>> president bernal:good afternoon, commissioners and dphs staff and members of the public and welcome to our first hybrid meeting of the san francisco health commission of tuesday, march 15th, 2022. secretary, will you call the role. >> clerk: yes, before i do that i have a statement to read. welcome to the health commission meeting, being held in hybrid format, in person here at 101 grove street, and broadcast live on sfgov-tv, and viewing via webex or calling, and with the access code 24578016709. that information is all on the agenda posted online. before i begin i remind all

present and attending in the meeting room today that the health and safety protocols and building rules must be adhered to at all times and this includes wearing a mask and covering your nose and mouth during the meeting, including anytime that you may speak. failures to adhere to the rules and requirements may result in removal from the room. we appreciate your cooperation with these rules and the requirements in the interest of everyone's health and safety. please all note that hand sanitizers are available, and we welcome the public participation during public comment periods. and there will be an opportunity for general public comment towards the beginning of the meeting and an opportunity to comment on each item or action item on the agenda. each comment is limited to three minutes. the public comment may be taken in person and through call in. the public comment first from those attending the room in person, and then from people attending the meeting remotely. those attending the meeting in person are requested to submit a

public comment card to the commission secretary. instructions for those calling in remotely can be found on page 4 of the meeting agenda. note that the city policies along with the federal, state and local law prohibit harassing conduct against city employees and others during the public meetings. and it will not be tolerated. moreover, public comment is allowed on matters within the jurisdiction of the health commission. note that the next health meeting is on april 5, 2022, beginning at 4:00 p.m. we thank you for joining us and please be patient as we learn this new paradigm. oh, for those attending in person, note that there are public restrooms on the first floor of this building. and now i'll do roll call. >> president bernal: thank you. >> clerk: [roll call]

>> president bernal: now and we'll have commissioner chung read the ramaytush ohlone declaration. >> commissioner chung: we are on the homeland of the ramaytush ohlone who are the original inhabitors of the san francisco peninsula. as the indigenous stewards of this land and in accordance with their traditions, the ramaytush ohlone have never ceded, lost, nor forgotten their responsibility as the caretakers as of this place as well those who reside in their territories we benefit from living and working on the traditional homeland. we wish to pay our respects by acknowledging the ancestors and relatives of the ramaytush ohlone community and by affirming their sovereign rights

as first people. >> president bernal: thank you. and our next is an action item, honoring dr. david woods, and to present that resolution we have the chief operating officer and deputy director of the san francisco health network. >> good afternoon, commissioners and secretary, and director colfax. i currently serve in the dph as the chief operating officer for the health network and the covid task force lead. i'm honored to be here before you for this item to recognize dr. david wood whose will retire as the chief pharmacy officer. we have been lucky that dave chose a career in san francisco and here at the department of public health and he's brought a sense of culture to the department, and pride to the work and the way that pharmacy services have been delivered. and so i'd like to thank him as a teammate and as a friend and speaking for those who have had a benefit to benefit to the work

that he did, we are extremely indebted. so reading the resolution number 22-11, honoring dr. david woods whereas, dr. david woods served the city and county of san francisco at the department of public health for over 0 years, and, whereas, during dr. woods' tenure with dph he served in the following leadership roles. the critical care, critical pharmacist, and the in-patient pharmacy supervisor, and the chm manager, and the laguna honda hospital pharmacy operator. and whereas, dr. woods guided the pharmacy department through expansions of the new building at laguna honda hospital and ensuring uncompromising ability of his team to provide the highest quality pharmaceutical care to the patients of san francisco. and he oversaw the computerized

entry and multiple robotic automation through the dph network. and, whereas, dr. woods had cultivated a culture of data-driven improvement. his true north is always in the care of patients. and he broke down the barriers through the patient assistance program and a 340b drug discount program and a network of provisions to access medication and he had promoted a just culture through the department with fairness, support, and development with accountability and, whereas, dr. woods advocated from a patient-centered perspective and challenged staff to view their role as critical to the successful delivery of high-quality patient care. and, whereas, dr. woods prioritized staff development and maximized the talents of his team and whereas, throughout his career at the dph, dr. woods

promoted and advocated and facilitated the evidence-based prescribed practice. and whereas, dr. woods whose competence and integrity and empathy are reasons to be admired by staff. and we honor dr. david woods. >> president bernal: do we have a motion to approve? >> i so move. >> second. >> clerk: can i check the public comment line? folks on the line if you would like to make comment on item 2 do so by pressing star 3 now so that we can recognize you. and then folks in the room, i have not received any public comment cards. if you have any for this item, let me know. it looks like there's no public comment. >> president bernal: first i

recognize dr. brent colfax, the director of health. >> i wanted to add to the resolution and thank you for this resolution. i just want to thank dr. woods for his incredible contributions to the health department. and i had the privilege of working directly with dr. woods in the covid-19 response where he was one of the response leaders for a number of months. and i just wanted to thank him for his integrity and his quiet wisdom and his advocacy on doing right by the city during this incredibly difficult few years and especially during his leadership in our covid response. so my gratitude and thank you for everything that you have done. and best wishes on whatever comes next and maybe we can encourage you to help us a little bit more with our pharmacy work at dph going forward. but he certainly deserves a break in the interim. so thank you, dr. woods.

>> president bernal: thank you, dr. colfax. i would like to associate myself with dr. colfax's remarks that particularly during these last two years our roles have called us to do more creatively, to dig down and to find more within ourselves to do the critical work, with regard to pharmacy and getting critical medication to the people that we serve under very difficult circumstances. so i thank you so much for your leadership and for your great work on behalf of the department and protecting the public health of san francisco. commissioners, do we have any other comments or questions or comments? >> clerk: dr. chow has his hand up. >> president bernal: commissioner chow. >> commissioner chow: thank you, i wanted to take a few moments because i think that dr. woods deserve this is and even more. i have known him since he worked at zuckerburg and then laguna, and all the way through he was

consistent in working on behalf of patients and increasing access to the medication in working through the medi-cal requirements and the fact that we move from a single pharmacy where patients had to come at general in order to get their meds, to a much broader one. and these were daunting tasks, obviously, with a lot of bureaucracy. and a lot of problems in making sure that as the patients were able to access that, that we were also able to count directly on the drugs. and all the way through, he has been a professional. i just want to thank him for all of these years that i have known him, and i have known that he's been outstanding in the work he's done for this department and for this city, and i wanted to thank him and i fully support

this resolution. >> president bernal: thank you, commissioner chow. seeing no other comments from commissioners, secretary morewitz we can have a roll call vote. go ahead. >> clerk: [roll call vote] the item passes. and dr. woods is here in case -- >> president bernal: please come up. >> clerk: how about a round of applause. [applause] >> thank you all so much. this is truly an honor. when i started at san francisco general in the pharmacy over 30 years ago there was no computer we did everything on paper, pencil, erasers, cardstock. medication safety is so different now from what it was before.

because of your contributions and your willingness to go the extra mile to give us the tools and the resources, we now have probably the best electronic health record that is found anywhere. and you continue to support the leaders of the health department and the hospitals and throughout the organization by providing us the infrastructure that we need to do the best job we possibly can. so that we can take the best care we can of the patients that we all serve. so, thank you so much. i truly appreciate this honor. [applause] >> president bernal: thank you, dr. woods. you can't see but we're all smiling very much in gratitude up here. so congratulations and best of luck on your future endeavors. the next item on our agenda is the health commission officer elections. and we will begin by opening up the floor for nominations for vice president of the health commission. do we have any nominations? >> i would like to make a

nomination. >> president bernal: yes, go ahead. >> i would like to nominate commissioner dr. laurie green for another term as vice president of the health commission and if i could make a few remarks in her impact and qualifications for the officer position. clearly, we all know that dr. green is a pioneering physician and a leader in healthcare for many, many years in san francisco and is recognized by the highest, not just in san francisco but in california and throughout the nation. she has strong ties to many constituency groups in san francisco and deeply cares about all populations and shows that

at every turn with regard to the programs and issues and policies that come up to the commission. she's insightful, strategic, thoroughly prepared. and engaged fully in all of the issues that do come up to the commission and beyond, you know, 150%, 200%, as far as i have been able to experience. and, finally, dr. green has exercised a really strong collaborative leadership with president bernal and has exemplified i think the kind of collegial, but critical, leadership and -- in the position of vice president and as a commissioner overall. so i'm more than happy and glad to be able to be nominating dr. green for vice president of the health commission.

>> president bernal: thank you, commissioner guillermo. doe we have a second? we have a second by commissioner giraudo. vice president green do, you sip the nomination? >> vice-president green: yes, sir. thank you so much. and i'm so humbled by your words. and i am honored that i would have the opportunity to serve with president bernal, who is terrific. and, you know, this is probably been of all of the things that i've had in my very long career, this has probably been the most impactful and the most joyous opportunity that i've had to serve and i am so grateful to be part of the commission and to form the kind of bonds, not only with my fellow commissioners, but also the leadership and the teams at dph. i pinch myself every day and i every day have such respect for all of the dedication and the work that goes on here to make

san francisco such an incredible place to receive care as a patient. and to work with those who are so committed to healthcare equality and making this the greatest city in the world. so i'm really honored and grateful for the nomination. >> president bernal: thank you, vice president green. secretary morewitz do we do public comment or go to a throat? we'll go ahead and do roll call vote. >> clerk: [roll call vote] congratulations. >> vice-president green: thank you. >> president bernal: the second part is the nominations for the

position of president of the health commission. and for this i hand it over to vice president green. >> vice-president green: i open up the floor for nominations for the presidency of the health commission. is there a nomination? >> vice president green, i would like to place a name into nomination. >> vice-president green: please >> i would like to place in the nomination for president, or incumbent president, commissioner dan bernal. as we know, commissioner bernal began his presidency during the early phases of the pandemic, and during this period of time he has not only carried out the duties of president, but been a steady influence and support for the commission, for our director of health, and for the city. we are all aware of the skills and the services and his dedication to the work of the commission and this health department.

it is, therefore, my privilege to ask for your support of commissioner bernal to continue to serve us along with dr. green, a great team, as the officers for this coming year. >> i second the nomination. >> vice-president green: was that a second, commissioner chung? >> commissioner chung: yes, i second the nomination. >> vice-president green: great. so do we take a vote? >> clerk: yes, would you like to say anything, commissioner? >> president bernal: well, yes, first of all, it's my great honor and privilege to accept the nomination by commissioner ed chow, who when i came on the commission served as president. he has been a great influence and guide for me and provided a very steady hand and very strong advice whenever i needed it, which had been often, particularly in the early days. so, first i want to thank mayor

london breed for appointing me to the commission. also for her bold leadership in leading our city through the most effective response to the covid-19 pandemic in the country. this, of course, all was accomplished by prioritizing the essential services and protecting public health and relying on data to drive the city's response as she pointed out during her state of the city address last week. many people refer to san francisco as the city knows how and -- the city that knows how, and you need to look no further than the dedicated staff and the leadership of the san francisco department of public health, the city's largest department in how they were able to not only carry out their daily work to serve the people of san francisco, but to go above and beyond to expand their role and to take on more than i'm sure they ever thought they would to lead us to the place that we are today in the pandemic. so i'm grateful to the leadership and staff of the department of public health, my

fellow commissioners and the people of san francisco for your cooperation and for caring of each other that really helped us to effectively respond to the pandemic. and just grateful for the opportunity. so, thank you. >> clerk: we'll do a roll call vote. [roll call vote] >> president bernal: and with the continue to continue to lead the commission alongside dr. green. >> clerk: congratulations. and i'll check the public comment quickly. folks on the line, if you want to make public comment, this is item 3, because we skipped the minutes, please press star 3. and folks in the room if you want to make a comment, let us

know. no public comment. so, commissioner, may we go back to the minutes? >> president bernal: yes, thank you. and we're going back to item number 2, pardon me, item 3, approval of the minutes of the health commission of march 1,, 2022. do we have a motion to approve? >> clerk: commissioners, before you make a motion, commissioners green and chow found three errors or things -- areas that needed amendment so i'll point out on page 6, i corrected three things on the third paragraph, second line, instead of covid-10, i corrected that to covid-19. and then on the -- same page, item 8, under commissioner comments, commissioner giraudo's comments, there was -- sorry, there was a word that said training and it should say

trainers. and the last line of the first paragraph should read as i'm about to read, the previous required training amount was four hours per year, that will change to 12 hours over the next three years. commissioners, i sent you this version and it's also posted online, so when you vote, please note this is what you are voting on. >> president bernal: thank you, secretary moreowitz. a notion approve? >> i so move to approve the minutes. >> second. >> clerk: all right, folks on the line if you would like to make comment on the approval of the minutes, press star, 3, now and folks in the room if you would like to make a comment, let me know now. no public comment. i'll do a roll call vote. [roll call vote] the minutes pass. thank you. >> president bernal: thank you, and the next is the director's report, dr. brent colfax, the

director of health. >> good afternoon, commissioners and president bernal. you have the director's report in front of you, just a couple of items. people actually, that i wanted to acknowledge and celebrate as part of the incredible dph team one is supervisor stephanie recognized dr. baba, and he is our deputy director of health. recognized by the supervisor in honor of women's history month at the full board of supervisors on march 8th. as you know, dr. baba has done an incredible job in the department, and has expedited his team, including overseeing much of our covid-19 response, supervising for all aspects of dph, and basically helping to keep the department moving in the right direction, with a large focus and emphasis on health equity and equity within

our workforce. so i want to thank supervisor stefani and thank dr. baba for this recognition. and the other employee recognized most recently was charles sam, he was recognized on march 8th, march 8th was a big day for dph staff. recognized at the san francisco rotary club, at their 34th annual service recognition luncheon. and mr. fang was recognized for his work during the covid-19 response and he is a long-term dph employee and i had the pleasure of working with him directly a number of years ago, and his work in covid-19 response -- one of key things that he did was to develop and to stand up our first isolation and quarantine protocols in hotels. as you know, those have become a model for covid-19 response, not only in san francisco, but across the country. and he is also now part of our -- leading our covid-19 task force, and he helps to prevent

and mitigate outbreaks at long-term care facilities and other congregate settings. so he's a key leader in our covid-19 response and delighted to have the rotary club recognize mr. fang and just to state that this was the first time that -- i'm told that this is the first time in history that the rotary club as part of their emergency service recognition included a department of public health staff member. so, congratulations, mr. fang. and then other parts of the director's report are before you. i provide more details on the covid-19 update in the next part of the meeting and i'm happy to answer any additional questions now or at that time. thank you. >> president bernal: well, congratulations and thank you to dr. baba and mr. fang for their leadership and excellent work. thank you for bringing that to our attention, director colfax. commissioners, do we have any questions or comments on the director's report? any public comment on this item?

>> clerk: folks on the line, if you would like to make public comment on the director's report, please press star 3, and i don't see public comment. i'm looking for hands, and i don't see any commissioner hands. >> president bernal: director co fax, covid-19 update. >> thank you, brent colfax, director of health here with the covid-19 update. so we'll just go through the slides quickly and i'll take additional questions. next slide, please. i have -- i can't -- is there a way to fix -- >> clerk: mykayla can we close it and reopen it, because there's gray squares showing up on top of the data. >> if not -- >> clerk: this is the perfect time to thank the sfgov-tv team and those who made all of this magic work. we're like in a futuristic

movie. so thank you all very much for all that you have done and you continue to do. >> president bernal: yes, we want to associate myself with secretary morwowitz's comments and it's not just today to ensure that this meeting runs smoothly but there's been weeks and weeks and weeks of preparation that led to us this point where we're able to have a hybrid meeting. so thank you to our i.t. friends and also to the secretary for organizing all of this for us. >> clerk: it looks great, mykayla, thank you. >> thank you. with regard to the covid-19 update, you can see on this slide here, i think that we'll change it to slideshow, there we go. well, it's back, i'll just keep driving. and so on this, it shows our covid cases per 100,000 residents since the beginning of the pandemic. on the far right of the slide here we continue to see a sharp drive from our omicron surge, our current rate is 10.4 per

100,000 and that's much lower than our peak earlier this winter where we were at over 275 per 100,000 cases. and the insert on the u.s. trends are surges and caseloads, ebb and flow really at this point reflects the national trend. i will say that we are seeing cases starting to trend back up in europe, so while we're in really good shape in san francisco and pretty much in the united states as a whole, we're watching these increases carefully and with due diligence. next slide. in terms of our cumulative cases over time, we're now at over 122,000, and that steep rise there in january of this year. and then, unfortunately, our deaths have increased to 827 people who have died due to covid-related causes and our sympathy to their families and loved ones.

next slide. this is looking at covid deaths by month. and you can see that we did have an increase, sharp increase in our deaths in january of 2022, commensurate with the omicron surge. we know that due to our very high vaccine coverage rates, our relatively high booster rates, combined with the fact that omicron was not as biologically virulent as some of our prior variants, our deaths were not nearly as proportional to case rates as they were in january of 2021. and that is the case, but you can see that we've had a relatively high numbers of deaths reported in january 2022 and of february of this year. these might go up further because of delayed case reporting. and often that is compared to our 2021 surge and the number of deaths is thankfully significantly lower. next slide.

this is our current rates by vaccination status. as you can see here, if you are -- if you received at least your initial vaccine series, the rate of covid-19 is 9.4 per 100,000 and if you are not vaccinated the rate is nearly twice as high. next slide. in terms of hospitalizations, you see here that our steep drop in hospitalizations, which is really good news. we have 46 people on the 11th across our san francisco hospitals reportedly with covid-19. just to emphasize that this number includes people who were diagnosed with covid-19 who may not have been admitted specifically for covid-19, as well as out in jurisdiction patients and you will note that we have just nine people diagnosed with covid in our intensive care units across the city. again, as of march 11th. next slide. and we have the vaccination, and

our vaccine and booster rates are much higher than comparatively across the state and across the country. you will note that our 65% booster rate has not changed for a number of weeks now and our number of people who received boosters has slowed dramatically, despite the efforts to do outreach and education and encourage people to get boosters. on the 5 to 11 year olds we're at 70% have completed their initial series so we continue to make progress there. and we're watching all as the cdc and the f.d.a. and other governing and recommending bodies in regard to when vaccine will be recommended for 0-4 year olds and there's some indication that additional booster recommendations may change in the relatively near future, but that we have -- that has not been fully determined yet. next slide. and then just a booster

recipient by age. you can see here that the people who benefit most at the population level from a booster with regard to protecting from hospitalization and deaths, 65 and plus, were 83%. and 50 to 64 year olds were at 75%. and those number does decrease with age. and, again, these numbers have slowed down but we are better off than many other parts of the country. and i still encourage people, if you are due for a booster, and you haven't received your booster, please get your booster and boosters are readily available across the city now and you can make a same-day appointment in many cases. next slide. i did want to update the commission on health order changes. as of march 11th, indoor restaurants and gyms and theaters and events no longer have to have proof of covid vaccination or a negative test

to enter. just to emphasize that wearing a mask inside such facilities when possible is still strongly recommended. businesses are urged to consider requiring patrons and staff to be up-to-date on vaccinations and individual businesses are able to adopt more restrictive measures for their own facilities. there's also been no change in pre-entry requirements for mega-events and we have a line with regard to that. and overall our health orders are increasingly aligned with the state orders overall. next slide. so in summary, thankfully, the covid rates and hospitalizations continue to decline in our city and our prevention activities are focusing on continuing to offer low barrier vaccinations to individuals. and there may be more vaccines and boosters available. and additional variants and surges are possible and our response must continue to be elastic, flexible, and

sustainable. so that's my summary for today and i'm happy to take any questions from the commissioners. thank you. >> president bernal: thank you, director colfax. secretary, do we have any comments? >> clerk: if you want to make a public comment, please press star 3. no comments from the public, commissioners. let's see if there's any hands up from commissioners. i see no hands from the commissioners. >> president bernal: all right, thank you, director colfax. our next item is resolution making findings to allow teleconferenced meetings under california government code -- >> clerk: i'm sorry, general public comment. >> president bernal: i'm sorry, general public comment. >> clerk: are there folks here for general public comment? there's no one on the line. so there's no general public comment. so we can go to that resolution. >> president bernal: and the next is retion leutionz making findings to allow

teleconferenced meetings under california government code section 54953 [e]. secretary. >> clerk: you approved a version of this resolution over the past year or so which allowed to you have remote meetings. this is an adapted resolution and language that allows for some of you to be participating remotely and some in the room. so it's a similar concept of you passing resolution, allowing for that hybrid meeting. we will do this every month. >> so moved to approve. >> president bernal: we have a second? >> i'll second. >> clerk: in the room, any public comment on this item? there's nobody on the line so i'll do a roll call vote. [roll call vote]

>> president bernal: next up is the san francisco health network update with roland pickens. nice to see you in person. >> nice to see you. >> clerk: if you can speak up a little bit. >> testing, one, two, three. good? good afternoon, commissioners. it is my pleasure to present this winter 2022 update to you on the status of the san francisco health network. you will recall that my last update to you was a year and a half ago in the fall of 2020.

at that time, we were almost one year into the covid-19 pandemic emergency response. and actively pivoting our focus and a substantial amount of our resources from our routine healthcare delivery system operations to a still unfolding and burgeoning global public health pandemic. as you will remember, we were doing things like reducing primary care and specialty care clinic capacity by converting as many businesses as possible to virtual visitacions. we were reducing the maternal and home visit nurse positions. and we suspended positions at the laguna honda hospital and redeployed thousands of our health network employees into

disaster service roles in support of the city and county-wide public health emergency activation. at the same time, many of those staff were implementing new and innovative models of care like shelter-in-place and isolation and quarantine hotels for vulnerable populations. now, here in the winter of 2022, we are two and a half years into the covid-19 response, hopefully now in a period of recovery and ready to pivot back our focus and our resources to our core healthcare delivery system operations. next slide. and in today's presentation i'll discuss the impact of our covid-19 response on our strategic initiatives and true north metrics over the past 2 1/2 years and our plans for reinstituting our strategic

planning and deployment across the network. i'll then share a few areas of focus as we begin the implementation of cal aim, and what that portends for the work we have to do as we restore and open up our delivery systems and programs to their precovid-19 levels. finally, i'll share with you a brief summary of the experience of the past two years across the network major divisions as they best to live in the two worlds. the world of delivery operations and of resourcing an unprecedented response to a global pandemic. next slide. as we do with all of our presentations we start with the

dph organizational chart to give a visual reference of the areas that we'll be discussing today. today we will be focusing on the lower middle section, which depicts the san francisco health network. next slide. when i came before you in 20 -- in the fall of 2022, i shared this slide that showed midway in that fiscal year, that was fiscal year in 2020, we had to pivot our focus from what had been a very well planned out and coordinated process using the lean management system, to monitor and improve our healthcare system and

organizational performance and our health outcomes, using our ex-matrix and our true north measures. we have remained in this deferred status until three months ago in december 2021, when we began to have more and more of our health care system staff return to us from their disaster service worker assignments. and we began meeting again at the network leadership team to restart our strategic planning and deployment for the rest of this current fiscal year in anticipation of having new and updated strategic initiatives and true north metrics for fiscal year 2022-2023, which begins on july 1 of this year. next slide. so within the department of public health and the network,

we develop and implement our strategic initiatives using lean. as we have discussed here before, lean is both a management system for running an organization, and it is also a methodology for process improvement. and while there are several tools and documents in the lean library, the two primary drivers of the organizational's implementation of lean are the true north and the ex-matrix. next slide. and mykayla, you can tab on through, i think three times, through to the very end. okay, and one more. one more. okay. there we go. so this slide shows both the historical and the present and the future status of our strategic true north measures and true north performance

measures. you will note in the top right that next week on march 23rd, we'll actually be having our first strategic planning session that we've had in the last two years to develop what will probably be a new set of strategic initiatives and true north metrics that are based upon this dph quotient strategic planning session that occurred back in november. next slide. actually, go back one more. so one of the things that i wanted to point out is that the last -- the last column that basically shows where we've been in the last two and a half years. and it basically shows -- you will see that green represents those true north metrics that were on target. and it shows the impact that covid-19 had our delivery system.

the fact that we were not able to achieve the levels of success and meeting targets as we had done in previous years. and also, more importantly, the color purple which represents those performance and health outcome measures that were actually deferred due to the deployment of staff, specifically our quality analysts who really drive a lot of the data monitoring and the data validation to report on these metrics. next slide. and this is just a one-page summary of what those true north metrics were this past year and probably the big takeaway is that when you look at this, you will notice that san francisco general and laguna honda, that there's fewer green in terms of the targets they were able to meet versus red, the targets they were not able to meet. and particularly then when you move down to the section and the

ambulatory care and the jail health and paternal child health, they actually had to defer active monitoring of all of the true north metrics because of all of the network divisions they were the most impacted in terms of having their staff to pivot their focus from regular operations to disaster response. next slide. this slide you have seen before and it is courtesy of dr. bennett. this slide has been previously presented to the health commission. and it represents the equity maturity of the various divisions within the network, and it also includes our sister division of behavioral systems within dph. and just to refamiliarize you with this, this represents the levels of maturity that are divided into three areas over an

organization. so, for example, the first blue color represents zghg, and the categories from left to right are normalizing, organizing and ops. normalizing refers to when an organization is usually starting its equity work, usually with the initiation of equity training. the second level of maturity is organizing. which is focused on building equity infrastructure in terms of having positions and budgets targeted specifically at equity and then, thirdly, operationalizing, which is when an organization is more mature and is actually implementing equity programs and policies. and you can see here a snapshot from dr. bennett in terms of where each of the parts of the network are in their journey, with zuckerberg being the

furthest along in its activities. and there are specific examples across on the left in terms of just some specific activities that were done in those areas. for example, primary care actually added a physician equity lead to their team. and zuckerberg incorporated equity in all of its performance measures across the hospital. and the scale for measuring this is, one, equals the planning stage. two, the beginning or organizing stage. three, means that the organization is in the working stage and actually implementing programs and policies. four, means that they've achieved equity goals. and, five, means that they're sustaining achievements for one year and beyond. next slide.

so now i'd like to turn to some of the current areas of focus across the network. you have heard before about cal aim, which is the state's plan for implementing additional enhancements to the medicaid/medi-cal program. it also is the state's ability to implement its 1115 medicaid waiver. it launched in january of 2022, although there have been planning in the works for the last two years. you will see at the bottom really the populations of focus for cal aim. you will notice that there's a lot of synergy with these populations in terms of the populations that we're currently focusing on across the departments. for instance, persons with

serious mental health disorders and people experiencing homelessness and people of risk of institutionalization. though we have been spending a lot of our time in covid response, we have also simultaneously been preparing and working on cal aim. several groups have been established. we have partnerships with san francisco health plan and several community benefit organizations to implement some of these new programs. the program elements of cal aim are listed on the right side. currently enhanced peer management and community supports, those are things like actually for the first time medicaid will now pay for patients who have medical respite, which they have never, ever paid for before, but those were considered reimbursable but now for first time will receive reimbusment for those.

san francisco long led the way in providing these services and so after many years of having these supported by the general fund, we can now have state and federal reimburse blunt for reimbursement for thosetypes of next slide. and a big component of cal aim is value-based care which is also part of the previous medicaid waiver. and it stands for follow the incentive program. this is very much aligned with our true north metrics. so there are approximately 25 to 40 different health outcome measures that are required to be reported on, and our reimbursement from the state is going to be based upon whether or not we meet the goals for those areas. and some of those are listed there as an example.

colorectal cancer screening and free admissions to the hospital next slide. and, finally, as i begin to wrap up, i want to share just some of the highlights of the past two and a half years of experience of the staff all across the network who as i mentioned before have really been living in two worlds. the world of their regular healthcare operations, and the world of covid-19 response. and we have broken this down by the major divisions within the network. so we'll start with san francisco general. as you can imagine, as the city's only trauma center, san francisco general was really on the forefront of the city's emergency response. so in addition to a lot of work in terms of opening up additional spaces for covid-19 vaccines and testing, they also

did improvements in their own care clinic to try and mitigate the impact of care and particularly volumes within the emergency department. you will see some of their success that they were able to reduce the percentage of all respiratory patients seen in the urgent care center to 59%. and that they were able to save at least 20 exam room hours per day by virtue of some improvements they made in their progress. and the other was occupational health and safety. as you can imagine, covid-19 is a big deal from an employer perspective. so there was new requirements for tracking staff in terms of making sure that they got their initial vaccinations, boosters, implementing testing protocols

for staff who did test positive when they were able to come back to work. and so they had to enhance the operations of occupational health. next slide. and as we are moving into this period of covid recovery, different efforts across san francisco general to really reflect and memorialize much of the work they've done in the last two and a half years. so the facilities team at zuckerberg actually established a resilience garden, which you may have already seen, but, if not, when you're on campus, we encourage to you go by and to take a look at it. it's near building 30 and 40, and it's really dedicated to the zuckerberg staff, all of the staff who participated in covid-19 with their work. and there was also a lot of energy that went into -- as you

know that the state and the health jurisdiction developed and mandated staffing vaccinations, and so a lot of the work to support vaccination across the network was actually done by the staff at zuckerberg next slide. in terms of the experience at laguna honda hospital, you will all remember that at the very beginning of the pandemic, a lot of focus was spent at laguna. in fact, director colfax dispatched me over to laguna for a couple of months to help to really with their covid-19 response. and it was all hands on deck. it wasn't just me. we had members from our quality department, several of the staff from zuckerberg went to laguna honda. director colfax got the cdc and the state to come in and to really consult with us. and because of that, we think

that we had as good as could be expected outcome for covid experienced at laguna. but, you know, covid-19 is not all they had going on at laguna they continued to have the required and regulatory surveys and continued to do well in their survey response. but the impacts were significant. you know, they had to close to admissions at laguna for a while and cease patient visitacions visits for awhile. as i said in the midst of the challenges of covid-19, there were also successes and maintaining five and four stars for staffing and for quality measures. and laguna was recognized as

a -- as a leader in quality by the california association of public hospitals and health systems, winning an award for quality in terms of their covid-19 response and long-term care. next slide. as i mentioned before, ambulatory care of all of the network divisions was the one most heavily impacted by covid-19. and you will remember that ambulatory care consists of our primary care clinics in the community and maxine hall and the western edition, and ocean park out in sunset, and patrairo hill and southeast. all of those clinics were severely impacted by covid-19. they had to reduce much of their service going to tele-health visitacions as much as they could and many of their staff were redeployed from those

clinics to support our covid activities across the city. and particularly our covid command center operations down at moscone for the year or so that we were there. they were able to sustain some of their advances. so, for example, part of covid-19 they had great success in improving the blood pressure control for african-americans and that continued even through covid-19. they were able to sustain that. and i think that is a testament to all of the work they've put in over the past several years to build their -- particularly their quality management infrastructure. next slide.

and another example of the work that we had mentioned previously that whole person integrated care, wpic, is the newest section within the ambulatory care that focuses on individuals, on nexus of individuals experiencing homelessness and also have behavioral health and/or substance use disorders. that group was pivotal during our covid response, particularly in the work that they did out in the streets and within the shelter-in-place and isolation and quarantine hotels. next slide. another area of the network that you don't really hear a lot about is our central administrative operations that includes materials, management or supply chains. and when you -- if you stop and

think about it, supply chain during the pandemic is really a big deal. getting the ppe that we're all wearing right now, when there's a worldwide shortage of it. getting it in san francisco, and helping to distribute it to other health systems within the city, and helping to distribute vaccines and to help within the city. materials management supply chain and pharmacy are critical centralized parts of the network and they too were called to be in action during covid-19. next slide. and as you did earlier today, you honored dr. david woods, in terms of the pharmacy operations. and here's just a small list of some of the activities that the pharmacy team live over the last two and a half years. in the midst of covid, also

increasing naloxone distribution across the city. and they successfully implemented wave two of our implementation to bring up the epic pharmacy module called willow. and they have actively participated in mental health san francisco programs related to mental health and substance abuse. next slide. then finally another area of centralized operations was the area of interpreter services and rehab services and occupational health and occupational therapy, physical therapy and speech and language pathology and home health. those are all in one unit of the note work. even though they are centralized services they too were involved in the covid response. home health actually began delivering covid vaccinations to

their patients at home while they were still doing their home health visits. and interpreter services, their volume actually went up by 22% over the course of the pandemic because they were being asked to provide more interpretation, particularly out in the community, as we were having more covid services at the zip code and at the neighborhood level. next slide. okay, that's it. so, you know, hopefully i would like to leave you with a couple of themes. one is that, you know, we definitely have lived in two different worlds over the last two and a half years. our regular operations and our covid world. we feel that we're on the road to now being able to pivot back

to our regular operations but we know that it won't happen overnight. some people decided that healthcare wasn't what they wanted to do during this process. we have many vacancies that will need to be filled. and we have a commitment from dr. colfax and from our h.r. colleagues that they will prioritize our network positions so that we can get our services back on track as soon as possible and as quickly as possible. so that concludes my presentation and i'm happy to respond to any questions or comments that the commission might have. >> president bernal: thank you, mr. pickens. before we go to commissioner questions or comments do we have any questions in the room?

>> clerk: questions in the room? how this will work is that i will put three minutes on the clock for you and i have a statement in read before we do that. for each agenda item members of the public have an opportunity to make comment for up to three minutes and the public comment process is to have feedback from individuals in the community. however, the process does not allow questions to be answered in the meeting or for the members of the public to engage in a back and forth conversation with commissioners. the commissioner does consider the comments from the members of the public when discussing items and please note that each individual is allowed one opportunity to speak per agenda item and they may not return more than once to read statements. written public comment can be sent to me and i can give you my email address. so i have three minutes on the clock and when the buzzer goes off, note that your time is off >> caller: my name is lily and i work for san francisco general,

dph. i'm here today to actually ask this health commission, it's really a call to action. i understand that it's great that the presentation just done regarding what is ongoing in the past couple of years. what i'm here to talk about is what is going on now. and as we talk about, you know, urgent care rates being, you know, better because we're sending patients from the e.r. there, i'm saying that action is not available on night shifts. in addition to that, there are, you know, obviously a few near misses that have happened, and it's just not safe. the other thing that i would like to talk about is the supply chain issues. we have been every day -- and today it's like d50 is not readily available. and last week it was green tubes and the week before that is it is blue tubes and prior to that we had to send it to mission bay to get processed. so these are huge concerns is that we cannot do our job and protect our patients if the things that we need are not

available. so that's my call to you as this health commission is to do right by not only the patients, but also the staff that works at san francisco general as well as all over the city. we just need supplies. we need things so that we can do what we have to do. thank you. >> president bernal: thank you. >> clerk: is someone else ready for public comment? give me a second to clear it. okay, you may -- i'm sorry, megan -- you have three minutes on the clock, when the buzzer goes off, please know that your time is up. coyle i am megan green, i'm a nurse at san francisco general. i just wanted to come up here and to basically say that i feel like there's a disconnect and when the gentleman said that we live in two different worlds, i think that it is very apparent that we live in two different

worlds. the last two years for me and my co-workers have been hell on earth. i went over to laguna honda yesterday and admitted a nurse who was a cna on my floor before the pandemic started. she said she just cried in her car before going into work. they're frequently getting mandated to stay. and they're asking -- being asked to take on incredible patient loads. and i can tell you that as working as a nurse at the general that when there are fewer eyes on patients, really horrible things happen, including death. and it's really awful to watch. i have a hard time sleeping at night. i don't sleep for more than three or four hours at a time. and i just also wanted to talk about there's been a lot of talk about equity. and i think that we should all look at each other in this room there's a lot of m.v.s and a

lot of j.d.s on the health commission and there's not a lot of people who are on the front lines. there's not a lot of people who have been in it. it's a lot different sitting at home on zoom and talking about this stuff. but, like, i had a covid positive patient cough in my face. like, our experiences are very different. i just feel like the people who are on the front line have been forgotten. and that garden -- i just found out about it today -- i just feel like we're all -- we're all forgotten. every lesson that we learned during the pandemic about how frontline workers and teachers are so valuable to our society -- and then the moment that the vaccine and the booster came through and everything is now open and now we have forgotten everything that we have learned. the pandemic showed how much global warming was affected by all of us commuting to work and

yet somehow we're supposed to, you know, to get everyone to come back to work? i -- i just don't get it. like -- we're living in two different realities. and it's great that you guys are talking about equity. but, like, coming to the general and come to laguna and talk to some people who actually worked the pandemic and who watched -- my favorite patient died with no family members around. i was the only one around. like, i just wish that people could actually see what really happens. and that you could experience our pain. >> president bernal: thank you. >> clerk: next. >> caller: hi, i'm julie from the emergency room at san francisco general. it's been two years and i made it, kind of, sort of. i agree with what megan was

saying that the equity -- i have to just -- the equity is mind-boggling, with what is happening. you guys, please come, we'll take you on a tour, let us take you tour and let the frontline take you on tour. the equity, if you have been to the hospital, i know that our deputy here has, and it's considered one of the most violent places by those of us who know the city. ask this gentleman here. just as dangerous [indiscernible]. people who are screaming on the streets and get picked up by the paramedics, that's where they go, because they can't go to others because of covid. guess what is happening now, we have a pediatric area in the emergency room that is super cute, that's where kids should go. they should not be in the general adult area. and they should not be in pod a next to the first four rooms

that are psych rooms. this is not equitable. none of you would let your kids or your grandkids or nieces or nephews or relative does that. if you saw that you would freak out. these people have psychiatric emergencies and none of this money -- i don't know where it's going, there's a ton of money but they get dumped at the hospital and from these streets and children are having fun with them in pod a. and there's nobody at the hospital to even for us to turn back to once we're done doing whatever we do. and the violence happening, over 400 assaults were recorded. i don't know how many are not recorded. i don't know those numbers but i can tell that you many of our people do not file a report because it's not unusual, or we don't have the time or energy. the multiple universes like megan was talking about -- 12

1/2 hours, and you get a 30-minute lunch break, just to get 45, plus another 15 before covid. this is not equitable. this is not saying thank you to the front lines. now we're so short staffed that you come in for a 12-hour shift and you are told that you have to stay for another four, five or six or whatever is mandated. why do you think that people are leaving? would you do that, get in and get punched, think that you will get punched and get yelled at and told by a patient that you're horrible and you're trying to save their lives and you don't get a lunch break? come on. it's like an abuse situation there. it's like a giant domestic violence situation there. people are going to be waking up though. we need to get more staffing in there. we need better education for our staffing. we're just -- it's so broken. i wish you guys would come and talk to the staff. please. >> president bernal: thank you. >> clerk: and then person on the line would you league to make a

public comment -- would you like to make a public comment. that is last of the public comment on those items, commissioners. and i don't see any hands from the commissioners participating remotely. >> president bernal: seeing no comments or questions -- >> clerk: i'm sorry, commissioner chow just raised his hand. >> president bernal: commissioner chow. >> thank you, and i appreciate the presentation and it gave us an good overview of the last two years. i am looking forward at this point and your goals are very clear that you're trying to orient that, and at the same time, work on the cal aim program. so i am wondering what your time frame is in which we're going to

be able to understand more as cal aim continues to evolve, what we're going to do. it's amazing that we did come in with such outcomes that we were able to actually exceed what we had estimated as the incentives for higher quality. but with the changing cal aim program, where do you think we're going to be, where it would be then not just a group of puzzles, you know, pieces, but but to now have some, i guess some concrete measures and performance measures behind it. because i would imagine that is what you're trying to bring, because cal aim is, of course, you know, one of our important

elements. -- and in a deal, mostly with ambulatory care. so just some ideas when we might be able to hear how this network has been coming together, and we have an opportunity to be -- because of the way that i think that we're structured to really be a model for the state too i think, as everybody i think is struggling with what are the parts of cal aim that then put that puzzle together. and truly then we will have accomplished a great deal and improved lives, not just on the acute basis, but for their health. so, sorry if it's such a long question. i thought that -- we got a way of understanding when we might be able to see some of these elements, realizing the state is still writing it. it is much appreciated and we

could calendar the progress. >> thank you very much for that question, dr. chow. i will make a few comments and then i'll ask our chief medical officer, i can tell by looking that she chomping at the bit on video. but in terms of time frame, so the good thing about cal aim is that it didn't just come from nowhere. it really builds upon the last 15 years of medi-cal waivers within california. and particularly the last waiver had the program that you remember called "whole person care," where it focused on individuals experiencing homelessness, and also mental health and substance use disorders. and so much of cal aim as i mentioned really targets that population. and so to the extent that -- and

we begin to choose our new strategic initiatives and true north measures, we will incorporate as many of those cal aim measures and programs so that, you know, there are synergies and we're not duplicating efforts. in terms of time frame as i mentioned, i think that it was slide six of my presentation, we're actually having our strategic planning session next wednesday, the 23rd. which is a combination, we have actually met in december, and january and february to do our pre-work. but we will be selecting our new strategic initiatives and true north measures. and those will then become effective july 1 of this year for the coming fiscal year. and so i'll let dr. horton really tell you more about kind

of the time frame of cal aim and what we expect in that regard. >> thanks, roland. and thanks, dr. chow, for the great question. i totally agree with roland that one thing that we're really trying to do is to align all of these programs. so in terms of our ocean work, we really want to align it with the goals of the other major initiatives that we have. and we'd like as well as to have cal aim, the ocean work and our strategic initiatives align with mental health s.f. best, and our tenderloin initiative, etc., so alignment is really what we're going for. i think that we all see all of these programs as a way to get where we need to go in the health system, rather than sort of individual silos, that we are trying to individually engineer in terms of the specifics of cal aim though, i will say that we've already launched enhanced care management.

we have that as a really comprehensive case manage mentat program for folks with severe mental disorder and substance use disorder and people experiencing homelessness and those with severe chronic illness. we have three teams and we're approaching this as an integrated health network and a behavioral health team and a street medicine and supportive housing team and a primary care team. and we're working closely with the two managed care plans in town who refer us patients and we figure outcome part of which team is appropriate for them. and right now we have 139 patients and we'll get monthly refers going forward. the exciting thing about is that once we have the system up and running it also becomes -- we start adding additional

populations. so in about a year we add justice involved populations so we'll add people in our jailed health system, for example. and enter enhanced care management when possible and when applicable for that individual, before release. so they can have a re-entry process that is assisted by case management programs. and then also we'll have some long-term care and skilled nursing facility populations that will receive those services. the other major piece of cal aim that is getting planned now and will get launched in july as roland mentioned is community supports. we have medi-cal reimbursement and then in about a year working with hhs, all medi-cal pate thes who need it will have access to housing navigation, tenancy support, housing support, in

partnership with hsh. and the final thing they will say is that our behavioral health visits, so our whole behavioral health services department, is working on changing and realigning things in terms of documentation and the way that they bill and document and interact with the state. and as of a result of cal aim. and we see that as positive changes that will be less burdensome and more transparent and facilitate the information exchange with the rest of the network when those cal aim instigated adjustments happen. so happy to answer any other questions about where we are with cal aim. >> thank you, dr. horton. i'm wondering as you were talking what measures aside from

this, what measures would we use to understand -- when we had the whole person initiative, and even previous to that, we were seeing that we were able to triage people and check them out and able to get them more healthy. so, yeah, these are great aims and, of course, the space has and we have this all put together. and maybe that's what you do, we'll get measurements and then be able to follow it and what timeline in terms of the waiver and how long will cal aim actually allow us to do these things? we start pilots and then they become, you know, a new program and we've lost some of the lessons learned often. >> yeah, i totally agree. i think that in the absence of the state saying -- besides how many people have you enrolled in healthcare management and how

many people are in community supports, the state hasn't handed us a lot of metrics to follow, and so we're going with the metrics that we are targeting for other areas. you are right that ocean will help us to delve deep into that but we're very aligned already with the dph social work, especially around the a3 focused on people experiencing homelessness. so, you know, looking at people who have been assessed for coordinated entry into the housing system and looking at utilization metrics and decreasing utilization. and then also looking at continuing to use some of the whole person care metrics like people who are sustained in their housing services. and people who are not only initially engaged in case management but have ongoing interaction with case management. we probably will also continue to follow some of the behavioral health metrics that are part of that dph a3, like routine care, both in primary care and dhs

care and follow-up after emergency -- emergency behavioral health type care. so those are metrics that we plan to follow, whether the state also decides to put them in place for cal aim or whether they make sense for cal aim and they're important for the rest of our initiatives and those are key metrics that we'll follow. >> commissioner chow: , yes, that's really nice to hear and i'm going to -- i am going to suggest to this commission as to an update process upon which then it would make sense to understand. i know that when we did that street outreach, the data that we were getting, even at the monthly basis i think that really impacted to us that here was this successful program that we were able to divert people from direct -- police officers

to the right, you know, type of mental health programs. and there were some tangible numbers and there continues to be. i think that is a tangible thing and how many people were then able to get care and if we were able to even see where the firss of the program went, i think that it would be really encouraging at this coordinated effort was actually, you know, helping people. so i just leave that to you and the commission leadership as to how we might best be able to follow that just like we're following sf mental health. i think this is just as important an initiative, and all of the hospitals had measures pretty well established and we follow now s.f. mental health, and that's a whole coordinated

program. and it would be nice to actually see -- not just what the clinics are doing, but what are we doing overall in ambulatory care in all of these different silos that will bring it together and into an ambulatory system. so, does that even sound reasonable? >> yeah, i think that it is totally reasonable to look at metrics for progress for cal aim and i think that i look forward to that ongoing discussion. i also just wanted to add that for certain populations, i think that it will be very clear what we need to follow. for example, our justice involved populations, we will need to track who is enrolled in medi-cal prior to release and how many of them got hooked up with ecm and how many with sud and connected with community-based ongoing routine care for those issues. so we will continue to refine that. i think that the other piece is

just because it is -- i mean, one of the absolute pillars of cal aim is that care case management program is that i have mentioned this very briefly earlier, but i think that one of the things that we always track with our case management programs is utilization, proper utilization of services. so a shift away from the high utilization of the sort of -- we call, you know, emergent services for ambulatory sensitive positions and a shift into routine and preventive care and contact with our case management. so that will be one of the main buckets of the metrics that we will be following because it is -- you know, it is the main pillar of being a case management program. >> commissioner chow: thank you very much. and i look forward to our next progress report. >> clerk: commissioners that's the only hand that i see at the moment. >> president bernal: thank you, commissioner chow, for your

suggestion and i know they'll follow up on that. seeing no other commissioner comments or questions, i believe that we can move to the next item, is that correct? >> clerk: yes. >> president bernal: our next item is an update on the community and public health committee. we have our chair here, commissioner suzanne giraudo. >> commisioner giraudo: thank you very much, and we had three items. the first was we had requested an update on the numbers for the food program, and it was many things to me, and i thank commissioner chung on how many families have been served by the food program. and as well, how many are continuing to be on it and the reason that there's still a wait list of one of the programs of over 9,000 is based on funding.

but i -- i appreciated the updated numbers and i believe that you have had that information in your packets. and mark morewitz had also sent that to you by email today. the second part of our presentation was on an update on the prenatal program during covid. and a couple of the highlights that were quite interesting is there was an increase during the pandemic of hospitalizations for mental health issues. and a decrease for black, african-american for hospitalization. but for that population, there was an increase in self-harm behavior that had been -- that

were in the emergency room. so it was -- there was a not a clear explanation other than the existing disparity, as well as not all of the people were screened with the edinberg depression inventory to try to screen them early and to be able to access services. the staff that -- that there were gaps in staffing which accounted for the decreased number of referrals. and currently they are building staff capacity. there are long wait lists. and are very committed to serving that population, sooner rather than later. but, again, it's based on staff their goal is better coordination with resources and going forward, one of the

mayor's children and family recovery task force was focused on prenatal programs for better coordination with resources. the second program was the whole person care. and just to kind of refresh everybody's memory, that this brings together existing non-traditional primary care, urgent care, and behavioral health clinical services primarily serving people experiencing homelessness. within whole person care, there's a number of integrated care programs that include street medicine, sobering center, whole person care, shelter health, open access clinic, urgent care, public health nursing and nurse

management and medical respite. a number of facts were presented too. in 2020-2021, there was an increase in the number of patients. they had 7,576 clients. with a total of 47,044 encounters. the budget is $13.6 million. and the majority is from the general fund. the -- one of the other couple of highlighted programs is the covid healthcare for people experiencing homelessness, especially in the focused in the shelter-in-place hotels and with those people that had not been connected to care. and that is the goal. the street overdose response team has been presented to you

before, over 560 individuals have been served. managed alcohol program currently is 10 beds with a hope to scale up to 20. and, again, we just heard about cal aim enhanced care management, is a significant part of whole person care. and the last presentation, a part was on the maria martinez health resource center. and the expanding services, and they will be moving from ivy street to a new location. so it was both programs were very informative and we had also asked for updated reports from both programs to return to the committee. that is the highlights of our

report. >> president bernal: thank you, chair giraudo. any public comments? >> clerk: person on the line, if you would like to make a comment on the public item, community health update, no hands and no one in the room to make public comment. i don't see commissioner hands either, commissioner bernal. >> president bernal: thank you, chair giraudo. and next item we'll go back to other business. any other business? seeing none, no need for comment. >> clerk: and a person on the line, if you would like to make a comment for other business, item 10, please press star three. no hand, commissioner. >> president bernal: item 12 is the joint conference committee and a other committee reports and a brief summary of the march 8,2022, laguna honda hospital jcc meeting. >> thank you, president bernal. at the march 8th, 2022 laguna

honda jcc meeting we reviewed the executive team report as the first item on the agenda and also the regulatory report. and the committee then discussed a new proposal for senior housing -- for senior housing projects on the laguna honda campus. and quite a bit of a discussion there. but the committee did request that the presentation be made to the full commission in order to give the public and the full commission an opportunity to weigh in on the decisions for this project. it is significant endeavor. and many different constituencies and the public and the full commission would want to have the opportunity to have an extensive discussion and dialogue on the project.

and then during the -- we moved on to the equity and culture updates and we heard the progress on laguna honda's equity activities. very impressed with the amount of activity that was -- that occurred during the many surges of the pandemic. and you got a little bit of a report on that from roland pickens. he shared with us the network, the health network update. and then in closed session the committee approved the credentials report and the minutes report and then we discussed the medical qi report i want to thank commissioner green for stepping in at the closed session, i had to leave early for a prior commitment. and that would be the end of my

report. >> president bernal: thank you, commissioner guillermo. any public comment on this item? >> clerk: person on the line, if you would like to make a comment on this item, please press star, 3. no hand, commissioner and i don't see any commissioner hands as well. >> president bernal: seeing none, we move on to our next item which is a closed session. commissioners, permission to enter a closed session? >> so moved to have a closed session. >> second. >> clerk: before we do that, there's still a person on the line, person, if you would like to make public comment on the closed session, please press star 3 now. double checking here. star, 3. no public comment, commissioners. >> president bernal: please, call the roll. >> clerk: [roll call] all right,

everyone, so please give us a few minutes to transition. folks who might be watching, we're going to still be here but we'll be in closed session and so you won't be able to see us and sfgov-tv people, prepare now consideration to disclose or not disclose? discussions in closed session. >> i move not to disclose. >> president bernal: is there a second? second, anybody? >> clerk: say it again, commissioner giraudo. >> >> president bernal: a second. >> clerk: i'll do a roll call vote. [roll call vote]

and then we're finally at consideration for adjournment. >> president bernal: a motion to adjourn. >> i so move to adjourn the meeting. >> second. >> clerk: by the way there's no public comment and no one in the room. so we'll do a roll call vote. [roll call vote] >> president bernal: we are adjourned. thank you, commissioners, and congratulations vice president green. >> the first for this format, so hopefully we'll choreograph better next time. >> president bernal: it feels weird but we'll get used to and thank you, mark, for everything

>> as a woman of color who grew up in san francisco i understand how institutions can have an impact on communities of color. i think having my voice was important. that is where my passion lies when the opportunity to lead an office in such a new space came up. i couldn't turn it down. i was with the district attorney's office for a little

over nine years, if you include the time as an intern as well as volunteer da, all most 13 years. during the time with the da's office i had an opportunity to serve the community not only as the assistant district attorney but as director of community relations. that afforded the opportunity to have impact on the community in an immediate way. it is one thing to work to serve the rights of those without rights, victims. it is really rewarding to work to to further the goals of our office and the commitment we have as city employees and advocates for people who don't have a voice. i don't know of anyone surprised to see me in this role. maybe people have an impression what the director of the office of cannabis should be like, what their beliefs should be. i smash all of that. you grew up in the inner city of

san francisco. my career path is not traditional. i don't think a person should limit themselves to reach full potential. i say that to young women and girls. that is important. you want to see leadership that looks diverse because your path is not predetermined. i didn't wake up thinking i was going to be a prosecutor in my life. the city administrator reached out and wanted to have a conversation and gave me interest in the new role. i thought you must not know what i do for a living. it was the opposite. she had foresight in realizing it would be helpful for somebody not only a former prosecutor but interested in shaping criminal justice reform for the city would be the right person for the space. i appreciate the foresight of the mayor to be open how we can be leaders in san francisco. i was able to transition to the policy space.

here i was able to work on legislation, community relations, communication and start to shape the ways our office was going to reform the criminal justice system. it is fulfilling for me. i could create programs and see those impact people's lives. i am the change. it took truants youth to meet with civil rights movement leaders who fought to have access to education. being a young person to understand that helped the young people realize this was an important thing to give up. what we find is that young people who are truanted have a really high homicide rate in our city, which is a sad statistic. we want to change that. >> coming from a community we are black and brown. i don't reach out to other people. i don't think they feel the same way. >> i had the great opportunity

to work on prison reform issues and criminal justice reform issues. we created a program at san quentin where we brought district opportunities to lifers and talk about how we are all impacted by the criminal justice system. we brought over 40 elected das to san quentin for the situation. now we are inviting the police department. our formerly incarcerated group born out of this programming asked for the opportunity to work on a project where we could bring the men in blue on the outside to come speak to the men on blue inside to start the healing dialogue around how the criminal justice system specifically in san francisco impacts the community. i was attracted to the role. there was a component of equity that was part of this process. the equity community here in san francisco is a community that i

had already worked with. before i took steps to visit cannabis businesses i thought it was important my team have a chance to go inside and speak to men who had been impacted. that conversation needed to happen so we know how we are making an impact with the work that we are doing. the da's office as we were leading up to the legalization of marijuana in the state we started having conversations on the policy team what that could look like. the district attorney was really focused on the right side of history for this. we realized it would be quite a heavy lift for individuals who have been negatively impacted by the war on drugs to expunge the record. it was important to figure out the framework to make it seamless and easy. they put their minds to it after

some time and many conversations the data analysts and other policy walk throughs on the team came up with the idea to engage the tech community in this process. code for america helped us developed the rhythm to be used for any jurisdiction across the state that was important to create a solution to be used to assist all jurisdictions dealing with this matter. the office of cannabis is the first office to have a completely digital application process. we worked with the digital team to develop the online application. there are going to be hiccups. we are first to do it. it is one of the most rewarding parts to offer a seamless -- to offer a seamless approach. that is how they can find solutions to solve many of the community challenges. the best way to respond to prop

64 was to retroactively expunge 9,000 cannabis related records for san francisco. it feels like justice full circle for my personal experience. in the past i was furthering the war on drugs just as my directive. really coming from a place of public safety. that was the mandate and understanding. it is nice to see that pass a society we are able to look at some of our laws and say, you know what? we got it wrong. let's get this right. i had the privilege of being in the existing framework. my predecessor nicole elliott did an incredible job bringing together the individuals super-passionate about cannabis. >> the office was created in july of 2017. i came in early 2018. i have been able to see the

office's development over time which is nice. it is exciting to be in the space, stickily in thinking about her leadership. >> looking for the office it is always we might be before my time when i was working for the forboard of supervisors. i learn new things every day it is challenging and rewarding for me. >> we get the privilege to work in an office that is innovating. we get to spearhead the robust exprogram. >> i am excited she came on board to leverage experience as a prosecutor 10 years as we contemplate enforcements but approaching it without replicating the war on drugs. >> i was hired by cam laharris. i haven't seen a district

attorney that looked kind of like me. that could be a path in my life. i might not have considered it. it is important that women and certainly women of color and spaces of leadership really do their part to bring on and mentor as many young people as they can. it is superimportant to take advantage of as many opportunities as they can when they can intern because the doors are wide open. plans change and that is okay. the way this was shaped because i took a risk to try something new and explore something and show that i was capable. you are capable, right? it was about leaning in and being at the table to say my voice matters. voice matters.

>> hi, you are watching san francisco rising. focused on reimagines our city. our guest is debbie rafael director of san francisco department of environment to talk about climate action plan. welcome. >> thank you. it is a pleasure to be here. >> thank you, too. i have seen the climate action plan. it is a very detailed document that might be a little incontinue dating to digest is there a simple way to summit up? >> you are right. this is a science-based document. we are very, very proud of the rigor. over 150 implementable actions to achieve net zero emissions by 2040. i think i can summarize everything in the plan in four

words. zero 80-100 roots. that is all you need to know and think about when you think about your own climate action plan. let me explain a little bit more. zero. zero waste. landfill incineration. zero toxics. cutting down what you buy altogether. that is really how we are going to reduce emissions upstream from all of the manufacturing and mining that happens because of the decisions we make about what we buy. zero. everything in your blue and green bins. as little as you can in your black bins. 80% of trips in sustainable low carbon mode. public transit, bike, walk, carpool. think about the ways you can move around the city, achieve mobility without having to get

into your own personal vehicle. 100. 100% renewable energy. that means, first of all, reduce the energy you use. energy efficiency. when you use it whatever source of energy it is, it needs to be all electric. carbon free. that means getting off diesel and gasoline. natural gas heats our homes. it is used in cooking and cooling in buildings. 100% of that energy we use needs to be electric and needs to be supplied by renewable electricity. very easy in san francisco. you can buy 100% renewable clean power s.f., pg&e has 100% renewable. zero, 80, 100. that is how we do bad in the

world. we need to pull out the carbon in the air. we do that with roots. using your green bin. every banana pill, dirty pizza box, eggshell put in the green bin. it becomes compost that is spread over agricultural lands radically changing soil chemistries, improving health of soil,ability to retain water and pulling carbon out of the air to store underground. 180 pages of carbon action zero, 80, 100, roots. >> individual responsibilities really are important. we have a big part to play. how is this dealing with corporations and big businesses? producers of co2 and methane?

are we putting pressure on the manufacturers, producers and distributors? >> that is a fair question. as individuals we have an important role to play. it only goes so far. san francisco has been a global environmental leader for decades. the policies how we hold others to act has driven action at state and federal level. there are two ways that san francisco applies this pressure, as you call it, on others. first our authority to pass laws. second is to exercise our power as purchasers. let me give you examples. how do we pass laws? mandated city-wide composting, banned natural gas in that construction, all new buildings in san francisco will be all electric, and will be operating on 100% renewable electricity. that is the law.

required installation of easy charging in parking lots, large commercial buildings right now convert to 100% renewable energy and electricity. we ban materials that can't become posted or repsych-- composted or resickled. we banned styrofoam takeout containers years ago. more recently be banned p fox a forever chemical in the packaging making it impossible for it to ever breakdown. that second bucket is really interesting and very powerful and very quick. that is our power as purchasers to move the market. send signals to the market place. the kinds of computers the city buys. use the highest standard of environmental performance to drive manufacturers like apple

and microsoft to make changes to the way they build the electronics. we have carpet standards to get rid of chemicals and plastics like pvc and rubber chemicals driving the marketplace. those are very effective tools. you are absolutely right. it is an and not an or. >> what challenges do we face as we pursue our goals. you mentioned one. >> the overarching challenge we need to bring everyone along. i mean that in the broadest sense of that word. this will cost money to change natural gas water heaters, get off gasoline in cars. that is a cost. how are we going to raise revenue so we don't cause undue burden on those who can afford

it least? those are most impacted by the impacts of climate change and pandemics as well. how are we going to raise the revenues we are going to need to help everyone who needs it. secondly the changes will require significant political will. how will we build more housing. there is a section in housing in the climate action plan. as the mayor says housing policy is climate policy. we need to get out of cars and support transit and biking and walking. some is resources. some is political will. finally, some of the changes we need don't exist yet. we need new technology, we need research to new ways of doing things. our ski can't be responsible for that. how do we align with the people with the big bucks, state,

federal government for research and technologies are developed to help us meteorchallenges. >> san francisco is known as the forefront of environmental movement. what are you most encouraged about for san francisco and climate efforts? >> end on the positive. it is easy when it comes to city and county of san francisco. i call it the eco system. there is a tremendous power in the willingness of the san francisco ecosystem to work together to take action. that ecosystem are the residents first and foremost. elected officials and mayor, businesses and frankly also our city staff. that ecosystem gives me great hope. in fact, it is working quite well. the numbers show it. san francisco has reduced its emissions of carbon from 1990.

that was the baseline to 2019 by 31%. that is a phenomenal number and the envy of cities around the world. 31% reduction in carbon at the same time that our population has grown by 22% and economy g.d.p. by 200%. those numbers send a very important message. that message is that it is possible and san francisco is proof of this. it is a rising city and environmentally conscious one. we can reduce emissions and still have a thriving city. that gives me tremendous hope and democracy is important for people who share your values. thank you. >> thank you so much. i really appreciate you coming on the show. thank you for your time you have given us today.

>> thank you, chris. it is an honor. >> we will be back with another episode shortly. you are watching san francisco rising. for sfgovtv thanks for watching.

this meeting of the san francisco ethics commission. this hybrid meeting is being held declaring existence of a local emergency data february 5th, 2020. the minutes of this meeting will reflect that pursuant to the february 10th mayoral proclamation, city commissions and boards created by the city charter shall hold meetings in person with conditions specified. the ethics commission has now resumed in-person meetings in city hall with a new hybrid