>> all right. good afternoon. staff and san francisco, welcome to the healing commission meeting of tuesday august 2, 2022. call the roll. >> yes. >> commissioner chow.

>> present. >> commissioner guillermo. >> present. >> commissioner green. >> present. >> commissioner giraudo. >> present yoochl commissioner bernal. >> present >> yield to vice president green to read the recommend ramaytush ohlone acknowledgment. we are on then set roll only land of the ramaytush ohlone the original inharsh tans of the san francisco peninsula. as the stewards of this land and accordance with traditions. the ramaytush ohlone have never seated, lost or forgot responsibilities as care take and all people who reside in their traditional territory. as guests we recognize we benefit from living and working on their traditional home lavenld we wish to pay respects by acknowledging then cestors, elders of the recommend ram

community affirming their rights as first peoples. >> thank you vice president green. >> secretary morewitz >> welcome to the august seconded health commission meeting held in hybrid format in person room 300 broadcast live on sfgov.org and availabling via web ex. i like to remind all attends nothing person today all health protocols and building rules adhereed. wearing a mask. covercovering nose and mouth including when you speak. failure may be removal from the room. we appreciate your cooperation with the requirements and interested anyone's health. note that the hand stan sanitize are stations are at the upon entrance of the room. we welcome public participation. there will be an opportunity of public comment in the beginning of the meeting and then on each

discussion or action item on the upon agenda. each comment is limited to 3 minutes. i encourage anyone to raise their hand at the beginning of each victim to make sure you have time to have your hand up and be seen there is a delay for you watching on sfgov.org that is a way to ensure your hand will be seen by us in time comment taken in person and call in. for each item first from people attends nothing person then from people in the meeting remote. submit a card to me and instructions for those remoat found on page 4 to which access closed caption hover overwhelm the live stream or on demand vo a pop up with the cc logo will show and you can click on cc. tell be displayed under the video city policies and federal, state and local law prohibit harassing conduct against city

employees and will not be tolerated. public comment permitod matters in the jurisdiction of the health commission. our next meeting on august 16th of 2022. thank you very much. >> all right. second more wichlts approval of the meeting of july 19, 20 twoochl a note on the minutes for those of you who have been watching it is commission received updates on the situation of laguna honda hospital the second meeting. we are concerned. and we will do everything we can to support the excellent staff at laguna honda on to get everything back in compliance and are concerned about the passings we learned about from those period of time after they had been transfer friday laguna honda. we are pleased learn cms decided to pause transfers and discharges. at this time.

so, we will be having another full sdpugz both in open and closed session at our next meeting. >> commissioners do you have the minutes before you? upon review, if there are no amendments do we have a motion to approve? >> i move to approve the minutes. >> second. >> second. >> and commissioners before we get to a vote there is a hand i will go to the caller i have a message to read before we get there. >> for each item members have an opportunity to comment for 2 mentes the process is designed to invite feedback from the community. the process does not allow questions to be answered in the meeting or to engage in conversation with the commissioners. the commissioners do consider comments when discussing an item and making requests to d ph. each individual is allows an opportunity to speak.

may not return more than kohns once. one other note if you are making a comment on an am item i'm going ensure the comments pertain and if they don't i will ask to you stop and comment on the correct item. for this item we are talking about the minutes, i'm sorry. so -- commissioners we have no comments. commissioner chow. >> yes. commissioner giraudo. >> yes >> commissioner jarmo. >> yes >> commissioner green >> yes >> commissioner bernal. >> the item passes. >> our next item honoring tracie packer will be moved to the next meeting when we have the opportunity to honor and thank her for her excellent work at the department of public health we look forward to seeing her at

our next meeting the next item is the director's report. we have doctor grant colfax, director of health. >> thank you, president bernal and good afternoon commissioners. just to read through a few items here in the report and i gallon to the covid-19 update. looks like the slides are appearing on the screen. a couple of, key things to highlight just to share with the commission that i was able to attends along with breed and leadership at san francisco public works, the opening of the new southeast family health center. which is a beautiful, new 22,000 square foot neighborhood clinic that will continue to provide family primary chairman with behavioral health service tailored serve the needs of the hunter's point community. and the center is important

legacy of community healing advocacy and expands the original southeast health center opened as a stand alone clinic in 1979. the existing now the over building -- has been among the busiest in the san francisco health network serving 4 thousand annualy. the older building remain next door and include office space for staff and dentsal services for patients the new clinic expands a community vision to support bay view residents providing affordable health care meeting the need for health services that approach health care from a whole person approach integrating health, mental health and others improving well being. i think that the new building i don't think the new building very much is in keeping with the

research which indicates that the environment of care, the quality of the environment and things like the lights and spacing has an affect the over all environment as anning affect on health this . clinic knocks it out of the park in terms of structure and reflecting that philosophy. i encourage the commissioners to visit when you have a chance. i want to ad ensure that we recognize that this 39.5 million dollars fund bide the public health and safety bond passed by san francisco voter in 2016. acknowledge, this is a long project and want to thank public works and all the team d ph that worked on this and acknowledged the clinic staff. who were very resilient in

working with regard to through i haved i have while the new building was going up next door. thank you to everyone for that regard. that highlighted with regard to the monkeypox epidemic in san francisco. we continue to see increase in cases as of earlier today there was 310 reported cases of pox monkeypox in san francisco. commission need more vaccine. we continue to provide vaccine quickly as possible when we get it through the state. and an example of this was yesterday at san francisco zuckerberg hospital a thousand vaccines were begin in the morning alone. we received 4, 200 vaccines last

week that is exhausted across or 10 cites. we did receive good news from the state today that we expect to receive our next shipment will be 10, upon seven00 vaccines. we don't have a date for when they will arrive, that is we were told the next shipment. improvements a doubling of supply. we need splich 35,000 to the highest risk group and now about 75,000 vaccines in total to protect those fully at risk. and doctor philip system here to update. >> they are having trouble hearing you, can you pause for a sect. anything we can do? >> commissioners can you hear me okay? >> could i have a thumb's up if you hear me fine? >> commissioner bernal, yes, mark, it is you are a bit muffled as well. >> we are. not as bad as the doctor. >> i apologize i want to problem

solve this. >> can you hear me, well? >> yes, no. thumb's up or down? okay. so -- i need y'all i'm not sure but we need to work on this now we are in a meeting. [inaudible]. >> might be grant's microphone. president upon bernal sounded better than the doctor did. how about this mic commissioners, is this clear yoochlt this is okay. >> yes. >> may be i don't want to make you -- is this better? are this does not have a thingy on it. >> how about i apologize doctor coal fact when you comment can you speak here.

so we do this and it sounds like you will be fine if you do. [inaudible] gentleman ahead. director. can you hear me now? you are still muffled. >> still muffled, they are saying. >> i don't think it is that they have heard me before. >> can you hear me. it is the audio. >> yea. >> we are hearing the same thing. muffled and garreled. is the microphone okay. >> yes, no.led.

is the microphone okay. >> yes, no.led. is the microphone okay. >> yes, no.bled. is the microphone okay. >> yes, no. is is possible to recess so we can i'm not sure what to do. >> we will call a brief recess until we have audio issues sorted out >> thank you for your patience an we ends the resxesz start from the top with the director's report. >> thank you. doctor coal fax. thank you. secretary, good afternoon, can you hear me? excellent. all right. so -- i will start from the beginning of the director's report. i didn't where added that people were not able to hear.

so, i was really delighted attend the opening of the new southeast family center opened to serve as a health care hub for the bay view neighborhood residents. this is a 22,000 square foot neighborhood clinic providing family primary care with a behavioral health service tailored to the needs of the hunter's point community. at the opening in addition to the many community leaders and members present, joined by the mayor and supervisor walton and leadership at the san francisco public work's department. and -- this health center is has been and will be an important part of the legacy of community driven health advocacy in the neighborhood and expands on the

original center opened the doors as a stand alone clinic in 1979 after a long history in of community activism. the center now the older building has been the busiest clinics in the san francisco health network serving 4,000 patients annualy. this older building will remain next door and support the service of the community including office space for staff and will continue on provide dental service. the new building expands a community vision to support the bay view residents providing affordable health care and meeting the need for health service this approach health care from an upon whole person approach fizzal. mental health and other supports improving over all well being.

we know that the physical environment of people receive health care is directly affects their health and well being. this new building embodies the value of providing health care and welcoming environments. i was encouraged the commissioner to visit. i want to -- really commends this out reach health center staff. they saw this building go up next door and some of them worked on over executive on making sure that this happened. and it was a project based [inaudible] on time and on budget and to that [inaudible] say that this project was nundzed throughout public health and safety bond, which was overwhelmingly passed by voters in 2016. another key area now with regard to monkeypox epidemic.

we continue to see increasing case in san francisco. as early are today we had a total of 310 cases diagnosed in san francisco primarily among men who have sex with men including gay men and trans men represent 95% of the case. san francisco has over half diagnosed cases in the state. you know, we continue to work with our community partners and ensuring aware ness and prevention are provided. we are continuing to vaccinate people. we just got good news that our next shipment of vaccines expect to receive over 10, 500 double the prior ship. this . is good new its is still not enough. you recall, the 35,000 vaccines

to vaccinate the highest risk and the 75,000 to vaccinate the groups that are nouchl so, some progress not enoughment ton get run out of vaccine the demand is high. san francisco hospital are vaccine clinic did a thousand alone yesterday. and there is increasing demand across the vaccinate and vaccine site catharsis giving monkeypox vaccine. that was after the chair i think you are aware that has our public health officers declare a state of emergency on thursday. to embody myself and the mayor declaring that emergency which will allow us to harass resources effectively at health department. coordinate with key partners and increase awareness of the

serious disease. this disease can have a severe consequence in terms of pain, blistering of wounds and disability. so, the doctor will provide updates further down in the presentation. >> in term it is of additional upon report, just to reenforce the president bernal's comments with regard to laguna honda. the team there continues to focus on working toward successful recertification of the hospital as the commission heard the state have ordered us to pause discharge us from the hospital. we are responsive to that request and will recall that you

will be forced to discharge patients per cms plan demanded we implement. now we are on pause and working with families and residents and federal and state partners to continue to share updated information and ensure the patients and the patients the residents of laguna honda and the staff have all the information they need. and as a health department and laguna hospital leadership of [inaudible] that our residents need to come first. residents of the hospital needs come first. pleased as we closed the budget season to make sure that the commissionness what our 22-23

and 23-24 budget was approved and i'm looking and believe this is a typo. our budget is a little more than the 2.9 million that is 2.997 billion. make sure that was corrected. but really want to again acknowledge the work that jenny w you gos and her team did on this presentations you know how much time it takes and different moving parts. just pleased to see this went forward and the we -- emerged with air budget that for the most part meets needs and add backs that you can see -- as that are put back initiatives you can finds that on the report. >> i wanted share in closing, one -- sad announcement that we

had a passing of a highly valued employee on the [inaudible]. who was a [inaudible] tech in health worker 3. passed away last mont. unfortunately. he was born and raised in san francisco and graduated from [inaudible]. worked for public health for 20 years. prior to d ph a sxharn emt. and his first 13 years working with d ph at adult immuneeration travel clinic [inaudible]. and approximate the department of community has an investigator with the continued disease control team and the front desk operation's manager n. past 7 years a team member at [inaudible] [echo]. so on behalf of the department we extend condolences to his

wife and family and friends and those in the community who are impacted. thank you that's my director's report. happy to take questions now. the commission would like to follow up i can provide the covid update and turn it over to doctor philip for additional monkeypox information if conscience [inaudible]. >> i think may be if we continue said through the full report and take comment and have commissioner questions since you have mentioned the vaccine on monkeypox. >> i will go to the covid update. i'm sorriful commissioners and director. i did not realize what you said commissioner green the director's report is separate we need to check with public comment. >> okay. >> folk on the line if you like

dmoent o item 4 the director's report. press star 3 now. i see one hand. give me a second to get the timer up. each of you will have 3 minutes this comments should be related to the director's report information in the director's report. >> okay. let us know you are there? in. i wanted to comment on the next item number 5. so i will call back >> thank you. >> g. ahead and leave your hand up it is okay. >> all right. so it looks like there is no public comment on this item. thank you very much, commissioner green. >> no worries. any commissioner questions or comments on this director's report?

>> [inaudible] separate item i wanted to get a feeling as to [inaudible] will be at laguna do we have an idea is it -- where it is an indefinite pause. because this will create [inaudible] if you don't understand how long the pause will be. and number 2, whether or not there is discussion with the tms continued discussion about the 120 beds we may lose if we are required to follow the new guidelines for facility placement? >> thank you. commissioner chow and -- i can see -- laguna honda was in the commission chambers before we

had -- [inaudible]. okay. >> can you i will answer -- >> sure. >> thank you for that question, doctor chow. [inaudible]. [inaudible] regarding the closure discharge plan, on the recent communications from the state how long the pause will occur, it is still to be determined. the state is reviewing along with city are reviewing where we are currently, they told us to you know -- stay put for now and they will let us know when the pause may resume. at this point we are told it is -- paused for now until further notice.

in terms of the 120 bed to the currents requirements, you know, we -- continue to have our -- [inaudible] of which [inaudible]. and our understanding [inaudible] [garbled audio] >> mr. pickens? >> yes. >> you are breaking up i'm not sure you knew that. >> no, i didn't. is that better. >> could you repeat the last i think you can are heard up to the last sentence >> sorry, thank you. >> the 120 bed reduction, our communication from cms we will be required meet the 2 patients per bathroom that requires the 120 bed reduction that is what we are operating under now we

will have to make that reduction. >> thank you. were we working on whether or not we are going to lees lose that capacity then? >> we are continuing to look at what our options are as a result of the 120 bed reduction. ure know options just because those beds will no longer meet the requirement does not preclude us from looking at all the other appropriate uses that still benefit the population served by laguna we might be to use the beds to accommodate other levels of care. that determination is looking at the possibilities and no determinations have been made. >> thank you very much, if you just keep us updated that will

be helpful. >> will do, thank you. >> thank you. and any other questions from the commissioners on the director's report? >> i don't see in the participate -- i guess we will go to the covid-19 update and monkeypox. >> thank you. vice president green and commissioners. i'm [inaudible] treasure. health i will go quickly through this covid-19 update. just to say we have the message is -- we are seeing promising signs the [inaudible] going off. and this [inaudible] typeset is not so but we are seeing signs of things moving in the right direction. [echo] the case rate per 100,000 residents on the right peeking 61.4 now down to 38.5.

obviously them does in the reflect all the cases or the home testing or the people who are asymptomatic or are and don't test. but again, it combined with others i will show it does paint a more promising trend then and there we have seen the last couple months. >> case that we tried 168, 291 case of covid-19. society commissioners who are following this to say this includes people diagnosed with covid twice. upon just to declare this is case no longer individuals that is consistent with the state and i believe the cdc reporting as well. unfortunately 937 deaths due to covid-19. since the beginning of the

pandemic. >> and were this discipline show that by month death. deaths as we know go up when case go up. we had that [inaudible] due to our higher vaccination rates and the far right of the slide, case will go up due to reporting delays. >> turn to cases by vaccination status the vaccines protect against infection they are not -- certainly have advocacy the variants and reminds the commission we near a da5 surge. you see here that the rate of infection among those who are unvaccinated compared to those who complete an initial series. >> hospitalizations.

129 individuals as of the 29th were in the hospital with. comp i haved. this includes people who were there diagnosed with covid and in for reasons admitted to the hospital with covid and that includes who may not be san francisco residents. you see icu a number is low at 18 across the city. hospital [inaudible] remains robust. with over 36% of icu beds available and 20% of acute care beds available. we are in no danger of losing our capacity. a big difference from in the pandemic we are watching carefully. in terms of vaccine administration to hit high points 75% of residents have, 85% have been vaccinated shown

on the upper -- the 85%. [laughter] 85% [inaudible] vaccinated. 75% residents eligible for a booster were boosted. and down at the text outside of the graph you see that we are doing well with 5 to 11 year olds 76% initial series and 0 to 4, 22% received a dose. we like to see that increase. it is higher compared to state and national numbers. so, relatively low. >> in terms of the boosters and those of you following this closely. you will see that this number is 63%. this is -- differents from the prior percentages we have shown it is lower. method of category the percent boosted is changed in keeping with our county partners and the

state who are looking at percent of all residents all ages with a booster dose the prior was done of all people who were eligible for a booster. that it is also 75% and this number is 63%. the team believes the boosters will potential for boosterses recommend across all ages this is the met tricks we need to follow. and the communitiad a whole indicated is better of the risk levels for people become severely ill in addition to age and other behaviors. >> indication of san francisco case stabilization and opt malcapacity adequate temperature is likely the boosters will be recommended this fall.

watching that carefully and health care partners are red to responded. and again our recommendations with the bay area health officer who is stress the importance of continuing with the reduction measures we than can mitigate with the masking and keeping updated on vaccinations. and knowing how and with respect and when to acsefsz that very important life saving antiviral treatment if you are infected. so i will stop there and [inaudible] i can take questions and doctor phillips will provide other additional updates on monkeypox. >> yes. and public comments will be at the end of both of you speak the commissioners can interact on covid if they like now. >> commissioners, comments or questions for director colfax?

all right. seeing none. secretary you can proceed to the monkeypox update. >> i'm not -- director colfax is doctor philip going to verbally or you doing the monkeypox? i believe am doctor philip will give a quick verbal update. >> thank you so much, director colfax and good afternoon secretary morewitz and commissioners. thank you for having me. doctor colfax covered all the main points of monkeypox response. and so i'm happy to answer questions but as the commission knows we were happy to have the support of president bernal and the commission in our declaration of public health emergency the first jurisdiction in the country to do so last week. and then followed by other jurisdictions including the state of california which

announced yesterday. we are very hopeful that the state declaration and will allow us to have additional flexibility to responds. and does allow for vaccination by additional personnel including em circumstance personnel and we will hear from the ems colleagues later. we appreciated their collaboration. it also will potential leave allow for a faster pivoting of the covid teams that are available to provide vaccination service that have been contracted through the state. and the state has been work to add monkeypox to the venders repertoire and work and this announce am will allow that to happen more quickly and also really arc line our ability to get data from the state data bases related monkeypox. the prior agreements were covid specific. there are many way in which are

declaration and issuing our public health emergency as well as the states happened yesterday, will be very helpful. doctor colfax mentioned the work happening at san francisco general hospital and the vaccine clinic there an arc stoundzing 950 vaccines given yesterday to people. and we are hopefully got this am additional 10, 700 dose coming to san francisco. and i will say that as an incident command team now we are starting to think about how we pivot our approach and really have more partners that are able to deliver vaccine in smaller amounts to make sure we have an equal focus while maintaining some ability to do higher volume through put not only through the team at san francisco general but also to the partners at kiez

and ucsf ready and stabbing by to get more vaccine and opened their vaccine clinics to their parent and members butt public as well. all of that information to the public can be gathered via sfgov weresmonkeypox. we push information out that way. there are teams throughout the activation and the city that are partner to try to get out information and awfuls to push vaccine out as quickly as we can. i'm happy to answer questions and00 oaf very happy to come back with a formal presentation the next time. has been very busy the past week as you can imagine. >> thank you. we are aware. i have to say that despite the supply issues we have been facing i went to get my vaccine and was impressed how well the process was runful how friendly and helpful our excellent staff over at the general are and it

was good process. . convey our thanks to everyone on the front lines and working behind the scenes to have a smooth process that will ramp up once the plies available from the federal and state governments >> thank you very much for your kind words, president bench you will pass its and they'll be heartning to the people working, to hear. >> thank you. >> commissioners, comments or questions? >> commissioner green? >> yes. first i a heard the same feedback about the clinic it is a credit to the department in the usual right in the frontline the benefit declaring a health emergency put our stakes in the grounds the pfrnls us getting the vaccine out to people who need it. there are 2 questions. first is

small pox vaccines begin until 19 sfoochl what are you recommending for individual hos had a small pox vaccine do they have immunity. does it matter what year they it. i'm not sure of the information tuesday be helpful and the second thing is if you can reiterate somebody wants to go to sfgov and finds how they can get a vaccine, were there clinic hours as keep get more vaccine what will the structure be. when we started giving covid-19 it was confusing. now that we have been through that what should people look for. as we get more dose how will they and not where will they know to go. it is great kaiser will give to others but do they as well anning online sign up like wall greens for covid-19. >> thank you for both of those excellent questions. the question about a small pox vaccine thap is important. what is believed that there is

some cross protection that occurs and available to people who previously vaccinated against small pox but likely not complete. if it has been 3 years or longer since a person had a vaccination against small pox and exposed or in groups we recommend become vaccinated for monkeypox, then they should go ahead and seek the vaccine sthachl is the concern recommendation there. and your question about how to get information out is important. my understanding is that our partners at kaiser have call upon centers and what we will need to do is make sure that we are sharing ways in which they can be accessed. we know our partners at the san fran aids foundation an partiality vaccinating site and partner through the city have a phone line and publicized that on their website people call and

get on the wait list. those are important things. we will try to consolidate special have there be a routed people can get a point of information. as you know, as we move from covid it is challenging not onsite someone can put in information and look for availability across the systems that we v. that would be ideal. we don't vice president that. we can try to make it clearer where people should start looking and asking. i want to ask people tong about the if they have health care. think about their health care and providers. there will be more access in coming days for different provider system. that might be a point of access we are using routes the sfgov site and the clinic rat the general we are also sending out messages in real time. sometimes through social media to let people know what they should do and when doses are

available. as we go quickly as we can had we run out and the supply allocate side complete because people have been so quick and good about coming and getting the vaccine that could benefit them. we arityerating on the. and improving vice president issue green. and you know you mentioned we'll think about equity. who are the new partners? the new hours that might be accessible for certain people? all of those will know part of our thinking and engaging with community to understand how we can best match their needs to how we are work in our own systems or part norse get vaccines out with as much equity as possible. tell be a balance we are trying to achieve. >> thank you. do you envision there will be a place online where people is sign up similar with upon people signed up for the city cites for

covid testing? i did in the realize. but is that something you foresee either through our partners systems or through our own website? >> i think we want to explore it with our partner systems. and we are work to see if vender partners might be to deliver monkeypox vaccine against monkeypox at some community cites. it is early in those processes and those discussions but it may be possible. we also understand a state level the state is looking at usingless might have turn system and the other systems they had in place. that could be another benefit to people if we have our cites list said. more to come on that and a point well taken. weep want to decrease the mystery where peoplical go to get this vaccine thap is important. >> thank you very much.

>> >> thank you doctor phillips i had a question on covid want to continue to follow up on the monkeypox. understanding the vaccine distribution. what about the treatment distribution? that seems to have a [inaudible] when is the actual [inaudible] and how somebody, if say they near a practice setting is able to access those who have the license to give the treatment this . is an important points. thank you commissioner chow for asking it. the treatment is an approved treatment for small pox not monkeypox because of of that the federal regulators, fda and cdc require the paperwork to happen

as if there was an investigational new drug for monkeypox it has been time and labor intensive to do so. our cdc partners and fda decreases significantly the amount paperwork. i'm will told by assistant district attorney clinic staff that from an hour per patient rememberings. which is challenging to now 15-20 minutes. this is a bit of a burden. and so there could be additional providers that complete the paperwork and we could support them to do that but the to apply to get the doses and treat. but that's a barrier. we are doing 2 things one we are trying to support providers. there was a well received provider webinar put on by our team last week and we can provide a link to that. when it it is up. it is going through file

editting to be available to the people who were not able to attend that speaks a bit about treatment what the process is for becoming a treating provider with monkeypox and then it remains a challenge for some peopleful city clinic has played a critical rolism can't thank that team enough am. doctor cohen and doctor bacon and so many people have been work to try to have that be a central site for people that are not able to get treatment elsewhere or testing evaluation and follow up and vaccine. upon city clinic remains the site. we are trying to see where there recollected be other sources for treatment emerging throughout the city we know there is a need. working with partner us and know exploring ideas with

collaborators and colleagues about different ways this could happen as well we continue is an important area and we are working on trying to increase access to treatment. >> sure. in follow up, if somebody did have a parent they thought should receive or a candidate for treatment, is it is that our website is the -- you know answer or -- and -- or is it that they should all be directed to city clinic? >> city clinic has limited capacity. they want to try to help if a provider felt it was indicated. provider is welcome to reach oust to city clint and i can numbers and contacts and information are available on the swiebs that is directed to providers and have information about monkeypox. a we have more available we will make that available, too. we are encouraging health

systems and if there are unaffiliated provide irs it would be great to see how to help. support them as the administrative burden decreases and we advocate with federal partners to decrease it further to have more sites and providers able to offer this part of their routine practice. we continue is a challenge now. >> thank you. >> thank you. >> i don't see other questions. anyone watching apologies for my absence i went to another location as we wents full reshlomo the audio issue resolved for future meeting. secretary morewitz. >> public comment on this item. >> folks on the line upon each you have up to 3 minutes to comment. i have a timer when the time are goes off i will let you know

your time is and up finish that sentence and i will mute you. and i will unmute the first person. caller let us know you are there. >> yes. >> i'm elizabeth -- of i'm a member of senior and disability action. last week many people in san francisco cheered the bart board reinstated the mask mandate. we expressed our gratitude to the board for allowing us to participate full in public life during covid. several bart board members expressed frustration that the health departments of the county served by bart remain silent about mask mandates and don't respond to bart requests for when the health departments are thinking regarding masks. upon it is not right that the

san francisco health commission stays silent at covid numbers shore unchecked. remember this public hasn't is the name of your department. please lead, live up to the words public health. please put this place an indpoor mask requirement for san francisco. read beyond the misleading headlines in the chronicle and see hospitalizations long covid cases reinfection numbers are rising. thank you very much. >> thank you for your comment. next caller, let us know you are there. >> hello. >> yes. begin. >> okay. as far as the monkeypox, i theme we get very aggressive with this and shut this down.

so that it does not go wild like is happen with covid. and as the last commenter stated, everybody is waiting for the public health officers to lead. . when we ask them to put in a mask mandate or other safety protocols, they respond that's above my pay grade r. pyle follow whathd public health commissioners say. it is very dangerous for us to go to routine appointments at small clinics or go shopping or to just walk around when nobody thinks that covid is still here. and nobodying has heard that a mask mandate has been put back in play-offs because the only place it is happening is bart. >> so, i ask you to please,

lead. with all of the safety nshs we need for covid. and monkeypox. i want to tell that you my daughter is going in for a procedure next week. asked what their monkeypox safety protocol is they answered, they have no instructions. that has to go out a. s. a. p. to clinics and hospitals in the city at least. thank you. thank you. next speaker, please. yes. i'm alice an member of senior disability action. i support both public comments the speakers said. i support all covid and [inaudible] monkeypox safety of measures. that are needed include being those at [inaudible] advocated at the last of meeting and those

at san francisco aids foundation and harvey lbgtq democratic club advocated for among other lbgtqmpxv safety equity measures. regarding of the coy i haved. levels are high at 13.2 average test positive. the new york times covid tracker says that quote, the test positivity rate in san francisco is high suggesting cases are significantly urngd counted. that is an important factor and part of every report. additional leave. sf reports health experts warn test positivity rate 5% or more is a cause of concern. we need to bring back broad mask

requirements that was there during delta case. similar rates. we need that to protect ourselves from long covid. this is can be devastating. re search afford in the comment before shows that each if you are vaccinated, fully vaccinated and boosted especially if your boost cert wang are vulnerable to long covid. many have really severe side affects from long covid. some cut hours. some cannot work. you are all at risk. your loved once are at risk. protect us. and this is the time to do everything we can to stop the monkeypox that [inaudible] crisis. needs to be safe places to isolate for people with shared how doing for covid and

monkeypox it can be long and needs to be paid sick leave for everyone who needs to isolate and recover from the serious virus. additionally, there needs to be full education regarding the ways it can spread. the cdc insufficiently protective of pregnant health recommends health care workers with a patient seek care should wear mask approved equipped with network 95 filters or higher. you need to >>-- explain that with -- in your public health messaging there needses to are protection for the person weapon who diagnosed with monkeypox but we need to be wearing the masks. >> thank you. >> time is up. thank you for your comments. >> buzzer did not go off.

next caller. you are unmuted. >> you hear me? >> yes. begin. >> hi. i'm jan a member of senior disability action. i'm calling to comment about covid-19. i have a few question when is looking at hospitalizations and deaths are you could you think the number of long covid patients committed suicide due to condition. there is a lot that are in pain with no hope. 2, the number hospitalized or died due to post covid health emeffectses afternoon mild infection. 3, the number hospitalized or died from delayed medical care do to exposure risk. concerningure focusing on hospitalizations and deaths and not caring about cases upon even though we know the risk of long covid are not insignificant if you mean are looking at

hospitalizations and death you are not looking aye at a complete picture. you are not dpoek using on long covid. start gathering fact about thes number of residents who is have long covid you talked about it once in the several months. and you stopped doing that you need it start again. count long covid that arc rises from mild cases and occur 5 to 30% of covid survivors. it it is impacting our economy. the institution has estimated that 4 million full time workers are out of work because of long covid 2 penalties 4% of working population that is a conservative estimate. showed up to a leader of public health. [inaudible] they are a public health leader than [inaudible]. i'm concerned that the doctor phillips said she did not see mask mandates coming back.

a may 202 survey showed 75% of democrats would support an indoor mask mandate in a progressive city there is no [inaudible] or on ramp [inaudible] for where they are triggered i like the commissioners to ask, whether on ramp/off ramp regarding mask mandate this is is bask public health. i want to you push on this and not expect a not addressing the issue. 2, why are mask mandate in place for essential service. now people sharing space with people with act ever covid pick up at the pharmacy in mask optional environments. every time we come to the meeting we talk about the urgency and he you are not doing anything. people ever continuing to die.

peoples lives are in your hands. listen to yous and reinstate a mask mandate. thank you. >> thank you for sharing your comments. >> next caller? >> thank you, so much good afternoon i'm vinnie calling if the lbgtq democratic club the need to make known to the public their plan to address the latino community regarding their over rep centation in monkeypox case. i'm calling to reiterate the need to expand the right to recover program. to cover both covid-19 and monkeypox. as well as the need for health commission to push forward and pressure other officials to provide paid sick leave for

individuals who become infected with monkeypox. thank you very much. >> thank you very much for your comments. >> caller? let us know you are there? >> yes, hello. i'm [inaudible] and i'm [inaudible] stanford university human rights and mental health. today i'm calling as an [inaudible] disability right a member of sva and a concerned bay yash parent of a rising fifth grader enrolled to attends in person school begin nothing less than a month. and concerned about long covid. vaccines can serve 15% protection from. according to the study to date. and which threaten 10 to 50% of people with covid k with long-term [inaudible].

i'd like to say how grateful our family and many covid families are to the [inaudible] of the area our county public health boards have the spirit of solidarity and protection and health and safety from the start of the pandemic. as a result they kept transmission rates the lowest in the country and around the world compared to most places. and weer disturbed how quickly the mitigations were abandon start nothing february with promises to return to mitigations like masking during periods of high transmission. but were not seeing metricks from returning masks. we need kinlts mitigations even periods of low transmissions maintaining low transmission mitigation remain in place. our schools tell us they are

looking to view to county health boards for guidance and not reinstate mitigations without your support. i like to urge universal masking in accomplices that need to be accessed by schoolchildren and by the general public. where as spaces shared or close contacts are necessary and ability to participate in public life to do safe socializing. in person learning and quality of lives deupon penned on public health agencies like yours. thank you very much for your leadership. thank you for sharing your comments we have one more caller with their hand up. >> can you hear me? i'm elizabeth i'm calling am just to urge to you bring back the mask man dachlt i don't know when you are waiting for.

i mean the case nshs still upon sky high even though it is a slight dip in the numbers. it was pointed out there are many rapid test catharsis not reported. you know the numbers are almost certainly far higher than they are than we are aware of. what is the purpose of public health not to protect the vulnerable. and all of us. serndz to covid is like fatalistic garbage. it is. and like you know if you don't have easy measures save people from disease and suffering and death then when is your job this is preventible. i'm [inaudible] so many people -- i live in public housing for the elderly and disabled in san francisco. i have been an upon prisoner in my apartment since the mask mandate went away.

my manager are not become they are look to you guys i'm not able to use the laundry. i keep the trash in my fridge so i don't expose myself. leave my apartment once a week to check the mail. and do stuff in the morning. and is is no way to live t. is ridiculous to me that like i know others who are in this position, too, i tried calling different offices about this and saying hey, what ask can i do they are like, sorry we can't do anything. public health are not back they have to do it. it is unacceptable. so i want to point out a couple things. it is you know -- pharmacies, too, it was said; not having mask mandates indoors people getting in line with people getting vaccines you know when

masks are optional. i'm not able to safely any to the dentist or the doctor. over due appointments i can't take the bus and then when i get to the office you know people are not going to be masking in all areas of the building. if the village that office is shared in an office building with other medical office and i guess other once, too. there are no masks required in the elevator and the lobby. it is kinds of pointless you are exposed. i am vaccinated i wear high quality mask but i'm enemy a high risk category. and public health should be protecting everyone. those of us at high risk deserve to be arc live and part of public life. you know we are not deadwood and treated like that. it it is just disgusting.

time is up. >> thank you very much for your comments i don't mean to cut off this is important but your time is up. thank you very much. that was the last upon person with their hand up. commissioner bernal you are muted. >> thank you. callers for calling to express your perspect and i have concerns. moving forward to our next item is general public comment. >> commissioner bernal i believe that -- that commissioner green or chow green might have a comment? >> thank you. commissioner chow. oh. can you hear me? >> yes. >> okay. so -- i was going to ask doctor

fill time follow up which obviously public comment on this subject brought up already. bart did go back to a mask mandate where we worry mta and county did not put in an over all mask mandate. continued to require masks in the press release health facilities, trains, buses, airports, jails and homeless shelters. i'm not exactly sure these other high risk areas we talked about before public health officers are standing. and upon why at least public transportation we are not able to convince mta that with this is important. i than put up a sign saying you know masks advised but that is

only if they are flashing their signals. some of us don't have any of that they have a permanent you know display of the number. so, and of course, there is a mask advise at the rear of the bus which nobody cease because they have board the bumps realizing we can't enforce everything, just the idea of that we would have recommended not just recommend but it it is mandate to go, i think on public transportation is probably well accepted. i think you have spoken in the past that as you have public transportation a good number have masks and the people are going in pharmacies and in our city do, but we have a lot of people who come in from other

areas, too. and don't have that same feeling of collectivism. i'm wondering where we are with mta? one agency which perhaps we can get better agreement and where you know upon fellow agency in los angeles was important. >> thank you. commissioner chow, this is important. one thing i want to point out is this with the exception of transit all the cites you mentioned los angeles county required masking they are essentials we do as well mandates and shelters and in congregate settings, residential facilities for elderly, et cetera . so, the piece about transit is important. and what we understands from mta leader should when than i have evaluated their surveillance cameras and on routine buss and

other vehicles. 80% of the passengers are observed to be wearing their mask is a high percentage and showing that their messaging around marshings are recommended and general message nothing san francisco like the health officers say masks are encouraged and now a good time for us all to wear masks in public spaces. . that is happening. and will continue top have the discussions later this week. with leadership and director tumlin and others. to talk further about this issue. but i want to start with that baseline it in sanning fran, people on transit are masking. i think that is a qualitative sense i gave you from taking the metro and bus. but i know that from the data that was shared with us by mta that is something they are also quantifiablely measuring with

surveillance. it is important to understand this and i think continued evidence and discussion is important. mta, buildingses, residents all the organizations are able to put in their open masking mandates. i want to make that clear. does not require a health officer order for individual businesses or entities or agents to have a masking requirement to enter premesis or to ride their vehicles or enter their lobys or common space that is really important for people to understand. i understands this this continues to be a challenging situation. and we are in a time there are high cases. and unlike earlier periods of the pandemic such as during the delta wave, we have additional tools. we the tools available for people to use. including treatments preexposure

for people immune compromised and treatment after testing positive for covid. we understands that these are concerns and this people have concerns about long covid. i'm happy to talk more about long covid it is challenging. not a single definition we don't have a way to surveillance for it. and we deponent understand the best way to prevent temperature reducing cases is a way but mask mandates over all generally when we don't know when this case level might be decreasing are challengering we encourage people to mask. >> thank you for providing the data that mta has been finding and the baseline is high. and understands there are a challenge. i will would think that the commission would like to take up

the issue. long-term covid at we understand the state now since it is a dynamic set of definition and it is intermediate covid. the be nice the current state of long covid and what we should be looking for. or when we can do. you know. >> thank you very much for your response. >> and doctor, thank you. i wanted to lends my support to hearing more about long covid. mt aboard is capable of doing what bart has done, twice in putting a mask mandate and the same process bart has.

>> yes, that is correct. >> thank you. vice president green. >> thank you for that explanation. i believe in another meeting you remember working with ucsf on the long covid issue and an active area and study. dihear that correct low there is a relationship and you are delve nothing this aggressive way with them. >> yes, thank you upon vice president green. an evaluation planned in a very systematic way with ucsf. that has not fully started yet. the plan is to try to do that so we and understands and explain better when the true problems might be and have a uniformed definition that the researchers are use and can will be replicated throughout the country by other researchers in

a multisite way. yes, weep want to participate inspect that as sfd ph with the partners and colleague in san mateo public health as well. >> thank you. we want to hear the information coming forward. the other question is also when i read the bart announcement made clear this both station workers and security individuals on barted trains will have masks available. do we know where municipal emstands on that? i think we know what high quality masks are. is there information can you share about how muni plans to handle what bart has done >> thank you for this quest. i then and there this was an area that -- you had mentioned as well earlier. i was able to find out that our teams are working with community organizations to make sure that masks are available there. i was not able to find out about

how muni might be handling on their vehicles keeping masks available. i'm meeting with director tumlin in the coming days and make sure to answer that question and if there are ways to facilitate those masks being available, we will work together. on that. so i will have more information to report back >> thank you. it would be serveed follow bart's example and making the masks ready low available to muni riders who may need them. >> thank you. >> you are muted, sir. >> i'm sorry it has been long since i have been remote i lost all my skills. so, thank you to doctor philips and colfax for your presentations we look forward to hearing more at the next meeting

the next item is general public comment. >> okay. folks on the line who would like to comment upon this is the time to the do this. press star 3. star 3. so. to clarify before i read a statement. general public comment are for items that are for not listed on the agenda. if you have a covid comment or monkeypox comment that topic has come and goneful general public comment is not the accomplice to do that. i will stop folk wlo will talking about thing on the agenda or will be later each item has its own public comment. okay. each of you have 3 minutes. i will read a statement. members may address on items

within the subject jurisdiction of the commission but not on the agenda. each member may address for up to 3 minutes the brown act forbids discussing items not on the agenda including raised during public comment. here weave go. >> i see one hand. i will mute you. let us know you are there. >> hi. i will be quick. how do you sleep at night doctor phillips people are dying under your watch and refuse to have the indoor mask mandate that is a comments related covid it is fashionate does not belong under judicial public comment. i don't see other hands, commissioners. >> i apologize. >> all right. thank you secretary morewitz the next item is resolution we heard previously july fifth meeting. declaring access to reproductive

health care the public health issue. secretary, will we read had second reading or move to discussion and vote. >> what i would like to do is not read the full i read the full residence wlougz we discuss today on july fifth i'd like to note that the addition its is clear what has been added based on input. in on your copies for the public. i will read the additional text. suggested by bernal where as on july 8 of 22 president biden signed an executive order to protect acstoesz approved abortion medications and defepdz the rights of patients and providers and where as on july 15th of 22, nancy pelosi and the u.s. house of representatives advanced 2 bills preserving access to reproductive health care.

women's health production act which will inshrine protections of roe v wade in law and restore the right to abortion nationwide and ensuring rights to reproductive freedom act the right to travel across state lines to obtain an abortion. on the mrauz, be it resolved, the word service add. i will read the clause with that word. the san francisco health commission reports the right for every pregnant person to have reproductive health service abortion, available by trained professionals. the last addition was based on commissioner chow's request to put dates on the data sources. championship is i'm sorry. did not list the page under the term, data sources. that's all that i have. happy to answer questions about anything else you said but otherwise, it is up to you. >> thank you, secretary morewitz

for drafting that resolution and commissioners for thoughtful input as well. before we is there a motion to approve this resolution as amended? >> moved. >> approvad amended >> i second >> secretary morewitz do we have public comment? >> i'm checking if you like to comment press star 3 now. i don't see hands let's wait a second. >> no hands, commissioners. all right. no public comment. commissioners comments or questions. >> vice president green. >> i want to thank everyone for working hard on this and creating a statement. you know someone whop does ob in 10 days i have 3 patients survival and future fertility

would have been affected had they not had access to terminate the pregnancy. so -- i'm grateful to be in california. i feel for my clothe in other states who are suffering such dlemace and challenges. not only exercising their free speech but providing for patients the life saving care that they deserve and so i'm very grateful to everyone who supported the resolution who supports women's rights. >> thank you vice president green for everything you did to craft this resolution and providing perspective for the commission, we are grateful. upon >> other comments? we can go to roll call vote. >> yes, commissioner green?

>> yes. >> commissioner. >> yes >> commissioner guillermo. >> yes. >> commissioner chow. >> yes. >> commissioner bernal. >> it is approved. thank you very much. >> commissioner, i'm sorry. [inaudible] i can't figure out how to raise my hand on this. i wanted thank the commission for passing this and also to vice president green's comments. we are seeing an increase in out of state people seeking out of state care for reproductive health including the san francisco hospital and we will continue to ensure that the reproductive --up holding our system of public health. thank you for this resolution. >> thank you. >> our next item is familiar on the agenda resolution making findings allow meetings under government code section 54953e.

we have pass third degree resolution every month for the past several months. it is identical to previous versions of this resolution it does in the require a reading do we have a motion to approve. >> i move approval of the teleconferencing resolution. >> i second. do we have public comment >> there is one hand. >> let's see. grab the timer. >>you are unmuted let us >> you are there. can you hear me. >> i'm so glad you have these meetings available virtual it makes accessible to public

comment for so many not able to be present. and i -- help that you continue to keep them in this format so we can continuing to show up as members of public. >> thank you for sharing your comments. that's the only hand, commissioners. thank you. i like to recognize secretary morewitz hard work in creating the capable for the dmoigz hold the meetings virtual in a hybrid format as we move forward. >> apologize we have old equipment that breaks down it is not under our control all the time yoochlt thank you. gentleman to a vote. >> commissioner guillermo. >> yes. >> commissioner giraudo >> yes >> commissioner chow >> yes. >> commissioner greench >> yes. >> commissioner bernal. >> yes. >> passes, thank you very much.

>> next for discussion is san francisco emergency medical service update we have doctor brown medical director and andrew who is the acting ems director. welcome. >> thank you. chair and commissioners can you hear me okay? >> yes, loud and clear. >> thank you. >> this will be a joint presentation with myself ems director and deputy director emergency management robert. we will try to hold comments to the time scompliment then reserve time for a question. i hope you received the materials we sent. i will turn over to ems director to get us started.

thank you. >> doctor brown are you turning over to andrew? >> that's correct. am he will start the presentation. >> great. i don't know who is who. andrew is sorry online? i'm sorry. andrew is online. i can't see. i think he is trying to speak but his -- he is not coming through. >> you are unmuted can you speak. can you hear me now. >> great. sorry. thank you for having us today. for the to the next slide. i want to introduce myself the

acting ems director also on today we have deputy director [inaudible] rob if you want to introduce yourself. i'm one of the deputy directors at department of emergency manage export working with the [inaudible] since it has been part of the [inaudible]. and rob if you typeset take this one >> sure. >> the ems part of dem since over a year. july first of last year. and -- i will speak to this year's budgetful we made a couple changes. reorganization with a reclass

the second deputy director. added a 25-33ems for special care. and there is a shared epidemioiologist position we share with d ph for mutual work. one of our focus is going to filling several of our vacant positions as quickly as possible. . includes the deputy director position we anticipate filling shortly. i will turn it over to andrew. thank you >> thank you. next slide, please. i recognize health commissioner last time we met very much the topic of discussion and wanted provide a brief over view where we are at with [inaudible]. you believe [inaudible] the destination determination program that we started during

covid-19. we since reiterated the program and have created ems alert. we are excite body the program. and got good feedback from the ems alert. instead of air manual it is automatic. and pushes it in our readiness system which is the hospital disaster and diversion management program. you will see with the screen shot the lower part of the presentation. what this does is looks at ems surge everyones. and ambulance at hospital and ambulance who have in the past 60 minutes. our goal is to reduce the surge events and best to distribute the ambulances across the system.

ems alert is facing out toward the em circumstance system. diversion is facing internal in the hospital system. and is this is available to dispatchers to ambulance andrews hospitals to see ems alert. each facility has a ratio built in based on license and capacity. it is looking at hospital data and trying to merry hospital data so we can distribute patients and that's our next phase of this program. as we see walk in traffic and boarding and such within the emergency departmentful >> next slide. >> it is important to look at the affects of our programs. . the surge transports you see when covid-19 shelter in place start in the 2020 our caddy implementation a pilot and ems alert start in the january of

2022, and continue to see those ems surge events decrease, which is a really promising sign. we. see very little bypass rates through alert and diversion and continue to see levels. and -- doctor brown will take this one. >> thank you. andrew. what i wanted point out in this slide is the interrelationship between diversion and parent off load times. and it is illustrated as a teeter totter where the i deal situation is to have a low level of both categories. the way that can be related if you think of a number of parents

approaching an emergency department and ambulance. those patients will go to another facility so that will tend to cause a surge in that facility. but will have a faster off load times. [inaudible]. on the other hand the diversion rate if decrease to too low we finds difficulty where a lot of patients are wait nothing line if you will in ambulance trying to get in the emergency department. if we only emaddress one without the other, we will have a worse imbillions or situational problem. the reason they are not ideal for patients care is that [inaudible] off load delay the patient is on hospital groundses but not has been assessd and

cared for by personnel. they are being taken care of by prehospital personnel. diversion situation marnlt parent who is want to go to a specific facility or there physicians wish them to go they are unable to access it the facility is not on the diversion. those are not ideal. >> this shows 2 graphics on hospital diing version rates i will focus this and andrew will focus more on the patients off load problems. we have seen distortions of e america s normal business. routine due to the pan dpij. it is hard to factor that out. over all. low but due to the affects of covid had on both patient in the

first surges and on staffing the later surges, we still had high rates of diversion. the point of the graphic on the left is this the percent change of diversion has been high where as the percent change of ambulance transport has been low suggesting the 2 are not the only 2 things linked. transports are not the only factor that are causing the rates. and you see on the right we have stabilized the diversion hours by month and stable at a higher rate. we want them on the diversion rates. have the next slide. we will talk more about how well we are working on this. upon this last part on diversion points out the levels versuset percentage of transports in the system so -- facilities that may

not have the largest volume of patients are having higher rates of diversion. and as long as there are high vol unanimous patients have lower rates of diversion. this is due to work going on at facilities and due to the status with taking types of patients that are higher length of stay or require more resource. trauma patients an obvious example. and other parents such as strokes and patients that have behavioral health issues are a factor. one thing we can do and working hard that helps both diversion to remin low is siphon patients oust system before they get in an ambulance to the emergency departmentful how can we do this? some are in place such as work

by the paramedic program to have care plans and alternates for patients so they don't come to the emergency department and don't get service that benefit them. other examples are instituting a nurse to be able to take level calls lower calls and work with the patients and determine alternate destinations things like appointments and clinics and alternate transportation. so they don't get in the system. we are unique to have alternate sites. now diminished but want top restore quickly the specifically the out call sober center and soon into being cant centers and pds psychiatric emergency services to accept patients as

they have in the past. those are alternates siphon out of the system before they reach the emergency departments. [inaudible] thank you. for ambulance patient off load times you heard [inaudible] or [inaudible] and so this slide represents we have seen a baptist an increase in san francisco. approximate this really started. see this last year in august and assessment. and really came to a peek during the omicron surge. it came down after and seeing a rise again. san francisco is one of many jurisdictions in california that has seen the issues with ambulance off load times. traditionally have not had these. in response, we developed an arc

cute alert program. in which ems supervisor with clear ambulance back up to the 911 system. result nothing ambulance stuck at hospitals. idea to get ambulance back out on the road fast as possible for the next 911 call. next slide. as i briefly mentioned the policy options that we had developed the past year. we set out to look at 3 items one is arc cute issues the other 2 are systemic diversion and challenges went ems system. we have 4 policies that represent the issues and updated several times the past yearch through our process. what we did in stomach of 21 released the policy. and we focused on the release of

the systemic diversion and part of that we developed a collaborative effort with weekly middle eastings and trying to obtain the best consensus with final approval of the policies from the emergency release to permit implementation early july with effective dates of july 11. this work group was small high level and focused. included ems agency and representatives including a member from san francisco general dispatch and the public. we are very proud of products it took a lot of work to get there. we are not at the ends of the road and continue to meet and work on this important work. and looking at reassessment in january of 23. we have seen hospitals implement

new pilot programs, hiring treaging and want to give upon hospitals the opportunity to work internal on the different projects. we also -- release many recommendations we will be happy top share with you, but keep in mind that our goal is 30% for diversion and 30 minutes for [inaudible]. but irrelevant we are taking a priority on 5% until we get to january of 23 and work closely with the hospitals. there are potentials for adverse actions. our last step. we reserved some until the state committee releases finding in terms of midgation for the different. i think the big take home points in recommendations to the body is really the importance we hear universal low across from aural ed's result in e d boarding.

staffing and then really many of the facilities ask for more resource sobering and behavioral health. >> the diverse we'll take questions want to give an operational over view we look at different providers within the system. like many areas of the health care system we see over all staffing issues across care and that does result in in challenges with hiring for emt's and paramedics. we are happy to report this the fire department is in the process of planning 60 additional em circumstance personnel resulting in an increase in response capability for the san francisco fire department ems division and excited about that. this should help with eventses and reducing the response

intervals. we remain engaged with career programs. city emt and hosting internals at the agency providing free training and opportunity to develop career path ways to ems. finally, other priorities for the year sorry the ab1544 transition. this means turning from a pilot to permanent. tremendous amount work. we got the right team and working clantive with our fire department partners this part of this transition with the new regulations that distinguish turn it back over doctor brown. >> thank you. ipmented emphasize our clinical goals. for our priorities for the

coming year. and we now have advisory committees for heart attack and stroke, trauma and now our ems for children. so we are working on plans that will go in our plan over all to increase our cape abltds and different arenas on the children group they met for the first time doctor from mission bay and we will work a bit on behavioral health crisis for children buzz this is a problem and we want providers to deal with that and assist families in the field. we will implement the heart association get with guidelines program for stroke care. we will have more on how the cardiac and stroke centerses are doing take care of patients and

keeping the care again throughout the communities. the care is going well across the community and improving the cpr and performance. one of the issues you will hear about in the ends is pulse point app that will provide additional response capability from within the community when there is occurred iac arrest. showing you we have friends catharsis improving in cardiac. you are seeing that after years

of stagnant performance. we are improving but we have yet to best sum up the measure over all cardiac arrest survival is in the [inaudible] the way we measure the levels across all system in thes united states and through countries in the world. our goat we were stuck at 30% or so mark temperature is good to see it is continuing to be elevated. it is where we use improvement are in the use of last 2 rows aed's and the performance of cpr before ems gets there. use of aed is close to 25% and they are life saving device

utilized instead first few minutes result in a higher survival rate. the use of cpr most communities in the 40 to 50% range. we are working on those areas and where we use the most improvement and over all survival for cardiac arrests for san francisco. the potential this covid affect had in the community in causing more of the conscience. we are tracking this and the

distribution within the community to be sure we are getting patients taken care of. we want to evaluate or explain about the pulse point system. ems agency is excite body this new app we implemented. this is for community members and the qr code is present on the screen for anyone watching andments to download the appch pulse point a 911 call for cardiac arrest will upon send the appropriate response and through the program tell alert users that are signed up. show the nearest location and photo of the nearest aed. and so -- if you see on the left hand side of the sdleen is a

real life event. near my office at 16th and mission. and valencia street can be brought to the seen for case. many other jurisdictions in the area have this. we insist they see increasing survival rates and bystander interventions and are excite body this roll out. >> we have a public press release going out next week. we are excited show that in collaboration with community groups in the bay view next week and are excited get this tool out to the community. we are excited for the functionality that will be coming to this app in terms of adding languages. potential low over dose and verify respond are program that allows responders such as off duty firefighters to go to

residential addresses. as much not sxifkz earnvention we give is critical and we are excite body this. >> next slide. the ends of presentation here. want to talk about our top priorities for the fiscal year. one is ems plan mission. required do that annualet framework of the system. and projects we are working on and are quality improve am programs. and our community triage alternate destinations development implementation and submission to the state ems authority for approval. and i will turn to rob to take the next one. >> yes. linked previous slide. linked to some of the community

paramedicine we are placing improved health care at dispatch. and there will be embed crisis clinicians at dispatch and working with the -- of dispatch to -- flush that out. obviously the work as andrew mentioned on diversion, and will be approximate watching the impacts of the adopted policies. and as i mentioned. previously, a big priority is hiring 5 staff vacancies after the adopted budget. doctor brown? >> the last 2 items i wanted to

mention are increase effortses commune engagement. we regularly participate and assist partners in the city emt program to get more participation in the ems system or providers from the communities. we have worked with the faith based coalition in bay view to redistribute our defibrillators part of the covid response and get out in community places and had 8 of the 22 of those were already placed with cp r training for members of the community in congregation its is about getting the education out to the community and my understanding how vital their role is? intervening. and last of item i wanted highlight the need to develop as a communities and back you know a trauma center capability. san francisco general is our level one premiere trauma

center. should anything happen, we have no back up or alternative in the system. we have not had this for many years working in various ways to mitigate that now we are working with partners in mission bay and others to develop a backup or surge capacity. so. unfortunately if we have a large masdz shooting overwhelm a facility or damage to the trauma center we would have trauma cape ability to help. we appreciate support your support behind trying to make this a reality quickly. next slide and we will take questions after this one. >> thanks. we laufrped our new website last month t. is more sleek and user friendly and accessible.

invite everyone to look at our new website with our training initiatives. and opportunity went ems system. i want to thank the ems staff and approximate executive director it has been a great year. at dem and you know want to thank everyone. we had response it is to ems events. programs and community events and want to acknowledge all of our colleagues and dispatch providers possible provide and awful our purchase in the ems system. >> we are happy to entertain questions. always happy to provide report and information and contact information is on the screen. thanks.

>> thank you, director and doctor brown. before we do commissioner comments or question system there public comment? folks on the line if you like to comment on this item, item 9. press star 3. so we can recognize you, star 3. wait a few seconds. i don't see hands, commissioners. >> all right. vice president green. >> thank you for this presentation. i had 2 questions. first, i think the app is wonder and will a demonstration on how to do cpr. one question i had if someone is home arc scomploen they are someone in the house and alone, suddenly arrests does this app allow someone to press a button and connect? because i think the big issues is dialing 911 and trying to do

cpr is there an efficient way someone can get through when it is just 2 people or on the street finding machine in isolation. wo we talks at the county about staffing as an issue in terms of barriers i'm surprised when i saw the off load time of i wonder the extent to which we analyze things like the number of [inaudible] in the room. number of beds in the hospital. een beds could be hospitalized. i than is a huge [inaudible] but are we trying to identify which are the once we might be able to approach with data efficiently

and do manage to correct? i can take the first question and part of the second question. the app does not provide the opportunity to call 911. what it does do is provides trukzs on handling cpr. really instill people handling cpr. early access to finely 11. "program it allows for off duty female go to to a resident verified as a physician or nurse to provide that so neighboring can provide cpr in early access in dire situations. and the question about staffing, we are work closely with our

hospital partners and the upon council to get this data information. the work group was focus on the policy the first 2 quarters. now we are moving in the over all policy decisions but into the operational hospital staff. and working with data personnel in terms of making better decision across the care in the. silos. that is the next phase to address the diversion issues. >> the only thing i can ad is i beg forgiveness i had a technical glitch the first part of your question. i did not get but my understanding is around the resources within a facility that might improve the boarding situation and the delays. the one thing is the great things working with hospitals is

the hospitals in the community had a range of efforts in this regard. and several of facilities st. francis had success with through put and increasing the [inaudible] and diversion rates and apply to [inaudible] delays. they have been share that knowledge with san francisco general. the difficulty is that every facility has its own internal components and its yours they emphasize transplantses or surgeries elective and emergency and so forth. so -- no 2 facilities are comparable. a matter of translating these and over committee obstacles the work the health commission is

doing in terms of improving the -- back sxendz how we can all hospitals have patients red and safe to be transferred to other treatment. free up beds to keep the process flowing for patient catharsis entering the system. we are seeing the front end on our side. i therein issage amount going on the back thaendz is kril critical. >> thank you. >> i continue is complicated and i appreciate the efforts. >> commissioner chow. >> thank you. for this update. and it is impress and i have your explanation of what the ems alert program is -- as an automated system. and does that -- i assume that replaces caddy? and that is the first question.

try to analyze why. i'm impressd that california is so high as you say with the 40 to 50% dpr. claimd that astonishing and find our number is bad we are a compact city. assure trying to solicit professionals are you out reaching for accomplices like the medical society or hospital personal. not hospital administration. we might want to sign up weather nurses so they can be helpful in their community. in terms of the professional side. i think it is good to hear we look at professionals that might be able to do that and being

able to get in the homes and we open to commissioner green's problem. last low there are ways of getting people to do cpr such as throughout heart association and what not. and -- if this is beyond the level what are we doing differently that would actually help raise the percent of people withhold be participating asseen in the public setting. >> thank you for the questions. i will start out with number one ems replaces caddy which is great from a fiscal perspect and i have operational perspective. we confined 2 venders with data sources.

we had others reach out. which is cool. that is on the cutting edge of this. in terms of cpr within the communities, we started our cpr consortium. this combines ems the fire department and our other ambulance providers ems agency and community groups, which is important to get community groups involved. we had a team roughly about a dozen cpr kits that come with the manikins and deploy them out to different groups. we gave one to the ymc ah and other like fwroups to provide that training for members. it is part of the tenderloin initiative as well. we are able to give kids the linkage center the training takes place in those settings and provide that opportunity. we are focused very much on

community efforts. we also part of our plan intend to have cpr train happenings we host the sign ups and such. and then can match those groups with ems providers in paramedics to train out handling cpr and nar can reversal for over dose that is within our with house and work to improve that. >> what about the professional side working with the medical society. nursing you know nursing -- unions and things like that? is there an out reach for those people? >> we have not looked at that we want to focus on community. i think that is an opportunity

where we could take that add that in the cpr consortium and work to ad the individuals to the pulling point app that get more information such as residential neighbors. that will improve the arrest rates with that first minute or 2 of hand's only cpr this is a great thing we can take back. >> a follow up question on ems alert, where is the patient preference in that system? that is if a patient wanted go to st. maries, the first, second, third priority. >> how do we handle that type of request? >> we generally try to keep people first medical need. traumatical go to san francisco general. or if you are having a stemy or

stroke you go to the special facility t. is on medical need. we will also look at diversion as well. and potentially medical home. at the campus may be that person cannot be seen at vaness campus but at mission bernal or another. we keep people enemy that medical home and then after that if all those other criteria are not met we look at alternatives for the individuals but we try to arc void that and provide talking points society patient can understand the facility of choice is impacted. and you know the crews can reach out to the base hospital. thank you we look forward to your success in the coming year. >> thank you. commissioner.

thank you commissioner chow i see no other hands raised. so with thatef, thank you dpreshth and doctor brown. we look forward to seeing you again. >> thank you. a pleasure. president bernal and commissioners good to see you again. >> take care. >> thank you, commissioners. >> all right. it is okay with my fellow commissioners we like to make up the agenda a bit and move to an update on the july 19th community public health committee. >> unfortunately we will move that up to the next item and go back to the regular order. so we have chair of the committee susan giraudo. >> thank you very much.

i appreciate it and this was moved from the last meeting this was leth and he my presentation today. the first meeting the first presentation we had was a behavioral health update. on the internship problem this has been one of the concerns. and doctor hillary [inaudible] forward with this and there is now a new website. and it has the on boarding for the upon interns visible throughout the department are now centralized. it is also a very easy to access website. i got on it myself as well as have a number of potential interns i'm aware in the past

they had difficulty but this was simple. we heard about the increase number of partnerships and trainees. the number of increased trainise the civil service trainties is all upward motion. in hopeful recruitment. but as we heart in multiple presentations the continues challenge with the workforce across california. so, again. one of the so -- priorities that were presented was also to increase the on boarding in a more stream lined way. continue to build out the website. support the supervisors upon who -- are essential to the internal program.

and also furthermore additional for the interns as we think with workforce issues and san francisco, that -- this is important. so the presentation was excellent. and very -- promising. as we are trying to develop our future workforce. the second presentation was on the jail health service. and again it was really wonderful information. as she stated in the beginning. . stlr 154fte. and the program of jail health

population. and possibly 8 huh human. doctor prat noted since the new district attorney has been in place that the -- number of definite increase in that population at the jail. she noted the increase immediate since this was a few weeks ago with the presentation. what are the components of service medical behavioral health, hiv, dental and pharmacy. 56 registered nurses that are within this prop providing service to inmates the population as of april 19 was 94% amendment 6% female, forty-four % of the population

was black. and am the residents where the inmates were [inaudible] south of market, tenderloin and mission. it was interesting she noted 35% of the population is unhoused. and that this is probably an under count of this category within the jail system. of doctor prat explained complex process of -- how an inmalt move through the system. 80% of the people in the sf jails are awaiting arc judecasion. they near lim lee bow it is for a number. months. and covid exacerbated this

process. and again, with the complexity of the process, to try to move inmates to the proper treatment exactly follow up. from which jail to residential treatment is detrimental to psychiatric case. in the future, they are look for looking at new positions. to increase the discharge rate. and again which is excellent, wonderful as we are all looking at that, but that difficulty is -- in the planning.

. the presentation -- excellent and comprehensive. >> anybody in the public comment line with hand raised. >> make sure we are covering bases. >> folks on the line if you like to comment on item 14 the community health update press star 3. no hands. thank you, commissioners. >> questions for commissioner giraudo. all right. >> thank you, commissioner for that update. >> back to item pardon me. item 10 the 2016 health and safety bond update. we have mark primo the capitol

oversight advisor and his team. whom i will ask him to introduce. >> commissioners [inaudible] [no mic]. [inaudible]. can you hear me. >> good evening. i'm mark primo. commissioner bernal introduced me skip that here with me in person is terry [inaudible] upon senior project manager for the 2016 [inaudible] bond from [inaudible] public works [inaudible]. listen nothing is ceo doctor suzanne [inaudible] and listening in is project management staff from [inaudible] during thes

presentation we want to address the 5 questions that mark from the commissioners [inaudible] commissioner green and chow will do that not sequential way [inaudible]. [no audio] >> par of the dilemma the pandemic caused in the department is the bidding climate. last night reviewing the can china town health center i ran across data i thought i wanted to share with you which is the rights [inaudible].

if you get one bid you are purke 25% over of the normal cost. where you want to be in the publicly competitive bid projects is 4 and 5 we balance out. as a result of the pandemic and wrong perceptions of covidz, a lot of contractors steered arc wave from inment once everwork for public health like in the residential sectors where they. felt the projects were safer. [inaudible] and affects other projects in the city may be not getting one bid but only 2 to 3 bids rec park, library, police and fire. [inaudible].

[cannot hear speaker]. we are tracking just first and third those other [inaudible] we went in there were 3 other departments selling, they had a seconded sale we did not participate this the number to the far right [inaudible] like on track for the hospital and the clinics up 70%. money is [inaudible] spent in projects

control the front ends monet programming, permitting and design. construction money is the money that we are spending now. that is -- [inaudible]. [speaker sounds far away] i will have [inaudible] start talking about data that he uncovered related to results of the pandemic. upon supply chain problems and other issues that are impacting us and other [inaudible]. thank you. good upon afternoon. commissioners. can we move to the next slide? so, the top of the slide -- you see that cost drivers we

discussed before [inaudible] in the previous presentation they are impacting us [inaudible] one bigger one is the [inaudible]. and so -- what we shared with you before it was difficult to come up with -- real life did thea to demonstrate what we were experiencing. and since then there has been a lot of data and i can share that with you. the one below is from the construction association. and it shoes historical data on the pricing index and product price indesks construction material. everything has gone up. even beyond the current inflation rates -- those profound indicator on the chart is the roller coaster ride you

see with lumber and steel. [inaudible] why is this important? because [inaudible] contractors [inaudible] that is from industry publiccasions that contractors being on the projects rely on to educate them and given insight on where the forecasting for the next [inaudible] bid. this provides us [inaudible] move on to the next slide. analyze inflation. these models. we received data for all the individual construction product. i picked out one steel it is

indicative everything we saw across the board where have, look at the right side of the slide, the historical data and a future forecast. follow the oranges line. blue line indicates upon inflation as 2%, 3%. currently the percentage of inflation we are experiencing is [inaudible]. if you upon project it higher tell meet that [inaudible]. and so the forecast of pricing of materials level off a bit. [speaker sounds far away]. 2023. we use this as a tool and put this become on the future bids we will have. this slide concentrates on

materials. move to the next slide -- shows labor. labor is more predictable. and it is following inflation as expected. so -- upon where we are in the bid. moving to the next slide. this is represents the [inaudible] this also has impacts of on project deliver schedules. important because you see we are seeing extreme [inaudible] one that is not list said here is switches [inaudible] now we are

sprngs 5 [inaudible] lead time for switches. and where that come it play the ends of the project when we deliver the system [inaudible] we are could be subject to [inaudible] we are proactively ordering [hard to understand speaker] which is earlier now we are quoted 500 days. moving to the next slide. the current picture of our upon 2015 budget and current 22 budget by actual bid. first 4 projects are in construction. now we have [inaudible] the

contractor and the numbers are [inaudible]. [inaudible] permitting phase. the approval from [inaudible] important to note that the [inaudible] [echo, far away, cannot understand speaker]

[inaudible] do you mind -- addressing commissioner chow's question about the 85 million? the question of >> what time do you start looking at scopes where you adjust the program? >> so, right now we have 85 million dollars gap we don't have a resolution for.

looking for creative ways to provide additional funding. but [inaudible] the methods or funds, we will not move forward with -- projects that don't have funding. now [inaudible] now those projectses will not move forward until we identify [inaudible]. upon the program but we have every intention of filling the scope once alternative funding is [inaudible]. >>mented it add on the slide where we identified 5 or 6 areas we are not stopping there.

we identified [inaudible] regional funds of 75 million dollars that we have paid for. we are seek out currently stimulus money that have a nexus to the services it provides the other area we had to revisit is going become at this time mayor's budget office and controller's office and capitol plan and letting them inform them of how this pandemic has actually really made budget challenges a nightmare. especially in the area of [inaudible] mental and hospital service. i think we will at least pursue that -- as other departments

pursue it like the fire department and police. we should be able to ask that question about any future funds thanksgiving could attributable. [inaudible]ing could attributab. [inaudible]ng could attributabl. [inaudible]could attributable. [inaudible][inaudible] sat down infrastructure group where they applied a lot of risks because of unknowns. things behind wall and ceilings and floors. and able to reduce that budget by 4 million dollars. that activity will continue. different trades under [inaudible] supervision. also putting a lot of pressure on the general contractor [inaudible] who go out in the

community and get more bids they are competitive and bring down the costs. talk about the stimulus funds. and the behavioral health. . commissioner chow asked about the other projectless in the 2016 bond. i think you have seen. southeast just opened in july. and last act castro mission next mont. those projects were not without budget challenges but we figured out a way to get them done. applied for a fema grant. we received energy money and applied all of the resource of money to make sure of the projects got diagonal china town? health center >> china town is funded

commissioner chow, by prebond money that gets reimburse when passed we got 2 million dollars to jump start that project. it was [inaudible] tell be in the 23 bonds or that's the intention and why we got the 2 million dollars. i think that will [inaudible] am complete or about to be complete and any questions i will get in -- and china town.

good evening. commissioners. i'm joe chin the public works manager for 2016 public health and safety bond program. i will talk about the project updates related to the [inaudible] and the community health center component. >> reached the completion for 2 projects that is the [inaudible] project. both now in the close out phase. the meantime, public works awarded a contract to builders the manage construction on the next 6 projects. and [inaudible] infrastructure or early stages of construction. public healing lab, dental in [inaudible] and demolition phase.

seismic upgrades focusing on the excavation allow the construction of the new joints separates building 5 and [inaudible]. most of the projects have a consideration of 1 envelope to do 2 years. and having duration of 3 years. since the completed the presentation we received the [inaudible] and that leads the psychiatric emergency service project that is under the plan review process. i'm happy to report that all the community health center projects on target to be completed by ends of year. [inaudible] a ribbon cutting on july 14th and the building well received by staff and by

[inaudible]. the new -- clinic opened to patients on july 29, last friday. work improve am funds the existing clinic complete november of 22. and received approval to ouch as of july of 22. focussing on [inaudible] and it build out. with target date move in as well as the ribbon cutting ceremony by mid august to late august of 22. with that i will turn it become to mark. next slide. apologize on the [inaudible] project manager staff out of the country or office or on bart.

so -- here you see the last time we saw you project was at 58% now 77 the glass is going in the scale is beautiful. fits in the neighborhood. questions from commissioner chow why are we -- running a deficit of 85 million and how is usf research building going? there are major risk level difference. one is their build suggest new. grounds up and we are in a building pre65, 24/7 with surprises and high risk. we are [inaudible] they are not. what they did early on was came

up with the deliver method best value. that basically means instead of getting your architect and engineers on board first they flipd and got the contractor in first and the contractor anticipated in selecting the architect. that made a difference because of the project attracted the a list. of got a good general contractor who did the hospital on geary street. and used his. architect firm [inaudible] the other thing that they were able to avert was -- they got the contract signed 6 monthses before shelter in place. they did not have that dilemma of -- our contract was october 2020. we were [inaudible].

they look today in. all the stuff had [inaudible] and what nay did 2 week in the pandemic called all the suppliers and trade suppliers and demanded they buy now. and 80% of them the plumb and electric bought all supplies before the supply chain problem hit. i think that is the reasons there is successful they took one hit basically when shelter in place was ah nounsed because of the fear and am confugsz around coming to a work place. they lost time that's when terand he his group used that lot for testing. and so -- they lost i think 3 to 6 months they had to pay out

extra to that. those other differences with there project and ours. and then commissioner chow in china town we are doing more due diligence of that project than on any other clinic before we went to voters. we were able to get a commitment of 2 million dollars so in the last year we did geotechnical exploration. and to a report. we finished programming. we finished design, about 35% of design effort. now going in to the next level which is design development. and running cost estimates at every point so we keep track of where we are going with the scope and if we make changes we'll make them. schedule now another year of design that takes us to 2023 and

the construction duration is 24 months looking at 2025 for completion. i think with that you can take general questions. can i do public comment. [inaudible] would you stop sharing and thank you for doing that. commissioner bernal i will check to see if there is public comment. folk on the line if you like taupe comment on this item the public health and safety bond of press star 3 now. star 3. all right. there are no questions from the public. commissioners? >> comments or questions,

commissioner chow. >> yes, i want to thank the presenters for helping to answer parts of my question. thank you especially on the more detail on china town. and i assume your finance saying china town is a building that can be occupyd and can being used until you get to the construction phase? that -- remember your studies so -- i -- i also appreciate -- the difference between a new building and being able to walk in places versus what appear to be our need as we go through building 5 to continue to take them in part and are this is

where we reach the astronomical changes. our laguna honda experience which we lost a whole tower. and but that was actually -- although the public understand this is was trans parent to the commission, also in terms of the explanation and [inaudible] helping us understand why [inaudible] whether were free but your explanation tells me we will be trying to complete our renovations and -- but you will keep us under all the circumstanced what has been done otherwise, is that a fair statement? [inaudible]. >> thank you very much. and -- i'm reassured that you are working on china town.

concern body it there was a question of whether the building could stay or not stay and hate to see us lose a valuable asset in the community thank you. there is a dhument goes in similar. i would say [inaudible] reducing some of that old planning. look now the building large size of the -- [inaudible]

>> if it is in the too much trouble tell be good to understand what is happening there so that can feel comfortable we will not lose it. thank you. >> okay. more questions? more questions from the commission? are there more questions. i don't see any. >> thank you. >> thank you. all right moving to the next item is the finance and planning update. i believe do we -- commissioner chow are you take thanksgiving one. >> guillermo today, sir. >> thank you.

>> i will wrap this up i know we are entering our [inaudible] so. we had a fairly straightforward meeting with finance and had 3 contracts to approve and 2 new requests contracts. as well to recommend to the full commission the first was -- approval to the amendment to the covid task force contracts with laguna health for a contract amount 6 million contract term remaining the same basically this contract continue the support of the covid command center emergency response services this would go through june.

of 23 which represents an extension but decrease in the over all dollars spent stot covid command center. second a contract to the county of santa cruz the add administrator upon county for the -- lg local government agency to maintain the targeted case management and medical service trust fund. has been -- the county willing to be the add administrator for the program. that contract is for 3 years.

for a tonight amount of 1.5 million. dollars and that's brought forward in the last is a contract with some health services group who we know is the fwroup this has been working with laguna honda and the department on the recertification process. this is a contract that will go through just until december of this year. which is meant to that additional resources to assist in the recertification project and the pilot project that will test the restructuring of the staffing category the staffing expertise at laguna honda include a nursing home add

administrators and assistants that will go through remember december and -- hopefully enough data collect exclude we will know whether this pilol lot program is part of the future of laguna honda is manage that can be continued as we are continue to invest in the on going survival and continuation of the long-term care services and smith service at laguna honda. want to make sure that was -- informative to the full commission as -- information that indicated the movement forward and the process for recertification for laguna honda. the second item was approval of request to approve 2 new contracts one related laguna

recertification a contract with tisecta incorporated. which was to mark, do we need to approve the contract report first or do we. >> it is all together. go ahead with your explanation and you vote one time on everything >> >> okay. . jury room so this was -- emergency contract with trifecta 3.5 million dollars for temporary staffing support. this goes through december. 2022. and for 3 primary staffing needs one on going regular staffing. that has been plan said. as per of the operations of laguna honda. the second was again to assist in restructuring of staffing as

part of recertification. the third is what they call point in time staffing which has to do with one time projects like the repairs that are happening over at laguna honda. this contract was awarded to a minority women owned business which is a goal of the department to try to bring more upon minority and women owned business to the process of contracting. and -- but should be note third degree is a well vetted company with branched throughout the state. and all of the positions that they are providing to us are -- similar to licensed and certified as required for that. purpose. the second contract request is

to uc. and this is for the purposes of the recruiting, training and ed based clinical champions who advocate for expanded subtans abuse and navigation across 7 hospitals in san francisco. this it is a project that is part of a research grant that was provided to the national association of city and county council show from the cdc. they have in turn provided fundses to san francisco. county as well as a few other counties state wide program that it is meant to train -- the

navigators and dweel opioid over dose throughout the city. this is something they are00 ino have ad and exciteings and help us with data. assist with patients coming in the erjs d for opioid over doses and related care service that would be required and [inaudible]. that is again that is a project that is lasting through upon june. from august -- of this year through june of 2024. and again that was awarded requesting a contract to be awarded to ucsf. that is it. >> thank you.

commissioner guillermo. do we have motion for approval of the consent? so moved. >> second? >> second. >> is there public comment. i don't see hands if you like to make comment on item 12 press sar3 on consent calendar. >> i see no hands roll call commissioner giraudo departed commissioner guillermo. >> yes. >> commissioner green >> yes. >> commissioner chow. >> yes. >> commissioner bernal. >> yes. >> it is approved. thank you very much. >> go into other business. is there other business. >> may i check public comment. >> please. >> folks if you like to make comment on other business item

13 press star 3. >> no hands. >> the we did this. the joint conference committee report of the july 26 san francisco general hospital meeting. i believe that is commissioner chow thank you president bernal. the committee did review reports that includes the regular report we near good shape the ceo and hr report where we did discuss the challenges of filling our nursing and other critical staffing. presentation on the core measures status was also discussed and during the medical staff report include that

changes in the over laying rule and regulations for botox procedures. the surgical privilege list. family and community medicine privilege list and ortho peddic surgery list. these are list were modified due to information received during a survey process. in closed session the committee approved credentials report expect received and approved minutes report. that was -- our middle easting and was very helpful. i think for all of us to participate in and general seems to be continuing to move along a path of continual improvement. >> thank you commissioner chow. do we have public comment? >> folks on the line if you like

top comment on item 15, press star 3. >> star 3. no no handses, commissioners. >> all right any comments or questions. thank you, commissioner chow. >> next is a closed session do we have a motion to convene in closed session? >> so moved. >> second. >> public comment. >> if you like to comment on item 16 close the session. the commission will be back after a brief closed session to close out the meetingure welcome to wait in closed session you will not hear or see us. no handses, commissioners. >> all right. roll call. >> commissioner green. >> yes. >> commissioner garm over. >> yes. >> commissioner how. >> yes >> commissioner bernal >> please give us a few minutes

we are back in open session, is that correct? yes , sir, we are in open session. >> okay. do we have a motion whether to disclose or not disclose the closed session discussions. >> move nod to disclose. >> second. >> actually is there public comment on moving book back or disclose or not disclosing raise your hand for item 17. i see no hands commissioner guillermo. >> yes. >> commissioner green yoochl yes. >> commissioner chow. >> yes. >> and commissioner bernal >> now a motion to adjourn. >> so moved. >> second. >> roll call commissioner guillermo. >> yes. >> commissioner green. >> yes.

>> commissioner chow. >> yes. >> and commissioner bernal. >> yes. >> thank you very much, thanks, everybody. >> thank you, >> bye.