>> all right. commissioners dph staff and sphrrksens. welcome to the meeting tuesday july 19th, 2022. secretary morewitz, please call the roll. >> commissioner chow. i can't hear you, could you speak up? commissioner chow. commissioner chung, you were muted. >> present. >> commissioner green. >> present. >> commissioner giraudo. >> present.

>> and commissioner ra nawlt. >> present. >> good afternoon and welcome to the july 19th, san francisco meeting. this is held in hybrid format with the meeting occur in-person here on grief street room 300 and broadcast live on sfgovtv. 415-61-5003. i would thriek tell you that all safety protocols and building rules must be adhered to at all times. this includes covering your mouth and nose with a mask. failure to adhere to the rules may result in a removal from the room. we appreciate the cooperation of everyone in the interest of health and safety. hand sanitizer sedations are available here at the entrance

and we wm your participate. there will be an opportunity for general public comment at the beginning of the meeting? you may comment on each item on the agenda. public can comment will be taken both in-person and in call-in. public comment will be taken first from people in attendance then if those meeting remotely. you must submit a public card to me. if you're attending remotely, us the link because there is a delay on sfgov. if you watch on sfgov and i would like to make public comment. hit *3 so your hand goes up. to access closed captioning hover over at live stream or on demand video. a pop-up overlay will pop us and

you can click on that. please note that city policies prohibit discriminatory and harassing comment against city employees and others during public meetings. public comment is permitted only on matters under the juris ducks of health commission. next meeting will be hels on august 2nd, 2022. thank you. >> we'd like to recognize commissioner cecelia chung to offer the land acknowledgment. >> the san francisco health commission acknowledges that we are on the unseeded of the aloney who were the original inhabitants of the san francisco penance la. in accordance with their tradition, the aloney have never ceded or forgotten their responsibility of the caretakers of this place.

as well as for all peoples who reside in their traditional territories. as guests, we recognize that we benefit from living and working on their traditional homeland. we wish to pay our respects at that that acknowledging the elders and relatives of the aloney community -- o loney community and acknowledging their rights as first people. >> our next item for action is a approval of the health commission meeting of july 5th, 2022. commissioners, after reviewing the minutes before you, do we have a motion to approve? >> move to approve. >> second. >> and commissioner, there are several correction i would like to note. several ever you point towtd me, i apologize, i did have covid can when i took the minutes.

as you consider approval, please include page 8 on number four of the covid update under public comment, the first paragraph, there is the third line it should said she noted that dr. philips should make masking decisions. and under shawna reefs, covid was missing an "i." and after conditiony asked, the second sen tensz, they noted that the number one symptom of long covid in children should be mental health issues insid of "are" there is a space oo missing between that person's name and the word "we" should be taken out. and finally commission or chow noted on the consent calendar i was remiss in not including the

krtsz beyond the contracts report that were on the consent calendar. i will add that on the documents of those contracts that awe proved last meeting. i apologize profusely for the errors. >> thank you secretary moore wits. we're -- morewitz. glad you're feeling better. >> let's check public comments. dpoaks in the line, if you'd like to make comment on item 20, the minutes, press *3. and general, anyone making public comment is encouraged to do in the beginning so your hand goes up and we can see you by the time we do public comment. no hands so commissioner chung. >> yes. >> commission railroad chow 37 yes. >> commissioner green. >> yes. >> commissioner durdo girdo. >> yes.

>> and commissioner vaulty. >> yes. >> next is the director of health. >> thank you and good afternoon. just a few key items on the direct us report to be followed up by a covid update and also a monkeypox update. i will just highlight the on-going need that we have for monkeypox vaks glean disprks dr. phillips will go into more detail here but to emphasize with the current cases in demand in the community, our demand far outweighs supply. we've received 7,000 monkeypox doses and we've asked for 35,000 vaccine doses as quickly as possible to meet the most immediate demands. dr. philip will provide more details. i do want to update the commission that we have a number

of vaccine sites that are able to offer monkeypox vaccine when it becomes available. one site is included at the zuckerberg general hospital that opened in record time and started administering vaccines last week. did over 400 vaccines a day and including a drop-in basis. dr. philip will provide more detail on how we're managing and working to advocate for more vaccine at the local level. a couple other dwrots emphasize the general medical unit was present during the san francisco pride parade. luckily, they have they had two medical emergencies but through education and outreach and i wanted to thank the staff that participated in that including our partners at the san francisco fire department and emergency department staff at

zuckerberg san francisco hospital. being the month of yul, the commission is -- when our new residence stops at the general hospital and combined with sars, zuckerberg welcomed over 500 new residents. as you know, in our partnership with ucsf, it's one of the premier teaching hospitals in the country. we're proud that we're continuing the tradition there. as we finance to emphasize the importance of providing trauma-informed care across the entire department, i wanted to point out that we're tongue provide training if that regard. that's my director's report up update. we'll provide more details on the monkeypox but i wanted to

pause to see if there are any questions. >> if you would like to make comment on directors' report. press *3 now. *3. no hands, commissioner. >> any comments or questions for director cole fax. >> i don't see any hands. >> we can move on to the next item which is the covid-19 and porchgy pox update with director cole fax. >> thank you commissioner. and president bar nal, i'll provide the update and go go on to the porchgy pox update. just to go through the sites

relatively quickly. next slide, please. you can see the san francisco covid cases per 100,000 residents, we're continuing at a high rate of infection at 50.4 per 100,000. you can see on the slide that the trajectory is consistent with the national picture. we've -- we're starting to see increases in hoptions with this as well. next slide. we've had over 165,000 cumulative cases of covid reported. reported over time and goan emphasize this is an under count, many cases are undiagnosed and unreport and now with home tests available, our case count doesn't reflect the

true prevalence of covid-19 in the community. unfortunately, we're 929 deaths due to covid-19 in san francisco and our condolences to the loved ones and families and friends of those who passed due to covid-19. you can see account deaths over time drr many fewer deaths compared to the peak challenging time in winter ever 2021. of 2021. you can see there are increases in deaths consistent with our cases surging. again, to remind the commission and the public that there is a delay in reporting a death. particularly the last two months on the slide do not necessarily reflect the total number of deaths to be reported over time during those months. next slide.

our case rate by vaccination status. we know that the vaccines including boosters are not fully potective to acquire covid-19 but there is protection encouraged here. you can see here by the case rate of unvaccinated residents among those residents who completed the initial series 6 vaccines. there are so many residents in san francisco who received vaccines and the boosters, that rate represents a far larger population than the population that's not vaccinated. our hospitalizations, we continued to see increases in hospitalizations particularly with new variants that are even more infectious than the omicron, we see increase in

hospitalizations. this represents all people in the hospital dwgd covid-19, not just people in the hospitals specifically for covid-19. and it includes out of county transfers. we estimate that about somewhere if the range of half of these cases are in the hospital due to covid-19 related issues. our hospital capacity remains robust. you can across the hospital systems the capacity at 36% and the medical surgical beds are at 17.7%. this is a metric we continue to follow particularly when we see increases in cases. we want to maintain our hospital capacity. the other thing that is important to mention here is that we have just 19 people with covid-19 in the intensive care unit. again, that's another key metric that we're watching. next slide. in terms of administration, as

you know, san francisco remains one of the most vaccinated municipalities if the country. you can see a percent of the population is 84%. 74% of vaccinated residents have been boosted. we're continuing to focus on those most vulnerable including those 65 and over. among 5 to 11-year-olds, we received 76% of completed their initial vaccine series which is remarkably higher than most jurisdictions in the united states, far higher than the national average. that population has recently become eligible for vaccine we're at 18% that received at least one dose. and then, booster recipients we administered over half a million booster vaccines and you can see

again, consistent with our focus on those most at risk for poor outcomes due o covid-19, our booster rates are relatively high particularly ra among the people 50 and over. next slide. in summary, the san francisco case rate and hospital stations has increase expdz we've seen again the numbers starting to go up relatively steadily across the state and country o. most infectious variants are feeling the rise and hospitalization including ic capacity remains adequate. the health officers stress the importance ever taking safety precautions as the region has an increase in covid cases and making sure that people understand that well-fitted and 95 k and 94 high quality mask indoors are critically

important. and we moved beyond the cloth mask or recommending the surgical masks c surgical mask is better than no mask at all with you but we want to eam fa size to wear the n 59 and k 95 and k 94. the test kits are ready available. we know the federal government has made a number of kits available for the public. it's important to stay update on your vaccinations. know how to reach a clinician. and to ask your provider about retro viecial treatment -- antiviecial treatment if you were to test positive and continue to stay informed. that's our key update and summary. i'm happy to answer any questions from the commissioners.

>> do you have any gers director cole fax before moving into the second part of the presentation. >> we'll koom to you for comments at the end of dr. philip's presentation so you can ask questions or make comments about both. i see commissioner chow and giraudo have their hands up. >> i was going to make it a comment and thank you for letting us know that 18% of the [indiscernible] received the vaccines. i learned that the expiration dates on the home kits actually have been extended in many cases. and one can look on the website from the federal government to find which ones they were. we found they could extend some of the dates expiring in june and august by about three month. that may be something that the

public should be aware of. >> can thank you commissioner, we appreciate that. we'll make sure people have the link to the site. it is acceptful especially for people who have kits that may otherwise appear to be expiring. thank you for that. >> thank you commissioner chow. i learned the news just as i was about to discard some tests presumably expired. so thank you for sharing that. commissioner giraudo. >> pup thank you. thank you. my question, dr. cole fax, is about masking. i know in response to the public comment about masking again for meuny, my understanding is -- muni, my understanding is that lax county is possibly reinstating mask mandates for

indoor spaces. do we have thoughts on considering that on our public transit in san francisco? i know my staff gets a little confused. they come over on bart with the masks and muni, maybe, or maybe not. what is the consideration? >> i appreciate the question commissioner. and i'm going to turn to dr. seussen philip director of our population division and health officer to share our most current thinking on that. >> thank you. and good afternoon president bernal and commissioner giraldo and commissioner. we are aware of our colleagues in los angeles, we heard about thirl thinking on some of our statewide calls. we it's been a challenge even with their mask requirement in place as it has been in new york

ensure can compliance. enforcement becomes a real challenge. we continue to focus on making sure people understand the information billion the current sub variants, the importance of high quality masks rather than moving to a health officer mandate. the other challenge with requirements health orders and mandates is there is not a clear end point to these high continued rates of transmission. because outside of some of these settings, people are gathering, people are meeting without masks on and it would be more highly transmissible variants. it does become challenging to achieve a level of control and a population level which is what we'd like to see. it's a challenging time. very aware of that. continue to always think about the balance there. and certainly are interested in

hearing about our colleagues' experience in los angeles with their foaption move to re-- potential move to reinstating their masking there. >> thank you dr. philip. any other hands raised? >> commissioner green. >> i think i would like to follow up with what exetion commissioner giraudo was speaking of. in the early part of the pandemic. we had parameters that we were following. what would trigger on a different approach and how closely we would follow los angeles' decision making. the other question that troubled me is i know my staff like professor giraudo's when it comes to the city. many have young families and are concerned about living in spaces

where in their outside life they have control on who they are one footway from but on public transit, they don't. one of the other considerations beyond the epidemiology is what are we doing to help jidz especially those who are financially disadvantaged to have access to the high quality masks? i buy them my selves and 20 masks are $30 or more. i wonder if indeed we are not going to put limitations or mandates on public transportation. what are we doing to help people who feel like they can control their environment every prais, but when they have to go to point a to point expwrks have no choice but to take public transportation, to ensure that he they have the ability to protect themselves with the highest quality masks available. >> those are important points. one of the things that we have

done again, the change in the circumstances now is that you stayed, more availability of masks and we have do everything we can to ensure that all people in san francisco have as much access as possible to those. also, we have vaccines freely available now and we have treatment. in terms of masks which you brought up, we are working with community partners and people have been able to get masks through some of those routes. we know there are federal programs for people to access masks. we are trying to do what we can and providers are encouraged to give masks to people who are their patients who have a higher risk. we are trying to do what we can. when people cannot access masks or don't want to use a particular mask because they're uncomfortable, we say a respirator type mask is not

available, then double masking with a surgical mask with a cloth mask over it is an alternative. we want people to have access to n 59 and a k 59 or kf 94 if at all possible. >> is there any effort to coordinate this for example with muni with the public transportation organizations? because i do know some people who live in the city don't necessarily have their medical care in the city or necessarily know the community partners to which they might outreach to get masks. >> to coordinate mask provision through transportation partners, i think that's a very great question. we haven't had that specific conversation although we are closely communicating about challenges around covid more broadly. that's a good point that we'll look into and follow up on.

i will follow-up on. >> i appreciate that because as you said, it's going to be with us for a long time. and what maybe healthy today may haver in vulnerabilities. if they can pro tech themselves, that would be a real win. >> i wanted to add as well that school is out now. when school was in session, there were masks purchased by the city to distribute throughout the school district as well. we understand it's a need that we need to keep being attuned to access to the masks. >> other hands? >> i see commissioner chow's hand but i don't know if it's left over. >> i had an addition regarding the issue of masking. and i really do agree that by

continuing what you have written there earlier in the report about indoor masking is really important. i'm wondering if there is also as you're pointing that out to the public that that includes public transport. because we heard the testimony in the past about, you know, the closeness of a very vulnerable population that are in. buses and trains. i wonder as we talk about people masking indoors, shouldn't we have probably informed them that actually a bus is indoors for one thing or something like that. with the changing the stamp and possibly changing it again and the idea of trying to get municipalities to be more

uniform in the issue of the transit, it will seems to me that if we're going to continue to be in the strongly represent manned that we should be trying to emphasize that public transit is one of the praises that we s. as da-5 seems to be much more infectious, are we looking at whether or not there are cohorts of the disease coming out of our larger events that we've had? is that possible? is there going to be some sort of additional suggestion due to the apparent increase of sus septemberal bility to da 5? >> susceptibility to da-5. >> we do not have an ability right now to completely identify

where people may have gotten infected because people are out and about in many more spheers 6 their life. we're happy about that but it makes it difficult to estimate where people may have gotten infected. we say currently that people should consider masks if they're outdoors but in crowded large groups of people for events ask those types of things. i think yourix+ç point is good t we should reevaluate that language in light of da-5 and make that a stronger threamtion people do that. stronger recommendation that people do that. in reminding people about transportation is also well-taken and we'll continue to emphasize that. we know that our partners at mta have implemented signage both on the outside of their vehicles and inside to remind people that the masks are strongly recommended. i do ride both bart and meuny

muni andon average most people e wearing masks on the vehicles. i think that is in contrast to other jurisdictions. i do want to say it's not perfect, but overall, residents of the city and people using transit in the city are largely asking. masking and i think those reminders are important so thank you for emphasizing the importance of strength expng maintaining that communication and partnership to have their be multiples routes of reminding riders and the general public of the importance of masks on public transit. >> thank you. >> dr. philip, would i like to follow-up on something that commissioner mentioned yesterday. they have the opportunity to restlaipts at the up coming meeting. you might ask them about some of the barriers and what their

experience was with the maskena dmaint. particularly since they deal with five different county jurisdictions with different health offices and orders. a person said that they were able to go ahead and institute the mask mandate without the direction much even any one of those five counties. what is the situation if san francisco with muni? >> that is correct. bart was able to do this and on its own. we enscourge and supported that decision as health offices but it wasn't dependent on the health officers in any county. muni as well as any other organization is able to dharym masks would be required on their premises within their vehicles. agencies do have the ability to place requirements on its riders on its guests and staff. some businesses have chosen to do that within the city.

certainly the mta would have an opportunity, would be able do that. it does not require a health order to make that decision as a agency. >> thank you dr. philip. >> thank you. >> secretary morewitz, any other hands? >> i do not see any other commissioner hands. >> we'll move on to the porchgy pox update. >> if you'd like to make comment on the two items, this a great time press *3 so we can see you in realtime adds we go to public comment after this presentation. thank you. >> i just want -- i want to take a moment to acknowledge dr. phillip and their team that they're doing a fantastic job with challenging circumstances with another infectious diseed that came on top of covid and thank their team for the tireless work to do everything we can to get the vaccine out as

quickly as possible. >> thank you director colefax. i'm happy to be here on behalf of all the teamses and partners across the city. and thank you very much michaela for presenting the slides. next slide, please. so i have spoken with the commission about monkeypox before. this, again, is not a new disease but it's new in terms of the speed with which it's spreading person-to-person. the primary manifestations are skin lesions which may not be life threatening in most cases but can be severe for many people or some people. world wide there have been 13,340 cases in the u.s. a little over 1800 in california. 266 and just this afternoon updated number from san francisco of 141 cases. next slide, please.

this is the first time that we're sharing some of the demographic breakdowns of the case of monkey nooks have been identified in san francisco. among san francisco residents. this is based on data, this is not the full # 4 # cases. this is based on 86 cases from last friday. the majority -- vast majority of cases are occurring in persons age 25 to 54 years old. next slide. when we look at race and ethnicity, what will we see and on the right, the column on the right is the proportion in san francisco to be able to see which race and ethnicity groups are concurrently proportional. what is striking with us and working on is that if you look at hispanic or latin x, it's

nearly 30%, 29% whereas 15% of our population and we can talk about counter measures and partnerships that we're working on there as well. we see that people who self-identify as white are 47%, 48% of the cases. black african-american is 7%. asian is 5.8% as well. next slide, please. when we look at gender identities it's seen worldwide, it's overwhelmingly people who identify as male and that is true in san francisco. next slide. for sexual orientation, the vast majority are also who we knoll steul orientation, please note there are 9% whom we do not have this information are same-gender

88%. next slide, please. vaccination is really going to be the main stay of getting this outbreak under control. vaccine is not effective once people get the symptoms but once they're exposed or at risk, vaccination can prevent development of lesions and prevent someone from being inif infectious to another person. the federal government in most cases distribute to states and allocate to counties. that is what happens in san francisco. there are a few jurisdictions including los angeles, new york and chicago that receive direct allocations from the federal government. san francisco is not one of those. we receive our allocations throughout state of california. the u.s. department of health

and heulen services has most recently said it's distributing 144,000 doses. there are limited doses due to worldwide supply chain issues that are complex. hhs naits they'll be able to deliver nearly 2 million doses this year and 2.2 million more in the first half of next year. which is quite a long time in the course of an outbreak that we'd like to stop as soon as possible. next slide, please. what we have said in san francisco as dr. colepacks colex mentioned we need a number with the population case phthalates we have of porchgy pox infections. we requested 35,000 doughs to get it to the most impacted communities and individuals. what we have received as of last week was about 3600 doses and

just today, we have received our newest allocation which is 4,163 doses. overall we received about 7,000 doses. we have -- our vaccine teams tes done an amazing job if pushing out 95% of the doses to communities and partners to administer doses. we have just 242 doses that are remaining. we are keeping some in reserve for people who are identified as contacts or high-risk individuals. pregnant women, monkeypox can be severe so they're prioritized for vaks even. vaccine. the total number vaccinated is 2700 people to date. next slide, please. so eligibility has been a big

and important topic in the area of concern. many, many san franciscans really do need the protection offered by the vaccine and they should receive it. right now our priority populations are those most impacted as you saw in the slides. gay men, bisexual men, trance persons and other lgbtq san franciscans. we're also going to expand to include sex workers as well. previous to today, we had been limits to vaccine to people who had a known exposure or told they had been in contact with a case by public health or venue they had attended. adds community spread has increased, it makes much more accepts to switch to a more general policy that takes into account more of the risks that

people might have. we're working within this to provide equitable pathways for people in the communities. it's going to create more command and that will be a -- demand and that will be a challenge when we have limited vaccines. we want to not be a barrier or a bottleneck to people understanding that they would be eligible for vaccine as the supply allows. it's important to emphasize that due to these limitations, even though someone may be eligible for a vaccine, it's not the case right now that vaccine is always readily available to them. next slide, please. so, our vaccine strategy has been several toaltd. fold. we're trying though make sure that geographically we're locating sites for people's access and he engaging with our health system partners. we have a combination of both appointment-based vaccine visits

as well as drop-in and that we are trying to think about pop-ups venue-based and we have such strength with our community partners building on sexual health know-how in the city that we're build on a great foundation but trying something new is always challenge. it's great to have the partners and staff in dph working on this. we're going to have to distribute the vaccine quickly. we want to build immunity and we also are hearing from our state partners at cdp, that the more that we can demonstrate that we can administer the vaccine quickly. , the more that will flow to california of the doalingses received. we also want to prioritize health equity. so we're partnering with our community-based organizations os and build on the relationships and some structures and communication strengths of our covid response as a city. and really lean on the partners to make sure that people who are

disproportionately accessed to monkeypox have access to the service ksd we'll build on the know-how within the city to do this. at testing as well, initially there is a lot of information here that you'll seen slide. the big summary about testing is that very early on, just as for covid, test was limited. it went through the state lab in richmond and had to go to cdc to be expimpled it required lot of confirmed and it required a lot of testing and it meant we were not able to do as much testing as we'd like. as often the 11th, we have

testing that increased at some of our national testing such as lab corps and quest. and our public health lab in record time after receiving the instructions and the core materials launched this on the 12th. we're building up to a capacity much 188 specimens a day which is a boost for san francisco to have local testing with lower barriers. we're trying to increase the turn around time and getting people test results more quickly. it was take up to seven days and now we're able do that within the span of a couple of days. treatment is also a really important factor. many people can recover from monkeypox without specific treatment. they can rest and do symptomatic treatment but for some the oo

lesions are very painful and located in the body where a super infection can be serious. in those cases, people need antiviral treatment. antiviral treatment one is t-pox. it's limited right now and only available threul a few providers in san francisco and can only dreals the most serious cases. it's recommended for these serious cases, however, this is a drug that's been fda approved for smallpox, not for monkeypox. the cdc stipulated this has to be given under a investigational drug protocol because it's for a new disease. this is expensive administrative processes and is a barrier for many providers in -9d community to administer this essential drug.

we're working as the dpa to help providers offer treatment via technical assistance and trying also -- city clinic and it's team made itself available for people who are not otherwise facilitied with hemal health teams not offering this. big kudos for them. increasing access and filling the need that they've noticed. next slide, please. so all of this is dependent on our work with community and making sure that people are aware of monkeypox, the numbers of cases and what they can do. we've been using multi-prong strategies and appreciate the people on the team who have strong community connections and no-how about how to do this. we've been engage in community meets. last week i attended a meeting

and 575 people on that webinar at one point listening to the information. i want to thank the a.i.d.s. foundation for their leadership. in addition to that, we have teams that are engaging other community-based organizations partners. they'll be a presence at festivals. we know there are a lot of gatherings and celebrations this summer and we within the to be proactive about how we're getting information to people you see some of the various way weers' doing that and the website is updated with increased cases and elt jibility criteria. we're trying to maintain multiple routes to get people information. this has been some of the community outreach to date. weave he given over 20 presentations and e-mail outreach to organizations that serve and part with lgbtq groups

and that are in-person events at parties and corridors and neighborhoods. there is outreach around pride and there have been ads that have happened in the bay area reporter. billboards as well. outreach tool kits have been trance a lated into various languages. and targeted media on social media is an important component also. here is really all of the information and i think the one thing i would want to say in wrap-up is we're trying to balance having as many people get the vaccine as possible and understanding that there are equity concerns that we need to keep in mind. and we are constantly trying new strategies with our partners and subject matter experts and community in our health systems and within dph.

we'll use a exings of drop-ins and invite person seem in who are from over-represented groups who may not otherwise be ail to stand in line and get access so we create a different route for people to get vaccines. i'm happy to answer any questions and appreciate the support of the commission on this emerging topic. >> thank you dr. philip, i attended the a.i.d.s. foundation virtual town hall and the strength of the partnership was evident during the event. before commissioner comments or questions, secretary morewitz, do we have any public comment? >> we have about 10 people. first i have is a statement to read. for each agenda item members of the public will have a chance to make public comment for 2 minutes. this is for feedback from individuals in the community however it does not allow questions to be answered in the

meeting or to engage in back and forth conversation with the commissioner. they do take consideration of people from the public. people are aloud one opportunity to speak per agenda item. written public comment may be soanlt to the commission at the address mark.morwitz at sf.org. i'll put three minutes on the clock. when you're done speaking, if you press *3 to lower your hand, that would be helpful to me but that's not necessary. first caller. let us know if you're there. >> i'm alice. [indiscernible]

the equitable option affect everybody. [indiscernible] [indiscernible] they're taking a risk. especially when [indiscernible] additionally, [indiscernible] has increased from one patient [indiscernible]

weave been wearing an n 95 does not protect against covid. [indiscernible] i'm having computer problems. >> thank you for your comments. >> thank you, caller.

>> next caller you're on muted. let us know you're there. >> i am. >> you can begin. >> i appreciate the remarks on possibly resuming mask mandates. the dpa covid data reported website showed as of last sunday. 42,872 additional covid cases have been reported in the past five months since march. 1st. 24% of the 164,000 cases mentioned a few minutes ago, of those 42, 800 additional cases, 13,800 or 32.4% have happened in

the last four weeks alone. given this increase, the bph [indiscernible] asked to resume mandate wearing masks both indoors and outdoors the bay area county started to do given the virulence of the new variance. the san francisco a.i.d.s. foundation and dph adopted a goal back in the '80s reducing the human suffering from hiv-aids to reduce the new human suffering caused by covid. please ask the mayor to resume mandating wearing of masks both indoors and outdoors now.

thank you. >> thank you, caller. >> next caller, you're unmuted. >> can you hear me? >> yes. please begin. >> all right. i'm an organizer at senior disability action. i'm calling in to urge dr. philip and the health dmoition reinstate a countywide indoor mask mandate. we've been call in the meetings for the last couple of months. over that time, we watched cases and help the positivity and hospitalizations rise exponentially. early on we were told that dr. philip did not want to bring back an indoor mask requirement because there might be a time when we needed it more and she wanted compliance to be better and argued that compliance would be bet for we waited to be in more of a crisis than tt at the

time. we didn't agree with that liefn think bug now we're in a crisis. where is the mask mandate? it seems disenjen with us so say when things are out of control to say we can't have a mask mandate because there is not a clear end point in the high transition. honestly, not requiring masks indoors in public settings because people continue to gather ask spread covid at home and private places is saying there is no point to have public inspectors come to restaurants because people might eat meat at home. many vendors are without safe public transportation because of this lack of action that dr. philip and the health commission is taking. we want to reach out to the doctors who raised concerns on

the health commission, dr. giraudo and dr. green, thank you for listening to us which we don't feel the health commission has in the past. we need a mask mandate everywhere so people who are hive risk, seniors, premier disabilities can go places and go to pharmacies and to the store and get medical care and ride transit and attend meetings like you are where i see everyone is wearing a mask. actually this looks like a safe working environment. please listen to your communities and reinstate ain door mask mandate. >> thank you. caller, you you are unmuted. caller, you are unmuted.

>> hello. can you hear me? there is not clear ininstructions on how to unmute. i'm on my phone. maybe you can put instructions. in the future maybe you can put instructions on how to unmute on your phone. i ould thriek -- i'm , i am a member of senior disability action. i, like others, have been listening in on these meetings for the past couple of months seeing cases continue to rise and hospitalizations continue to rise. i'm highly concerned that there is still no seeming urgency to reinstate an indoor mask mandate. according to the cdc, all nine bay area community are high contact. it's been reported that

healthcare workers are burned out even when there isn't a surge and many are leaving the healthcare profession in droves. droves. they're not easily replaced so we need toin steut more preventive measures. right now he see that in sf county,s at the positivity is over 15%. from what it looks like on your graph, that's a peak of the omicron surge. it was 18.9%. we're nearing what was the peak and there is no indoor mask mandate. i'm concerned about dr. philip's dmeant seems to suggest there is no point of instituting an indoor mask mandate because of poor compliance and enforcement. the fact of the matter is you're ate public health department, you're a public health leader and your job is to solve problems. this feels like either a cop-out

or helplessness. there are things you can do to increase enforcement meaning more signs and education and clearly explaining why it's foreign mask even if you're vaccinated as we are in the still in a mask disabling event. we still don't know what the health outcomes are. this is not an unsolvable problem. it's a lack of will not problem solving. we're in high community levels which should trigger an indoor mask requirement. people are getting outdoors now. there should be an outdoor mask requirement in crowd the settings. jewia riceman has talked about

in the past about on and off ramps. we need to dooment metrics with the fact that you don't need to ever the metric. it's highly concerning to me. it's part of your job. if you can't do your job, interest should be someone else to do your job. i understand you're under a lot of pressure, dr. philip, but you need to lead with moral conviction as you have if the past. >> your time is up. everyone gets three minutes. thank you caller, you are you be unmuted. >> i'm glad to have this chance to speak today. my name is amy, i'm a parent of a opportunity at sfu csc. i think it's em pier toif implement a mask mandate for the 2022/2023 school year and as soon as possible so parents can

have peace of mind about sending their children into a congregate environment where there is no choice. all these cases are not necessarily being reported. it's purting parents tbeep a rock and a hard place to have the kids in school without a mask mandate. you can hear their issues around compliance and i would say solve those. when you don't have a mandate, people are less compelling to wear a mask. if only takes one kid not wearing a mask in a class to infect the others in the class. i feert up coming school year and i hope you can take strong public simple measures that have been implemented before to protect kids across sfusd.

>> caller, you're unmuted. let us know you're there. >> hello. >> you're unmuted, please start your comments. >> yes. this is sherrill jackson. i've been hearing what you have to say today and i think it's concerning that we make sure that we're keeping our vulnerable communities voices heard and we need to be ensuring that we amplify the voices when they're asking and requesting different things to happen within their community. we need to ensure that they have the opportunity to feel safe using public transit. public transit is used for -- as mentioned before, making sure those who can get to and from, to work, to take care of their

loved ones, to meet with their loved ones and do with daily chores imelting to and from special hospital visits and things that have nature. we can all understand it's the right thing to do to make sure that people are safe. as a member of the workers with disabilities, there is similar concerns with those with disabilities within the organization and i think it's important that we continue to recognize their needs and ensure that we are listening. i think we can do that. i think we can work together in order to accommodate to people's needs. that's what we are a here for is to make sure people are safe. these are equitable decisions we need to make now and it's important to move forward on this. let's get down to business and ensure we get this done, thanks.

>> thank you, caller. caller, you are unmuted. let us know you're there. >> yes, i'm here. thank you for having me. i'm joe. i appreciate the media because we badly need to have a mask mandate for transit. the transit opportunities are woke and against public health. it appears to me because good public health is stalling. we need scientific guidance to make difficult decisions and sadly, most people don't know that sfgovtv exists much less watch it. when you're a public health officer, you might want to dhar and re-- want to consider that and this works with only people that read the power points.

masking just to protect yourself only goes so far. for public traints that is a sense i have issue. there are people -- sensitive issue. people can get long covid with permanent disability. some can even die yet we're wore idea about compliance. we're catering to the people that don't want to protect their neighbor. give me a break! come on san francisco. you guys are supposed to love your neighbor. you guys are progressive on social policy. protect your neighbor. that's really why we need a mask mandate because going fully masks being recommended, there are places like twhawg tried that and the masks come off. even more rural county if

washington, the masking recommendations goes nowhere. authorize' up with ear and out the other. please mask mab date. thank you for make -- please mask mandate. thank you for taking my comments. >> thank you, caller. you're unmuted caller. let us know you're there. >> thank you. i think it's outrageous that there is not a mask mandate. the excuse that compliance is a problem is ridiculous because the longer you go without having a mask mandate the hire the compliance is going to be. you need to do this right away. it's on your part and it's caving in to businesses who care

more about making money off their restaurants and hairstyles and sloons. sa loa saloons. my daughter was positive yesterday. it's very much on my mind. [indiscernible] about a month ago this was a hiking camp where people spend hours of time on tours. there is no indoors. most of the time they're on the trail hiking. they're hiking single file, sixfeet apart.

they're hiking over hills six feet apart. being outdoors is no longer an assurance of being covid free of having an infection. it shows all the more why it's necessary to have a mask mandate both indoors and outdoors. the lack of it is just outrageous. it puts people who are dependent on public transportation and drivers at increased risk. reinstate the mask mandate. thank you. >> thank you for your comment. we have three or four more kawrls with their ndz up. caller, you are unmuted. let us know you're there. >> thank you so much. i'm vinnie calling in from the

lgbtd democratic can club. i wanted to tharchght commissioner for their urgency in response to the monkeypox crisis that is entirely preventable. i'm urging the dmoition continue to apply pressure at the state ask local level for testing as a means of breaking the trance transitionchange and have progrr people quarantines for monkeypox that can render someone unable to work for three to six weeks which is a stressful amount of time to be in quarantine and ice explaition without pay. thank you for your attention to these t these hearts. her -- these matters.

we have to make sure sex workers are safe in their settings. thank you so much. >> thanks for your coment comments. next caller, let us know you're there. >> can you hear me? >> yes, please begin. >> >> so i just wanted to let you know i had my hand up in the web access but it didn't work so i called in. maybe in future you can call inner to people watching the video can raise their hand that way. i'm a member of senior disability action and you know, i'm just really concerned that cases are spiking right now and we have no mitigation measures that are being taken by the department of public health. it's just crazy to me that there are no, again, there are nop ofn

these on ramps that we'd implement if things got worse which they obviously are. we have the highest numbers that we've had in san francisco and nothing is done by the department of public health to sloat spread. we have to have indoor mask mandates brought back. i'm immuneo e immuneo compromis. i can't go to the doctor or use the laundry room or take a bus or go to the grocery store. i can't get my teeth cleaned. i know others in this position and we're just being left out to dry. this feels like eugenics to me. it's like i don't know why the city is just abandoning us. i just -- i don't want any more people to die and get sick. you know, you have to bring bact mask mandate. thank you. you have to bring back the mask

mandate. thank you. >> thank you for your comment. next caller, let us know you are there. >> hi, can you hear me? >> yes. please begin. >> great. my name is saira and i'm with senior dispaibility action. i'm high disprisk i live in ray high-risk household. according to a july 515th news article, the bay area is experiencing the highest peak in cases since january. they're highest since early february and experts are warning that the latest omicron variant is the most infectious and transmissible yet. the repeated line is that people need a "break" from that scene but once another surge occurs that would be the time to reinstate a mask mandate.

we're at a point with these new variants so why isn't there pressure to reinstate a mask mandate? all nine bay area counties are at high levels of covid according to the cdc yet zero counties have a mask a mandate. that's one of the most easiest and effective ways to stop the spread of this deadly virus. it boggled my mind that there is so much unwillingness to implement a sure fire measure to better protect people. l.a. county awndzs it as they just reinstated their mask mandate. why don't you? and encouraging masks is not good enough. two-way masking is better than one way. you require masks at your meetings but not elsewhere in san francisco. i'm not going to sign off another one of my comments with

a "thank you" because i'm tired of using polite woreo words to public health officials that are treating this virus like an exercise instead of something with dire consequences for people like me and other vulnerable people. i will finish with this,: do your job, reinstate the mask mandate. >> thank you. caller, i believe you may have made a comment. is this -- you're unmuted, can you hear me? >> yes, i did make a comment. >> i was going down the line, thank you very much. commissioners, that's the end of the public comment. >> all right. thank you to everyone who called in. commissioners do you have questions or comments on this item which is the monkeypox update? can.

>> i don't see hands from commissioner. >> all right, seeing no other questions, we'll move on to the next item. thank you dr. philip and director colfax. next item is general public comment. >> sure. let me first erase all the hands. foation on the line, if you'd like to make general public comment, this is the time. i will read a statement. at this time the public may dreats comis on items of interest to the public that are within the jurisdiction of the commission but not on this meeting agenda. each member of the public may address the commission for up to three minutes. the brown act forbids the commission for takes action or hearing an ylt not on the agenda. please note that each individual is aloud one opportunity per agenda items. individuals may not be able to make a statement for those not

attending. this is a time for comment on issues not on the agenda. i will stop you if you do. we have one hand. person on the line, let us know that you are there. >> it's patrick. please stop downplaying the severity of the crisis san francisco faces with probably closure during the eight months since laguna honda plugged -- >> the next item is laguna honda update. this comment so far -- >> let me get through this. it's not on the next agenda item. >> go ahead.

>> i was shocked on july 12th hearing dr. chow downplay the laguna honda closure wouldn't be so bad because it wouldn't displace current residents. it struck me that dr. chow may not understand eliminating those 120 beds will affect thousands of san franciscans far into the future, denied add noition laguna honda. i think dr. chow should save face and resign from this health commission. thank you. >> next caller please let us

know you are there. >> my a name is elissaa ma tros. elissaa matross.what are you wan terms of reinstating ain door mask mandate? even higher rates of long covid and hospitalizations? so many agencies depend on your decision. your decisions control bart, muni and sfusc. reinstating an indoor mask mandate protects many people. why is the san francisco version of the emperor's new clothes? is san francisco no longer the leader from protecting the public as it was at the

beginning of covid? finally what do you say to people and their families who get covid on transit that doesn't have a mandate? do you say sorry, but there are not enough of you yet. please think about that and reinstate a mandate. thank you. >> that's the last comment, commissioner. >> all right. thank you, callers for sharing your comments. the next jt is a resolution amending the healthcare accountability ordinance minimum standards. for this we have max gara. health program manager to present the resolution. this is an item for way approval is requested. >> before you begin, can you please pull up a presentation and thank you to kenya for doing

that today. >> good evening commissioners. i'm max gara a health program plan where the office of planning. this is to share recommendations forked ordinance minimum standards for 2023/2024. we're requesting an approval of a resolution to revise the minimum standards for up coming two years. i'm happy to take any feedback or questions you may villetend of the presentation. i tried to incorporate responses to the questions i received beforehand to this meeting. next slide, please. health care accountability ordinance was enacted in 2021 21

and is to reduce the uninsured. the idea is to reduce the works who have access to affordable and comprehensive insurance. the law requires employers are a contract with san francisco provide health insurance plans that meet minimum set of standards to their employees can. employers must pay a fee if they choose not to offer a health plan if it meets the standards. .fee is paid directly to the department of public health intended to cover healthcare to the uninsured that may seek healthcare services in san francisco. the law requires that these minimum standards be reviewed every two years. this slide shows the relationship that the office of labor standards and enforcement and dph each have with enforcement.

as the diagram shows, dph facilitates the process to update the minimum standards. ollsc can focused on enforcement and engages in action to respond to worker complaints and health of the employers. so again, pursuant to the ordinance, minimum standards are reviewed at least every two years and the health commissions that the sole authority to rescriez the him standards. since 2004 there is a work group at that to consider revigs to the standards and develop recommendations for the health commission to consider. the review and recommendations consider impacts to plan affordability for both the exploirs employees and plan availability to employers. dph's office of planning reviedz research and analysis and works with stakeholders to develop

recommendations. for may to june of this year, dph convened four meetings with the work group. in total there were 13 individuals representing employers, labor, brokers, health explans city agencies. several members have been involved since the inception of the law. note that the work groups include equal number of people impactedded. i want to thanks for your time and process. attachment c lists the members and respective organizations. our discussions pore over cost sharing elements. to provide level setting, i want to review self key turns. out of pocket maximum refers to the maximum amount and

healthcare expenses that a beneficiary is paying out a year. they pay out an amount bfl copays and coinsurance kicks in. copay is the what the person must pay. if you are 20% and it's $100, you pay $20. next slide please. over the years, the work group has been creative and effective in leveraging reimbursement to mangt needs given the rise in healthcare costs. health savings accounts are two types of medical reimbursement vehicles to help employees pay for medical expenses and provide

tax incentives for employers. next slide, please. to inform the process, dph conducted an analysis of health plans available and how they complied with the current minimum standards. specifically we evaluated 165 small group health a plans across nine carriers from the third quart of 2022 that are available in the local market much san francisco. this part of the narcotic is evaluated because small businesses have less flexibility in choosing ens plans. it's crucial that the minimum standards are set so that there are a healthy number of plans available. one of the primary fiepgds from the review is generally only gold and platinum plans are compliant with the current stts. standards.

only 2% were townder found to be compliept. this limited availability is driven mainly by increases in coinsurance and copays exceeding the current standards. i want to share some general themes. first, the work group only fa sized the importance of maintaining access to affordable and comprehensive care for employees while ensuring that employers have access to quality health plans for their staff. secondly. the minimum standards are increasingly difficult to revise in a way that is affordable to both employers and employees due to the continued rise in healthcare costs. the work group members express concerns that the non-profit sector is facing rising costs of business, healthcare and living in addition to inflation. members suggest these create

challenging to provide affordable coverage for their employees. to address the issues. the work group expanded a work group for employers specifically silver plans to increase -- and decrease cost responsibility to employees. at this time i would like o share the work group's recommendation for the minimum standard revisions for your consideration. the work group reached consensus to deeming gold and platinum plans compliant as long as the employers cover medical deductibles. by design they provide the most generous benefits for employees and may even encourage some to offer gold or platinum level plans for this reason. the work group is also recommending maintaining the requirement employers fully

cover lan premium and there is consensus to maintain affordability for workers. the next set of recommendations should be considered in tandem as they collectively aim to expand a number of silver plans to employers and decrease cost responsibility to employees. first i'll start with the out of pocket maximum standards. under the current standard plans out of pocket maximums cannot exceed a certain specified amount and this is synced to the outof pocket limit for silver plans. under work group recommendations dhl standard would be changed to require employers cover out-of-pocket expenses up to 50% of the plan's out of pocket maximum. for example, if a plan's out of pocket maximum is $8,000, the employer must convert initial $4,000 in expenditures. these expenses must be covered on a first dollar basis

including deductibles, copace, coinsurance must be counted towards the out of pocket max. employees may use a third party administer that count towards the out of pocket maximum. reimbursement options include using hras and there is no need to refund the amount. this is used by employers to cover employee medical deductibles as required by the current minimum standards and has been in place for some time or in some form since 2015. since 2013. so overall, by agreeing to increase the employer cost responsibilities, the group agreed to increase the cost-sharing standards for coinsurance and co-payment to allow for greater availability and silver plans which i'll talk

about in more depth in a moment. so to understand how the proposed changes to the out of pocket standards impacts cost responsibilities, we again examined health plans available on the small group market. specifically we looked at the average cost responsibility to employers and employees under the current and recommended standards. under the current standards on average, if we compleud exude the coughs of the premium employers are responsible for $2,200 or 26% of out of pocket expense. under this recommended standard comploifer employees will be responsible for up to $4,000 in expenses or 50% of expenses. awhile this have a significant change, employer representatives emphasize that despite the increase in their cost responsibility, the greater

availability and silver plans allowed by the compromise is highly desirable and has greater flexibility to tailor plans to their staff makeup and needs. so on to the medical deductible standard. given the decision to require employers to cover out of pocket expenses, the work group recommend that the requirement be removed. on average silver plan deductibles are 20% of the out of pocket costs and will still be effectively covered by the employer under the new out of pocket standard in most situations. the deductible limit will remain at $3,000 and the platinum and

gold plan will be covered. again, given the decision to require employers cover out-of-pocket expenses, the work group is recommended cost sharing limits for coinsurance and primary care payments be adjusted and there by increase the availability of affordable plans to choose from. the group is recommending the increase. the work group is recommending copayments increased from 50 to $60 per visit or if a coinsurance is provided that it be no greater than the coinsurance standard. while the increased cost responsibility to employers will defray the impacts from these changes in cost sharing for employees, work group members voice strong concern about employees having to payer this those expenses up front while waiting for reimbursement. we evaluated the possibility of

requiring employers provide an employer-funded mechanism such as a prepaid debit card for employees to pay for expenses up front. upon examination, the health benefit landscape as well as the work group recommendations for previous years, this would be challenging and complicated to implement. one the primary challenges is that this requirement could result in cash flow issues for organizations if they're required to fully fund health savings reimbursement product to cover 50% of out of pocket expense. in lieu of requiring employers cover an employer-funded mechanism to cover out of pocket expenses up front, dph will issue a strong threamtion an employer-funded mechanism like a debit card be provided to

beneficiaries to cover out-of-pocket expenses such adds copays up front. seven out of the eight members agreed to accept the recommendations from these standards. so, regarding drug -- prescription drug coverage, the work group agreed to retain the current max 200 maximum and all tiers of prescriptions be covered and this is consistent with state law. standards 8 through 16 relate to the central health benefits and were straightforward to reach early consensus to maintain the standards. all together, these recommendations should increase the number of available silver plans from 2 to 30 with 75 of silver plans becoming compliant. the standards will ton provide an opportunity for employers to

offer gold or platinum plans to comply with the law. once the standards are adopted, they'll be disseminated to all employs and further labor enforcement will explain the standards and answer questions for employers. dph supports the package of recommendations and respectfully ask for the health commission as approval in these changes for 2023 and 2024. i would thriek provide one last thank you to work group members for their country breution to the process and i would like to thank you michelle for her work and and i'm happy to take any questions or councilmembers you may have.

>> secretary morewitz, do we have public comment in. >> i see one hand. .please press *3 to make a comment. i'll start off with the one person who has their hand raised. caller, i've a unmuted you. let us know you're will there. >> this is debbie from human services network. we're in associated with non-profits. i've been a member of the working group since we began holdings the stakeholder meetings back in 2004. i'm calling today to urge the commission to adopt a code of standards. as a non-profit representative, i would like to share our perspective in supporting the standards.

we always seek a balance that ensures both affordability and availability for both employees and employers. our non-profits are committed to ensuring that our workers have access to quality healthcare plans and we believe no workers should ever forgo ahead care because though haven't afford to use their insurance. as employers we need access to a broad range of choices in healthcare markets that fit our budget. i'm sure you are aware that the city does not fully fund the non-profit contactors or provide inflation-based increases to the contracts. this led to seriously under funded contracts particularly for legacy providers. the result is our workforce is underpaid. we're having trouble hiring and keeping workers. we have a extreme lack of city and county workers. it's imperative that the city take action to stabilize the

organizations or face of loss of frontline services. for those reasons, we must continue to have access beyond gold and silver platinum level plans. siller plans are more affordable, employers can tailor them to the needs of their workforce. right now only two silver level plans meet the standards and the proposed standards will allow a much greater choice of plans and in return of the flexibility, employers are willing and able to contribute more funds to cover coinsurance and deductibles. that's our thinking. we believe these proposed standards are a win-win for both employers and workers and in particular would provide more money for workers rather than putting more money into health insurance premiums. we share the concern is that employees often have to convert cost up front. we acknowledge there are imper

imperfections in the system but we'll continue to work to moving towards creative improvements. thank you. i hope you will approve these standards today. >> that that is the only hand from the public. >> thank you caller and secretary morewitz. commissioners, any comments or questions on this resolution? >> it looks like commissioner chow is trying to raise a hand. >> yes, i just wanted to compliment the presentation for a very difficult set of problems that they faced and to actually do as the former public speaker said to be able to balance a quality accessibility, a norld bility. affordability. the explanation they gave in this power presentation show hay

great deal of work on part of the workforce. this is a complicated subject in order to afford the employees the opportunity -- not the opportunity, but to have the opportunity to be able to participate in the insured marketplace and i certainly support it. >> thank you commissioner chow. other questions or comments? >> commissioner green has her hawnd. hand up. >> as someone who has to make this choice every year with my own employees, this is a very difficult balance. and i'm heartened to hear the comments that non-profit employers in particular are still on board. i think the ability to have

these silver plans excellent. there are plenty of counties that people cannot afford it and people are not going in for care. the idea that you come up with this solution and work collaboratively, i think you deserve high compliments. it's complicated and you have the solution. i wanted to give you grach layings and say i would be in favor to mac a motion to approve this plan. >> do we have a second? >> second. >> and i would thriek add, prance out of order, thank you, mr. gara for providing the last slide of the working group. i think it inspires a lot of confidence in the commission not only the quality of the work but see how broadly representative

of the providers and in labor in particular organizations that serve different parts of the city and different communities. thanks for that. >> thank you commissioner. >> secretary morewitz, are we ready to go for a vote? >> we're ready. commissioner. commissioner chow. >> yes. >> commissioner green. >> yes. >> commissioner chung. >> yes approximately commissioner giraudo. >> yes. >> and president bernal. >> yes. >> thank you. >> next item is the laguna honda closure plan and recertification update. for this, we have mr. pickens? >> mr. pickens is out. >> we have wilma hathaway?

>> i am not [indiscernible] but i am [indiscernible] i at the chief operating officer of the health network and i come before you this evening for the commander for the laguna honda efforts. with me is our chief operating officer and we have terry, acting chief nursing officer for laguna honda and [indiscernible] chief quality officer. i'll kick it off to dr. hathaway. >> thank you. good evening commissioner. president bernal and dr. colfax. as you are aware, centers for medicaid services entered laguna hondas participation. this is nearly $550,000 per peay day.

after our participation was terminated, we worked with cms and cdph on the closurer and transfer relocation plan. this plan had to adhere to comments of both cdph and cms to get approved. it took place may 13th, 2022. this approval of the closure plan oo allowed reimbursement through mid-september. implementing this plan is required by cms. laguna honda must show progress in transferring and discharging of the residents. while awaiting transfer and discharge, laguna honda continues to provide excellent care for the residents. finding placements is a challenge. res didn't care teams comprised of physicians, nurses ask social

workers will need to assess all patients' needs. this is to ensure that we can identify the most appropriate facility to meet their medical care needs. for closure, residents have a right to a peel a discharge. it's handled through the california of appeal hearings. laguna honda has posed several questions to the state billion transfer and appeals processes that remain unanswered. however, we're doing our best to get answers as quickly as possible. we continue to work with residents and families and providing support for this process. either done through a town hall, unit community meetings, family meets and one to one conversations. we share information on behalf of the state.

we also have partnered with city, state, and federal agencies. this includes human services agency, the department homeless and supportive housing, ghcs, tdph and gms. we await responses to help inform our closure plan activities and communication with residents and their families. next slide, please. this slide provides high level overview of the actual closure plan process. it details the four steps or components of the closure plan process. we start with step one which is the notification step. this occurred may 169, 2022 when all patients and families were given the 60 day notice of the closure plan.

step two and three were p simultaneously. step two is the patient care management. this includes patient assessments done by the resident care team. this includes the medicine physician, nursing and social worker to provide an understanding of the resident care needs. step two also includes patient family meetings that occur. these are the meetings where expectations are set regarding the closure plan, details of the closure plan, as well as informing the patients and families of their rights. step three is a closure operation. this is the stheap includes facilities phone calls and referrals. step two and step three take an abundant amount of work and require an abundant a. workforce. the results is to make sure the

evident is successful, laguna honda has created a facility outreach team to make daily phone calls. we have increased clinical support staff to aid with the referral process. we have plans to have weekend social services support. and we have developed care coordinators under patient and utilization management to review medical records to involve patient assessments as well as for discharge appeal. step four is for placement. it includes either transfer to the same level of care which is aka skilled nursing facilities or discharge to a lower level of care which is for the communities. for those discharge to the communities, we work collaboratively with other city departments to ensure a safe and appropriate discharge.

for any placement to take place, three components need to be met. a comprehensive assessment needs to be completed, appropriate facility is found, and the resident and families need to agree to the transfer. next slide, please. the next two slides are our closure plan dash boards. these are available on laguna honda website and it's updated every monday at 5:00 p.m. what i have included here is the dashboard as of end of week 8 which is the week for july 4th. it gives data numbers on the daily assessment, meetings, referrals, number of phone calls made to the facilities, number of transfers and number of discharges. as you can see on that end of week 8, we had a census of 623.

we have a total of patients assessments of 482. the number of family meetings shy of 300. and the number of referrals is 940. for number of calls we've made and assessment of available beds, we've made thousands. we make thousands of phone calls each week on the hopes of finding appropriate placements. these are both san francisco county and neighboring counties as well. for transfers to skilled nursing facilities, thus far we've transferred a total of 35 patients. one in san francisco county, three in hal immediate county and 31 in sab mateo county. in some cases residents no longer require the care of a

nursing facility. these residents are routinely discharged. when a resident does not have a home to be discharged to, the city is committed to finding an appropriate placement within san francisco coordinated response system. as you can see, we've discharged a total of 13 to the community. # 1 san francisco county, two to other counties. this is further broken down to discharges three for home or housing. three to medical respite, four to boarding care and shelter. all transfers and/or discharges have been voluntary. laguna honda was informed of three former patients who recently passed way after they were transferred to other

skilled nursing facilities. laguna honda community is saddened by the news and offer sympathy to family and friends. because they are no longer our residents, i cannot speak if any specifics. once they have transferred, we no longer have regular updates about them. what i can say is our residents health and safety is the top priority as we implement this man tri closure man. we -- mandatory closure plan. we know there is stress in changing environments. we have physicians, medical row expriersd behavioral health providers along with nurses and social workers all thoroughly assessing the patient's needs so they're transferred from laguna honda safely. >> thank you dr. hathaway.

please advance the next slide. from here on out, we'll provide updates and the recertification update for laguna honda. can. this is the visual that has been presented before. it's a visual representation of our timeline. as of today, we're positioned on road three in the column above july which is right after our first mock survey. i'll talk about that more this evening around the outoutputs of that experience. our highest priority as laguna honda is to get recertification so we can continue to provide care for our residents. we have made a number of immediate improvements to as well as continuing the hard work for making the changes needed to ensure the sustainable success of the improsms.

improvements. experts are conducting an assessment and making recommendations so laguna honda with implement and sustain them. we'll not be submitting our application until we're prepared for the recertification survey and ensure success. one of those i am able to discuss is the bed reduction. ga geuna honda is able to change proceed ruhrs and operations to allow for successful recertification. one of those requirements is to have no more than two residents per room. this regulation is intended to increase the quality of personalized care experience. what that means for us is we must reduce all rooms that have been built to account for three patients to no more than two per room.

this will result in a reduction of 120 beds. 11 acute care beds are not impact. a task force is working with resident care teams to identify and move residents in a way to minimize reduction and support residents in the units. unfortunately, and after focused conversations and consult with cms, there is no latitude with the application of requirement and no waiver available. this regulation falls under the physical imenvironment regulation meaning after november 2016 vendor can accommodate moor in than two residents. we'll notify the affected residents and will support the residents. as dr. hathaway mentioned, we know it's disrupted to move neighbors so we're trying to do this in the least disruptive way as possible. this is not related to the closure plan. it is a requirement for us to

comply with the latest federal regulations so we can recertify again. next slide, please. one additional update i would like to share is around the kitchennal floor renovation project. this is intended to help us modernize the kitchen floor and bring it up to standards. it's required for rehe certification. irish recertification. re-- recertification. we've submitted documents to complete the pilot in several neighborhoods. working to ensure safe and nutritious meals are made for the patients is the up most priority for us. this includes preparing the gallies on the neighborhoods for meal preparation. we have on going consultations with cdph. in ray recent consult, it resulted in a need for a food

vendor. the timeline is yesterday to be determined but we're working regularly and daily on this project. now, as we through the slide, would i like to highlight some items. on this slide i would like to highlight the critical recertification and patient safety information of frontline staff. this is critical and it will be incumbent upon to us engage our frontline staff to ensure that they are prepared with the most current and recent information and we can answer their questions as they arise. on this slide, would i like to highlight using the cms critical element path ways. they are standardize as an improvement tool. for the monitoring and evaluation to ensure that they are routine and continued in conjunction with laguna honda

leadership and strafl straf and ensuring that we'll be able to answer the questions of the staff as they arise. on this slide, i'll talk about the mock sur race. laguna honda includes the first portion on july 9th 2022 and we're still monitoring the survey. they are unannounced so teams going throughout the hospital at all shifts across several days a week. we requested an extremely thorough review including a complete assessment of all federal skilled nursing categories as well as all acute care standards. a second moks sur -- mock survey is planned to test our readiness before the recertification survey would occur. the second mock survey will not take place until the corrections

are completed. i will say that we're prioritizing those as the most serious so we can make theur we address those and sustain the corrections. next slide, please. as a result of mock survey one, there were gaps in improvements that we need to make which are already underway for the long term improvement. for every deficiency noted, laguna honda staff implemented an intervention for corrective action. in addition to specific corrective action we have larger streangs for widespread system change. this is a photo from the all-day improvement summit where the findings were viewed and root causes were identified and kownlter measures or corrections

were developed. this is multidisciplinary including frontline staff engaged in developing the active corrections. this is important because these are the corrections that they and all of us will be expect sod to sustain. as we previously reviewed with the commission, would i like to provide an update on the pilot reorganization. we're excited about this pilot reorganization especially the partnership that have been provided. laguna honda launched a resorgs to align with the skilled nursing model. implementing this now provides a time to adjust and freep for recertification surveys. this pilot does not affect job classifications andçóñ refocuses disciplines back to their areas

of expertise. other changes include the following, which is increasing leadership and management support on each unit. increasing expertise and regulatory compliance and training on the units. we've brought in the role of a nursing home administrator and assistant nursing home administrator. finally we've established roles of administrative director positions all to allow us to have high funking and best practices. before i jump into the cms recertification, i wanted to talk about mock survey certification.

the recertification will be rolling out to address all cms regulations and sustained compliance. that will provide us a robust education and training for all staff. i'll highlight a few of the results here. nursing staff will receive additional training and it is directed to staff and in addition to that, we'll focus on critical element pathwaysy care compliance program of best practices. it allows our staff to think in the same way as the other services. the education rollout is intended for all staff that are part of the entire care experience. one thing i'll share now is the mook survey. in the interest of time, i'll highlight a few critical

results. in this first slide, the mock survey effects control. we have findings i would thriek include. there are numerous failures on policies and procedures including high jen and glover changes. now, positive corrective actions will include laguna reviewing the program to ensure that the best practices are implemented, followed and sustained for regulatory compliance. there will be increased hygiene audits and response to follow best practices. in regards to re depth rights, the mock survey finding did find several instances where it was noted that staff failed to

respond to concerns. for this, the immediate corrective action is all residents are being reviewed by the expert consultants to make improvements and implementing a weekly report by the laguna honda executive staff to immediately make statements available forvpatients. the residents will have daily access to their funds seven days a week. finally, in this slide, i would like to discuss another category of mock survey findings. it will be the freedom abuse and anything and comploiment exploitation. .the resident allegations were

not thoroughly investigated. and -- documented. our response to that is staff will review all residents to identify those are seat belts which are considered a restraint and see if it was for postural support or restraint. we'll see if there is a less restrictive alternative. the goal is to be restraint free and corrective actions include immediate reporting of findings and actions. we'll include reporting and the identify actions will be tracked and audited to ensure they're implemented and validated. on going monitoring will be on going. finally, the next slide is about the laguna honda updates. the closure plan and recertification updates will continue to be provided at the health commission at the second

meeting in both open ask closed sessions. the closure plan and recertification updates will be provided monthly at laguna honda and the findings and actions will be made available to the public this week. you can find it on the dedicated web pages at laguna honda.org. with that, that concludes the prepared presentation. i'm happy to take any presentations. >> thank you to you both for this excellent presentation. secretary morewitz, do we have public comments? p. >> we have two hands. item 7, laguna honda hoption and closure plan. please raise your hand by pressing *3. we'll start with the folks who raised their hand and go from there.

first on the line, you have three minutes. >> it's patrick. >> please begin. >> on the ohh on line closure database, it shows between may 16th 2022 and sunday july 17th, 2022, there were 40 planned discharges to skilled nursing facilities, one in san francisco, the other 39 out of county. plus 16 planned discharges to community-based, 12 in san francisco and four out of county for a total census reduction of 56 since may 16th. ohh's actual discharge reports

to cms and cdph included laguna honda's 13 unplanned a wols and amas include bringing the total census reduction to 69 since may 16th. the census two days ago object sunday july 17th is now 613 residents. however, on october 14th, laguna had reported a census of 710 residents. so do the 613 patient census as of sunday suggests the census has shrunk by 97 residents since the middle of october. of the 40 people discharged, the dashboard had reported on just

yesterday that two had died, not three. inspector hathaway just mentioned that 5% death rate potentially due to transfer trauma, the dashboard must start reporting post discharge expirations and awols and amas that should be obtained and you should obtain from the public conservator and our ombudsman the post discharge deaths and report them on line on the dashboard. thank you. >> thank you your comments. commissioner, we have someone in person that would like to make a public comment. i have three minutes on the

thing. when the buzzer goes off, please end your statement. >> i'm joseph urban. i work for the healthcare consultant and regulatory compliance. i've successful navigated a cms audit. i'm also the creator of the petition to ask sect [indiscernible] to stop this forced relocation. the chronicle came out with an article in this subject. i amount author of the medium article. working with cms i feel for you and your staff. but what i would like you to understand is if your primary priority is for recertification or the safety of the residents? achieving the end goals without

considering the morality of the process will unfetter any process no matter how horrible. collateral damage is unacceptable but the ends cannot justify the means in a just society with the deaths of three recently transferred residents, the current process is faulty and undeniably dangerous. you are on trend to have 40 deaths. transfer trauma is a big risk. it's hard to mitigate in this relocation program. there is no relocation quote required for recertification. this seems to imply that the relocation program is not scheus. displeusively rinked with the recertification program. what will are we striving for? i'm going to seument objective is for the department of public health to maintain a good faith relationship with cms ford to

decrease the possibility of recertification ?iem 2023. i'm going to thawm is because of two objectives, one is to continue to receive cms funding through september. and recertification is quite risky. unfortunately this is true then the strategy is at the expense of the residents and the staff. the ends justify the means. the means are killing people. if my hypothetical sis is hypots correct, you need to push back on moral grounds and make the recertification coupled with requirements. the city can fund laguna honda for a few months through the eventual recertification. thank you. >> thank you for your dments. >> thank you.

>> next person caller, you're a unmuted. >> i'm here. can you hear me? >> yes, please begin. >> i'm alicia, i'm a frontline nurse working with people withive a.i.d.s. in san francisco. i'm calling in about la geuna hospital. i've seen how our referrals to the hospital is a life saving program. they've taken patients that other skilled nursing places would not take. it's important to the h.i.v. word it's it's the only skilled nursing facility in the area that has exre competent care for people with h.i.v. losing this hospital would create a care gap for many.

plans to discharge patients are dangerous. there a gap between medical beds and patients in need. transfers to lower levels of care for patients that require the level of care could prove fatal. the clinic where i work received reports ever patients going to navigation centers or medical respite against a temporary post on care. post-op care. these are the in the naism patient safety so it's unthinkable that the plan they are continuing is impacting pairkt safety. i ask that you advocate to advocate for a halt on all patient relocation from laguna hospital based on concerns of

safety. create recertification based on critical need for service. the creation of emergency access beds in skilled nursing facilities for medi-cal patients. incentive for skilled nursing facilities to accept medi-cal patients. when one institution is threatened we need a safety net for the elderly and disabled. >> thank you for your comments. next caller, please let us know you're there. >> i'm a medical student at ucsf and rief' seen the twhai laguna hospital has saved people's lives. i'm echoing what folks said here that the city pay for a few months until we can get a

resphrergs cmf. recertification. this puts them in precarious positions where their needs are not met and exacerbates the problem that we have around housing. we deeply spreect laguna honda hospital and i ask for the city to pay nem through the certification process. >> next caller, let us know you are there. >> hello. thank you. commissioner, my name is ann. am i on? am i on speaker? >> yes. >> okay. and i'm on the board of san francisco gray panthers.

laguna honda is an important issue for us, a key issue as it should be for all san franciscans. and this -- these transfers are horrible. this is not the first time that the panthers had to raise their voice behalf of vulnerable people. today i must respectfully demand that la dweuna honda stay home, stop all discharges of residents. no further discharges for non-diseligible residents until safe arrangements are made. thank you very much. >> next caller, lotus know you are there. >> can you hear me? >> yes. go ahead. >> this is dr. palmer.

if you look, there have been 35 discharges and three have died. that's close to 10% death rate from the discharges. you've got probably a total of 600 sick patients. we're looking at -- we can look forward to 60 deaths. i think they're not asking you to do patients in. would be preeferl to the city to pay the way for a few months while working on decertification than killing 60 people. there is every possibility that cms will negotiate with you to extend payments if they are working in good faith. don't call the discharges

volunteer. they're forced. we know one of the major locations in san mateo is a facility with inadequate care. you have to stop discharges. ñu■ the petition now is now almost a thousand signatures and there is more to come. the people of san francisco do not want you to do this. this is going to put laguna honda in a death spiral and you'll lose staff and never be ail to come back. this is killing laguna honda and killing the patients while there. please stop. thank you. >> thank you for your comments dr. palmer. i think we have two more callers. caller, please let us know you are there. >> we are concerned about the

plan to transfer laguna honda patients away from their home. nobody should be transferred from laguna honda until there is a safe placement for all patients. we must respect the appeal of all patients at laguna honda hospital. stop telling pairks they can't appeal the decisions. all the patients have a right to appeal and they should contact chandler for help, (415)974-5171. stop telling people that if they win their appeals they may have to pay for their care. stop telling people that the transfers are safe. three have died already.

stop telling the public that all patients can be transferred safely. there are 600 patients needing nursing facility care. sometimes i have to go out of town -- with the high risk of trauma. cms continues paying in september, the city should pay until the end of december when laguna honda should be recertified and the city must apply for the waivers from cms's requirement which would cost # 20 beds. when -- 120 beds. clinicians at laguna honda must maintain their right to determine who gets admitted free

from pressure from san francisco general. the city must provide long term services and supports including adult day help services. but no transfers until the supports and services are in place. the crisis is an intersection of the city's refusal to provide beds for people can [indiscernible] use. putting them instead at laguna honda which is not staffed or equipped to handle them. real estate is so expensive, that facilities get [indiscernible] cities refusal -- >> thank you for your comments.

commissioners, we have two more hands up. caller two, let us know that you are there. >> hello. my namal is [indiscernible] lander. i'm a former registered nurse and i've had a number of dear ones stay at la dweuna honda hospital. laguna honda hospital. we've known of this critical situation since october of 2021. this slow-moving crisis has unfolded over nine months, yet, i really don't hear a tone of crisis. there is a little distress and no effort to mobilize the community on behalf of this community resource.

[indiscernible] i find this threat to our greatest sanctuary for the vulnerable, frail and ged deeply troubling. supervisor [indiscernible] spent his last months at laguna honda well-cared for by the staff. we provided hugs and conversation and i must say that patients need to be nearby for family and friends too do this to monitor their care and make sure that they are being provided for. and we saw that at laguna honda. day-to-day care for him.

this a precious and vital scfers and must be preserved. harry is only a high-visibility person, but every person in laguna honda has needs or they bo not be there. be there. the staff must be able to serve its mission. this is a staff that is highly qualified and has received commendations. please do what towk hont memory of harry and other people who have lived out their last days at laguna honda in comfort by helping meet recertification i would say even expanding the services so the poor and infirm can be housed in comfort. some requirements seem

unnecessary. i feel as though the cms should be sued by the city attorney. for the unrealistic demands. i feel the city must pay the $20 million a month to keep laguna honda open and keep it a available for the increasing number -- >> thank you for your comments, your time is up. thank you so much. >> thank you. >> we have one more caller. caller, please let us know you're there. >> hello. >> you're on. commissioners, that is all we have today. >> thank you all for sharing your comments. we'll move on to commissioner comments and questions on this presentation at this time. do we have any hands raised? >> commissioner green has her hawnd. >> vice president green.

>> that was left over. >> seeing no other questions or comments, we can move on to the next item. my understanding is we're skipping item 8 for a future meeting. we look forward to hearing from commission giraudo at a future date. commissioners, do you have any other business? seeing no other business -- >> we have to check on public comment for that one. anyone like to make a public comment for other business, suppress *3 thousand. we have two hands. please let us know you're there, caller. >> i patrick.

i am patrick. in addition to my comments earlier, include post discharge and post transfer patient outcomes you including post discharge deaths due to transfer trauma as an equity matter. i recommend this commission require and direct laguna honda to expand the data reported on line on the dashboard to include reporting demographics of residents discharge including gender, race, ethnicity and age ranges and most importantly, how the discharges -- how many of discharges involved behavioral outpatients versus long-term care expectations. also the weekly dashboard lumps into a single category board and

care, residential care facilities, and residence care facilities for the elderly into a single reporting metric. i believe and remedies connections should direct lhh to break out the number of discharges to each type of each facilities and not aggregate them into a single number. that would provide more doaks members of the public -- context to members of the public and not be burdensome to laguna honda's staff. >> we have one more hand. caller two, let us know you're there. caller. hole. >> hole. hello. are you trying to make public

comment? all right. i'll mute you. commission, we can move on to the next item. >> next jt a report on the july 12th, 2022 laguna honda hospital jcc meeting. we'll have vice president green providing that update. >> thank you. we heard a presentation similar to what we just heard, we discussed the steps mandated by cms which included the initiation of closure plan and the reduction from three residents to two which would eliminate 120 beds. we reviewed the results. mock survey. the restructure of leadership for skilled nursing expertise. we were told that the kitchennation plan would folt choice of a food vendor to give

the residents their options. a presentation was excellent about lgbtq resident experiences along with follow-up implementation plans. in the closed session, approved the reports. two reports. >> i'll check on public comment on this item. any folks on line, if identify like to make comment. press *3 now for public comment. >> thank you. next jt is a closed session. yrk next item is a closed session. in order to have a closed session, we need to hold a vote as to whether to convene in closed session.

do we have such a motion? >> i so move to convene in closed session. >> second. >> and i see a hand from the public. before twoag a vote, let's take public comment. >> forgive me, it's patrick offering a brief, brief comment on the jcc july 12th report. i was having trouble pressing *3 buff ended it. i would like to offer for what it's worth, a bit of an apology for my potentially strange remarks on july 12th. i was as always emotional and that's due to my 20-year commitment to laguna honda

hospital of a worked there a decade. some have shared with me that they thought i was inappropriate when i repeatedly said on july 12th, shame, shame, shame isn't it interesting that dr. chow himself has used the word "shame" tonight. about this loss of 120 beds at laguna honda. you folks could have prevented this if you had not flunked the october 14th survey and flailed in the dark between october 14th and march 8th. when i worked at laguna honda,

you several times formed inspections and rallied the troops and put all hands on deck and you got [indiscernible] you didn't do that this time. it is, as dr. chow said, simple that we're going to lose the 120 beds far into the future. >> i'm not sure what happened. >> you mean i hadn't gotten my full three minutes? >> please keep talking. there was a gap in your talking. >> okay, i don't know what happened either. because i hadn't moved my hand -- my landline hand-held phone. it is so heart breaking after

being one of the last standing skilled nursing advocates in this town. we're going to lose the # 20 beds permanently. wow! you guys know and i know that we have an upward trend of people turning 65 and above that are going to need the beds. you need to explore building more skilled nursing beds, more board and care beds, more mental health beds, more -- >> your time is up. thank you for your comments. commissioners, that's the last call and honestly, i forgot -- was there a motion and a second for the closed session? >> yes, sir. >> i'll start with the roll call

commissioner chow. >> yes. >> commissioner chung. >> yes. >> commissioner giraudo. >> yes. >> commissioner green. >> yes. >> and commissioner bernal. >> yes. >> members of the public, thank you so much. if you don't mind, clees the door behind you when you leave. folks and the public, we'll have a closed session and be back if you'd like to wait. while we're in closed session, you will not be able to hear or cease us but we'll be back afterwards. thank you soap for attending. >> wire' back in open session and we'll take a motion whether to disclose or not could disclose what was discussed in closed session. >> i so move not to disclose. >> second. >> roll call vote. commissioner giraudo. >> yes. >> commissioner green. >> yes. >> commissioner chow. >> yes. >> and commissioner bernal. >> yes. >> thank you very much and now

we're in consideration for adjournment. >> do we have a motion? >> i so move to adjourn. >> second. roll call, commissioner giraudo. >> yes. >> commissioner green. >> yes. >> commissioner chow. >> yes. >> and commissioner bernal. >> yes. >> thank you saul so much. >> thank you. everyone.

>> good morning everyone. thank you all so much for being here today to mark the completion of the all new southeast family health center. [applause] >> yeah. my name is carla short the entroom director for san francisco public works and i have the honor kicking off the festivities. i'll turn it over to mayor breed in a moment but ypt to tell you one thing that stuck out for me for this project and that is teamwork. this is a collaborative effort from start to finish. public works lead design project management and construction management and worked very closely with the department of public health, which will operate this amazing

facility, a clinic that plays a critical control in the bayview and san francisco neighborhood health center network. the arts community helped enrich interior can art work and local agencies and initiative helped pitch in with funding. we had more then 40 contractors collaborate on this project and much of the labor came from local residents. it is always great to see when a project can help support jobs in our community. the driving force of course have been the community members who made sure the city delivered. the community partnership has been the foundation of this project success. and i reallypt to note the beautiful glass wall that is designed to welcome the community to this building. this is meant to be a building for the community. -thank you. yes. [applause] i doopt to take a moment to thank some of our great public works teams who helped shepherd the project along.

some of the key players include our city architect ron alameda who is here. the bureau of architectural manager julia loe also here. the project architect charles king and richard gee. i know i saw charles earlier. the lead design architect, greta jones. project manager, (inaudible) and construction manager (inaudible) ed ryan. from the drawing work to work on side the project managem construction helped make the important project come to life creating spaces that bring people together and express community vision for itself. thank you also to the fantastic artists and i hope everyone will get a chance to see the beautiful art inside. (inaudible) yes.

[applause] ron sanders and william rodes who contributions have infused beauty culture and love into this project. and finally, i want to thank san francisco voters who support of the health band was crucial. so, that thank you everyone who played such an important part in the amazing project and i like to invite mayor breed who has shown incredible leadership during the pandemic and throughout her tenure and amplified the importance of our public health system. madam mayor. [applause] >> thank you carla and you had me at on time and under budget. really excited about the new southeast family health center that is finally i believe a dream realized. in fact, a lot of the work that former

supervisor sophie maxwell did while on the board of supervisors and i want a member of the redevelopment agency commission with all the stuff going on here and oscar james would come to the meetings and fight for this community and the fact that we are starting to finally realize a lot of the promises made to the bayview, a lot of the decisions that we are making have everything to do with input of the people of this community and it has taken a long time, but here we are. we know how important having a community health center is. in fact during the global pandemic with a lot of uncertainty and fear, part of the work we did into the emergency response had everything to do with the southeast health center that is located there and they were able to work with us to set up a place to do testing and when

the time came for the vaccine they were the place that first got the vaccine in order to serve this community. but more importantly, to make sure that we work with the community. that we provide the resources and part of that is making sure that we are coming together not that we are dictating what should happen in the community but how we work together in order to make these things possible. and i want to take us back a little bit, yes, these bonds that the voters passed on a regular basis help us to build projects like this and this bond passed in 2016, which not only made it possible for the southeast health family health center here we built from scratch, which is a beautiful building, but it also made it possible for us to remodel max ine hall in the fillmore making sure people in the community get services. half the people served in the facility next door are african

american. over 40 percent are people from the bayview hunter point community so we know when we build it they will come because we know the need is so critical in this community to make sure there is a place within close proximity of where you live, a place you can come and a place that is culturally sensitive about the needs of our community. i'm glad and excited about this and looking forward to seeing this place, become not just a place you come when things when you are having problems but a place you come for preventative care. a place you come to canggregate and hang out like the george davis senior home and i see cathy davis here. we know community is so important and this new health facility is about community, and i love the fact that 3 african american men artist who are part of the amazing community in san francisco had a opportunity to

showcase not object their art but their art as reflection of the community so this truly is your southeast health center here in the bayview hunters point. [applause] i know everybody is anxious to get in here and get a back seat or-vaccine or booster or get things checked out. it is okay, doctor, privilege. none of your business will be in the street so dont worry about that. before we get started and cut the ribbon and get this place open to the public, i want to introduce the supervisor for your district, the president of the board of supervisors, walton. [applause] >> thank you so much madam mayor. good morning everybody! this truly is an exciting day for us in bayview

hunters point. before i say a few words i want to pay homage to the folks who made sure we had a health center. some may recall we were getting sent to silver. some may recall the health system saying we can go over places to receive services but we had giant fight to make sure this health center existed in our community. i want to say a few names and know i'll miss names and some will curse me after i get off the podium. a lot of people fought to make sure we had this new health center. they served orn advisory committee, put in hours and time to make sure this happen. (inaudible) carpenter. thank you for your work. he looks younger then i am even though he has been doing this decades. commissioner

richardson. dr. jackson. my aunt, williams and so many community giants oscar james and a lot of folks are depicted on the quilt you will see inside so when you get a chance to look at the amazing art the mayor talked about, make sure you look at the art, try to understand the history behind it because so many fought for this to happen. if i didn't mention your name understand i love you and charge to my head not my heart. i want to give a big shout to supervisor maxwell and supervisor cohen for there process of making this happen. as i had a chansh to take a tour earlier and look at the services that are going to be offered to our patients here ing the district and the growth having our own x-ray machines and x-ray techs on

site. private exam rooms and brand new facilities and making sure people understand you are cared about in the community and do everything we can to make sure you have the amenities and things you deserve and we know health care is a basic right so i thank dpw for the work on the building, department of public health for their work with community to make this happen because this work only happens when folks come together and realize that when you make noise, things can happen and most certainly that is what the community did. that is why we ended up here today and i appreciate that. as i see james richards who -mayor breed honored him with a day a few years ago and put up a billboard because of all the work he did putting people to work on facilities and buildings like this. it is important we remember and recognize how we all got here and the work that took place to get here. thank all you for showing up and community.

thank you for supporting the work and vision of making sure that we have the proper health care in the communities because we have the biggest disparities in health care as a black population so we have to make sure we have facilities, the care and programs ing place to address those health disparities. we love you, appreciate you and look at this new full facility. come in and take a tour after this press conference. thank you so much. [applause] my apologies--as the mayor talked about when this pandemic started, we were one of the first communities to step up and say we need testing right in our very own community. one of the first communities to step up and say we need vaccinations in our community and work closely with department of public health who did respond and heed the call and thank the

leadership of dr. colfax and seeing the project through fruition so have the honor and privileged introduced the department head lead for department of public health, dr. colfax. >> thank you and good morning everybody. it is great to be here and thank you mayor breed and thank you president walton. thank you dpw. acting director short for your work and it is amazing what is accomplished when community government came together and i just got a tour of the building and it is so incredibly inspiring. the physical spaces where we deliver care really matter. the quality of the building, the artwork on the wall and design and layout contribute to long-term health. there are few american cities that provide this level of direct care to the residents and deeply proud of the network 13 clinics including

this new state of the art building. in particularly the southeast family health center is a special place with service few neighborhood clinics have and already mentioned we now have-will be having x-ray on site, so you can get care when you need it, not have to go to another place to go to another place to get something. we have a new facility where we will be doing on-site optomry for eye exams. we call this low barrier access but is saying we are doing everything we can together to make it easy and convenient for people to get the medical serveess where they need it, where they need it all in one location and our first patients will be receiving care in this facility later this month. and already mentioned, this center is here

today because generations of wisdom and community activism. the bayview community came together and fought hard for federalfunding, which allows the initial building to be established back in 1979. i know a lot of people have been doing the work and also want to specifically thank mrs. olly burgess for her leadership and advocacy for the health scepter and shaped the new facility behind us today is a legacy of her incredible leadership. and this is a busy clinic. we serve over 4,000 patients a year and this new health center renews and expands the commit to help equity brings services for where they are needed most. i want to thank you who are part of the legacy including and especially our patient advocacy groups. because of the success of the clinic and the new building is because of the care you provide

and relationships you built. the future is bright and i do want to personally thank the dph team for their work including cathy jones. cathy i dont know if you are here but thank you for your work on that. to lisa (inaudible) and kate kim and long-term medical director keith seidel who mentioned 4 medical directors were involved created the building and entire ambulatory team. now it is my great pleasure to introduce a key leader and member of our southeast health center advisory board member oscar james. mr. james we met pre-pandemic in the old building where the board was meeting and i have to say it is astoubding this project came on time on budget because of you and others during a pandemic. that is just incredible, so it is a honor to work

with you and thank you for your support and leadership, because of you the gap in health care services you were so key in organizing to build the original southeast health clinic and because of your vision and leadership we are here today to inaugerate the new building so mr. james, my pleasure. please. thank you. [applause] >> thank you very much. they already said my name so everyone know that already. but i want to say a couple things about my board members who are present right now. i like everyone to stand so everyone can see them. those who stand and raise your hand. these are the people who really made this possible. karen pierce, i wish you would stand

up. we have been dealing with this every since the 70 when we first got this property along with the model cities who bought the property when they were trying to take this health center to silver avenue and san bruno and we bought this property cht this property is deer to us in the community. a lot who do not know about this community. this particular property here is the old south basin, channel street project. one of the first projects built in bayview hunter point before they started building the houses on top of the hill. these houses were on stilts and when it would rain it would flood and people had to use (inaudible) we have done a lot of work in the community to make things possible for us to have the type of facilities we have now. dr. davis vision on senior housing. the

swimming pool. the redoing of the bayview park so we have a community now that is really has been thought of by people in the community, especially like a person like james richard. (inaudible) who played a very important part in this community. we have a plaque with numerous people in the community. a lot of people are missing but one thing i want you to focus on is the young men for action was the group in this community. when we started in 1966 during the riots, we made sure people in the community got jobs first and we only have 2 or 3 members left, which is james richards and dr. mayberry on the quilt. what i say to you young brothers and sisters in the community, if you say this is your community, fight and do something for your community. we started at the age

of 18 years old. 18 years old and we started with clubs. people talking about club, people are bad and all this and that. we only are this because of the vanguards. the south boys. the sheiks. they were the ones who made all this possible. you say this is your community, then act like it is your community, stop killing each other and come together and build the community for your kids. we are old g's now. we are old g's. i'm 76 year olds. i started at 18. it is you guys turn to do this now. it is your turn. if you dont step up to the plate all this is in vain. stop the killing. we dont need that. we need to know our history in the community, how the chinese, how the blacks, how the mexican americans made this community what it is today. with that, i didn't write no agenda, i talk from the shoulder. i

want each and every person to learn your history in the community and come together. if we say we are a community we the community of one. god bless to each and every one of you. [applause] >> thank you mr. james. thank you to all of our speakers and thank you all for being here today to celebrate this momentous occasion. with that, i would like to invite the speakers and other ribbon cutters to join us and cut this ribbon! >> 5, 4, 3, 2, 1! [applause]

>> >> welcome to our wednesday july 20, 2022 meeting. >> please rise for the pledge of america and to the republic for which it stands, one nation, under god, indivisible, with liberty and justice for all. >> >> thank you. >> take roll. >> yes, please. >> debra walker? here.