that switch is slated to happen in june or july of this year and that will be a very important change in our system because

that will mean 100% of these types of calls will be diverted to the street crisis response team. we're very much looking forward to that. next slide please. now it was focused on the tenderloin, and now we launched an additional five teams. our seventh team is pending. [please stand by]

update you on some of our new and ongoing work. i think that as you all surely know, over those deaths in san francisco and nationally continued to be epidemic numbers

and rates. right now in san francisco, over those deaths continue to be in large part driven by the presence of fentanyl, and we also observe great disparities who is dying over those deaths with black, african-americans at four times the rate of deaths from overdose than other san franciscans. additionally, a disproportionate number of deaths are among people experiencing homelessness, approximately one-third. next slide. so far we do have preliminary data for 2021, thanks to the medical examiner and it does look like overdose deaths have decreased in 2021 compared to 2020. and so what you see in front of

you is that -- that 2021 data by month. and what you can see are higher numbers earlier in the year with a slight decrease later in the year. and as much now there are estimated 650 overdose deaths in 2021, compared to more than 700 in 2020. and i think that while that is good news and are likely a number of reasons for this, including including intensification of some of the efforts in the city and with community partners, some of the improvements may also be due to the lessons of social distancing in the wake of the original shutdowns and the early covid surges. next slide.

and we are still laser focused on our approach and our strategic plan and this is a share that we showed last update with our strategic interventions and programs that seek overall to reduce overdose deaths in san francisco and reduce the racial disparities in overdose deaths as well as among people experiencing homelessness. and we are strengthening going from left to right overdose education and distribution of pharma production supplies. you heard one example from the doctor where we are looking for opportunities to do overdose education and naloxone distribution in as many settings as we can who work with folks who are likely to experience or

witness overdose. we are working to expand access to and remove barriers from high impact treatment, especially with medications. and as well as supporting services that seek to link people to care and this is through the office of coordinated care as this is scaled up or through the very focused programs as you see here, with bridge clinic partly funded by dph and operated by our colleagues at u.c. i'm going to speak a little more about our focus non-fatal overdose response teams or sorts, which is you have also heard about. and then finally taking a broad and more upstream approach and we are looking for ways to support social support and decrease stigma for people at risk of overdose as well as their loved ones through strategies that include primary, secondary, and, of course,

tertiary prevention and i'll talk more about that later on. next slide. so as part of our work in healthcare, we have expanded behavioral pharmacy hours in order to expand access to treatment. in december, the hours of operation expanded from 33 hours a week to 61 hours a week. and the behavioral health pharmacy is an important focus of access to care and support. working with the community partners and all of the dph, the pharmacy has worked to distribute naloxone and we have approximately 28,000 kits a year to our own dph clinics as well as some community providers. and just to be clear, this really complements the long-standing efforts led by our colleagues at the harm reduction

coalition, the dope project, as well as many other community providers. we are providing delivery of substance use disorder medication to shelter-in-place sites and isolation and quarantine hotels in order that people can continue to maintain their medication and support their goals of recovery. we have offered more frequent medication pick-ups as well as on-site telemedicine visitacions to respond to needs of clients at more hours a day. and ongoing work, just to remind the commission and how important the pharmacy is, the pharmacy has on-site harm reduction services, essentially like fentanyl test kits and safer use for those who are using and at risk of overdose. and we also seek to champion innovative practices and really i'd like to really commend the behavioral health pharmacist, led by dave smith, who is a champion of innovative use of

something called microdosing of a medication that is particularly useful in the setting of fentanyl to decrease initial symptoms that one can have when starting this medication and promotes adherence ongoing. next slide. as i mentionedder the sort team or the response team which is, again, a program that is housed in our ambulatory care under drm in partnership also with the community para-medicine program in response to 911 calls for overdose, this sort team is trained to respond to and to handle overdose by, of course, administering naloxone, but additionally offering harm reduction supplies, and linkage

to ongoing care and treatment. and they have handled so far more than 700 calls as of december 2021, and that is really impressive. next slide. last nftionz about overdose, we have been fortunate to receive more than $8 million in federal grant funding to further address the opioid overdose epidemic and substance use. this money is via the federal agency, and it has been tagged to both covid money and american recovery act money. the money is very carefully for primary prevention that is to prevent the use of any use or risky use among young people and to meet that part of the program

and we elected to build and strengthen our web and social media youth program on opioids as well as implement an evidence-based substance use prevention program called strengthening families. with programs that aim to do early diagnosis and treatment using sort of the infectious disease model, and this is really aimed at people who might have risky use and could benefit from more engagement and interventions. we are do rfps that will focus on black, african-american communities, offering financial support to do community outreach and engagement and, again, aiming to reduce risk of overdose in a group in san

francisco with a disproportionate risk. finally with tertiary prevention which is really the treatment of people with an illness, substance use disorder, we are doing a number of efforts, including promoting integration treatment in youth through mental healthcare, support, substance use care and integration within a perinatal team, and we are also using funding to enhance the street overdose response team to be able to do follow-up of folks who are housed in addition to the follow-up that they're able to do for people experiencing homelessness. and we are using funding to do technical assistance and support, evidence-based care to prevent overdose and get people into treatment for their substance use disorder in seven san francisco emergency

departments. and as you can tell these are happening across our systems of care and with partners and so it is very important to be able to consolidate what we're doing and to describe it and to ultimately know whether and when it is effective in order to both measure progress and change direction as we need. next slide. this is also very small and i apologize. what you see in front of you is our proposed sf key performance indicators. we provide these into the following domains, housing or access to housing and wait times for mental health and substance use care. overdose response, and access to routine care for behavioral health, and access to or use of crisis and urgent care and

quality of life. we have defined these metrics and we're going to operationalize them as part of our hiring of the next 100 that will include an analyst team who will be able to carry out the important analyses that we have set forth. i want to note for the commissioners that these are not all of the metrics but we are really choosing to elevate the core ones after consultation with the teams, subject matter experts and community partners, including our implementation working group to focus and to really drive change in these areas. next slide. and finally my last couple slides i want to provide some workforce development updates. we -- as we have discussed before we have a workforce program, which we are very proud of, but which have significantly

slowed down due to the covid deployment and vacancies, we are very happy that we have hired up again and moving forward with a number of initiatives. we have been able to develop a web presence. you can see one example on your left here, which is the san francisco county loan repayment program. which provides financial incentives for eligible employees and hard-to-fill or retain positions. and we also launched our multicultural student stipend program to address the need to recruit staff with special skills or sensitivities to provide racialally, culturally and linguistically competent substance use care. and finally just a preview of our fellowship will launch in march 2022, which will aim to

provide comprehensive support to children and families of african descent whose functioning is affected by behavioral health related issues. next slide. i want to share our key equity initiatives and acknowledge that we are overall aiming to embed equity, and both by analyzing outcomes and by thinking about racial and culturally congruent interventions across all that we do. and we are aiming to embed it throughout our division. so next but -- or and -- next slide -- i want to highlight just a couple of things here which didn't come up in other places. and under the mental health

services act we have an intervention which i think that we have spoken about previously to implement culturally congruent care. the program will test and evaluate responsive behavioral health interventions for black, african-american clients at four of our civil service clinics. we're excited that the hiring purse will enable us to complete hiring of 15 positions and we'll be staffing that initiative. next slide. some of our other initiatives that address equity include internally we have launched affinity groups with our own workforce and our own staff and creating separate spaces for them to speak, get support and to build capacity on racial equity concepts and practices. so for 30 attendees that have joined us and we'll be expanding

to additional affinity groups this spring as you can see on the slide. i'm just returning back to our substance use and overdose prevention work that you have heard about previously. primary prevention of substance use, we'll have a focus on particularly groups of disproportione effects of overdose and black african-americans are among those groups in san francisco that we will be focusing on, both in our primary and secondary prevention efforts in the city using the grant money. next slide. thank you very much, and i'm very happy to take questions. >> president bernal: thank you. before we go to comments or

questions, secretary morewitz, do we have public comment on this item? >> clerk: there's no one on the line at this time, commissioners. >> president bernal: commissioners, any questions or comments? commissioner giraudo. >> commisioner giraudo: thank you, doctor, for this excellent update and for answering most of my questions. as usual. but i do have one more which is on page 3, which is the slide on the behavioral health science clients and where you provided prevention, early intervention services to more than 20,000 people. and here you have listed the crisis programs and school-based programs, etc. is there any data that breaks down of the greater than 20,000 people how many have -- were

served within these programs? or is it just general? >> thank you, commissioners, for the questions and i tried to work them in but i didn't do it elegantly enough there. so i have some of that information -- so let me just kind of say first is that we collect program specific data and since many of those programs are sort of low thresholds we do not collect by name. so there are some we think duplication of persons across those services and that's why we are leaving it a little general what i can share with you is that in the crisis debriefings about a thousand participated, but in our stigma reduction

program, it is a smaller and peer-led program, about a hundred participated. we also worked outside of schools with parents and families in something called mental health consultation about a thousand participated. and then finally our biggest program, which is what we term our population focused programming, which does more general education, offers sometimes screening, both informal and formal, and has a very broad reach, reached more than 20,000. so we used that 20,000, knowing that we likely exceed that but we don't have individual identifiers to know the precise count. but that gives you a sense of the volume across those interventions. >> commisioner giraudo: great, i appreciate that. and i am most interested in school-based programs as well.

as we hopefully can increase them. so, thank you very much. >> president bernal: thank you, commissioner giraudo. commissioners, any other questions or comments on this excellent presentation? >> clerk: it looks like commissioners green and chow have their hands up. >> president bernal: yes, vice president green, thank you. >> vice-president green: first of all, i wanted to compliment you on the hiring and it's so remarkable that you have been able to pull together a team and not only fill these vacancies which are critical to being able to actually operationalize the programs. i also incredibly impressed by the way that you have been able to expand and really thoughtfully develop the programs. a few years ago some of these things were just ideas that we really weren't sure how we'd implement and i look at things like the street team and the way that you have developed and expanded it, i think that this

is really reassuring and i have such confidence now that we'll be able to tackle and really, really see good results for programs that are really so difficult to approach. one of the questions that i had, you know, i was looking at your key performance indicators and i have two questions. one would be when will you develop, like, what the meaningful percentage increase, percentage decrease, are for some of these elements that you have identified? and then in what timeline do you expect to be able to gather and update? i understand that there's a whole team that is necessary to be able to, you know, to get really accurate information about how the programs are progressing. but what do you see as a timeline? because these data are not only valuable to celebrate success but to help us to understand why we might need course corrections. so i'm wondering, you know, and, obviously, hiring has a component to how quickly you can accomplish some of these performance indicators.

can you give us a little sense of that and what we might be able to anticipate going forward? >> so i -- thanks for the question. and also i just want to -- so much of this work came before me. i just want to acknowledge that, including dr. hammer and dr. almada and so many colleagues in terms of the hiring, this has really been a department-wide effort under chief operating officer, mr. wagner, with ms. kim, the director of h.r., their teams. it's been extraordinary. so really i take no credit, or i -- i look forward to taking some credit but this is so much built on the work that came before me in terms of metrics, we -- this is a matter of some urgency in my view. we have been -- we have been

challenged by staffing and we -- once we have staff in place, i think that they'll move much more quickly. and i expect to see initial sets of metrics, even if it's not fully complete. hopefully by spring, and if not, by early summer. so that's -- i believe that is where we're headed. and your other question about sort of change and benchmarking change, i think that this is really a fundamental question for us, which is in some and even dare i say many of these metrics that we don't actually have a baseline. and so part of this first round of work is establishing a baseline. and then setting targets for improvement that are achievable and -- and doable for the teams

and for ourselves. and, you know, this is not -- this is a challenge in lots of areas of behavioral health. i want to say, not just for us here in san francisco, but it is something that the field is evolving to have more benchmarks around quality, around what is a good or a best number to achieve. and so that is part of what we'll have to be working through. and i'll absolutely share our thinking as we develop that and share the benchmarks with all of you. >> vice-president green: well, thank you so much, and i am sure that there's goals and stretch goals and thank you also for the shout out. because over the years we have heard so many different members of the department who are so committed to this work, and it's great to hear that everyone has contributed. and we are really looking forward to seeing how this evolves and how your results guide us.

>> president bernal: thank you very much, vice president green commissioner chow. >> commissioner chow: yes, thank you so much for the wonderful update on this very important project, or i should say initiative, that really i think will be exciting to see how it really does change the health of our vulnerable population. and in that end, beds are of course a critical issue here. on page 11, i'm trying to understand how i should be reading this, because you have -- you have some of the projects that are with four squares and others with five that are said to be complete, but then in the scoring if we were to score it, it comes

across where some of the boxes are crossed out. so this is more technical. what should i be reading here and if it is complete and that's what you think that is fine, how is that different from the greens that say open? >> thanks for the question, because we want this to be understandable and we're very open to feedback. so green is open. and so i think that at the highest level, you can know that when something is green, it is accepting clients or guests, and it is in progress. and we sort of moved into implemented and following it to make sure that the pair is good and we're getting patients in and out or our clients in and out. the boxes and the sort of details of the boxes are intended to show -- depict the phase of implementation. different projects might have

different implementation steps, depending on whether they contracted in county or contracted out of county, or something that we are by and large not running ourselves. so our goal there was to give some sense of the life span of the pre-open part of the project. and i think that part of our goal is to depict also the complexity of starting a project. whether it is acquisition of real estate or rfping to find a provider and so forth. so that is our goal there is to give a chance of the lead-up as well as once it is open. i hope that helps. >> commissioner chow: it does. so some of the projects don't require all six blocks is what you're saying? >> yeah, exactly. >> commissioner chow: and others might and that's why there are some lines drawn. okay. so that's really very helpful.

and i really appreciate that. and now i see that this is kind of watching progress and what you are expecting in the complexity and what stages you are at. so, thank you. it becomes very meaningful. i appreciate it. >> thank you. >> president bernal: thank you, commissioner chow. seeing no more commissioner comments or questions, thank you dr. cummins and dr. almeda for your excellent presentation and we looked forward to what you would have to share and we're pleased with your work, so, thank you. i know that director colfax would like to say a few words. >> thank you president bernal and commissioners. i just wanted to express my gratitude to the doctors and to really, obviously, this is a key public health issue and we have a lot of work to continue to do, but i hope that the commission can see significant progress that we're making on these

strategies and the programs. with the existing staff and the new talent that we are bringing in, i am optimist take we'll see progress as dr. cummins returns to give updates on the many different initiatives that she presented today and reinforcing the commitment that i have and that dr. cummins have about ensuring that we are measuring what matters and that we're measuring that well. so thank you to dr. cummins and almada and the entire health team. given the many moving parts that we've all had to manage over the last couple of years. >> president bernal: and thank you to dr. colfax. >> clerk: director giraudo has one more comment. >> commisioner giraudo: i wanted to thank director companyins and jessica brown. one of the areas that they have worked so diligently on that had

been with our community and the public health committee is a centralized internship portal for the department of public health and it is excellent. it is up and running. and i have already sent a number of my doctoral and practical students to this site. so i just wanted to publicly say thank you to both of them for your diligence, excellent work on this. and i know that many of us are very excited about it. so thank you. >> that's great feedback. thank you so much, i will definitely share this with jessica and i'm glad that you are sending people to the website. that's great. >> president bernal: thank you, commissioner giraudo and thank you to the doctors again. we can move on to our next item which is other business. seeing no other business, we can

go back to commissioner giraudo, the chair of the community and public health committee for an update. commissioner giraudo. >> commisioner giraudo: thank you very much, president bernal we had excellent presentations today, and the first presentation was on the -- was the tuberculosis update and report. and it was reported that there are still many active cases, particularly in the tenderloin and south beach neighborhood, where it went from 6.7 per 100,000 to now 8.4 per 100,000. they presented data and approaches. one of the issues in part of the increases and the complexity with covid for access and the complexity of syndromic overlap,

but, again, many who may have symptoms -- i can't really diagnose it over tele-health. so it was a real challenge, and one of the focuses is really on primary care for both diagnosis, prevention and treatment. as things are getting more back on track, the committee asked for the staff to please come back in six months to report back on data with the approaches that they outlined going forward. our next update was on juvenile hall. and the work on the closure of juvenile hall. which, again, has been delayed due to covid. and the -- we had a very

significant 88-page report. but the actual work and planning from the report is just beginning. so the majority of what is in the report is outside of dph and the focus is on diversion. but what -- what is very much up in the air is under title 15, dph services will be in the new plan, but it is unclear where they will be as well. currently in juvenile hall there has been a decline in the population. the average right now is age -- is 14 individuals. but it is interesting to note that with the state guidelines,

the residents at juvenile hall can be up to age 25. so, in fact, there are two or three individuals within that 18-25 age range. currently, dph has 14ftes at juvenile hall, servicing the youth in emergency medical services and behavioral health and administration. our big concern is the application of dph services from a site such as juvenile hall, and what is the application for the dph services in the plan going forward. it is very much up in the air. and we were very supportive of the staff and advocating for the

dph services with the board of supervisors and the work group. they as well will return when there are updates to our committee. so those are the highlights of what was presented. thank you. >> president bernal: thank you, commissioner giraudo. >> clerk: i do not believe that there's anyone on the public line. do we have any questions or comments for commissioner giraudo? seeing none we can go to the next item, which will be presented by commissioner chow, who stepped in to chair the laguna honda hospital jcc meeting on february 8th. commissioner chow? >> commissioner chow: thank you, president bernal, and it is my pleasure to present this report on february 8th, we met and we reviewed as usual the executive report, the regulatory affairs

report. those are all coming along and they are all trying to respond to the various issues that the state came up with. and we were able to actually review in somewhat more detail than in the cast, under the new format, many of the areas that required corrective action from the state. and so it's becoming much more transparent to us and the public. and the work that the staff is doing to respond to these is very satisfactory and appears to be acceptable for the state and feds. the -- we also then looked at the -- i believe that the quality management staff was

working with each of the different units now so that it has become decentralizing coming directly down into the various units. they have put new staff together and those are now going to be assigned also to various units so that there could be a more direct assistance to those units in working on the quality measures for the entire hospital. and the other exciting part is, you know, that we have been talking for many years about a new department headquarters. and they were actually pleasantly surprised at the plans for the renovation of the m and o wings of the older buildings of laguna that actually look quite nice. so those people who have not seen those photos i think would be quite impressed for the work

they're putting in for offices, conference rooms and kitchen facilities. this is for the eventual move of several of the departments from 101 here, and including human resources and parts of the administrative staff. this is part of that master plan to move from our earthquake endangered building to both up to laguna and san francisco general. so that's very exciting and we have asked for quarterly updates on the finances and the scope of work and the progress of the work. for that renovation project, which is quite extensive. it's going to take the entire -- i believe that it's about four floors or five floors, both the m and o wings which were the old hospital. and really convert them to something that i think that if anyone had been at the old hospital area, they wouldn't have actually recognized that

this could be possible in the transition. so it's a wonderful work in progress for the department and for more adequate working spaces for everybody. at the closed session we then also approved the credential reports and the pip minutes report and that ends my report. and i'd be happy to answer any questions. >> president bernal: thank you, commissioner chow. if there's nobody on the public comment line, commissioners, do you have any comments or questions for commissioner chow? thank you, commissioner chow to step in for chairing the meet and congratulations on your reappointment. okay, the next item on the agenda is adjournment. do we have a motion to adjourn? >> i so move to adjourn the meeting. >> second. >> clerk: a roll call vote. [roll call vote]

i believe that does it for us. >> thank you, commissioners. >> president bernal: thank you, commissioners and thank you dph team and thank you members of the public.

♪♪ ♪♪ ♪♪ >> the san francisco playground's hitsvery dates back to 1927 when the area where the present playground and center is today was purchased by the city for $27,000. in the 1950s, the sen consider was expanded by then mayor robinson and the old gym was built. thanks to the passage of the 2008 clean and safe neighborhood parks bond, the sunset playground has undergone extensive renovation to its four acres of fields, courts, play grounds, community rooms, and historic gymnasium. >> here we are.

60 years and $14 million later, and we have got this beautiful, brand-new rec center completely accessible to the entire neighborhood. >> the new rec center houses multi-purpose rooms for all kinds of activities including basketball, line dancing, playing ping-pong and arts can crafts. >> you can use it for whatever you want to do, you can do it here. >> on friday, november 16, the dedication and ribbon cutting took place at the sunset playground and recreation center, celebrating its renovation. it was raining, but the rain clearly did not dampen the spirits of the dignitaries, community members and children in attendance. [cheering and applauding] ♪♪ ♪♪

>> welcome to the february 15 meeting of the transportation county authority. and the chair of the board and the vice chair is peskin. the clerk is angela sow. commissioner haney has a conflict in scheduling and cannot attend today's meeting so i am excusing him. and i understand that a couple of our commissioners are going to be absent between 10:30 and 1 is:00 and i will excuse commissioners melgar and ronen for that period. >> motion to require a vote to