49ers moved to santa clara in 2014. with structural claims and numerous name changes, many have passed through and will remember candlestick park as home to the legendary athletes and entertainment. these memorable moments will live on in a place called the stick. (♪♪♪). >> welcome to the health commission meeting of june 7, 2022. executive secretary would you please call the roll roll. >> commissioner chow.

commissioner chow. >> present. >> commissioner chung. >> present. >> commissioner green. i'm not sure -- can you speak commissioner green? let's see. >> there i go. i couldn't get off practice session. present. >> there you go. and commissioner giraudo. >> present >> and president bernal. >> present. >> all right. . >> so we -- [off mic] go back to my script because i'm not organized. >> of course. we have commissioner giraudo to read the parameter land acknowledgment. commissioner commissioner giraudo. >> thank you. the san francisco health commission acknowledges that we're on the unceded ancestral homeland of the parameter who are the original inhabitants of the san francisco peninsula. as the indigenous stewards

of land and in accordance with traditions the parameter have never ceded or lost or forgotten the responsibilities as the caretakers of this place and for all people to reside in their traditional territory. as guests we recognize we benefit from living and working on the traditional homeland and want to give our respect for the ancestors, elders, and relatives ramaytush oholone people and by the first people. >> you have information about hybrid meetings. >> good afternoon. welcome to the san francisco health commission meeting and appearing in person on grove street brought on sfgtv and

the number and the access code are on the agenda. before we begin i want to remind individuals all present today all safety protocols must be adhered to all times and wear a mask during all time and during any time you speak. failure to adhere to these requirements will result in the removal of the room any we appreciate your and hand sanitizers are available at the entrance and i have masks available if needed. we welcome the public participation period during public comment and an opportunity at the beginning of the meeting and an opportunity on each item of the agenda and limited to three minutes. public comment will be taken in person and first from people

attending in person and then those remotely. those in person should give a card to me and instructions on the meeting agenda page four. to access closed captioning cover your moth over the live stream or on demand video a pop over lay will pop up and click on cc and you have the opportunity to have it as you watch it. laws prohibit harassing of others and will not be tolerated and public comment is limited only on matters of the jurisdiction of the health commission. the health commission's next regular meeting on june 21, 2022. we thank you for joining us. >> thank you secretary morewitz. the please call the next item is approval of the commission meeting three weeks ago on may 17. commissioner you have the minutes before you. after reading them if there's no

amendments do we have a motion to approve? >> move to approve. >> second. >> second morewitz do we have any public comment? >> there's nobody on the line. commissioner giraudo. >> yes. >> commissioner chung. >> yes. >> commissioner chow. >> yes. >> commissioner green. >> yes. >> and commissioner commissioner bernal. >> yes. >> the item passes. thank you. >> all right item three is the director's report. we have director of health grant colfax. >> good afternoon president bernal and good afternoon commissioners and dph team and anybody from the public watching. director's report just a few items to highlight here, actually quite a few this week starting out there's the covid update and we will turn that as the next item after the reports but just a couple of things around dph. on friday june 3 dph

recognized genviolence awareness day. unfortunately more salient than ever. staff at zuckerberg san francisco general hospital wore red for the day and this was organized by the trauma program and sue peterson and the medical director, and many others that helped. there are a number of community and campus affiliated organizations that joined including the wrap around team, the moms demand action, the unite player, a violence prevention and youth development program. many wore orange and joined the walk across the bridge on june 4 bringing awareness to the unfortunate ongoing issue of gun violence in our

country. additional item excited to mention the expansion of managed care services at zuckerberg san francisco general hospital and the agreement with canopy health is renewed and with this agreement dph will pilot service including natal testing, triage and deliveries and allowing commercial patient who is have selected the physicians group within the network to receive these services there. employees who have selected their medical group through the system and employees selected their own medical groups and can access the pilot services. also next item wanted to congratulate our dph director of managed care who has been accepted to the carol emit scholarship and one of 22 woman

accepted to the class of 2022. a fellowship for women leaders in health which represents private and public systems, payers of health and centers around the country. stella has been a valued member of the dph team and awarded a full scholarship to participate in this fellowship and i want to congratulate her on that accomplishment. turn your attention to environmental health the environmental health team reported submitted a report to the cdc and wnr for publication with cryptoscriedium cases in the city with david avalos and the program was curious whether the lock down during the pandemic would result in a number of reduction of cases. the review of the data suggested this was the case with cases going back up to closer levels after the lock down similar to levels

observed before the covid pandemic response. this has health implications and we look forward to hope having that published in those soon. in the world of publications recognizing the world of the environmental and health medicine research work done in collaboration with ucsf and published the temperature screening of health care personnel is ineffective in controlling david avalos in the journal of environmental and medicine and specific to public health addressing best practices during our covid response. and additional rec recognitions of staff for their work. a key number of staff will be

recognized at the 41st good annual government awards a project of the san francisco bay area planning and urban research awards and recognizing outstanding work and performance in good government, in government work and just as you look at the list of honorees you will see many of our dph staff including those who were so key during our covid 19 response so the awards focused on the efforts across dph to respond to covid 19 and recognizes many of the leaders who were so pivotal to that work. also recognizing the san francisco health network. i had the pleasure of recognizing dph ambulatory care nurses and leaders from the health network select these nurse to

be recognized for their outstanding services in the categories nursing excellence and reduces specializes in classic and vintage car repair in health care. >> . >> disparities in health care. the network couldn't present awards in the last two years and 60 nurses were recognized for their dph services and you will see their names there and pleased see the nurses recognized particularly given that we weren't able to recognize them during the peak of the pandemic and another nurse leader michelle chung is nominate for a faculty award for the 2022 jane bellwet award given to an outstanding volunteer since 2010 and want to congratulate her for this nomination and then you have the link in the director's report to dph in the news. there's

been quite a bit of reporting and in terms of the reporting across dph and encourage the commission to look at that and happy to answer any questions on items i covered or any questions that the commission may have. thank you. >> thank you director colfax. do we have any public comment? >> folks on the line if you would like to make comment on the director's report please press three now and commissioners iolandeed at the last meeting it takes 30 seconds at times for the delay for the sfgtv delay due to the connection so if you don't mind we will have awkward pauses so we're not losing anyone. i will put 30 seconds on the clock. again callers if you would like to make comment on the director's report please press star three now.

all right. commissioners i don't see any hands. >> all right. commissioners any comments or questions for director colfax? . >> i see commissioner chow has his hand up. >> commissioner chow. >> yes, thank you director colfax for your report. i am wondering if it's appropriate to ask or under the covid 19 of the status of the monkeypox in the city? i was just notified yesterday of an acquaintance to my neighbor who was actually inquiry trying to receive treatment at general. i think that has been satisfactory resolved but i have seen there's a number of cases being reported anecdotally at least in the press and i know dph has mentioned there's a one i believe confirmed case in the city, so if we

can getup detdas on this i know the public is interested even though the contagiousness is somewhat less than covid. >> thank you dr. chow and our health officer and director of population health is here to answer your questions and provide additional details in regard to the monkeypox case that was reported last friday. dr. susan philip. >> thank you dr. colfax and good afternoon commissioners and thank you dr. chow for the question. yes, monkeypox is something we want to make sure that the public in san francisco and providers are aware of. as you very correctly said this is not the same as covid 19. the potential for widespread transmission and illness in the san francisco population is not there with monkeypox from what we understand

currently the same way for covid 19. we are working within our health department and population health division to work with providers and give information to the public and providers and follow up when we identify people that may have symptoms consistent with monkeypox to speak with them to facilitate testing and has to happen in two stages and the first at the california department of public health laboratory and people that test positive there are a prabble case. the specimen is sent to cdc and they're the 11s that can confirm a case of monkeypox. it may have change the since the last time i came over here but my understanding we have one probable case. i have not heard it's a confirmed case at cdc. we have multiple individuals we're working with and

potential investigated cases or individuals but we don't have other confirmed cases so the main thing we're trying to do now is make sure providers are aware that people are able to go to their providers and health systems for evaluation and the providers know how to do that evaluation and then contact us in dph for assistance with getting testing done. we are also working with the state to make sure that there is vaccination available. we give post exposure vaccination to people who have been close contacts to people with monkeypox or a probable case of monkeypox in order to prevent ongoing -- a development of infection and ongoing transmission, so the spread, the mode of spread of monkeypox to date is primarily skin to skin, very close contact, and so that really is one of the things that we want people to be

aware of, the mode of spread as well and we know there will be lots of travel as the summer commences and we really want to make sure people are aware of monkeypox and know that we are working on this very carefully with our case investigation and contact tracing team, our data teams and others at dph. >> thank you. i thought we were doing the testing here in the city but you're saying that the testing is actually sent to the state and then from there to the feds. in the meantime are we doing contact tracing? >> correct, yes. we are working with the individuals in parallel with sending the specimens to the state for testing >> and is the vac used as a prophylactic or treatment? i forget. >> it's a post

exposure prove lackis and the vaccine is a smallpox vaccine but a newer formulation. as you recall smallpox vaccine was routinely stop given to the population in the united states in the early 70's but there's a newer formulation that is easier to administer and less likely to cause rash to the people receiving it and that's what we do and to avoid close contacts. >> it's not the treatment but the prove lackis. >> that's correct. for the people diagnosed with monkeypox in rare cases they need treatment and we will work with the state there's a antiviral treatment available but that's in rare

cases and most of the time it's self limited and supported watching as they recover and takes the rash takes team to heal and scab over and they're not infectious. >> thank you. that's helpful. >> thank you. any other questions from commissioners? all right. seeing no hands i think we're -- >> [off mic]. >> there are no other hands. >> all right. seeing no other questions or comments thank you director colfax. we will take the next item and taking the agenda in a different order. the next item for discuss is the laguna honda hospital regarding the recertification process and transfer and patient plan and related issues. for this presentation we have dr. roland pickens of the san

francisco health network. >> please bring up the presentation. >> good afternoon director. >> good afternoon commissioner bernal. can you hear me okay? >> [off mic]. >> hello. okay. good afternoon commissioners. roland pickens director of the san francisco health network and the newly appointed interim ceo at laguna honda hospital. so it's my pleasure to share with you an update today and there's two updates in one. first we will go through an update on the recertification process for cms enrollment at laguna and then into the cms required closer, transfer and

relocation plan. next slide. so the primary thought i would like to share in which we have been emphasizing throughout this process both at laguna and within the community is that recertification within the cms program is our highest priority. in addition, our priority is to keep laguna honda hospital open so it can continue to provide the care that it provides to some of san francisco's most vulnerable populations. in an effort to do that we worked at warp speed with city leaders and departments to issue emergency contracts to bring on expert consultants to help guide us in this work. these consultants initial focus is on the

recertification process. in addition, they're also doing a top to bottom assessment of laguna honda in terms of its organization, its culture, its leadership, how it is governed and how it goes about delivering high quality care. in addition we're also those consultants are also providing expertise in terms of the recertification process and cms regulations, and they're two consulting groups. one is health services advisory group. the other is hma health management associates. next slide. so in terms of our path to recertification we're currently within this first period which actually began immediately after april 14 when the

recertification occurred. we started taking corrective actions then and have not stopped in that process but since our consultants have come on board they have been on the ground about a month now, and they have really injected themselves into the fabric of laguna honda hospital. they have been throughout the entire organization interviewing staff, making observations, doing real time course correction in terms of seeing any gaps in cms regs, and doing a lot of teaching and training and reeducation of our staff and it's only the beginning. we anticipate that level of support from the consultants to remain throughout the entire engagement. in addition, we've had a great partnership with our labor unions. they are at the table with us, very involved in following along our journey towards

recertification. next slide. so we're at the beginning of the month of june. in terms of the initial assessment that our consultants are doing we expect to have a report from them due in the middle of june which will really serve as a baseline of the observations and the assessments that they have done since they have arrived at laguna in may. this will be a jumping off point how we proceed in our journey recertification. they will share us with their findings how those findings then map to the hundreds of different cms federal regulations, identify gaps, develop corrective action plans to fill those gaps, and at the conclusion of that process they will

do a facility mock survey. that is scheduled to happen end of june, early july and in that process the consultants will actually serve as a mock cms surveyors and actually put us through the actual process simulation of what the cms survey will be. as a result of that we anticipate there will still be findings and gaps and in fact we encourage that because we want to know, we need to know what those are, so when we do finally sit for cms recertification we have assurances we're ready and we should be successful so after that initial mock survey in june there will be an implementation of corrective actions and the period to make sure those actions

are being followed consistently, and then there will be a second mock survey in august, and the purpose of that mock survey is again if we missed something or something new has emerged we want to go through that cms mock survey a second time to make sure we've not -- we've left no stone unturned and there should be no surprise when is we finally sit for cms recertification again, so next slide please. and so the plan for submission as we understand it right now based upon the schedule is that we plan to actually submit that application for recertification in august of this year, and again that's after the consultations, after the first and second mock survey and then the continued plan do

check act to make sure all the corrections are baked into the normal operations of the facility and at that point we be in september when we submit that certification application. then the ball is in cms's court. at that point we will be within the window where cms and we hope they will come quickly after pee wee submit that application to come and conduct the. >> . >> recertification survey. and it's important to explain that the cms recertification survey is actually a two part survey. we expect them hope hope -- hopefully come for the first survey and go over the requirements for participation. we are anticipating that's a successful

survey and put us in the 90 to 120 day period called the cms reasonable assurance period, and the way that works is when cms comes to do the first survey and we amount we will be successful they want to make sure whatever changes we made were not just quick fixes and won't last. they want to the institution to show it's made sustained and profound changes to meet cms guidelines. so after that period of reasonable assurance that 90 to 120 day period cms will come back to laguna again and again unannounced and then do the second and final survey for recertification, and again our expectation is that we will be successful and pass and at that point

regain provide a participation in the cms programs. next slide. so this is a visual of the timeframe i just went over. you can see it starts at step one which was in april when we were first decertified and immediately started implementing corrective actions. we brought on our consultants in early may. they have been on the ground for about a month now. they are continuing that assessment process. as i stated if you go on to then step number three we're anticipating having that first mock survey at the end of june. we will identify gaps, implement corrective actions. then in august we will do the second mock survey. at the end of

august, early september we will submit the application for certification by cms and at that point in august the ball is in cms's court and when they come for the first survey and start the reassurance period and then come for the second survey so you see we have a lot of work ahead of us. we started that journey a month ago and have several months to go in this recertification process so that's just a brief discussion of the recertification process and next i will go into the closure patient transfer and relocation updates and then we will be happy to entertain questions that you might have. next slide. okay. one more. so as i mentioned we're actually involved in

two separate and distinct processes yet related processes, so by virtue losing our cms certification participation status the cms rules require that when an institution is decertified it must formulate a closure, patient transfer and relocation plan. laguna honda fulfilled that obligation by formulating a plan submitting it to cms and they approved the plan on may 13, and it's important to note that with approval of that plan came a commitment for extended extend payments. cms indicated they're extending payments for an initial period

of four month with a possibility of two month extension and takes us essentially to the month of september. it's also important to note that the continuance of this funding is also contingent upon laguna honda successfully implementing the closure, transfer and relocation plan which i will talk a little more about. next slide. so again this cms required mandatory closure, transfer and relocation plan has six essential steps to it. the first step is notification to our patients and staff that we were decertified and of course that notification occurred immediately at the end of april when this transpired. we

notified both our patients, their families and our staff. the next step is actually a pretty big lift. that step involved assessing patients for safe transfer or discharge out of laguna to other facilities or discharge destinations and that's a herculean task. it involves a multi-disciplinary team of professionals and give a assessment to all patients and physicians and nurses and dieticians and everyone comes together and do a real time assessment of each patient. they involve the patients and their families in this determination. they meet with staff all the members

of the care team and they use this assessment information to then begin the process of searching for an available appropriate discharge destination. in most cases that will be another skilled nursing facility for those not facility with the terminology snf so that process began several weeks ago. we have a very robust team involved and actually trying to identify open skilled nursing facility beds both within our community and beyond. next slide. so i talked a little bit about what that assessment process is like. again it's very comprehensive, very time consuming. again we want to make sure that we've captured the needs of each

patient and trying to kind a skilled nursing facility equipped to serve the needs of those particular patients. next slide. so as you can imagine it takes a team to really make this process work, so in addition to working with other skilled nursing facilities there are also some patients who may no longer need a skilled nursing facility level of care and perhaps can be discharged into the communities or even go back home if they have the appropriate support services. in that regard we're also working with other agencies within the county, the human service agency, who provide in home wrap around services. we're working with ems agencies and coordinating ambulance transport as patients need to move to laguna to their

next destination and again we're working with snf. there are 15snfs within san francisco. we're in daily contact with all of them. there are several hundred snfs in the bay area and as you go beyond the bay area into california there are approximately 2,000 skilled nursing facilities and we're in contact with all of them for search for available beds. next slide. so this is some of the preliminary information that we have to share with you, and this is through may 31, so there's a little lag in the data but we will be working with the team to see if we can expedite getting these reports in the future, but if you start really at the bottom i will orient you to this chart, so it says "week one." that was

may 16 through the 22nd and week two may 22-27. you see at the bottom the respective patient census on those dates and as you go back to the top those are categories of discharge destination so if you look at that chart you see under communities there were no discharges to the community in week one but if you go over to week two there was one discharge from laguna to the community and an individual who was able to be discharged back home so that was a good outcome but as you can imagine that is one of 677 at the bottom so this gives you a flavor for the task ahead of us and while we're making contact with the 15snfs in san francisco and the

hundreds and thousands in california we're having a challenge finding beds for our laguna honda patients. next slide. again here's another graphic just to give you an idea of just some of the progress and again this is only through may 27, so there's been more progress since this, and we'll share that with you in our next update, but the blue bar represents placement assessments, so again those are the assessmentingses that have to be done for the patients in house and through may 27 we did 205 of those assessments. of that number 100 family patient meetings have already occurred, and of those 83 laguna honda patients of

referred for discharge referral, transfer to other facilities. we're still awaiting response from those other facilities in terms is there a match between that facility and the individual needs of those patients? and it's important to know this is an iterative process. when we send the referrals over oftentimes the referring facility will require additional information to help them make a decision. do they have a match for that patient? also if they do then that referring facility has to come to laguna and meet with the patient and the family and make the arrangements for the transfer with the support of the staff at laguna. next slide. again giving you just some of the statistics so i talked about our contact with other skilled nursing

facilities. this puts some real numbers behind those. you see each week we contact each 15 facilities in san francisco, the number of calls we made to those snfs in san francisco, and then the next middle rows represent the calls and contacts of the number of facilities that we contacted, 482 in the first week, 1,095 in the second week and the number of phone calls made and again you just can't make one call. you have to call everyday because the status changes. as with any hospital you have admissions and discharges so it's a constantly moving target. next slide. and this is a picture of just what we're finding in terms of bed availability, so again for those two week periods in may

at the top represents those in county of san francisco facilities. the first week we called all 15 snfs and found out there were 11 open beds available but it's important to know if you look above 11 you see zero and zero. that first row represents an available medi-cal bed. the second row represents an available medicare bed and that's important because 80% of the patients at laguna have medi-cal, and so the way most snfs work for their business model they a portion the payer mix of beds in their facility, and often will limit the number of medi-cal patients that they take, so while there were 11 beds available there were none for the majority of patients that laguna cares

for and you see the similar information for out of county which basically means all the snfs within california so in the first week there were 1,000 available beds. of those only 53 were for medi-cal patients and 157 for medicare and the following week there were no medicare and medi-cal beds available among the facilities that were contacted throughout the state of california. having said that we are expected to and are truly doing all we can to implement the closure plan. again this is a requirement from cms. if we expect to continue receiving that initial four month and then two month continued payments we have to show progress, so while we've only moved had one discharge

during that period we are aware of others that are actually in process and do know that these numbers will begin to increase, but the task ahead of us is big. prior to this meeting we were on a call to the state of california enlisting their assistance from the department of public health and health care services. we are actively partnering with them and discussing how can we add additional resources, a different actions to improve and increase our discharge and relocation numbers? and so there's still a lot more work to do and we will continue to come back to the commission and keep you informed as much as possible so that concludes my presentation and. i am

happy to try to answer any questions that you have. >> thank you director pictins. secretary morewitz do we have anybody on the comment line? >> we do. if you would like to comment on this item press star four to make a comment and we will wait 30 seconds to make sure you get this message. >> . >> again press star three. okay. there's no public comment and -- oh

sorry. >> commissioners any questions or comments for director pickins? >> commissioner chow has his hand up. >> okay. commissioner chow. >> thank you for a very extensive discussion of the process that's going on here. in the recertification the reason assurance period are we going to run into the same thing that during the second survey any minor findings versus major findings that would not normally cause a decertification will however disqualify us again? >> so i will answer that by saying i'm not exactly sure. what i do know is that during the recertification process we will be evaluated

on whether or not we meet the cms regulations. if it's -- whatever that regulation is and how one might characterize it but if it's a regulation in terms of infection control and prevention our staff wearing ppe appropriately you know that definitely is a standard and it will be subject to the interpretation of the surveyors as to whether or not laguna can submit or has processes and documentation that shows that we comply, so again as you're very well aware as a former surveyor yourself there are hundreds if not thousands of standards and particularly for certification survey. it's really like being surveyed for the first time so it will be one

would consider more stringent than normal review process and starting from scratch. they have to do a top to bottom survey of laguna in terms of every aspect of its operations that is covered by the cms rules and regs. >> so i believe the last time you had discussed that there could also be other than the clinical side that is involved in the recertification because it's not really like recertification. it's like starting a new institution and there might be state or federal measures to meet in regards to building compliance and all. is that still true? and is that also being handled? because

these two consultants are really looking at the services being delivered. >> yes. thank you for the reminder about that question before, so just to clarify so there's still an open question as to since this is an initial -- being treated as an initial survey will laguna honda be held to the building regulations that are currently on the books i believe adopted in 2019? versus held to the standards when the new hospital opened in 2010? because those standards are different in relation to how the building must be configured, for example patient rooms. how many patients can be in a room? how many patients can share one bathroom facility? that question has been on the table for several

weeks. we week with city dph weekly. they like us have posed that question to cms, and i believe we're still waiting on the answer although we continually ask for an answer to that question, but while we're still waiting on their answer we're still doing our own due diligence in terms of working with our consultants and our facilities engineering teams to assess if we are held to the current standards what changes or modifications will need to be made so we can still pass the certification survey? so we should know more soon but i think we're in the best place we can be given the guidance we have gotten so far from cms. >> very good. you mentioned we were working with consultants on that too. were they separate consultants? >> they're the same consultants.

>> okay. in the transfer plan during this period of time and doing due diligence you obviously conformed do we need to go out of state and what happens if we actually don't find space for a number of these patients because many of them don't really need what the long-term snfs do? >> great question dr. chow. obviously our priority is to look for and identify potential transfer discharge relocation to areas closest if not within san francisco, so that's why we've taken this concentric approach. start with san francisco and then go to the nine bay area counties and

then california wide in terms of search, but we do know that our obligation is to exhaust all avenues and that will mean looking beyond the state of california because again right now the uptake has been very slow, but we must show progress, not only in attempting to make referrals and discharges, but we actually have to effectuate some real numbers of transfers, and so we will be reevaluating what we're doing and making changes to the process so that the next time we come there will be more progress to report in terms of actual discharges and transfers. as you can imagine you know if we had our way we would like for our patients to stay but unfortunately that's not an option

available by cms. they made it clear our funding is contingent upon actively discharging and placing patients, so we must proceed with the plan, and having said that we again are in collaboration with the state, department of public health, and they in turn with cms to ask for their assistance so we're not doing this on our own but it's clear the burden is ours as the provider, but we also need and must get their support just given the enormity of the situation and the volumes of patients that we're dealing for and the complex care that our patients require. >> all right. i just have one follow up question on that and what are the patient rights and

what if the patient refuses because they don't want to go to connecticut and have a feeding tube and other needs that only this place in connecticut can take care of? >> another good question. so as you know dr. chow having served on the laguna honda joint conference committee there is a normal discharge appeal process that happens in normal times. that appeal right still exists for the patients at laguna. there's a proscribed discharge appeal process that patients may avail themselves of. that process is run by the state, not by lagun a we provide information to inform the discharge hearing officer when he or she makes their ruling but patients have that right so we have

to factor that into our planning knowing that some patients may exercise that right so we have to account for that in terms of the resources we're putting forward to actually begin to make some of the discharges happen and show actually movement again so that we do not endanger losing that extended cms funding. >> thank you we will look forward to the continued reports for us and the great work you're trying to do to meet all the regulations and getting us recertified. thank you. >> thank you commissioner chow. vice president green. >> thank you. i want to thank you and the team for the remarkable work you have done in this short time to know that you did an evaluation of 205 residents especially with the complexities involved not only a

testament to how the team at dph is taking us and the remarkable work you do with a terrific team can you project -- e lab grat on the issue and another one is easier to manage before we can complete our work. in other words to what extent are we disadvantaged by steps to move residents or the competition for the obvious minimal number of beds in the country i suspect much less proximal to san francisco? >> yeah. so great question, and the

sentiments you expressed are exactly the challenges that we have before us right now and we encounter it everyday during this process, and in fact we had that very discussion just an hour ago with california department of public health and department of health care services. i think all the parties acknowledge the challenge and at the same time remind us that we don't have an option to not comply and c dph is at the table. they're in dialogue with us. they are marshaling some resources on their side and we're in the process of figuring out how we can collaborate better together and where we can use their -- not only their expertise but their power to have discussions with other

facilities who may initially say no but if the state calls maybe they will say yes and if cms calls maybe they will say yes so that's something we're actively engaging with those partners on and we'll continue to push for that because again the task is enormous and we cannot do this alone. >> thank you very much and i would hope that cms would really come through to kind of help some of these very difficult triage situations. >> thank you. >> no other hands raised commissioner. >> thank you vice president green. director i have a few quick questions and just to clarify is availability of medi-cal or medicare certified beds regularly assessed at all at the state level or otherwise or something we're

creating out of whole cloth? >> i am not aware that the state does a regular assessment, but obviously from our point of view the fact that we're assessing it on a daily basis so we have the actual data. the state hasn't shared that this is something they're monitoring. i think particularly here in san francisco because we've done a lot of research and modeling in terms of the availability of beds. we were well aware when this started that there were basically no beds available in san francisco, and so now we're learning just to the extent that is the case in other counts -- counties and the state and i'm not aware of any. >> in regard to the data we have three weeks of assessments and two weeks of data but to go from

260 beds one week to zero beds the next week. is there even anecdotally we have to explain that swing and shed light on where we expect that to go in future weeks? >> sure great question. we asked that of the staff and it's truly a function of hospital discharges and admissions. you know that changes on a daily basis and hourly basis and it's even more exacerbated when you begin to segregate beds by pay or class and look at the government payors and it's an iterative ever changing flow and i have no doubt when we come back again there will probably be still additional fluctuations in the numbers but as best we can tell it's a function of the health care industry in terms of hospital in and out flows. >> great. thank you.

director colfax. >> thank you president bernal, thank you health commissioners. i just wanted to take a moment and acknowledge and thank mr. pictins for stepping into this role as interim ceo of laguna honda hospital and has a long outstanding show of his work with the hospital and thank the team and he is overseeing during this challenging time. we're making many discoveries and also ensuring we're doing everything we can to successfully recertify and continue to have laguna honda open to serve people in san francisco, so thank you for your work. >> thank you. >> all right. seeing no other comments or questions from commissioners thank you to you and your team for this excellent presentation and look forward to updates and let us

know if the commission can do anything to support your work. >> thank you very much. >> all right. the next item on the agenda is general public comment. secretary morewitz. >> if a person on the line wants to make a comment on something not on the agenda press star three and again it's for items not listed on the agenda. i will put 30 seconds on the clock. last time if you would like to speak please press star three. okay. no hands commissioner. >> all right. thank you secretary morewitz. our next item for action is

resolution honoring lgbtq pride month and it's critical when we see assaults on the rights and freedoms of the lgbtq community that the commission come forward and express its support for the community. i'm grateful to secretary morewitz for his excellence work in preparing this resolution and i would like to hand it over to secretary morewitz to introduce and read the resolution. >> sure. i would like to note this is the first lgbtq resolution that the health commission is going to consider. whereas june is lgbtq pride month a time to celebrate the wide spectrum of individuals that comprise the community and acknowledge their struggle for equal rights in the country and the world and whereas pride is celebrated in june to commemorate a group of individuals mostly transgender and gay men who protested in 1969 following a raid of the stone all inn in new york city and considered a turning point in the

movement for equality and individuals lesbian, gay, bisexual, transgender and queer are recovered to as lgbtq and members of the community are frequently raised with expectations from family and community of being cisgender and hetero sexual and each individual must identify with their identity or sexual orientation. communicate the information to those closest of them and search for alleys in their community. this deeply personal process is referred to as coming out and lgbtq people can be found in every race, ethnicity, socioeconomic class, genderrer, religion, geographic region, physical education level and disabilities and any group of people and around the world they make vital contributions in every avenue of life and profession and whereas throughout much of history of the united states same

gender sex relationships were criminalizeed in many states and many lgbtq people in the united states have been forced to hide their identities while living in secrecy and fear and whereas lgbtq people in the united states face discrimination in employment, health care, education, housing and other areas impacting their physical and hasn'tal well being and whereas the lgbtq community has faced discrimination and inequality and violence in the history of the united states and until 1973 the american contradict association categorized homosexuality as a. >> . >> "don't ask, don't tell" policy which gayed these individuals from the military because their presence would create an unurunacceptable risk and order and discipline. during the tenure bill clinton signed the defense of

marriage act and one man and one women and in the work place housing or public accommodations and 34 states have no explicit ban on discrimination on lgbtq individuals and education and youth have increased risk of suicide, homelessness, victims of bullying and human trafficking and developing behavioral health services issues and 13 states in the district of columbia have policies to profest foster youth on discrimination based on these traits and lgbtq of color are over represented in child welfare and juvenile justice systems and lgbtq in the united states in particular transgender people of color face a disproportionately risk of being victims of hate crimes and many have lost a job because of discrimination and 75% suffered work

place discrimination. these people suffer higher rates of harassment and violence on the job and members of the lgbtq community targeted in acts of mass violence in the united states and thear son attack in 1973 and 32 people tied and the night club shooting in florida and 49 people were killed and lgbtq people around the world are arrested or tortured because of their identity and whereas lgbtq people are individuals of all ages face disparities in the united states linked to social segment denial of human and civil rights. this results in a group experiencing higher rates of suicide and thoughts, mood and anxiety disorders, substance and tobacco use, hiv/aids and related

cancers. hiv/aids has disproportionately impacted lgbtq people in the united states and discrimination during the epidemic and a lack of research and funding for prevention and treatment and whereas compared to the other groups lgbtq people are less likely to have health insurance more likely to not seek care and culturally competent care and unlikely to report bad care by providers and there is data to needed to ensure the health of all lgbtq in the united states and including those in san francisco who remain visible without diversity to represent the groups needs and 2013-15 the united states supreme court reported in two

cases that same sex couples have a constitutional right to marry and the defense of marriage act was unconstitutional and in 2009 president barack obama signed the matthew shepherd hate crimes act and protect all people in the united states moat crimes motivated by this and the u.s. supreme court confirmed the employment laws based on discrimination and gender identity and whereas after world war ii thousands of military veterans who did not fit so society's normity came to san francisco and instead of returned to their hometowns and two groups were founded in san francisco -- and

whereas the tavern guild the first gay business in the united states was founded in 1962 because of raids of bars and three years before the riots individuals rioted in the tenderloin against police harassment and brutality and this is at the heart of the first transgender district in the world here in san francisco and the freedom league advocating for these individuals founded in san francisco and whereas the first lgbtq pride -- and whereas in response to the devastation of the idaho epidemic the lgbtq community created a matrix of social programs and partnered with the san francisco department of public health to develop the highest quality of research, prevention and treatment programs. we're almost done.

whereas san francisco has been home to may be leaders and many professional areas. the following are a few examples of san franciscans many lgbtq leaders. margaret chung first female physician. del martin and phyllis lion and lesbian couple and activists who founded the daughters of we lightis. rosinin. hairy hey co-founder of the [inaudible]. jose first openly united states president candidate in 1962. harvey milk first open gay politician in california. -- san francisco department of public health deputy of health. -- >> creator of the lgbtq rainbow flag.

lee jones co-founder of the aid foundation and aids quilt. -- harvey milk and a founder and tom waddle founder of the gay -- theresa sparks transgender activist former president of the san francisco police commission and past executive director of the human rights commission. barbara may comran, lgbtq indian activists, roma guy, activists and san francisco health commissioner. -- eachly gay man elected

to the u.s. senate and two gay man to serve in the assembly. hairy brit former president of the san francisco board of supervisors who introduced domestic partnership legislation. david campos latino former supervisor founding member of member -- the san francisco department of public health has lead by four lgbtqs of health. whereas the san francisco health commission may be included lgbtq individuals and individuals living with hiv since its inception and the san francisco health commission somed the lgbtq community throughout the history

and approved resolutions of lgbtq budgeted items and supported the san francisco department of public health programs serving this committee. now therefore be resolved that the san francisco health commission recognizes pride month as an important time to celebrate the significant contributions of lgbtq individuals to the history of the united states, the history of state of california and the city of san francisco and the san francisco health commission recognizes that lgbtq communities unharness the diversity and strength know the city of san francisco and further resolve that the san francisco health commission supports efforts through policy, legislation and social health and programs and data collection and shared community values to ensure that san francisco is a beacon of hope for lgbtq people around the world. >> thank you. do we have any public comment on this item? >> there's no one on the line. >> all right. commissioners before we go into comments or questions do we have a motion to approve? .

>> i move to approve the resolution >> and a second? >> second. >> all right. commissioners, comments or questions on this resolution? >> commissioner chow has his hand up. >> commissioner chow. >> sir you're muted. i will unmute you. >> thank you. i also wanted to thank secretary morewitz for putting together this very comprehensive resolution on pride month and on a number of our esteemed lgbtq leaders. i didn't realize as we were reciting and we left out and i hope we can amend by adding in jim foster who was a health commissioner and in fact the first openly gay person to address the

democratic convention, maybe all conventions. if we could write the appropriate a trubugs but i believe it would be an honor for this resolution to also include another one of our health commissioners who distinguished himself nationally. i would like to make that amendment. >> all right. commissioners is that amendment acceptable as a friendly amendment? >> yes. >> yes, but point of order president bernal. i think we need to have a second for the amendment. >> sorry. do i have a second for the amendment? thank you. is there a second? . >> second. >> second. >> okay. thanks. okay. friendly amendment proposed and accepted.

>> there are no more hands up commissioner. >> all right. actually i have a quick friendly amendment i would like to offer as well and apologies to secretary morewitz for not pointing this out sooner and looking at the whereas clause in 2009 president barack obama signed the act and i would amend to say in 2009 congress passed and president barack obama signed the matthew shepherd act and james bird act. is there a second to that amendment? >> second. >> commissioners chung and giraudo. >> yes accept. >> all right. thank you. >> i accept. >> all right. seeing no other comments or questions i would again like to thank secretary morewitz for your diligent work on this

resolution. that is really fantastic retelling of both the leadership and the challenges faced by the lgbtq community in san francisco and the continued work that needs to be done. with that we can move to a roll call vote. >> commissioner giraudo. >> yes. >> commissioner chung. >> yes. >> commissioner green. >> yes. >> commissioner chow. >> yes. >> and commissioner bernal. >> yes. >> the item passes. thank you all. >> great. thank you very much. our next item for action is a resolution making findings to allow teleconference meetings under california government code section 54953(e). secretary morewitz. >> commissioners this is the same text that you've gotten for months now. this allows if you pass this this gives you authority to meet in hybrid fashion. this is standard and you all pass it every month i believe for the past few months and prior to that it was similar

language for remote meetings. i am happy to answer any questions. >> all right. commissioners do we have a motion to approve? >> so moved. >> second >> and there's no one on the public comment line so i will do a roll call vote. commissioner giraudo. >> yes. >> commissioner chung. >> yes. >> commissioner chow. >> yes. >> commissioner green. >> yes. >> and commissioner bernal. >> yes. >> all right. that passes. thank you. >> all right. our next item is an update on mayor's june first 2022 proposed budget for fy 2022-23 and fy 2023-24 and for this presentation we have jenny lovie dph chief financial officer. >> alyssa please pull up item 8. >> hello commissioners. jenny lovie cfo. i'm pleased to present to you the

changes in the budget. slide. over all when said and done the proposed budget is shy of 3 billion and if you look at the budget book it's 2.9 999 and steadelling the edge and you see the allocations with the departments and the divisions that we have. it's represents $175 million increase compared to the current fiscal year . this is about a 6% increase when talking about billions but it is still significant increase nonetheless. next slide please. included in the mayor's budget in addition to our february proposals which i am pleased to say that the mayor's office accepted and has included as part of the june 1 budget includes several changes including continuing our covid 19 response, expanding hiv and

prevention and helping victims of violence and continuing of the legislation and continuation of the tenderloin center and investing some of the equipment needs and supporting cbo organizations with a cost of doing business. in addition layered across all of our divisions is a wage increase for city employees also 5.52% and it's challenging to see the exact value of this, but if you look at our -- 1.4 billion it's 75 million give or take. it's not perfect but a rough estimate sort what is driving some of the increases compared to the current year. next slide please. so diving into more of the details the mayor's office does continue to step down of services over the next two years. we have a total budget of 53.7 million for covid response as well as the san francisco

health network operating functions which we've had over the last two years, so that's the first year of the budget and the second year of the budget we keep $25 million place holder to be detailed as part of next year's budget presentation. as commissioners know it's been challenging to figure out exactly what our response over the course of the year will be and rather trying to make a guess we have a place holder and we'll revisit that in a second here. part what is driving the reduction and the step down is not only the work we have been doing to be prepared and we have baseline level of infrastructure and services as well as vaccines, home test kits available is that federal funding is being reduced. fema reimbursements will be limited in scope. we expect to be reduced to 90% as opposed to 100% of cost and as such expire in december 2022. our response as always will continue to evolve and work with the mayor's

office and the controller's office to seek additional funding and opportunities as they arise, and so what the budget before you here represents what our baseline level of services are, but as the commissioners know we have the response has evolved over the course over the last several years. next slide. going into a little bit of the basis for the estimates for the 57.3 million. 37.2 is going to covid response, 12.3 is related to testing this. gives a baseline level of 2,000 tests through pop up and mobile events and retain additional 1500 tests at our almena site through december 22. on the vaccination side we have 7.5 million and this will give us baseline vaccination levelings about 2400

vaccinations. again through pop up visits and a focus on priority neighborhoods to close equity gaps. our covid disease response unit of 1.8 million continues. the case investigation [inaudible] and outbreak management functions that we provided for certain settings including congregate settings and schools. the community engagement equity we have a baseline of 2.8 million to continue to coordinate efforts around prioritized populations. i will know that the budget does not continue about 25 million in one time funding for cbos we're receiving in the current year. we're working with the organizations to roll over unspent dollars to continue services for as long as we can we will seek out other opportunities as they become available. under isolation and

quarantine and this is based on the hotel voucher exploring a static site and a portion of the funding will go for coordination as well as clinical support for residents that may require isolation and quarantine. the shelter in place hotel services it's $300,000. you may wondering why the amount is so small. we are providing services on site through december of 2022. as commissioners may recall the hotels are being managed by the human service agency and the department of homelessness and supportive housing. they're planning on converting these sites to congregate shelter sites so they're no longer covid specific sites so we will continue our service and presence in a day way but it's understand under this covid 19 response. for surveillance we're continuing a million dollars for epi and all the data

reports that gives line and sight in terms where we with the pandemic and we have task force and logistics and 7.9 million and it includes rent to house all of these functions that we don't have existing space for as well as the information guidance section logistics, operations functions that we have including finance and cost recovery which will continue, human resources to support these additional staff as well as supply management at dph. next slide. on the health network side we're continuing to invest in recognizing that our operations have changed as a result of covid 19 and the mayor's office puts 11.6 million as to increase staffing versus maintain access to services and to meet staffing ratios and regulatory requirements. we also supporting the

monocleddial antibody clinic and maintaining the occupational health clinic and supports all dph staff and guides when we're exposed or perhaps test positive. last but least is a testing site and vaccine site for dph staff and san francisco health network work and laguna honda for staffing and includes support for outbreak management in this congregate site and infection control and testing of patients as well as staff and security and enhanced sanitation protocols. within primary care additional staff to support vaccinations and increase in staffing for the call center which supports the consult on the use of therapeutics for clients. next slide. in addition to covid 19 the mayor's office invests in other areas of dph and

includes $3 million of hiv prevention getting to zero. again this was our plan to have a zero new infection zero deaths and zero stigma around hiv so the mayor's office is continuing our commitment and making an investment there. this is in addition to our existing programming that we have. the mayor's office also continues the tenderloin center operations for six months 10.6 million will bring us to december 2022 and supports services ongoing through one time use of proposition c funds. we have $500,000 to comply with the rent contribution standards legislation which is legislation that caps the limit of residents contributions when they're living in permanent supportive housing to 30% of their income which is great for the clients but when we gap their

contribution the cbos take a hit in terms of loss revenue so this $500,000 is meant just to restore them and not create a negative impact as a result of this legislation that supports our clients. the mayor's office also invests $400,000 for language accessible services for victims of violence and then 10.7 million annually for the community based organizations cost of doing business and last but not least the mayor's office invests in moving it and it equipment costs with capital projects and related to all dph's facilities including zuckerberg san francisco general hospital and clinics across the community and health facilities that we'll acquire through bonds and future financing options. and this is spread out over the course of the year and a

continuing project and available for us to use because for the bonds capital cost are eligible but there's additional one time costs such as moving it and equipment that is not considered and so we're grateful for the support in our facilities and ensuring that we have world class facilities for our clients. next slide. in addition we have received some updates between since now and february so we updated our baseline revenues for this and add funds both years 38 million of potential one time settlements. we have one time increases through september 2022 and increases in the global program and patient revenue of 10 million. for behavioral health services we have 15 million in the first year dropping to 5

million and based on short fall of medi-cal projections. next slide. in terms of next steps the mayor has proposed her budget. now it goes to the board budget and appropriations committee and the first one is next thursday and we'll have a follow up hearing on wednesday june 22. at this hearing they will introduce any changes recommended by the budget and legislative analyst. on june 27 the committee is expected to complete its final deliberations and send a budget to the board, to the full board in july for review and we'll continue to update the commission as this process unfolds and i am happy to answer any questions commissioners may have. >> there's no public comment, no one on the line commissioners and i don't see any hands. >> no hands? >> no commissioner hands. >> all right. well thank you for that

excellent presentation. excellent and thorough presentations and no questions. >> thank you commissioners. >> thank you. all right. our next item on the agenda is the dph lean update. for this we have dr. lisa golden who is the director of the dph kaizen promotion office. >> good afternoon. can you hear me? >> yes. please pull up item 9 presentation. >> good evening. it's an honor to be here i believe last time we were here was before covid so it's been a while and it's fitting coming out of covid and k po has been involved in that area and coming out of the pandemic we provide you with an update and

thoughts on moving forward and some plans on moving forward so today is really going to be about a review, looking back a little bit and forward a little bit and overview as well and sharing some lean concepts. next. okay. you have seen the the north triangle before and at the bottom is our mission, protecting and promoting health and well being for all in san francisco. now the top is what we hope to achieve and making san francisco the healthiest place on earth and in between are the true north pillars and we talked about them last time, remember? so i won't ask you about it because you know it but i will ask you what is behind the orange box? do you guys remember what is behind the orange box? it's kind of like let's make a deal. what is behind the orange curtain and a little cheating because i

think you guys have the slides. okay. go to the next slide. so before the orange box are three core principles of lean. they're align, enable and improve. and they're highlighted on the triangle because the work can be encompassed under those areas and it's not a set of tools and if you think like that like some organizations do they're less likely to be successful. it's a mindet, a set of behaviors that change culture and help an organization to be successful so i will talk about our work in the context of three core principles. next. the first core principle is align and align is about creating ultimately value for our people and for the

customers and the patients that we serve. it's really about understanding and delivering on those needs. it's about also having the focus, the perseverance, and the constancy of purpose in order to achieve our goals and lastly about it's thinking systemically so how do we approach things from a systems level? one of the activitys is around alignment is strategic planning and it's something the leaders are responsible for to craft the strategic plan and deliver it. it provides the organization with direction and ensure we're moving in the same fashion and we're all on the same page so as we come out of the pandemic it's not surprising that leadership has foremost on their strategic plan planning and so it's also fitting that the dph leadership was the group that

started the planning in the first place in the fall to set the overall direction for the department and from which subsequently other divisions, the network, ph.d. other divisions can say what is my role and what is my part in doing this work and helping the organization be successful as they do in turn their own strategic planning? so these four key strategic initiatives are here, achieving health equity through community health model; improving health outcomes for people experiencing homelessness; also hiring and developing our diverse work force, and then improving with data to enable and align that comes into idea as an acronym so those four strategies are the priorities for this coming year, and as you can see

here they're in these format but in various stages of development and we hope to be able to share that with you over time. next. so the network in turn took what the department had decided upon and had their own strategic deployment this past spring taking into account what the priorities were for the department. they set 3-5 year goals and they're improve access and flow, decreasing over dose dates lining up with what the department is looking at. >> >> and effective managing revenues and expenditures. now the goal for them now moving forward is to look at some root causes around each of the different areas to then parse it down into specific 12-18 month initiatives and move from there, so that's the work they're going to be doing in the next couple of months.

next. so one of the things we strive for is both horizontal and vertical alignment, so that means that when the department sets their priorities each successive level in the department takes that into account and look at their role in achieving that goal and increasingly becomes operational as they move down the line, and you can see here the overlap in the color coding between those different levels. you can also see it's a work in progress, and that it's never going to be 100% alignment because there's going to be areas or priorities that are specific to one specific level itself. and also you will see here some of the motions scheduled for this year and cascading down and

when we focus horizontally and vertically we're more likely to be successful. next. so that align and talked about improve as one of the second core principles, and improve is about focusing on the process. we know that when we focus on the process we're must have more likely to be successful and that the outcomes will come as a result of focusing on the process. we also want to embrace scientific thinking and we use a3 thinking as the approach that we work on and developing a threes looking at root cause analysis and thinking about matching those root causes with the root counter measures because i know we all have been in a situation where we came up with a counter measure that didn't actually match the actual problem. how many of you guys have been in that situation? or maybe you fell in love

with a counter measure and you were waiting for a problem to go along with it. that's the other thing that also happens so problem solving is a key area but along with that sustain that work we need a daily management system and that system consists of four areas -- five areas i should say and those include team huddles so how do we engage front line staff in this work and set a certain level of accountability? it's also about eventual management so how do we service in a transparent way the issues to see if we're making progress and looking at standard work. the best known way currently of doing this work and tiered reporting which facilitates flowing of information up and down and aligns targets and goals so those read five areas and on top of that is develop our people, very importantly so i will talk about examples of

that work precovid and some of it during covid. next. so here's an example of problem solving so before we went into covid we had an hr boarding workshop and you can see in the first picture do you have an idea what they're doing there? what is happening there? they're going to ga ppe and seeing for themselves a staff person is watching the work unfold, jotting down which of the steps are happening, whether there's any efficiencies in that and then bringing it back to the second picture where you can see they're putting down their ideas and post lating some root causes there and saying if we do this what can we then expect? and then in the last picture you will see

it's an accumulation of the standardized work flow and standardization of documents we had to do as part of that workshop so that's problem solving as an example. visual management is another aspect of the daily management system and here's the example is the covid disease response unit and task force so when we first started we didn't have a lot of data and the skilled leads whether the nurse or long-term leads or other leads would branch and hundred dollarsel and the number of breaks there i were following? the number of watch lists they're following? we color coded and are you in red, orange, yellow or green status? and we knew the work for the day. we could trend it and then we could pivot our staff

to different areas based on the needs for the day. overtime this became electronic and virtual and it was great but it starts out with a very manual magic markers and poster process and to the right you see the standard work that was created there. next. so for daily huddles i talked just now about the operational huddle. this is an improvement huddle so before covid the behavioral health services pharmacy staff really wanted to deploy a daily management system and improvement huddle engages front line staff and invites them to proves individuals and steps of change and they work on and in the middle is the metric board and it helps them track whether there is improvement, whether or not they need to pivot or course correct, and then to the right

is the [inaudible] so daily huddles is an important aspect of engaging people in the improvement process and doing daily small tests of change. the next is standard work. standard work i know a lot of people think have many thoughts about standard work but standard work is really just the best known current way of doing the work and it's done -- it's not written by the supervisor or an external consultant. it's written by the people who actually do the work, who are intimately involved in doing the work and understand the details of it, so in this particular primary care example right after we went into epic they realized that epic handles things really different with respect to eligibility, scheduling and registration, and so they needed a different work flow. they needed to understand how the roles really would be

different in an epic environment so you see on the right the eligibility workers who are working on the work flows and the stickers in the left are proposals around the work flows which they finally made into an electronic format to use and then becomes an communication, orientation tool but also a quality of assurance tool in that now we know what is not normal, and it is the basis for which we can actually do improvement work. next. i just want to say a few words about the k po and covid so we came in as consultants and over time many of the kpo team were actually put into leadership positions and you can see some of the branches below. i won't talk about the impact. you've heard a lot about the high vaccination rates, the overall low death rates in san francisco compared to other counties in

the country. the hundreds of guidances and health advisers and faqs and health orders generated but i think it's good to think a little bit about how did we actually achieve those results? what were some of the things that were helpful so we can take them and use them in other situations? so here's examples of some of the lean concepts and tools employed in this. one of them i want to highlight is tiered reporting and when we think about tiered reporting it's not just team huddles all over the place. it's really a coordinated system of huddles where the front line staff huddle with the branch leads who then huddle with the executive task force leads who then huddle with the department leads so there's a quick escalation up and down the line of the work and not only a quick escalation but that at each level issues are being resolved at the

appropriate level itself, so that was a really key aspect of this work. in fact all of the branches put in huddles that were sometimes occurring twice a day during surge times. the other piece i was thinking was important in helping with this early on as developing the branches and trying to understand our roles we really needed to pools to do that and swim lanes and mapping was doing that and if you went to moscone during that time you would have seen on the wall these and branches internally and across branches we were looking at what their specific roles to not do duplicating and avoid over processing and other things. the last thing i will say about this a3

thinking. it's something that we've taught in before covid and i was talking to one of the branch leads about this and said "i knew about a3 thank youing thank you -- thinking and i knew how to write them before covid but during covid i saw the value of a3 thinking" and because of that she had her team write separate a threes in order to do the work and in fact all of the branches early on were required to write a threes to better understand the strategies for attacking those areas they were responsible for. i will say that [inaudible] provides the structure and the framework so that's the what piece but lean actually provides an approach and how do we actually pull it together? how do we operationalize this work especially in a prolonged pandemic the way this one is? but also it provides a

certain level of self discipline and consistency in the mits of an ever changing environment for staff so i won't continue on. i will continue on next. so the last principle is enable and enable is about leading with humility. it's about servant leadership. it's also about respecting every individual and allowing them to express their talent, their knowledge, their skill set but also helping them to develop themselves into being the best they can be. it's also about learning continuously, having a thirst for knowledge and creating a learning organization which is not always easy, but in the end it's about how do we then adapt and become

adaptable and flexible in responding to change, whatever that maybe, so here's some examples of trainings that we did, so the orientation training that we did jointly with hr prior to covid which was a way of introducing front line new staff on the lean basics. we continued to do a3 problem solving. this is a workshop with the leadership they requested and then humble inquiry and the gentle ask of asking rather than telling because no one likes to be told anything and seeing leaders as coaches and developing humility and the last item was the lean certification which unfortunately we didn't conclude due to covid so that's unable looking backward. i do want to take a moment now and look forward. next. what we're

doing here is we're reviewing our curriculum and we're bringing this all in house and we're looking at a tiered approach to training based on your role in the organization, so ensuring first of all that everyone has some basic understanding of lean and a foundation for which to have a common language and approach to doing things, but also if you're a manager then there's an expectation you should also be doing a thinking and know how to roll out a daily management system. we're hoping to provide certification, various levels of certification that is based on your how deeply you train in the organization and hoping to do this both virtually and in person. next. so the next item improve looking forward so a couple things that

we're starting to work on or hoping to work on first of all is this covid task force transition into dph so as we move into an endemic environment what does that look like in terms of the services that we continue to provide? how do we then integrate that into the work we're currently doing and learn from and understand the gap that we previously had in our response to be able to build in better capacity for doing this work moving forward? we also want to be really mindful of partnering with our health systems and our community to understand our respective roles there and also as individuals, individual responsibility particularly during times of surge to know what it is that we are responsible for in terms of having good infection control prevention practices, wearing

masks, or thinking about isolation, and then the second area we're looking at tackling is bhs access to clinics and this line with some of the strategic priorities around persons experiencing homelessness and then the third area we're looking at supporting and talking to roland is recertifying in the cms medicare providing participation program and there's a couple of other things in the pipeline too that we actually need to prioritize for it and whole person integrated care. next. just a couple of things about infrastructure so we're hoping to public convenience or necessity the. >> . >> . >> reconvene the council and strategic body from leadership

that provide direction for the deployment of lean and then as a counter part to that an operational agreement which is the lean alignment group with representation from performance improvement and kpo experts in the network and in the department who come together to standardize tools, the curriculum, help coach each other. certification as well but also to help with cross branch improvement efforts as needed, so those are the two bodies that we're hoping to reconvene and then next -- all right. so i have thrown a lot at you guys. it's a little bit of a whirlwind. i adopt to finish from this quote. a journey of a thousand miles begins with a single step but we say it

starts with a single [inaudible] so thank you. >> thank you. it's good to have a new lean presentation as one of the few steps back towards normalcy for us. commissioners. >> no one on the line. >> commissioners do have any comments or questions for her? >> commissioner giraudo raised her hand. >> commissioner giraudo. >> thank you very much for this comprehensive presentation. my question is for example on the key strategic 3-5 year goals under strategic planning let's look at improve, access and flow and i know on the following slide you've got a number of different areas as well. with this do you know present at the end of this process to

help you really reflect on whether or not the goal was met is the outcome data. i am always very concerned that we take what we plan. we implement it and what is the data, the outcome data of what you have implemented? >> yeah, that's a good question, so for each of the a threes they're required to set a set of metrics that represent their goals for the next year, whatever length of period of time. those are typically not the only metrics that you have to measure in order to resolve the problem so there maybe some outcome metrics that we have to work on but there's also process metrics that we have to track as well, and we don't want to wait until the end, whatever the end

is, so as we set this up we also set up regular report outs that are very much data driven in terms of the template of the report out that people are required so we can actually assess are we making progress? are we stalled? do we need to pivot in some way? so there's i would say an accountability process if you like that allows us to see earlier on then just waiting until the end in order for us to make changes over time. >> okay. thank you. i appreciate that because that is always my concern. >> yes, i totally agree with you there. >> thank you. >> thank you commissioner giraudo. director colfax. >> thank you commissioner giraudo. i just wanted to thank dr. golden and her team for all the work. the lean work -- you also have a lean

team so just to acknowledge that and appreciate how much you and your team have made contributions really during disruptive times and we always know that adhering to the lean work and the principles and the methodologies is so important during those times and often hard to do and you of a great leader and your steady hand is much appreciated. thank you. >> thank you director colfax and thank you again dr. golden. look forward to see you again soon. our next item is the covid 19 update and back to director grant colfax. >> good afternoon commissioners. thank you president bernal. just today you should have received the standard slides in your packet and i will summarize very briefly but i did want to give our director of population health division and health officer dr. susan

philip the floor for most of the presentation to provide you with an update on her thinking in relation to some of the questions the commission asked last week but very quickly in terms of our numbers our hospital capacity remains adequate to care for people with covid. our hospital numbers have been ranging between in the high 80's to just about 100 over the last two weeks and our case rate hovers around 55 per 100,000 so we're not anticipating any radical changes. we're obviously watching carefully and dr. philip will go into detail about that and we're cautiously optimistic that young children are eligible for the vaccine soon and the fda gave approval to yet another vaccine so more tools in our

tool box to address the ongoing pandemic and i will turn the floor over to dr. philip. thank you. >> thank you director colfax. >> thank you dr. colfax and good afternoon again commissioners. i really appreciate the opportunity to come and speak with you about many of the questions that have been coming up and i want to start by just saying i have really appreciated and been grateful for the opportunity to hear from many community members and leaders throughout the city in the past several weeks. we're in a transition period now with covid. in the past two and a half years we have been living through the pandemic. it's been a collective trauma for everyone. i have so much empathy for the concerns that people have voiced to me. san francisco

used the state derived legal authority of the health officer via health order very aggressively since the start of the pandemic and this is included orders that impact the general population. not only shelter in place at the beginning but vaccinations, testing and masking requirements. this began under my predecessor. for the 18 months i have been acting health officer and permanent health officer i have worked closely with the city attorney's office team to issue many orders also. our city lead the country and the state and also within the bay area region. we have lead in using any means available including health order to prevent severe illness and death when it was required. our reasoning for doing this has been that we were dealing

with a new easily transmissible virus with few tools to counter act the potential for widespread illness and death in the city. we didn't have readily effective ways to prevent infection or illness at the time. the importance of masks wasn't appreciated initially and when it was it was hard to obtain high quality masks. biomedical prevention tools including vaccines and treatments and antiviral treatments had not been developed and no clear idea when they would arrive and how effective they might be so our approach of acting early saved lives and san francisco having the lowest death rate in the united states and that's really to the credit of the commission, of the department, of

the city but really every resident in san francisco that did follow the health order it is issued collaborated to take care of themselves and their neighbors. we are now in a different time. cases are high. they are still high although they're lower than during the omicron surge this winter and severe disease relating in hospitalizations is not as high as the winter surge fortunately. we have now readily available high quality in this cases and the 95 series of masks and most importantly we have among the highest rates of vaccination in the world in our city and again everyone has played a part in doing this. people can get their vaccines and boosters in multiple ways including in their homes with mobile vaccinations and speaking with city

leaders including the mayor's office on disability and the director my understanding is that other cities really look to san francisco for that model of delivering vaccines directly to people where they could most use them including people having a difficult time for leaving the home because of mobility reasons or concern for the underlying health citizen and we can be proud of the work that happened to date. i understood today there has been 1900 doses administered by the mobile teams and doesn't count the doses by health at home and by health systems directing caring for the patients within their clinics and hospitals. rapid test and lab base test regular easier to obtain than previous times during the pandemic. people with weakened immune systems who are not protected with the vaccines can get mono

[inaudible] antibody treatment and people that test positive can be treated with antiviral medications and real world support has held up well from keeping people from getting very ill and preventing hospitalizations and including those with underlying medical conditions. what we do understand about the signs of covid and of course we're still learning. this virus still has a lot we don't fully understand and we have to be humble about that but we understand the virus changed over time and our understanding has had to try to keep up with that. vaccines do continue to protect against illness and dates but they don't protect against infections especially with the new subvariants and they're proving more easy to transmit person to person. the very good news, the essential news they do not appear to

be causing more severe disease than prior versions. this doesn't mean that prior interventions like -- this does mean that indoor masking may not have the same community level impact as they did before, not because masks don't work. they do work but because we have to use high quality masks consistently every time we're around each other and the virus will transmit easier. we know that sars [inaudible] two can be present in animals and reintroduced time again and again to humans. we're living with this virus for the foreseeable future and not eliminate it for the reasons i stated nor will we unfortunately reach herd immunity like the beginning of the pandemic we were hoping and enough of the population has protection through

vaccination or after recovering from infection and continue to live with these rates. people have expressed experience covid and i am concerned as well. the impacts after infection that can last for weeks to months. the challenge with long covid that it is something we still need to learn more b it's not clearly defined or measurable so it's difficult to know how we would put interventions towards ending long covid because we don't know how we're doing on a population level. it is critically important that we understand more about long covid in san francisco our department of public health is looking and working to collaborate with ucsf and san mateo health to do a population based analysis between san francisco and san mateo of the frequency of long covid, the outcomes and that's

the kind of discovery and science that will help us understand better the implications are of that particular condition. when we cannot fully control the virus we have to consider a harm reduction approach. public health ethics including via the american public health association and other expert groups acknowledges that there is no absolute right or wrong answer in most situations in public health. there are always trade offs in the decision making and one of the key considerations is the current context of the tools that are available and another important consideration is autonomy and independence in decision making. for example a continuum of ways to address public health issues and if we look just at the example of masking the least invasive way that public health masking that we can influence masking or think

about masking is as an intervention is education so splining how they're highly effective at preventing infections and we have done that at a minimum. next is ensuring masks are available and so we have been working with health and community partners and distributed them ourselves with a focus on equity to make sure everyone has access to the high quality masks. next is a mask recommendation that is in place now. we know that not only are they effective but we're using our accumulated knowledge and position with experts to say everyone should wear one indoors and we have done that as well. the furthest on the continuum is a legal requirement people are masked in indoor spaces. this limits choice. it's most acceptable when not taking such an action would result in significant harm to public health and there are no alternatives that could achieve the same

goal but are less author tearian. the health orders are proceed and extraordinary. most of us never lived like this prior to covid and impacted our daily lives as resident. we must strive the realistic goal with a changing understanding of the science of covid 19, and what we can do as the least restrictive measure that could achieve that goal? i am also -- i would like to finally say i am aware that the pandemic is not over and that we may need to use broad health orders and other measures again in the future. if there's a very different scenario that comes along where there are new variants that cause severe illness that cannot prevented by the current vaccinations or treatment i hope it doesn't happen but if it does we will

need to go back to generalized orders including making mandates and strictly enforced. it's my feeling we should wait and really use something like a health order when we get to that point, and that we're in a different situation for the reasons i outlined at the very current moment doesn't make it any easier for all of us to navigate the changing circumstance. i always wanted to directly address some questions from commissioner chow. thank you very much. some of the questions -- one of the questions was about cruise ships and cases on cruise ships and that there's a number that come into san francisco as a home port and could there be an increase in infections within san francisco? are cruise ships contribute something i want to answer that question

saying we work closely with the partners at the port and with the department of emergency management. we understand there are thousands of people on a ship and potential to have a lot of illness from covid 19 and we saw that early on in the pandemic so we've had close city collaborations and again with our expert colleagues in the city attorney's office who have been invaluable throughout so we had strictly requirements than most of the country for cruise ships and we heard loudly about that from some of the ship operators. we're in alignment with the whole state of california to again have a higher standard for vaccination of cruise ship passengers and crew than otherwise would be required in other parts of the country, so there are cases that occur and out breaks on cruise ships. we haven't had a case in which an instance or outbreaks or cases

caused a significant threat to hospital capacity over overall public health in san francisco so they do continue to be cases. we're not again at this point we're not able to know the exact number of every case. they report some outbreaks to us but again we have no evidence. i am not concerned it's an overall threat to public health at the cruise ships. the second question was related but mask events like the warriors games which occur in san francisco and again i would say they're indoor events where people are gathering and people aren't wearing the masks and so there is the potential for transmission but we have no indication they're significantly adjusting the overall case rates and in fact again we're not really going to be able to attribute specific increases or specific cases to specific sources where they can

occur, and again we're watching as director colfax said and we will adjust and we are telling people we recommend indoor masking as the standard that we're should be following so that's it for my discussion. thank you very much. i'm happy to answer questions that people have. >> thank you. before we have commissioner questions i believe we have people on the comment line. >> hi folks. i see four callers. i will read a statement and you're welcome to sit down because it might be a few minutes. members of the public have opportunity to comment for two minutes. the process is designed to invite input and feedback from the individuals of the community but doesn't allow questions to be answered in the meeting or members to engage in back and forth conversation with the

commissioners. commissioners consider comments from the public when requesting an item and requests. please note each individual is allowed to speak oneself and can't speak for others that can't attend the meeting. i will unmute each of you and you will have three minutes to speak and when you're three minutes is up i will say "time" and ask you finish your sentence and then i will mute you and we will go from there. caller are you there? . >> hi. my name is sara. can you hear me? >> yes, please go ahead. i am putting three minutes on the clock. >> great thanks. i justedded to address in fact mandates and talk a little about myself. i tame conaccurately ill and disabled a few years before the pandemic so i believe i have a unique story and experience to

share. i know very acutely what it's like to have your health completely up ended for one day to the next and that is why i care so much about long covid and the fact that this pandemic has been a mask disabling event. i don't know if you all are aware, i hope you are, but the cdc put out a week ago that one in five americans that contract covid will get long covid and i think it's one thing to recommend and i really hope people will mask but i think as we've seen if you tell people "you don't really need to mask. it's okay. take those masks off" and you're lifting the orders and putting

back on they're not going to take it seriously and even in the bay area i walk into stores i am high risk there is hardly anyone masking anyone and to say okay we can just encourage masking that's not enough. that doesn't go far enough. frankly i think it's a failure of leadership to lift the mask mandates. i think you need to reinstate them and not enough to tell people to mask because they're not doing it. we need leadership because long covid is a very, very serious issue and i worry without strong public health leadership people are going to learn the hard way what i've already done through pre-pandemic that they're going to do things that they think are low risk. they going to get a chronic debilitating illness and they think they did everything right and they didn't because our leaders are failing us so at the

beginning of the pandemic the bay area we like to tout ourselves and say we're the leaders so lead. lead. don't act like masks are the big oppressive tools. they're protectioning not restrictions and please for it is love of god reinstate the mask mandates and two way masking is one of the biggest tools to protect all of us, not just the most vulnerable among us but all of us. thank you. >> thank you for your comments. caller can you hear us? >> hi. am i speaking now? >> you're speaking now. i am putting three minutes on the clock. >> okay. first i wanted to share a story i read in the news had is relevant to covid and long covid. this is a recent story that profiled a man named

aaron and active healthy man before getting covid last year. he was several weeks past the booster shot so theoretically at peak antibodies now and believes he was exposed and a glitch with his train ticket and with employees. all of the mans wore masks but behind the noses and he was in a small room for 20 minutes. since he was inspected and got covid about that and at peak antibody protection from the booster. we went from climbing 6,000-meter peaks and "now outdoors rather get [inaudible] trail head and parks the van for the view and many days doesn't have the stamina to make the drive" and one of likely in the u.s. that have long covid.

i'm glad you're mentioning long covid now and you guys deliberately erased it from the narrative because it complicates the narrative of just "virus or mild" but am disturn said as mask mandates a author tearian. if they are why are they at your meetings? it's for me and not for thee. why are you strongly recommending masks at your meetings then? why not? because we know the answer. because it's not sufficient and you guys need to reinstate the mask mandate now to protect people like the previous caller said when you strongly recommend masks it's not enough. like i said it's estimated anywhere from 30 to [inaudible] covid survivors will get

long covid and 18-64 and 25% of 65% will [inaudible] mask of disabling event and young healthy people are getting lo covid. it's unacceptable that dph continues to down play or not implement the covid protections necessary to actually prevent covid. it's not -- [inaudible] it's not public health to mand date in public cells and the ongoing pandemic. do your job and reinstate the mask mandate now and if you can't there are many of us with public pressure for you dr. philip to resign. you're not doing the public health job. the choice is yours. >> your time is up. all right. caller are you there? >> hi. my name is alyssa.

>> yes, please go. >> thank you for listening. i urge the health commission to reinstate the indoor mask mandate in san francisco. as a newly retired san francisco unified school district teacher i living the life even with covid i can ride muni to doctors and parks and museums. without the mask requirement i rely on bart which doesn't rely -- which does require masks but a very limited geographical range. you can hardly go anywhere. i have underlying health issues which make the risk of contracting covid and long covid terrifying. i have a medically fragile husband with limited mobility and two one year old grandchildren who are too young for vaccines. i must keep

them safe. the country and the world are facing dire threats from all directions. i hope san francisco and the health commission can return as a beacon of home for all of us. thank you. >> thank you for your comment. caller let us know that you're there please. >> hello. >> yes. >> my name is -- hi. thank you. hi. my name is kenny and i am calling and asking to you show the courage that your colleagues across the bay showed in alameda county by reinstating the mask mandates. they benefit us ah you heard from callers about long covid and i heard the risk on

transportation. i am a immunocompromised person and i have a four and a half year old excited to start kindergarten but we're not sure he can because there's no mask requirements in school and she won't be fully vaccinated by the time she's scheduled to start. by that time we will be well into the fall and winter surge and as immunocompromised person if she brings covid to me i am at high risk of sesur outcome whether it be death or experiencing another disabling condition due to long covid. right now the policies make me my life expendable and to say it's authoritarian and too much to ask people to wear masks after i sat through this presentation and you're talking about spending huge amounts of money on covid two

presentations ago and the presentation after that says covid is over. we're out of twhy don't we get our messaging straight? we're not out of it. 20% of the infections will lead to long covid. we need to deal with that and impact our teacher and driver shortages, our shortages of employees everywhere. how it impacts 1.2 million people added to the disability population according to the bureau of labor and statistics in the year 2021. how many will be added in the year 2022? why aren't we doing everything we can to stop the transmission of covid? it's not just about hospitalizations and evening under hospitalizations san francisco is now in a high transmission state which you guys said would be whether we revisit mask mandates yet it's not happening. please reinstate

mask requirements. you're all just one covid infection away from being expendable like me. thank you. >> thank you for your comment. caller if i unmuted you. >> hi. my name is rhea small and organizer in disability action and born and raised in san francisco and lived and worked there for many years and i am very disheartened to hear dr. tipip's comments mask mandates about authoritarian and lack of choice as the previous caller pointed out. your department is requiring masking in the accident and people are social distancing and people are wearing the mask correctly. that is not the case in other areas of san francisco and not in public transit where people ride to get

to essential appointments, to get to work, to get home, to visit family and friends. many of our members don't have cars and depend on public transit and muni has failed to institute a mask requirement and said they will only do it if the department of public health does is it. in this case it's not cutting it. we need an indoor mask requirement and need it immediately. right now san francisco had a test positivity rate of 12.5% which is just unreasonably high. it's getting close as high during the height of the first omicron wave a couple months ago and for many people that means not leaving the house, not taking the bus, not being able to go to school or the store, or having to do all of those things and facing grave risk to our health and lives and i am concerned about the emphasis on the overfilling of

hospitals. that's the only problem that the pandemic is creating. as other callers mentioned one in five covid infections become long covid and anyone that has a chronic illness knows it's not something to take likely or can only last for months. as dr. philip said it can last for years and we don't know there's a cure or treatment ever for long covid. also being hospitalize side incredibly traumatizing. i have a friend hospitalized from covid and years ago and not recovered from being being on a vent later and it's a horrible experience for most people and there is room in the hospital it shouldn't be a rein to bring people into that experience when we can prevent it when requiring it and i think acting like requiring masks is

some horrible authoritarian move when it's one of the easiest and cheapest and effective things that we can do that doesn't harm individuals thank you. there's no side effects. there's no down side to requiring masks and we're urging you to use your authority immediately to enact a mask mandate. >> your time is up. thank you so much. commissioners that's the last public comment on this item. >> all right. thank you callers for calling to express your views. commissioners do you have comments or questions for dr. comtax? >> [off mic]. >> please come forward. >> i have three minutes and when it's up -- okay. go ahead. >> joe here. i have been riding muni all day today between erans and meetings mostly at the wonderful city hall and

wears masks is author tearian is theater of the absurd. when you mandate the mask you're protecting your neighbor from not just covid but colds and flus. some of us have family we have to worry about and the vaccines are wonderful and work against hospitalization and death and kind of okay against transmission but that's not enough when you have seniors at home in their 70s with health conditions like i do. it's not okay to consider non pharmaceutical interventions authoritarian. i think we should consider that a lot more and part of the problem is and i'm going to be nice with this board is the board that controls muni feels that if they impose a mask mandate on transit they're saying

that transit is unsafe so they're in a situation they need you to step up to the plate and lead. already the mta advisory committee and supervisor preston asked you to ask and let me be clear on this. i don't agree a lot with supervisor dean preston but obviously i agree on the mask mandate. we had had -- stephanie and how little i agree with supervisor preston but need the mask mandate for transit and make sure it's a welcoming environment and remove the covid threat not just from covid and public meetings. it's not authoritarian. it's caring and i don't know how i can teach you to care about other people during multiple airborne crisis not just the covid pandemic but flus and colds and i really want to leave it at that.

thank you for your time and thank you for your flexibility and understanding that i was locked out and i came late and speaking to the board of supervisors to pay tribute to the supervisor on gun violate. we need policies and actions, mask mandate. thank you. >> thank you. commissioners comments or questions? . >> i don't see any hands from commissioners. i'm sorry. commissioner chow. >> thank you. i just wanted to thank dr. philip for her explanation. i do think there still is a question as to why we cannot overcome this issue between muni and here because bart has

even previous to the alameda county already put in a mandate that of course does extend through the three counties, and it would seem to me that it's a mandate that would continues to sound reasonable in terms of mass transit so i'm not sure. it sounds like to me that muni is again finding a reason saying well that sounds like it's unsafe there where it's clearly it has the potentially more unsafe than other areas that have much more spacing and i don't know. i know that dr. philip had conversations with muni. is there some reason that muni can't act to act

independently or is that they actually think they will drop the number of people and they don't want to drop them in as much as it seems to me that bart has actually shown the way and actually bart has more space than muni does in the buses so i would ask dr. philip if she has an explanation from her discussions with muni? >> thank you commissioner chow and of course i cannot speak for mta leadership on their behalf but i can tell you yes, i of in discussions with them, and we both express that public health and public safety is important, and so i don't know the exact discussion so i haven't heard anything to the points that you alluded to about those particular concerns, so we would have to hear from them about

that. >> okay. it just seems to me that -- perhaps this is something that might be discussed with the mayor who also controls muni. it's sort of a limited mandate and i do think the public has continue to give some good testimony with at least a very -- what would seem to be a much more vulnerable area well perhaps even the open park or the larger arena in terms of dangers especially to the most vulnerable that use muni so i would leave that to you and dr. colfax to figure out if that is something would make some sense to ask

either the mayor or dr. colfax and perhaps the head of muni perhaps we can come to some kind of agreement that they could put that in like bart did so that's my comment today. in fact thank you also for your full explanation as to where we are going and hope that this will be understood by the public and much of the issue of the mandate becomes almost political and creates a problem where i think your approach so far to ask everybody to be respectful of everybody else i think has resonated with much of the community in terms of respecting

those who do wear masks so thank you. >> thank you commissioner chow. yes, i mean we not only ask people to respect that we're hoping -- we want everyone to wear masks and encourage that wherever we can and that includes supporting and providing whatever assistance we can to organizations that are considering for their own area for their own building or area that they control to require that as well. they're policies that individual organization, agencies, businesses can put into place. >> all right. thank you commissioner chow. secretary morewitz are there other hands raiseed? >> no other hands on this from the commissioners. >> thank you dr. philip. i have to say when i had the opportunity to witness your interactions with the public i found you to be empathetic and confident and inspire the city

with the response to covid and evidence in the data and the result us you mentioned before and thank you very much for, here today and we will move on to the next agenda item. >> thank you president bernal. >> thank you. all right. our next item outearned yearn is the finance and planning committee update which we will hear from chair of the finance and planning committee commissioner chung. >> good evening commissioners. i will try to keep this shorter since we're running a long meeting today. the finance and planning committee met right before the commission meeting and we reviewed a lot all of the items on the consent calendar and include contract report and two, three new contracts as

well as list of sources and also -- actually four new contracts, and after contract reports we had some like discussions and i think that at this point the discussions would come to the commission as well that a lot of the services being expended. it's [inaudible] service but because of the current situation our staff is still like trying to catch up with like [inaudible] and new contracts and so yes, so there is a process in place for that but i think that we need to have more conversations because in addition to that we came across

one of the contracts in the contract reports that will come back next month to have the discussion one of the organizations you know like might have to have like some corrective action plan but because of the important nature of the services and we cannot afford to [inaudible] so it becomes a rock in a hard place for us you know when it comes to approving contracts and feel like they're fiscal responsibility to address especially in this whole climate of non-profit mergers. i was liken that to coca-cola

and other big corporations and fortune 500 and big businesses and not enough revenue stream to support them, and so there needs to be more discussions about that. with all that said the committee would respectfully ask you to stop the consent calendar which is the next item on the agenda. >> thank you. we have a motion to approve. i know we have some recusals. before we go to a motion i understand we have some recusals to consider. commissioners. >> [inaudible] do we do the calendar by pulling out those items one by one?

>> yes, the sole source waiver preapproval needs to be pulled out and commissioner green and commissioner giraudo need to recuse themselves from line nine of that report and so then you all can vote on the entire report and want vote on the other line today because there's not quorum for that. i am happy to walk you through it so somebody needs to make a motion to pull the report off the consent calendar. i can't do it for you. >> i move that we pull the report from the consent calendar. >> second >> and then you can vote on the consent calendar without that report. >> great. so we have a motion on the full consent calendar except the final item [inaudible]. >> motion to approve. >> second. >> let me ask if there's any public comment on the line. person on the line if you would like to make comment on the consent calendar item

12 let us know by pushing star three and sorry commissioners for the awkwardness but i will wait 30 seconds to make sure we're honoring the delay. okay. you don't see a hand. i will do a roll call vote for the consent calendar coming the chapter sole source waiver pretumultuous list. commissioner giraudo. >> yes. >> commissioner green. >> yes. >> commissioner chung. >> yes. >> commissioner chow. >> yes. >> and commissioner bernal. >> yes >> and then commissioners green and

commissioner giraudo if you would verbally state your conflict so it's on the record and then we can move forward. >> i have a conflict with chapter .42 sole source waiver preactual all list item 9 >> and i have the same conflict. >> thank you. and so commissioners because we don't have quorum to vote on item 9 you all can vote on the report minus item 9 as a group so everyone can vote on this in the room but we need i motion. >> do we have a motion to that effect? >> i move to vote on the report minus item 9 on the report. >> second. >> great. i will do a roll call vote. commissioner chung. >> yes. >> commissioner chow. >> yes. >> commissioner green. >> yes. >> commissioner giraudo.

>> yes. >> and commissioner bernal. >> yes. >> thank you. the item passes. >> all right. thank you very much. the next item certificate business. commissioners do we have any other business? all right. seeing none -- >> commissioners may i make a comment? it's possible just to state for the record i have a conflict with item 9 as well. >> yes. >> thank you. >> thank you. all right. moving on from other business we will hear update on the may 17, 2022 community and public health commissioner from the chair. >> thank you. i will try to make it brief. the behavioral health services internship pipeline update was postponed since the presenter has covid so the other item was the tax update and the item was just for everybody's

recollection in 2016 the voted. the tax was implemented and the focus was low income population and the goal was decrease sugar drink consumption, increase the oral health of children, increase the healthy food access for you intrician security particularly during covid and the dollars would mainly go to community providers, the recommendations the group of the committees was the policy systems change where the target programs services, education and capacity building for work force development. in 2019-22 there were $10 million that was distribute distributed to 42 organizations. currently they're seeking community input for the healthy

community grants rfp. we suggested as a committee increasing outcome data and the number of participants served since that was not reported. the impact is that there has been 7% decrease in sugary drink consumption per the dph data since 2018. the statistics are a little different from the other data they reported 20% in decrease in san francisco compared to richmond california and a 50% decrease in purchases sugar sweetened drinks at super markets. the conclusion there is indeed a decreased consumption. we were interest also in the

data during covid since the data presented was from 2018 so we've asked the group to return with the updated information. anybody have any questions? >> i do not see any hands. >> thank you. >> all right. thank you commissioner giraudo. our next item are the joint conference committee and other report it is. we will delay the laguna honda jcc report commissioner guillermo for the next meeting and we'll hear from commissioner chow on his meetsing. >> yes thank you. i will just try to highlight the important business that occurred. we of course received the regulatory affairs report, the hiring

and vacancy report and from a personnel standpoint of interest for the commission dr. elena [inaudible] who was the chief of pediatrics at [inaudible] has been appointed at the ucsf vice dean. has a very long history at san francisco general and at the medical staff meeting i then conveyed the welcome from the commission the doctor and the gratitude of the health commission in regards to the work of the medical staff especially during the covid pandemic. dr. irlick announced a number of staff has been added to the laguna honda hospital recertification

process particularly important note is that tera [inaudible] who is the chief nursing officer at [inaudible] is now the interim cno at laguna. meanwhile she continues as the chief at san francisco general with assistance in maintaining that very fine staff that she has. as many of you also know the [inaudible] communication office has been deployed and quality staff and patient p staff to assist laguna in the recertification effort. importantly as you know work place violence has been a

problem particularly with staff and some violent patients. they have a team that has been piloted for complex patient situations and it was reported this has been very helpful in de-escalation and the use of law enforcement in such a patient incidents. there was a presentation on what the coming year strategic safety improvement plan would be, and reduction of patient falls remains a very important goal. otherwise we have the approval of the credentials report and the [inaudible] in our closed session so i would be happy to answer any questions. >> i don't see any hands. >> all right. seeing no questions or comments from the commissioners thank you commissioner chow. we will move on

to our next item which is a closed session. before we proceed do we have any public comment on the item? >> a person on the line if you would like to make a comment on -- oh the person is gone. no public comment. >> all right. we will hold a motion to hold a load said session on the item. commissioners do i have a motion? >> so moved. >> second. >> i will do a roll call vote. >> commissioner giraudo. >> yes. >> commissioner chung. >> yes. >> commissioner green. >> yes. >> commissioner chow. >> yes. >> and commissioner bernal. >> yes. >> all right. members of the public we will be back after the closed session is over and commissioners and everybody else give .

>> discussion. do we i have motion whether or not to disclose i portion of the close session discussion? >> i so move not to disclose. >> second. >> i will do a roll call vote. commissioner giraudo. >> yes. >> commissioner chung. >> yes. >> commissioner chow. >> yes. >> and commissioner bernal. >> yes. >> all right. and now we are at consideration for adjournment. >> i so move to adjourn the meeting. >> second. >> all right. >> commissioner chung. >> yes. >> commissioner chow. >> yes. >> commissioner giraudo. >> yes. >> and commissioner bernal. >> yes. >> all right. thank you everyone. >> all right. thanks all.

my name is steve adomi and i'm the director of the adult probation department. i do want to thank our partners from the department of public health with community services we've opened 300 units in the individual justice system trying to live drug and alcohol-free. so, before i begin, i actually want to thank destiny pledge and victoria west brook who -- they're my staff and one of the advantages of this project is thit