>> alright. we'll go ahead and get started. good afternoon commissioners, dph staff san franciscans. welcome to health commission meeting of tuesday september 6, 2022. secretary morewitz would you please call the roll? >> before i do so i will read the script the mayor's office mandated. good afternoon and welcome to the september 6 health commission meeting. this is (inaudible) broadcast live on sfgovtv tv or calling 1-415-655-0003. before we begin i like to remind all individuals present and attending the meeting in person today all helt and safety protocols and building rules must adhere to at all times. this includes wearing a mask covering nose and mouth at all times during the meeting including any time you speak. failure to

adhere to the rules and requirements may result in the removal from the room. we appreciate your cooperation. please also note the hand sanitizer station at the front of the room and masks are available upon request to me. we welcome the public participation during public comment periods. there will be a opportunity for general public comment towards the beginning of the meeting and a opportunity to comment on each discussion or action item on the agenda. each comment is limited to 3 minutes. public comment will be taken bothing in person and through call in for each item. the commission will take public comment first from people attending the meeting in person and then people attending the meeting remotely. those attending the meeting in person submit a public comment card to me if you like to make public comment today in the room. instructions for those calling in remotely can be found on page 4 thof meeting agenda. a note to those of you who are watching at

home, i encourage you to press star 3 if you would like to make public comment at the beginning of the item as soon it as it is called. there are delays depending on wifi and how you are watching and that insure you get in line at the same time. to access closed captioning hover your mouth over (inaudible) pop up overlay with the cc logo will show and you can click on that. please note city policies along with federal state and local law prohibit discriminatory or harassing conduct gaens city employees and others during public meetings and will not be tolerated. public comment is permitted on matters within the jurisdiction of the health commission. the next regular meeting is september 20. thank you for joining us. i will now do roll call. [roll call]

>> now commissioner chow will offer the ramaytush oholone land acknowledgment. commissioner chow. >> thank you. the san francisco health commission acknowledges that we are on the unceded ancestral homeland of the ramaytush (rah-my-toosh) ohlone (o-lon-ee) who are the original inhabitants of the san francisco peninsula. as the indigenous stewards of this land, and in accordance with their traditions, the ramaytush ohlone have never ceded, lost, nor forgotten their responsibilities as the caretakers of this place, as well as for all peoples who reside in their traditional territory. as guests, we recognize that we benefit from living and working on their traditional homeland. we wish to pay our respects by acknowledging the ancestors, elders, and relatives of the ramaytush ohlone community and by affirming their sovereign rights as first peoples. thank

you. >> thank you commissioner chow. our next item for action is approval of the minute of the health commission meeting of august 16, 2022. commissioners upon review if you do not have a amendments is there a motion to approve? >> i so move approve the minutes. >> second. >> secretary morewitz, public comment? >> no public comment in the room. i do see a hand and before we begin-before we take public comment i want to note i say this again later on, someone person made public comment at the last meeting noted there were misspellings of names and other things within the minutes and i want to just let everyone know that i take everything through hear ing it through these calls and can do my best to spell things correctly. if you like if any public commenter would like to spell their name during public comment we will not take time

for that and you are able to do that because we want to note correct name and if you like to also note pronouns or anything else we want to honor that. let's see-for each items members have a opportunity to make comment up to 3 minutes. the public comment process is designed to provide input and feedback from the community. the process does not allow questions to be answered in the meelting or back and forth from the commissioners. the commissioners consider comment with the item and make request to dph. each individual is allowed one opportunity to speak per item. individuals may not return more then once to read statements from individuals unable to attend the meeting. written comment may be e-mailed to health.commission.dph-a sfdph.org . if you to spell your name for the minutes you may do so during verbal comments. i have a

timer in my hand. each of you get 3 minutes and when the buzzer goes off please finish 3 minutes and when the buzzer goes off please finish your sentence and then i'll mute you. i see two hands. caller you are unmuted, please let us know you are there. >> i am. it is (inaudible) shaw. you know the spelling of my name. >> yes, continue mr. shaw. >> page 10 of the august 16 draft minutes report commission chow stated "the (inaudible) has been following state regulatory results by the existence of the critical element (inaudible) was not mentioned in jcc meetings until recently". it is important members of the public learn the recise stage jcc health commissioners

first learned of the cdp educational curriculum at (inaudible) the minutes report chow stated "the importance of having hma and hs (inaudible) consultants working with lhh because they understand the wide breath of federal guidelines. nursing staff should know those federal guidelines. hsag june 15 contract first amendment added, $5.2 million bringing the contract total to $6.98 million. mostly for survey using the cdp to support obtaining cms

recertification including training laguna honda nursing home administrator and assistance nursing home administrator new hires. it is not clear if either of those positions have been hired yet or whether they are being filled by hsag consultants. the laguna honda admin office and nursing office were unable this morning to provide the names of those two new hires. have those positions been hired and is the cep training being wasted on not training actual laguna honda employees who are new nursing home administrator and assistance nursing home administrator positions? after all, that training is for

3672 hours at $400 per hour. no city employee makes $400 a hour. we need to know if those positions have been filled. thank you. >> thank you for your comment. one more caller. call er let us know you are there please. you are unmuted. >> yes. thank you. can you hear me okay? >> yes, please begin. >> wonderful. thank you. my name is alice a active member of senior disability action and i have concerns about the minutes. i see that unfortunately my comments are not summarized well. there is important things missing and are the key points i was trying to get across some are not included. additionally, i see other peoples comments

are not accuracy summarized missing key important points of theirs such as (inaudible) her name is misspelled among missing some important points. so, what i was asking at the last meeting and glad it did make it in the minutes is the importance of listening carefully to the minutes before finalizing-sorry, listen to the recording of the meeting before finalizing the minutes and also good to send them out before so we have adequate time to review them. i only was able to review mine just before the meeting, dident have time to correct it, but in the little time i do have i will make a few corrections and don't have time to do everything. so, i was focusing on the serious problems, the inaccuracy in the minutes. i want so much focused on the agenda. i was supporting the

previous comment and others advocating for a far better public health response to covid-19 and pox for safety that focuses on equity. the reason i was trying to emphasize the levels of the pandemics are underestimated is because there is so much inadequate pcr testing and test at home and people that don't test at all and m pox there is inadequate testing and documented by senator scott wiener in his committee on (inaudible) they use the word. they mail still do monkey pox which is stigmatizing. what i am trying to say is we have no idea how much has spread because of the inaccurate testing and are mentioned at the time, little is in the notes. the things i'm trying to get across, that (inaudible) is often according to

briefings on m pox i read, people have m pox and sti at the same time and they are not tested for m pox because they-(inaudible) but especially true outside community of men who have sex with men. the one thing which is accurate is women who are (inaudible) is accurate, (inaudible) has inaccuracies and misses my main point. thank you. >> thank you. those are all the hands up, commissioners. >> alright. thank you secretary morewitz. so, would it be appropriate to offer a amendment to reflect the callers corrections to the previous comments? >> yes, but i like to hesitate. these are not summaries of every word and that is really important for people to know. other

commissions were supportive of something, these are narratives so happy to do that but also like to not make practice we take it verbatim because that creates a huge amount of work. >> understood. it appears to me the major point is focus on equity. >> sure. >> alright. is that-acceptable to the commissioner who moved and seconded? >> are yes. >> yes. >> let's take it to a vote. secretary morewitz. [roll call] >> the minutes pass. thank you. >> okay. our next item is resolution honoring tracey packer mph and to present on the resolution we have dr. susan philip, san francisco health officer and director of the population

health division. welcome dr. philip. >> can good afternoon. thank you president bernal, thank you commissionersism so happy to be here with you for this really really joyous occasion. i'm so pleased to have the opportunity to celebrate tracey packer. most recently our director of the community health equity promotion branch of the population health division. tracey started at dph in 1992 in health education at the prevention branch of our aids office. since that time, since those decades tracey has been a (inaudible) in the san francisco response to hiv aids since nearly the beginning and her career spanned the stunning advances in the science and policy of hiv prevention from highly active anti-ret row active treatments for people living with hiv to preexposure prophylaxis to prevent infection. centered the department work on the community in all

areas of her expertise from the cdc grants to hiv planning council to getting to zero, tracey helped insure that the san francisco model of care and prevention was built with, by and for community. it is hard to imagine how we could get to where we are now with the city focused on our adacious goal of getting to zero hiv deaths infection and stigma without tracey's countless contributions. as director tracey (inaudible) encompass many areas and aspects of chronic disease pregentian supporting helty policies and program. through it all the focus on the community is a through line. the emphasis on equity has also carried her throughout her career. she is also a strong advocate for and champion of her teams as well as a terrific colleague to which i can personally attest. for all these

reasons, it is fitting the commission is poised to honor tracey with this resolution today. thank you. >> if i may read the resolution. >> thank you and thank you dr. philip. >> tracey packer served the city and county of san francisco as a leader at the department of public health and whereas mrs. packer began as a senior health educator at the aids office prevention branch in 1992 engaging with invasion and compassion during a dire time. whereas in her leadership role of the hiv prevention branch mrs. packer was instrumental for impactful initiative such as collating the hiv prevention council and prevention plan which helped change the trajectory of cases in the city. whereas director of the community health equity promotion branch mrs. parking worked closely with

partners for sustainable change decreasing hiv, sexually (inaudible) health and wellbeing of all san franciscanss and whereas during the height of the covid-19 pandemic instrumental developing and implementing san francisco robust community response and whereas, mrs. packer focused system wide questions inequities and communities helping develop strategic initiatives such as getting to zero initiative and known for her integrity, dedication and helping to develop and strengthen relationships between diverse communities and dph and whereas mrs. packer leaves a legacy of leadership to support and improve the lives of all san franciscanss. she will be deerly missed by many in dph and greater san francisco public health communities. san francisco health commission honor tracey packer for outstanding service and leadership. >> thank you secretary morewitz. before we go to comments from

commissioners, do woo we have a motion to approve? >> so moved. >> second? >> second. >> alright. we have a moved and seconded. secretary morewitz, do we have public comment on the item? >> folks on the line who like to make comment on item 3 the resolution to honor tracey packer, please press star 3. again, star 3. and see no hands commissioners. >> alright. thank you secretary morewitz. if i may begin with comments. this is a bittersweet moment for me. i have been aware and admired the work of mrs. packer for many years before i came on the commission. san francisco model of care and prevention is a model for the nation. she is integral to that throughout the city history and confronting the aids epidemic. i personally someone who has been positive 32 years and very grateful for your leadership and hard

work for always putting san francisco in the forefront of prevention and caring for people who are living with hiv and aids and i just cant say enough. it is always a highlight for me when you come to the commission, you offer your reports about the progress we are making including our groundbreaking getting to zero initiative which puts san francisco on the path to zero new transmissions deaths and stigma and the result of that have been very very impressive and of course now we are entering the phase where there is always a focus on equity but trying to reach the people who are most in need and hardest to reach. your leadership and your legacy will continue to impact the work being done here at sfdph and san francisco and please accept my deep and personal gratitude for all of your hard work, for the good nature you bring to it and for your leadership and you will be dear

dearly missed but we know we will still see you. commissioners, any comments? >> yes. i am sorry i can't raise my hand, but i just are wanted to offer my congratulations and gratitude for all the hard work all these years (inaudible) the resolution speaks to all that. i want to materialize that. those on the commission really recognize (inaudible) wish you the best in all your future endeavors. thank you. >> thank you commissioner chow. commissioners, any other comments?

commissioner chung. >> mrs. packer, it seems i have known you a long long time already and i can echo everything that commissioner president commissioner bernal said and for me i think that you are the person fiication of integrity, and emotional intelgence. you are able to really look at how to really finding solutions for some of the most under-served population here in san francisco and for that you know, i'm really grateful and of course we have (inaudible) in so many different ways. i'm sure we will cross paths again. three decades of service is not easy, especially in public health so i congratulate you and hopefully you get some

respite and well deserved respite. >> any other hands raised? >> i do not see any. sorry, commissioner green. >> commissioner green. vice president green. >> i cant be nearly as eloquent as my fellow commissioners, but i do know several people who are friends and patients who work with you and the descriptions i hear is you are have a inspirational leader, incredibly inclusive and most of all kind, so i think as you leave your post you leave a legacy of people who will model their leadership and the development of their career after the incredble example you set, so wishing you absolutely the best and i know you have a gigantic fan club you are leaving behind. >> thank you vice president green. director colfax. >> thank you president

bernal, commissioners. hi, tracey. we have been doing a few of these now, but i'm so pleased the commission recognized your leadership and work and can't believe it has been 30 years and can't believe it was 25 years ago i first encountered you on the elevator and you were talking in one of your team members and laughing and joyously talking about all the work in a very inspiring way and thought this was somebody i know will do so much for public health and somebody i want to get to know so that thank you for all your work, for the partership and teachings and what you taught me and so many across the department. some things that stand out is you are the embodyment of (inaudible) in a department where some of us move forward (inaudible) that we are right. i think you have always been-had amazing

ability to help us step back and think about what is most effective and really that leadership is so important. i also appreciate the way you past those listening leadership skills and really talking to many people across the department, so grateful for that. the other component i think you really embody in the spirit and something the department continually strives for, but you have realized and created a partnership and those partnerships that are truly meaningful and productive both within the department and with the community partners and certainly this is part of the incredible work you did with hiv aids and we saw how much that energy and that perspective and the values that that work embodies were so instrumental in the covid-19 response so want to acknowledge and appreciate you for that as well.

finally, in the many years of the work, there was conflict. there was conflict and that conflict and bureaucracy can often be a situation where work slows down or stops and doesn't go forward and you found a way and you embrace conflict in a way that is protective and respectful to hear different views and then the incredible piece of that is even within our bureaucracy you were able to move forward often with consensus in implementing programs that made the greatest difference in public health, whether that would be hiv aids, all the way through to what we saw happen with covid so grateful for your leadership. we will truly miss you and certainly hopeful you will continue to make contributions to public health and to the world in general

and really want to wish you the very best on whatever comes next for you. thank you tracey. >> thank you director colfax. any other hands raised secretary morewitz? >> i do not see hands. i said tracey packer is one of my public health heroes and will continue to be so with that secretary morewitz, would you call the roll? >> sure. [roll call] >> mrs. packer would you like to say a few words? take as much time as you like. >> thank you so much. can you hear me okay? >> yes. >> probably will hear my cat who wants it go

outside. first of all, thank you so much. this is such a huge honor. there is all most no words to say how much this means to me. it really means everything to me. thank you commissioners, thank you dr. philip, dr. colfax and mark morewitz, secretary morewitz, just all your support and i wanted to say that my job has been my passion for 30 years. this has been the work that has really gotten me going every single day and as dr. colfax said, there is always going to be conflict in public health and we are all trying to figure the best way of doing things and i learned a lot about that and about how we actually get better for our conflict because we are hearing more voices and hearing different opinions and ideas and that's been hard but also i do think it made san francisco

what it is in terms of a leader. i wanted to comment on the community partnership. when i first started in hiv, community voice was a really important part of the work and i learned that. i learned that right away when i first started, and i grew up learning that and knowing that needed to be part of our work at all times and that has been a incredible blessing. to have the voices of community at the table, again sometimes not happy with what the health department is doing and sometimes really angry, but still a voice that was so important to listen to and hear which shaped the way we approach the work. i feel like that is such a key part of the success to public health in general and i like to say that

there's epidem logic data which directs our work and the voice of the community and life data also directs our work and i always held those as maybe not equal, but as important as each other and so i continue to see that the health department is doing that. we are really trying to strengthen our partnership and community engagement. i wanted to just also say commissioner chung sort of alluding to this, but i grew up here and i have had all of you as my mentors and teachers and friends as well, and from commissioner chow, i learned how to make a presentation to the health commission. i had my bumps in the road, but i learned a lot from you commissioner chow about how to get the point across more effectively so i will keep that close to my heart as well. i guess i just wanted to

say i'm excited-i'm so-i can't say, again so grateful for the honor. it is a huge honor to me. all of you have been so important in my work and i am excited to see where san francisco goes. i will be out there in the audience cheering you all on and also the people who are coming behind me in the community health equity and promotion branch are amazing people. you met some of them already and you will continue to and i'm excited about what they'll be bringing to the table. and then, i am excited but i'll be bringing. i don't know what that is yet. i am opening up a new chapter in my life and bringing all the work to me. the focus of equity is a really important part of the work in the last few years and especially in covid and excited about seeing how i might be able to bring that in other ways.

so, commissioner bernal, thank you so much for your personal comments as well and for your support during our presentations in september, october. thank you to each of you all the work you have shared today and all the support that i received from you for years and years. thank you. thank you so much. >> thank you mrs. packer and best of luck in your future endeavors and again, we hope and expect to see you again soon. take care. alright. moving on to our next item for action is resolution celebrating hispanic and latino latina latin x heritage month. for this we have dr. bennett. >> hello, can you hear me well enough? >> very well. >> okay. i'm on a

incredibly bad line so i hope my broadband survives enough for me to do this justice. i am here because the health of our latino latin x communities is central to equity in our department. anyone who didn't remember that has been reminded very forcefully by what happened during covid and that lessen was not just about remembering that people are here, but remembering so much the fabric of communities, the way they live in their homes, the kind of foods they eat, their celebrations, the fabric of community impacts people's health and impacts the way in which we treat them. am i still- >> yes. >> i disappeared. can you hear me? >> you sound great and look fine. >> i'm so sorry. i want to be sure that

it is understood how central the indigenous latin x south american immigrant communities, that entire very diverse group is to the health of san francisco. they are a huge part of san francisco and to the work of the department. we have many many areas in which we need to serve this community better. one is in delivering to them the kinds of providers and health care staff that match their community history and race and ethnicity and we do not have that yet. that is one of our goals and many parts of the department have that as a specific focus. we need to do better about our community engagement around areas of chronic disease, particularly diabetes that are very important to that community, and we need to do work on how we bring people in

regardless of immigrant status and insurance. we have lots of policy and openness. our need is to communicate that to communities who have been frightened and opressed and really pushed away from services by the ways in which sometimes our government has talked about them. so, i want to be sure that this resolution which talks about the needs of the community is set in the context of our commitment to the community and recognition that those needs have specific goals attached to them we have to take specific action to meet and we have a very active and involved staff that are very much part of the community and participating in setting the goals and taking those actions, so this is a whole department honor to speak about this group and to have latino latin x health be acknowledged by the

department. happy hispanic heritage month. >> thank you for your leadership and leadership of your team as well as laying out clearly the critical work we have ahead towards achieving equity for the latin x community. we will have commissioners reading the resolution and we will start with commissioner chung. >> commissioner you were muted. commissioner chung, you are muted. >> i thought i mastered this already. apparently no. whereas, september 15, to october 15 of each year it is celebrated nation wide as national hispanic and latino heritage month. dur traditionally honors the (inaudible) hispanic and latin x americans as we celebrate heritage rooted in all latin american countries and

are whereas, [difficulty hearing speaker] inclusivity for a stronger nation. encourages everyone to insure all voices are represented and welcome to help build stronger communities and stronger country and whereas, mrs. lily suarez who developed this year's theme stated, hispanics in the united states are a diverse group who bring a rich combination of language, culture, educational background and experience to the great american experiment. the diverse background brings with it a well thought ideas and perspectives. one uniting factor within our hispanic community is desire to be included and represented in all aspects of american society. we call on citizens of this

nation from all walks of life to look around and welcome new voices to the table. this will help us build stronger communities and a stronger nation. whereas, hispanic and latin x heritage month was originally (inaudible) week under president johnson in 1968 and later extended to a month during president (inaudible) also celebrate the independence of several latin american countries, costa rica, el salvador, honduras, (inaudible) on september 13 mexico-on (inaudible) whereas the united states

celebrates indigenous people day on october 12, which falls within hispanic and latin x heritage month and whereas the bureau (inaudible) estimate the latino population living in the 50 states at more then 60 million people in addition to 3.2 million people living in the common wealth of puerto rico making latin americans 18.7 percent of the total population of the united states and the largest racial or ethnic minority group in the united states. whereas, the 2020 bureau census data indicates that latin x community is 14.2 percent of the population of california and 15.7 percent of the city and county of san francisco, whereas, latin x americans have made and continue to

make significant contributions to medical and public health fields, including, one, (inaudible) >> commissioner chung, i believe this is where we hand off. >> okay. >> thank you commissioner chung. i am up next. whereas, latino latina latin x americans made and continue to make significant contributions to medical and public health fields including (inaudible) with the cuban born physician who discovered yellow fever was transmitted through mosquitoss in 1881. he theorized controlling the mosquito population (inaudible) was a (inaudible) bar bosea was the first persons

of african descent to earn a medical degree in the united states. number 3, (inaudible) was a spanish physician and bio chemist and joint winner of the 1959 noble prize in (inaudible) for discovering rna. four, (inaudible) was a panamanian nurse professor and organizational administrator. she founded the national association of hispanic nurses in 1975. she specialized in psychiatric nursing and named a un(inaudible) business and professional women. five, helen rodriguez (inaudible) a american pediatrician educator and women rights activist. the first latina president of the american public health association, founding member of the women caucus of the

apha and recipient of the presidential citizen medal. she is credited to expand the range for public health service for women and children for minority and low income populations around the world. jane (inaudible) cuban american clinical psychologist hilth care advocate, non profit executive and authser. president and ceo for national alliance for hispanic health. anatonia (inaudible) physician and public health administrator. she was vice admiral in the commission corp and served as the first woman and first latina surgeon general of the united states from 1990 to 1993. nora (inaudible) is a mexican american psychiatrist. she is the director of the national institute on drug abuse which is part of the national institute of health. her research greatly contributed to the

understanding of addiction. number 9, serenea marie (inaudible) md and mph is a physician and engineer. she also is the first latina astronaut to visit the international space station. 10, diana ramos md appointed at the california surgeon general on august 25, 2022. dr. ramos has more then 3 decades of medical experience with focus on health equity and reproductive health. 11, david sanchez was ucsf psychologist who served on the san francisco health commission for 22 years. devoted much of his career working as a professor and valued administrative leader on the zsfg campus helping develop innovative programs such as the latino assessment center and the child adolescent support advocacy and

resource center urban health program. now i'll hand it off to vice president green. vice president green, you are on mute. >> sor ry i have to go back. >> we hear you. >> alright. great. whereas, the san francisco department of public health has been lead by two innovative latino directors of health, sandra hernandez and barbara garcia and one dedicated effective health officer (inaudible) whereas, when compared to non hispanic populations latino latin x communities across the community experience many health disparities including latino latin x

individuals are twice as likely to die from liver or diabetes related diseases. twice as likely to go to the emergency room for asthma related symptoms. suicide attempts for girls grades 9-12 were 30 percent higher. latino menfore times more likely to receive a aids diagnosis. latinos were 80 percent less likely to receive prenatal care. 10 times less likely to be screened for breast cancer. 50 percent less likely to receive mental health treatment. spanish speaking latino latina latin x adults have lower rates of regulardantal visits. age 50 to 75 are less likely to be screened for colo rectal cancerse and 1 in 6

individuals live in poverty. whereas, san francisco latino communities experience the following health disparities, individuals diagnosed with covid-19 at a disproportionate rate compared to the percentage of the total san francisco population. latinos having sex with men have the second highest monkey pox rate in san francisco. latino latina and latin x individuals have the second highest rate of hospitalizations and emergency room visit due to diabetes. the second highest rate of new hiv diagnosis. latina and black african american mothers experience higher rates of food insecurity then other groups. whereas, the health commission acknowledge and deeply appreciative of the latino latina and latin x community partnership with dph regard to developing

landing effective strategy to address covid-19 and monkey pox in the local latino community and whereas latino latina latin x report experiencing wide spread discrimination (inaudible) significantly high level then white individuals born in the united states and earning college degree are not protected against this discrimination. 1 in 5 individuals report experiencing discrimination clinical encounters while 17 percent avoiding seeking health care for themselves or family members due to anticipated discrimination. approximately 1/3 individuals report experiencing discrimination with employment housing and police interactions. latino latina latin x individuals with college degrees have higher odds reporting

discrimination in multiple domains then those without a degree. there remains much to be done to insure members have access to resources and continue to participate and advance in the political landscape including expanding leadership opportunities within the san francisco department of health and the san francisco health commission and whereas the san francisco department of public health developed the racial equity action plan to address disparities and combat racism through activities impacting staff and whereas the health commission monitor the implementation of the racial action plan through quarterly updates provided by the director of the dph office of health equity and whereas celebrating hispanic and latino latina latin x heritage month provides a opportunity to recognize the achievements contributions and history of and to understand the challenges faced by members of the diverse

latino latina latin x communities. now, be resolved the san francisco health commission recognizes the significance of hispanic and latino latina and latin x heritage month as a important time to celebrate and acknowledge the many contributions have made and continue to make our community state and country and firthser resolved the san francisco health commission recognize latino latina and latin x communities enhance the rich diversity of and strengthen the city of san francisco. >> thank you vice president green and thank you again to secretary morewitz and are for your colleagues of the department for drafting and writing such a excellent resolution . do we have a motion to approve?

>> i move approval of the resolution. >> second. >> vice president green seconds. secretary morewitz, do we have public comment? >> if you wlike to make comment on item 4 the resolution we have gone over press star 3. i i dont see hands now. let's give everybody a few seconds. now hands, commissioners. >> commissioners, any comments or questions on the resolution? any hands secretary morewitz? >> i do not see any hands. sorry, commissioner green has her hand up. >> commissioner green. >> thank you. i want to thank secretary morewitz for his work on this resolution. it includes so many critical points what we need to (inaudible) very well done and i greatly appreciative. >> thank you. >> thank you vice president green. seeing no other hands, we can move to a vote.

secretary morewitz. [roll call] >> item passes. thank you so much. >> alright. thank you commissioners, thank you dph and secretary morewitz. our next item is the director's report and i will note starting in this meeting and moving forward the director's report will include both covid-19 update and the m pox update, so it will be in this agenda item again for this meeting and moving forward. with that, i will hand it over to director grant colfax, dr. grant colfax, director of health. >> thank you president bernal. good afternoon health commissioners. joining you remotely i hope to be in chambers next meeting. have a very complete director's report so bear with me as i go through the highlights

and details. so, with regard to m pox, which we are referring to instead of monkey pox, m pox we have 718 cases of m pox diagnosed in the city as of august 30, and we are seeing hopeful signs that the cases-increase in cases is starting to lull off and go down a bit. this is also being reflected in certain jurisdictions on the east coast such as new york city which is a couple weeks ahead of us for their peak so we are optimistic things are moving in the right direction. we are insuring a robust health response to m pox outbreak which aligns with our health equity supports communities most effected by the virus and that includes of course getting vaccines out to communities at highest risk. we have given

over 21 thousand vaccines in total and now receiving sufficient doses that as of today we are expanding eligibility for the vaccines to all gay bisexual transpeep (inaudible) we will move forward with providing a second dose to people beyond 28 days from receiving their first dose and this is also in alignment with other surrounding bay area counties. individuals that are eligible to seek a second dose the health care provider, there are multiple health care systems across the city offering m pox vaccine. we encourage people if you have kaiser go to kaiser for your initial or follow up dose. within the san francisco health network we will provide first and second doses for people who are eligible. good news on the m pox front. we are expecting to

receive 13 thousand additional doses in the next allotment and more than 95 percent of doses received have been administered so great progress made with regard to m pox. also wanted to touch on our dph collaboration with the san francisco unified school district. we are back to school. throughout the covid pandemic as the commissioners know, dph (inaudible) with special focus on san francisco unified school district. dph meets with the school district every 2 weeks and access covid-19 prevention and emerging health issues and during the summer of 2022dph collaborated with schools on multiple efforts to prepare students and families for a healthy and safer return to school. (inaudible) as a result of this collaboration. covid-19 prevention mitigation m pox

prevention and mitigation and back to school vaccine clinics. with regard to covid-19 prevention mitigation (inaudible) with pdph california department of public health and (inaudible) as a result. in addition dph updated the protocols on covid-19 outbreaks in schools. in align (inaudible) notify when 5 percent of the site population including students and staff reported or suspected confirmed-covid-19 cases over a 2 week period. we updated our website for schools that link to cdph guidance and how to report covid-19 outbreaks and share this with san francisco unified school district and all schools in san francisco including those at the school dist rict can receive technical support and guidance by contacting the e-mail listed in

the director report. m pox prevention mitigation because of increase number of concerns and questions from schools, dph issued (inaudible) spanish chinese and filipino and the guidance is available on our website. and then as i reported we hosted a number of back to school clinics both during the late days off august 20-27 at both the children health center and southeast health center and open to all san franciscans residents who are children regardless of insurance status or medical home. there was no requirement to be a network patient and these clinics provided covid-19 vaccines as well as other vaccines required for school entry. next topic page 3, very pleased to announce that dph

held its first virtual all staff town hall. this is the first dph all staff meeting in recent history, perhaps in history and we had over a thousand staff attend across dph so great turn out for a meeting held at noon virtually. i was joined with other key dph leaders including dr. hillary (inaudible) director of hr (inaudible) discussion connections to dph and san francisco and answer staff questions. we are able to answer many questions and share some of our perspectives on the state of the department. we were not able to answer all the questions because thankfully there are a lot of good ones that came up in the chat and we will be summarizing answers to those questions and getting back to the staff that asked those questions in a group format. good progress in terms of making-having the dph

staff at a level informed about what is happening across the department, getting to know division leaders from across the department and being able to answer as many questions as possible to help people understand various aspects of the department to clarify policies and so forth. good progress. we did get a lot of questions about our hr policy and hiring which is a challenge we have across the department and again happy to see people are engaged in this and want to acknowledge (inaudible) hr and staff work for not only organizing helping to organize such a large meeting but also being responsive as possible and transparent as possible of the opportunity and challenges we have with regard to hiring and hr policies. along that line, with regard to dph human resources, they did in partnership-partnered

with sfgovtv to develop a title (inaudible) the video celebrates diverse skilled work force and highlights the varied services and we actually shared the video at the staff meeting. i encourage commissioner tuesday watch it. it is a nice piece of a celebration of dph's staff and their commitment and perspectives and it is a nice (inaudible) encourage you to view that at your leasure. san francisco hospitals recently celebrated the 150 anniversary which is remarkable. the anniversary was august 28. (inaudible) zucker burg (inaudible) supporting public health for the san francisco community since 1872. as you know, this hospital has been a

key cornerstone of san francisco's response to health and health crisis from the 1906 earthquake to the 1918 flu pandemic to hiv aid epidemic to covid and to m pox. the general has risen to the challenge every time and want to congratulate the staff who work there, the ucsf partners who are key in (inaudible) most importantly celebrate the fact that people of san francisco are so supportive of our incredible hospital. there will be more celebrations in the future and to learn more about this year long celebration because when you are 150 years you celebrate all year, you can go to zsfg150.org website. also on page 4 overdose awareness day

was august 31. (inaudible) will provide more details to the commission potentially at this meeting and future meetings around overdose work. we are very committed to addressing the overdose crisis in the city. in recognition of this of the overdose prevention day, staff distributed (inaudible) test strips at the howard street, behavioral health centers and zuckerberg san francisco hospital. we also acknowledge and commemorate the event at the tenderloin center to (inaudible) continue to have resources to reduce the risk of overdose and treatment referrals as needed. really appreciate the work that was done on overdose prevention day. i'm sad to

announce the passing of a dph employee, (inaudible) mc daniels. a member of the environmental services team at laguna honda hospital. passed (inaudible) he will be missed. [difficulty understanding speaker due to audio quality] he was known by many on the first day of work. on behalf of dph we extend our deepest condolences to wife, children, grandchildren and his entire family. and then on the covid-19 update, just some key data. we have diagnosed over 175.300 covid-19 infections and fortunately over (inaudible) died due to (inaudible) the 7

day rolling average is 152 and 62 people were hospitalized in san francisco including 12 in the icu. i will say this is substantially down from our peak this summer, so our summer surge is pretty conclusively now decreasing, so that is good news. our hospital capacity remains robust. 85 percent of all san francisco residents have been vaccinated and 75 percent have received at least an additional booster dose and i think the commission is probably aware that last week the fda and cdc approved the so called bivalent booster doses, so these are specific formulations of vaccines that are engineered to protect from the omicron subvariant so this is

a updated version of the vaccines that more closely reflect the variants circulating. those boosters are being made available across the city. dph we expect to have the boosters available at the latest by september 17 and many people are already able to avail themselves of the booster at the pharmacy sites. we are working across the city to insure people have raised awareness of the importance of getting the booster as we go into the fall. as some speculate early on this is consistent with the likely future where people will be offered a booster just like a annual booster, it is like we get at least a annual covid booster that reflects the adjustment of the vaccine to whatever variants may be

circulating at the time. that is my director's report. i appreciate your patience and forbearance in the long update and happy to take any questions or provide any additional details the commissioners may have. thank you. >> thank you director colfax. we heard very positive feedback about the town hall meeting. i like to offer condolences to mr. mc daniels family and laguna honda family. do we have comments on the comment line? >> i see two hands. i will note if you like to make public comment on the item which is item 5 the director's report, press star 3 to raise your hand and i'll read this item again. for each item members will have a opportunity to make comment up to 3 minutes. the public comment process is designed to invite input and feedback from individuals in the community, however the process does not allow questions to be answered in the etmooing or for members of the public to engage in back and forth conversation with the commissioners. the

commissioners do consider comments from members of the public discussing an item and making request to the dph. please note each individual is allowed one opportunity to speak per item and individuals may not return more then once. written public comment may be sent to the health commission at health.commission.sfdph .org. if you to spell your name for the minutes you may do so during the comments without your allotted time. i see 3 hands. i'll take the order i see them. caller, you are unmuted, please let us know you are there. >> hello. my name is brenda barrels, a dph employee, and i was calling regarding when dr. colfax was talks about deaths of dph employeesism i want to make you aware there is a dph employee name

of michael (inaudible) a gay white male, a older guy who was harassed so bad he had a stroke. (inaudible) recovered from the stroke, came back to work and the managers double down on the harassment and saturday died of a massive stroke. i really think that all these things need to be (inaudible) a human resource person was-i was working with him recollect they tried to help him and he was working with to try to get him the training he need. he was denied training and they were riding him about what he didn't know. i just had to say that when i heard him talk about deaths of city employees, because that was a death that did not need to happen. the department had a role in this man's death.

>> thanks for your comment. next caller, please let us know you are there. >> yes. can you hear me okay? >> yes, please begin. >> thank you. so, my name is alice active member of senior disability action. i want to support for the testimony given at the last meeting by members and others for covid and m pox safety with the focus on equity. especially senior disability action members and (inaudible) powerful testimony about how we need to far better public health response for m pox safety with a focus on equity. he had very important equity measures around that which i'll discuss later if i'm not cut off. first i want to say

fortunately the sound has been cutting out of my live stream. i dont have problems listening so i did not hear all the director's report or the rest of the meeting. i tried by webex, and it says it is closed, (inaudible) e-mail about this. i cant be sure (inaudible) hasn't been covered. if i did understand correctly, the director said we have sufficient doses of the m pox vaccine. i strongly doubt that because we don't know how many people are at risk. even if all of the people who are in the eligibility category are at risk have vaccines available for them and i do not know if this is true, there (inaudible) housemates

of people eligible but not in the eligible category itself. the people in relationship with the eligible category who are not in the category itself. for example, a queer woman in a relationship with a bisexual man who otherwise would qualify. she would be excluded. there are other people who need the vaccine. for example, you might have seen the testimony in the news report of david watts and think his name is right but you see in the scott wiener committee on m pox which had a different name testified about how he simply hugged and kissed a frnd on the cheek and friend turned out to be a m pox lesion which was a pimple (inaudible) david watts got m pox and spread to the husband and spread to

the dog. one income family which according to the news report and testimony, which was when they had safely was not able to work. it is a crisis. >> thank you so much for your comments. sorry, your time is up. caller, you are unmuted. please let us know you are there. >> i am. it is patrick shaw. >> please begin. >> sadly, director public health grant colfax's report contains not one word about progress towards obtaining cms recertification. as important as preserving lhh as the safetynet facility is, shouldn't dr. colfax be providing twice monthly progress reports on efforts to

rescue lhh? has nothing of significance happened regarding lhh status since colfax last update on august 16? has colfax had no conversations with senator feinstein, speaker (inaudible) mayor breed (inaudible) others to report on colfax's efforts assisting lhh regaining cms certification? a related issue, there is no summary from mr. pickens actual powerpoint presentation to the commission on august 16 included in the august 16 meeting minutes. is the health commission secretary policy and practice to omit including a summary of the actual agenda

presentations made by dph staff to the health commissioners? you just announced that the m pox reporting by dr. colfax would appear twice each month in both health commission meetings. why isn't the same being done for progress on the lhh, cms recertification? dr. colfax needs to address the laguna honda hospital crisis twice every month. thank you. >> thanks for your comment. we have a final hand up. caller you are unmuted, please let us know you are there. >> hi. it is dr. theresa palmer, can you hear me? >> yes, please begin.

>> my comment is also about laguna honda. i'm disappointed there is no mention of it in this agenda. it is extremely important that discharges for skilled nursing facility eligible residents not resume ever. my understanding is that families and patients are being hassled once again to plan discharges to out of town facilities which are all most universally very low quality, and we know the federal government has exteneded the moratorium on discharges until november 13, but it is extremely important that discharge be uncoupled from recertification and that funding provided by the city or by the government to continue to keep skilled nursing eligible

patients there and that no discharges of people that can go to non-skilled nursing facilities occur until safe and local facilities are found. funding for existing residents must continue until recertification and no beds should be cut. we need those beds. people in the fucommunity who need nursing care are waiting 5 years and more for those beds or have to leave their community and go out of town or die uncared for at home. we also must have sufficient mental health and substance use programs and beds to give people the care they need to prevent inappropriate nursing home admissions, which is one of the ways san francisco got into the mess in the first place. please hear this and i do hope to hear some aspect of this addressed later

in the meeting. thank you. dr. theresa palmer, ex doctor at laguna honda and are (inaudible) >> thank you for the comments. that is the last public comment. >> thank you. commissioner, we have comments or questions on director colfax's director's report? commissioner chow >> yes. sorry, i was unable to raise my hand again. i do think dr. colfax report on covid-19 should include the trends like he was doing before. i think that is helpful to understand where we were and where we come from. i think it is useful to the public. not everybody looks up (inaudible) it would be great i think that

(inaudible) it is happening and really happening in a graphic fashion. also think it is important to continue to monitor our vaccine opportunities, especially perhaps we can be more granular in looking at the younger age group and the older age group. we are over 90 percent, but i think as you have shown in the past we are still lagging behind or there is a lag in the (inaudible) those under the age of 4 are just getting vaccinated now. that is valuable information so the public does not lose sight of the importance of covid and that while covid is becoming assimulated into everybody's life , the importance of covid,

the problem of the most vulnerable and (inaudible) still represent issues we really need to keep (inaudible) those were just my thoughts in regards to trying to expand back, but being more thoughtful as to what sort of information that is useful for a summary to the commission in regards to the status of covid. the second issue may well be (inaudible) wants more updates on laguna honda even though we are devoting a meeting per month in depth that it might be useful to do some sort of interim like we are aware of the fact we

are doing constant reporting on the update and while they don't have to be in depth going down to the floor level, i think the idea that-the fact these are happening-we are making progress would be helpful at least in the general summary since that is a important topic to the community at this time. those were just my two suggestions for (inaudible) view where covid is and where the laguna honda recertification program may be (inaudible) and i would look forward to report back [difficulty understanding speaker due to audio quality] into the report without redundancy.

thank you. >> alright. any other comments or questions from commissioners? >> vice president green has her hand up. >> vice president green. >> thank you. i guess i have two somewhat related questions about covid. the first is, if the school does reach that 5 percent reporting, are we offering guidelines or to extent dph become involved in helping schools see the safest way through that and then the other question, we are getting a lot of questions about this omicron vaccine, in particular pharmacies have it this week i believe, but will systems like ucsf and kaiser receive the vaccines through us which is after the 17 of september or getting it independently and what are people to do if they themselves had covid? if they are

pretty sure they had it during the month we suspect it was (inaudible) should they get vaccinated? is there any guidance on that? >> so, commissioner green, my understanding is the pharmacy-the pharmacy already received the boosters. we believe we will be getting our booster shots at the latest the week of the 17, so my understanding there is a lot (inaudible) that may be changing and we can get back to you on that and i dont have timeline in regard to the other health care systems. with regard to the threshold, i have to have the school team come back and report back on what the policy is if the schools reach above the 5 percent and then i dont have at my fingertips but there is a i believe guideline for the vaccines if you had covid how long you should wait but i don't have that specific timeline in front of me and dont

see dr. philip- >> dr. philip is here. >> she is. maybe she can answer both to the school and time period. dr. philip, i don't remember the time period or if you have that committed to memory. >> good afternoon. thanks director colfax dr. colfax and good afternoon commissioners. in terms of the schools, what we ask the schools to do, eeben if they dont meet the required 5 percent any time the schools are finding they have challenges or would like our advice or guidance we have open lines of communication that have been going throughout the pandemic and school always welcome to reach out and we can go over key practices for insuring that they have done all the things they need to do in terms ofventilation and management if they have cases in the classroom so we are always available to do that. what we find is the schools are very comfortable and confident in the ability at this point

with covid-19 to man j age for the most part so it is if there are very large outbreak and they would call-manidated to call us. welcome to call any time. they are mandated if there are large outbreaks per the state guidance. they are required to reach out and let us know. if they do that our teams work with them at that point to be able to decrease risk of transmission at that point. for the question of the covid boosters. i have to go back and triple check, but what our understanding is that it 2 months since the last booster and there isn't a official recommendation if you have recently had covid-19 infection you must wait. the 2 months is minimum and some experts advice waiting a little longer then that if people feel comfortable doing so.

it might enhance the immune response. you had another really good question about other health systems that could be getting vaccine and my understanding from talk wg the state colleagues is the large multi-county entities would be getting vaccine directly via the state and not via us at dph so they will continue to be aible to manage their vaccine for patient s and for the public they serve in that way. we dont have the exact timeline when all the entities will get it but we are trying to put out guidance and any direction we can city wide so people have a understanding of the vaccine that benefit who should be getting it. >> thank you very much. i had one last question i forgot to ask, which is a lot of people are wondering-(inaudible) if you sign up for vaccines on some of the pharmacy websites they ask what vaccines

you have recently. is there any reason someone cannot get a this year's flu shot and covid booster within the same timeframe because i think the question is confusing some people as to whether they have to choose one or the other. >> no. thank you dr. colfax. by understanding is that there is no restriction. there is no required spacing, no time integral that is mandated and people are able to get both flu and covid booster if that is indicated for them or the primary series for that example if they haven't done that to date. for most people it will be a booster and a annual flu shot and those can be given at the same time. >> thank you very much for clarification. >> i dont see other hands. >> alright. thank you director colfax. thank you dr. philip and we'll move to the next item which is

general public comment. secretary morewitz. >> folks on the line i have another statement to read. at this time, members of the public may address the commission on items of interest to the public that are within the subject matter jurisdiction of the commission that are not on this meeting agenda. with respect to agenda items, your opportunity to address the commission will be afforded when the item is reached in the meeting. each member of the public may address the commission for up to three minutes. the brown act forbids the commission from taking action or discussing any item not appearing on the posted agenda, including those items raised at public comment. folks on the line if you are making comment this is items not on the agenda. if you comment on something on the agenda i will stop you because this is just

for that. caller, you are unmuted, please let us know you are there. >> thank you. the commissioners have a confidence level that progress is being made on laguna honda. i don't think this is confidence is warranted. we have until november 13 to pause on these deadly transfers. what is to prevent them starting up against after november 13? has the city decided it is never going to push people with mental health substance abuse issues into laguna honda, which is the cause of all these problems? we haven't heard anything about

that. it is just abundantly clear what is driving everything about this is profits. it is the housing profits that caused increase in rents and caused the board and care facilities to be so turned into high priced housing. it is the hospitals not wanting to treat medi-cal patients, because the reimbursement is lower and the city is letting them do that. it is the cities of lowering the taxes paid by [audio cut out] >> caller? are you

there caller? we'll take the person in the room. i apologize, i should have done you first. i got the buzzer. when the buzzer goes off your time is up. >> robert rine heart i represent the san francisco black and jewish community coalition, a faith based group dedicated to social racial economic and health justice and dismantling systemic racism in san francisco. we are saddened and concerned by the landmark study life expectancy by (inaudible) in the united states 2000-(inaudible) national database of all counties shows in 2019 the life expectancy for black non hispanic people in san francisco was 72 years compared to all collectively of 83 and a half. black males had a estimated life expectancy of 68 and a

half. more then 10 years disparity ranks san francisco at the bottom of all counties in california. the data updates san francisco life expectancy numbers needs assessment. the cdc confirmed last week that the covid pandemic sharply reduced life expectancy nationally through 2021 for all groups. those effects and disparity will show up in the california survey also. we ask the health commission to take the following actions promptly-add racial dispare and life expectancy in san francisco to top of agenda including (inaudible) why these unacceptbly wide disparities persist despite all the tools already used by san francisco to address them. create a working group of public health and community members, san francisco office of racial equity and board of supervisors

to publicly discuss these issues, address the actions that must be taken to change and implement agreed upon steps that work to eliminate disparities and life expectancys between san francisco black population and other groups. i just like to add, i have thrown a lot of numbers out. our members, (inaudible) among friends, families and communities and they are grieving and they would really like your attention to this matter. thank you. i left a copy with our contact information with mr. markwits. >> thank you for your comment. we'll take the next online. person on the line, let us know you are there, i unmuted you. >> yes. my name is brenda barrels. to the previous speaker, i wholeheartedly support what he said. absolutely true. the system needs to do

more. one thing i want to talk about is employees getting covid. i just had it. i'm a employee and just had covid. (inaudible) sit in this room have covid. what i want to talk about is the safety of some of the buildings that we are working in. i work in building 90, 80-90 and those buildings,ventilation is horrible so it is not really safe and it is easy for covid to spread. so, i just would hope that the system, the department would look into that and do something to make the ventilation in those older buildings which is different from the newer buildings to make sure that the people working in those buildings have a safe working environment. >> thank you for your

comment. hi, caller you are unmuted. please let us know you are there. >> i am. it is patrick shaw. can you hear me? >> yes, please begin. >> alright. first, either the july august or september monthly contract reports on the full commission monthly consent calendar included (inaudible) june 15 contract (inaudible) adding $5.2 million bringing the contract for hsag to $6.98 million. if they have been on your monthly finance and planning committee agenda, but it is not been presented to the full commission so most members of the public have no idea about this amendment. why

wasn't the amendment discussed by the full health commission before the contract amendment was ordered to the board of supervisors for consideration and introduction on today's board of sups meeting agenda? the contract amendment mentioned the critical element pathways training. commissioner chow asserted on august 16 that the (inaudible) had not been aware of it. with this contract amendment-the contract amendment also not discussed by the lhhjtz. second item 10 on the commission's august 16 agenda to receive a summary of the august 9 meeting was differed

and not discussed when the august 16 meeting ran over time. why wasn't the august 9jcc meeting summary scheduled for today's meeting agenda? when will that summary be presented publicly? again, i'm very concerned about whether the nursing home administrator and assistant nursing home administrator positions at laguna honda have been filled, yet or whether they are being filled on a interim basis by hsag contract employees at $400 an hour for total of $1.8 million. we need to tell the public whether those 2 positions had been filled or whether the

training on the critical element pathways for training the nursing home administrator and the assistent nursing home- >> thank you for your comments. the next caller-actually, commissioner- >> hello, can you hear me okay? >> yes, please go ahead. >> thank you. this is alice, senior disability action active member. i first wanted to urge the commission to solve the sound quality problems with live stream. (inaudible) may not be not able to access webex, which said the meeting had been over for some reason. these are the official documents i got from the executive secretary. big parts are cutting out like

dr. philip testimony racial inequities i like to hear and unable to and therefore cant make comments as well as other parts of the meeting. another thing-i also wanted the second comment about concerns about poor ventilation and racial disparities. good ventilation is one important part of public safety around covid that hasn't been addressed yet. another part which has not been addressed yet is fleed to bring back a broad masking requirement as there have been high levels. in general, what needs to be addressed is the compelling public comment so that important public health issues like the one senior disict action brought up time and time again and (inaudible) m pox equity concerns. i think one reason people-i'm the only from the committee who

(inaudible) attendeding is because people are discouraged. there is so much (inaudible) not mentioned up to now accept by commissioner chow and thank you very much for bringing that up. that is so important. it is devastating for people's lives. people testified how devastating it is. i ask others testified how we are at risk even if we are boosted. i submitted summaries study which shows that and happy to submit more scientific supporting evidence if requested. it is not brought up that needs to be a important part of public health messaging. public health message hasn't been addressed yet and the need to let everybody know that they and loved ones regardless of boosting regardless of the health are at risk of long covid. people many people have had to cut hours or leave work because of long

covid. people probably are much more careful if they knew the risk of themselves and loved ones and hopefully people care broadly about the community and not spreading two dangerous viruses, covid and m pox. some people are taking precautions and that is wonderful but not enough people know the risk and public health needs to communicate that. more broadly, equity issues should be thoroughly discussed throughout all parts of the meeting. >> thank you for your comments. commissioners, if i may quickly clarify, it is appropriate to clarify when something is misstated in public comment or something can be clarified and there was a comment about the contract not being on in the minutes. it was part of the august 2 contract report and discussed by the finance and planning committee, it is in the minutes and you as a full body approved it as part of consent calendar and listed as the august contracts report. just to

clarify that for you. that is the last public comment. >> thank you for that clarification. our next item on the agenda is resolution making findings to allow teleconference meetings under california government code section 54953e as the commission and others know, this is a resolution we must pass every month in order to allow the commission and its committees to meet remotely for the next 30 days. so, i don't believe we need to do a reading of that resolution given it is the same resolution that came forward accept for changes in the date, so asking the commissioners is there a motion to approve? >> so moved. >> second? >> second. >> there was a hand up commissioners and i need to check for public comment. folks online, if you like to make comment on item 7 do so now by pressing star 3. i will unmute the person who has their hand up. hi,

person, are you there? >> yes. hi. my name is melanie grossman andime i like to make a statement about laguna honda. >> that is notd on this agenda item. thank you very much. folks i don't mean to be rude but each item has its own subject matter and comments from the public can be taken on that. laguna honda isn't on this agenda so the item we are on is specific resolution. i see no other hands. >> any comments or hands before we before we move to a vote? seeing none. >> roll call vote. [roll call] >> i'm sorry, what are we take agvote on? >> item 7 resolution to allow hybrid meetings. >> right. absolutely, yes. >> thank you.

commissioner bernal. >> yes. >> thank you. the item passes. >> our next item for action is resolution to recommend it thooboard of supervisors to authorize the department of public health to accept and are expend a gift of $47.678.13 very specific from the san francisco general hospital foundation. for this we have greg waung who is administrative analyst. mr. wong. >> greg, are you there? greg, i unmuted you, are you there? commissioner, while hopefully greg is getting on board maybe mr. wagoner can help with that. the resolution is before you and somewhat self-explanatory so you can ask questions and hopefully someone can answer them. mr. wong hopefully can get on board, but it is in

front of you. here we go. sorry, hi. >> hello mr. wong, thank you for joining in person. >> thank you. apologize for being late. >> no problem. >> the amendment of the health commission. thank you for taking time to hear the item. [difficulty hearing speaker] >> could you raise the microphone up a little bit? thank you, sir. >> members of the health commission, thank you for taking the time to hear the item. the (inaudible) education program gift is used for the english and spanish language (inaudible) [difficulty

understanding speaker] is there any question for the gift? (inaudible) with the subject matter expert on the case and we are here to answer your questions. >> thank you mr. wong. commissioners, motion to approve the resolution? >> so move to approve the resolution. >> do we have a second? >> second. >> alright. secretary morewitz, do we have public comment? >> folks online we are on item 8. let us know if you have any comments by raising your hand, press star 3. i see no hands commissioners. roll call vote. [roll call] >> the item passes. thank you. >> thank you very much sir. >> thank you very

much. >> our next item is dph behavioral health services update and for this update we have dr. hillary kunins and dr. kunins. >> good evening commissioners. very nice to be here. let me get settled. thanks for the slides. >> would you like a paper copy? >> i think-maybe, yes. good evening. very happy to be here to give you provide a update on what is happening in behavioral health services and are mental health sf at dph. i am going to

thank you for your questions. i will try to answer them during the presentation and indicate where i'm answering as we move along. next slide. you are hearing me okay? >> sound great. >> okay. first, this is just a outline from the presentation similar to our prior updates taking you through a overview where i just want to ground and start us, move into updates from mental health sf, address specifically overdose prevention and then share with you some updates on some of our infrastructure grants. thanks. and culturally congruent services. i will remaskism . thank you. next slide. you have seen this slide before commissioners. i like to just show it

at the outset of the presentation to remind us all of our mission and vision in behavioral health, which is to promote behavioral health for all san franciscans, prevent illness, intervene early, promote cointervention that improve health outcomes equitably when behavioral health care is needed it should be proactive , timely and available equitable and outcome driven. the context for our work is very much around some new funding and legislation enabling the change that i'll be speaking of. you have seen these before in mental health sf, which has legislative expansion and implementation of four domains including new treatment beds and facilities, street crisis response, office of coordinated care, and mental health service center. the work of mental health sf is largely

funded through proposition c funding, which provides support to the above domains as well as overdose expanded work and enhanced supportive housing. importantly, which i won't address today, but will in future updates, we are working hard to understand and implement various aspects of cal aim. this is california medi-cal reform efforts, which has the potential to change a lot of what we do and how we go over behavioral health services. next slide, please. i have been aiming to give you an update quarterly of clients treated. on had right side of your slide, the table is broken into two parts. clients receiving mental health treatment in the top line, clients receiving substance

use disorder treatment in the bottom lines. what you see in front of you is now closing out of the fiscal year 21-22, our data do lag so we try to lag our presenting them to you. you see on the top line that more children received mental health treatment. this is specialty mental health treatment in this fiscal year compared to last fiscal year and fewer adults and older adults received less mental health treatment this fiscal year compared to last fiscal year. a very small decrease. substance use treatment. again, compared to last year our specialty care system treated fewer patients clients compared to last year. just of note, this reflects only clients and patients treated

in the specialty care system using data that is captured in our electronic health system. we know in particular with new expanded programming we have increased services for thrirfbed and low threshold settings not captured in the data set. this is a limitation and being able to account for all the people we are touching in a unduplicated way and one which we are working to address. next slide. i want to share newly appointed leaders in permanent positions. first, we are in our managed care director section, we have appointed any shoey as the

utilization management director. this is a very important role in the context of us being both a managed care plan, a payer as well as on the right side of the organizational chart a care or service deliverer. we appointed in our behavioral health system of care, three new leaders. cal yu chung who is permanent as the transitional age youth director, (inaudible) adult system of care director and stephanie felder in a permanent role as crisis and hope sf director. additionally, we started a new section called population behavioral health that leader has been identified and started in the last few months since i last updated you and that is jeff hong. additionally, just to update on the hiring from january to

july, bhs hired a large number of behavioral health and mhsf positions, more then 350 and you see that exact number is 364 and that is as of july 26. next slide. turning now to mental health sf and you can go to the next slide. just going to get my cheat notes for questions i know you are interested in. again, i think this is familiar to all of you and just serves as a grounding slide. the 4 key domains include the ones you can see on the slide in front of you. i'll just also call your attention and i know you have the slides, is under new beds and facilities, there is a

monthly dashboard that gets updated and are under street crisis response there is also a monthly dashboard that gets updated so you can follow along with these updates even between my presentations. next slide. importantly, since i was last year-next slide. is more important information about one of our key mental health sf initiatives and that is the office of coordinated care. we have made good progress since launching the office of coordinated care and i'll call your attention to really-i will go up from the

bottom. we from january to august we received 101 requests for coordinated care. this is primarily with our first launch with comprehensive care management offerings to zuckerberg: we are accepting referrals to office of coordinated care bridge and engagement service team what we call bridge case management support. we are offering consultation with hospital staff about treatment resources discharge planning support coordination of providers. our next group that we are prioritizing to set up systems and are work flow is for justice involved individuals to behavioral health care and other services. really focusing on people coming home. moving up to the behavioral health access programs, we are really excited that

our behavioral health access center as well as (inaudible) which stands for office based induction center increased their hours into the evening. these means they are open a total of 50 hours a week. we are also in the midst of completing hiring to extened the behavioral health access hour s to the weekdays and we are hoping to launch very soon. at the top line you can see as i just alluded to very important part of our transforming work is to have a single health care record and that means transition to epic. that is a large project. we are working with colleagues from across the department including my colleagues behind me. one of our first projects will be to include epic capacity and the office of coordinated care. i

know that a number of you are also interested in other kinds of services that include care coordination and what isn't on this slide is our intensive case management expansion. we are in the process of adding funding to contract at icm program providers and getting ready to release an rfp to further expand the important critical pool of this level of care, which is a higher level then routine outpatient and the idea here is to serve people who need more intensive wrap arond and coordinated services. i'll also add another element of enhancing our ability to coordinate care also not officially in this office is adding care coordination capacity to our outpatient programs in order to promote retention, reduce dropping out of care,

and help facilitate care transitions and that hiring is part of the 364 that i mentioned just briefly. next slide. we importantly our teams are hard at work continuing to expand residential care and treatment. we have a number of recently open sites which were very excited about. these include soma rise, drug sobering center the (inaudible) project and most recently victoria's house. as of the end of august, the new open bed count is nearly 250, which is 2/3 toward meeting our goal of opening 400 new care and treatment beds in the city. next slide. i won't go into all of the

details about vick tore yu's house but this is really a lovely facility in the mission that is intended to be a 12 month rehabilitation center with 46 beds for people with serious behavioral health conditions including substance use disorders. it is designed to support to live independently in recovery oriented setting. next slide. the bed dashboard which i mentioned a short time ago really just showing has a lot of detail about our progress with the punch line being where you see green it means it is open, the facility is open and accepting clients. some of the sites are scaling up slowly so do not-not fully at

capacity. for example the (inaudible) project partnership with colleagues at the probation department. other sites are low threshold such as soma rise. i know you know about the drug sobering center which is a low barrier overnight model, but also available for shorter stays on a drop-in basis for respite and care and aimed at people who use substances and intoxicated to come in safely off the street. next slide. this slide updates you on our street crisis response teams. as you know and i know you had a number of presentations about the model of street

crisis response, which is a multi-disciplineinary response in conjunction with our colleagues in community paramedicine, or goal is to provide rapid trauma informed response to calls for service about people experiencing behavioral health crisis in public spaces aiming to reduce law enforcement encounters, unnecessary emergency room use and of course provide an appropriate behavioral health response. as of late spring, scrt is fully operational delivering 24/7 coverage. importantly, scrt transition to emergency medical dispatch. i know one of you was interested to understand a little more about what that means. scrt is still reached by calling 911. when a call is triageed to scrt it

goes into the emergency medical dispatch tree and if a team is not available immediately the backup is a ambulance rather then the police response. so, we are following closely including for response times, including for all the outcomes which you saw on our dashboard. so far it we feel is going well and monitoring closely. you can see some of the numbers below on the slide and i think just to address some additional questions, 15 percent of engagement resulted in clients being transported to the hospital meaning, they were felt to be too ill by the team from a behavioral health point of view and needed more intense level of care and

assessment. an additional 13 percent were linked and transported directly in the community to a social or behavioral health setting. somebody asked-sorry i dont have a name. commissioner names attached to the question. what percent were transported for injury and illness and assume that means medical illness. as far as i know and will double check, that is only for behavioral health transports and really ems, emt, not the special team would be responding to medical illness or physical injury. we have a number of parameters that we are using to monitor and evaluate the program, both from the scrt response and also importantly to the follow-up response. we have a dedicated office what we call office of coordinated care/scrt team. you can see that in the last

bullet where we ask the team to do follow-up after that essentially that crisis interaction. we are using the following parameters to track success, which include our ability to find or contact the person rates of connection to existing providers or treatment facilities. we are tracking whether and when people decline services. we are also particularly examined interested in stratifying these parameters by important variables like race, which we know where people may experience disparate outcomes. housing status. and what you can see on the slide in front of you is that we were able to engage 82 percent of clients in follow-up which we think is really terrific

knowing that folks are not requesting services. these are folks that had an event, a crisis and we are now following up. i'll also highlight we are getting better at the follow-up. over all the rate was 52 percent, but we are getting better and better. as you can see the july rate is 82 percent. next slide. i want to just turn now to our overdose prevention work. as you all know-next slide-overdose rates remain unfortunately at epidemic levels here in san francisco. this is also unfortunately true nationally. the data you can see in front of you are monthly overdose deaths starting from january 2021 through july of 2022. these are

preliminary deaths that as reported by the chief medical examiner. what we see here and what i want to highlight for you is we did see a decrease in monthly overdose deaths in the early part of 2021 with a flattening really in the latter part of the year and continued flattening in 2022. we know there is more work to do and we are really busy expanding some of the initiatives that i want to give you an update about. next slide. we are group-our work into 4 areas of strategic intervention and you have seen this slide before. we are really aiming to prioritize folks at the highest risk of overdose deaths in san francisco. that is black african

americans experience disproportionate deaths from overdose and people experiencing homelessness do as well. next slide. i want to just share key updates. first, from our street overdose response team and i'll just really thank and highlight my colleagues in whole person integrated care in the division of ambulatory care which is where this program sits. i think i want to just highlight the fact that the team continues to respond to many calls that include overdose approaching a thousand. so for nob (inaudible) one asked importantly how we account for the fact that many many clients accept harm reduction supplies, total of

683, that might include muloxon that help a person reverse a ovdose and save a life. that might include safe use supplies that prevent infection and other affects of substance use. fewer clients accept (inaudible) effective medication to treat oipoid use disorder. it can be prescribed by a licensed physician, nurse practitioner or physician assistant. we offer (inaudible) routinely (inaudible) i think this reflects the fact again that we are responding to somebody who is just experienced a overdose. they may or

may not be interested in taking any steps at the moment to change their future risk of overdose, part of that visit is helping to support the patient through a overdose, establish rapp ort, offer a menu of tools that can protect the person in the future and we'll continue to follow up with them. the team has a follow-up team called poet which conducts outreach following the event and it may be they accept additional (inaudible) or referrals for other care in subsequent visits. we describe on the right also a pie chart of where we have responded to the event. data is always something we are working to improve upon and as you can see we do have a number of events, 30

percent where we don't have a location entered into our database. this program i should say started up very quickly and as the expression goes we are building the plane as flying it and improving data systems, staff training, staff capacity, so we are optimistic that those data will continue to improve. the majority i'll just or the plurality of calls were responded to on the street according to these data. the team is also working with hospital staff particularly in the ed for them to know how to engage the team for follow-up and so the team is doing a lot of outreach to and working with hospital ed's to make that happen. next slide. just wanted to share a few other very

exciting updates, specifically in the category of projects or programsfunded by prop c. we have sig nificantly expanded the (inaudible) you heard about the hours in the presentation but we continued to increase new client intakes. in this case in the last quarter, 6 percent increase. we are also on the third bullet in the middle of piloting what we are calling a individualized contingency management program for people with stimulate use disorder starting soon so we can offer evidence based care for people with opioid use disorder and people with concurrent stimulate use disorder. the bart market street clinic is a treatment clinic for opioid use

disorder provided methadone and (inaudible) expanding the evening hours to 10 p.m. you can see the result so far. they admitted new individuals interested in evening hours, about they are also dosing that is providing medication many many times since april suggesting there is a need for evening hours and this is a strategy to promote retention and care and therefore decrease overdose risk. finally, my last update around overdose is to report in about the behavioral health pharmacy and lock zone clearinghouse and fentanyl test strips. the pharmacy is increasingly active in supporting the distribution of muloxon kits. they distributesed kits more to 60 (inaudible) we know about more then 2 thousand reversal. this is

likely undercount since not aerobic wn is reporting to us. additionally we piloted a first round of fentanyl test distribution. as you all-i believe heard me discuss fentanyl test strips are a way individuals who are use illicit substance can test the substance to see if there is fentanyl in it so avoiding unintentional exposure and unintentional overdoseism we purchased at the pharmacy 19 thousand fentanyl test strips distributed to 60 program. we are eager to continue to work on that intervention and use it as another strategy to help reduce people's risk of overdose. i'll just end with two more slides. i wanted to

share with you some information about some recent grant funding. we still need to go through official processes about accept and expend. i believe but wanted to make you aware of these-next slide. i think two slides. one more. the state of california has begun to distribute grant awards. these are for infrastructure building in the behavioral health space. we are actively accessing the grant opportunities and applying for them as they come up. the first one is a $6.8 million award, which we will use for the renovation of the crisis stabilization unit facility in the tenderloin. the second award is is a 5 and $5 and a half million award through another mechanism called the community care expansion preservation program

to support the preservation of board and care facilities. just of note as one asked, these are for adults who have social security or ssi and not exclusively for behavioral health needs but many do. i do want to add one more infrastructure grant which i neglected to put on the slide. we have-and this is a grant that came to you already. we received $1.98 million in the first round. probably about 8 months ago to expand crisis care mobile units. that grant is being implemented. last but not least, i wanted to just share with you some of our key work on implementing culturally congruent services. next slide. some workforce initiatives. as we

discussed last time and the fee feedback the commissioners provided, which i am eager to work on. we are very interested assessing our portfolio of service to understand the extent to which opportunity to improve our delivery of culturally and linguisticly congruent suvs. i spoke with you last time about our review of services tailored to the black african american community. what you see here is our initial assessment of services addressing the needs of asian and pacific islander communities. we have i'm pleased to report but i know more work is needed, 10 programs dedicated to api youth and adults. these includes three contracted community based organizations for api youth one dedicated civil service site for api youth, 3 community

based organizations and programs for api adultss that includes 3 civil service sites that have predominantly asian american clinicians or programming. the services are across a continuum of care that include crisis intervention, comprehensive mental health service. it goes on from there. these figures and programs don't account for the larger number of clinicians counselors staff and peers through our other sites who also contribute their cultural knowledge and language capacity to serve api consumers. so, this is sort of beginning of our cross division assessment of how we are meeting the needs of different communities in san francisco. still to come is programming for latin x san

franciscans, indigenous people, needs of the lgbtqi community and we are assessing with staff what are the other needs to make sure that we are have the capacity and reach to deliver important services to communities in san francisco. finally, i want to share the last update is that we are starting a anti-racist and cultural humble clinical practice training academy we are aiming to training clinicians and providers on core skills and providing anti-raceest culturally responsive clinical assessment and intervention. this is a two year academy for staff and contracted providers aiming to launch this fall. the first year it is a lodgeitudinal training program which i think as you all likely know is the way the best way to change clinical practice and

behavioral. this includes foundational training and consultations in year one and then in year two we'll train on very specific culturally adapted and responsive practices in order to build skills and ability to offer tailored services. i will end there. >> thank you dr. kunins. before we go to comments or questions, anybody on the comment line? >> we have one person with a hand raised. if you like to make comment on item 9 press star 3 to raise your hand. in the meantime we'll begin with the first person i see. caller, you are unmuted, please let us know you are there. >> yes. can you hear me? >> yes, please go ahead. >> dr. palmer again. i wonder with the new residential sites how many of them have access to people with

mobility problems? such as elevators, wheelchair ramps, and this kind of thing. >> thank you, dr. palmer. that is the only hand raised commissioners. if any want to take the question forward and ask it, feel free to do so, otherwise make whatever comments you like. >> commissioners, any comments or questions? any hands raised? >> i'm sorry- >> i can also start. >> i see commissioner giraudo. >> okay, commissioner giraudo. >> thank you very much. dr. kunins, thank you so much. you have made a huge difference in our behavioral health and

i know you have really-you are making a difference and i know from working and integrating with some of your staff they are so appreciative of what you have done and you are continuing to do. you are tackling the issues we face in the city. i have just a couple questions and i know you went over the 250 beds that we have and some like victoria's house, and others are just ramping up. often times in the media we have x number of beds and they are still unfilled. do we have many unfilled and is there a active waiting list for the residential beds? >> thanks commissioner. thank

yous for your comments. so, that is a great question. it is complicated answer so getting my thoughts. the answer is that there are wait lists for some bed types and not for others. we have on our website which we can get out to you a treatment sf web page and anyone member of the public yourselves can see where there are open beds and what part of the system. it is very variable. sometimes there is less used capacity then beds because of covid for example and facilities on covid precautions. there are times that staffing has unfortunately been a issue for providers as

you well know, we need to grow the behavioral health workforce. that said, as a general principal i think there are not large unuse numbers of beds in our behavioral health systems of care. we aggressively place people assertively place people as they are available. some of our bed types are in more demand and have scarcer ability to meet demand then others and in fact we are undertaking a bed -another bed optimaization analysis similar to the one dr. (inaudible) bland led several years ago. we are in the process really to reassess our city's needs as we are executing on the mhsf plan. i'll end by saying one last thing, as we reported in our

last year treatment on demand report in the substance use space we are aware there is need for more mono lingual spanish delivery of treatment and we are working to try to fill that need and the other need which we have identified and also working on is residential care for people with dual diagnosis, both mental health and substance use. we think part of the need will be alleviated through the opening of the mena project and victoria house so we are optimistic to continue to follow whether there are-those beds are consistently filled or whether people can get in without waiting. >> thank you. i have one more question. the anti-racist training academy is exciting. for this

curriculum. are you designating bhs staff who should be participating in the training, and what is the time commitment? i know it is two year program but more of a daily or weekly or monthly. >> let me get back to-i'm fairly certain it is not daily. let me get back on both of it questions. thank you for them. i wish i knew the answer, but we'll get back to you. >> thank you very much. i appreciate it and appreciate all of your work. thank you. >> commissioners, other questions. >> vice president green has her hand up. >> firs of all, thank you for the presentation, and i just want to say what you and the team assembled in such a short period of time accomplished is remarkable. the issues you are facing

are far away the most difficult (inaudible) and the world are facing. i can see from the preezentation and thinking and infrastructure that san francisco will once again be a leader and the work you are doing and the way you structure things will be a example for other municipalities across the country. this is so hopeful the trajectory you set and i can't-it seemed all most so hopeless just 3 or 4 years ago. just the staff you have been able to hire and the structure you have been able to establish. i think it is so clear you hit all the notes. all the areas of concern as you said from a anti-racist perspective to the cultural congruent care which is so critical. i appreciate you already answered many questions submitted in writing, but i want to complement you in

particular and your team for having done so much in such a short period of time and i think we'll look forward to the updates with great enthusiasm and hope rathser then concern and anxiety as time goes on so thank you so much. >> thanks and i appreciate you calling out the behavioral health team. it is a extraordinary group of people who are really working their hearts out to accomplish a great deal, so thanks, particularly for commending them. >> i don't see other hands commissioner. >> i like to echo vice president green's comments about your success in building up the new dhs leadership and also looking from january to july you had 364 hires within the division too. looking back pre-pandemic times we know being able to hire and fill positions has been a challenge not only behavioral health but throughout the department and your ability to fill the

positions which are needed and know (inaudible) has a good amount of credit to receive there as well but impressive and ecspoos speaks to the team you are assembling so thank you for that. i had a question about the data you provided. what specifically does that mean again? >> so, what that means is that the team has offered the client the medication bup mor 15. on the spot or bring them to a site that can do it right away and means that person has gotten started on the medication. >> got it. >> there is nuance trickyness to it. probably not worth describing here, but it is basically we have gotten you started on the medication for the

treatment of opioid use disorder. >> thank you. seeing no other comments or questions from commissioners-sorry, mark. >> (inaudible) >> commissioner chow. >> yes. sorry. this doesn't raise the hand. this was a extraordinary presentation as a follow-up. [difficulty hearing speaker] also where you are and so i think as we look at this more regular updates (inaudible) well acquainted with your charts and be able to follow all this. i am still concerned, trying to understand in the count of the mental

health on slide 4 when you had talked about specialty care, but the total you have about 16 thousand, i want (inaudible) or is that only the department numbers that are seeing mental health? i couldn't quite figure out some of your comments whether the specialty numbers were not here or what happened with the private sector. >> yes. sorry, i minute to include in the comments. that does include what is called the ppn, private provider network. that is inclusive of those services. >> thank you. the second question was sort of hold-over from the past. i understand the transientness of the tenderloin center services. are these new services you are now creating within the tenderloin going to be part of that

replacement or is there still a review of what to do with the tenderloin center services? >> thank you also commissioner chow for that question. i we are undertaking review how we can continue the services that were established in theteneder loinsenter. we are workly closely with community groups, community membersism importantly the guests of the tlc to plan what can replace the current structure. and we will-i'll have to continue to brief you all on that planning. >> that is great. (inaudible) we don't want to lose the people who are connecting with it. i wanted to thank you

for the culturally congruent service evallation of the asian pacific islander program particularly and look forward seeing data that as (inaudible) showing in terms of the work they are doing and the challenges they may have. the api community is really one that shies away from mental health, so it would be interesting to find out what are the unmet needs (inaudible) in the outreach as we should have (inaudible) san francisco health network, but we do know that historically there is reluctance to accept psychiatric care and i wonder as we are (inaudible)

many more programs then (inaudible) more acceptance as we think there is a need also to-outreach further and like i say, maybe (inaudible) [difficulty hearing speaker] there is a challenge trying to get that to them. again, i want to thank you for helping to force out a very important problem i think that the asian community faces. >> thank you. thank you all. >> thank you again dr. kunins, we look forward seeing you again soon. alright, our next item on the agenda is the dph it update and for this we have our chief information officer eric raffin and jeff

scarafia and (inaudible) chief health information officer. >> thank you for being so patient. >> good to see you. thanks for being here. >> mr. morewitz is it possible to drag the video box on the screen to the right? >> there is a mouse there. >> i should know that, right? >> that's okay. >> happy to do it if you have trouble. >> good evening. eric raffin. pleasure to bring the quarterly health information technology review. next slide, please. next slide alyssa. thank you. so, this is our roadmap and we'll keep it moving along quickly. we will start with

staffing announcement. as you mentioned president joined by jeff scaraafia the epic program director but pleased to share jeff is now our deputy chief information officer so congratulations again to you jeff and you'll be hearing from him in his epic role this evening and then in the future in his new role in collaboration with hopefully a new epic director as we bring that job out on the street. the rest of our road map for today is we have something to celebrate. we will talk about our progress, our financial stewardship, digital equity and what is coming next with epic. next slide, please. so, it may have slipped by, but august 3 epic had a birthday. the epic implementation is now 3 years old and as i stand here i realizing

i myself did not realize that the morning of august 3 and had to be reminded. we had so much go on in the last 3 years but it is amazing i stand before you in the midst of there challenges dph faced that not only have we risen to the challenges but also cep the epic engine steaming forward and this evening we'll share more with you about that progress. next slide, please. so, no plans for anyone to try to read the epic schedule before you. this slide is something that your commission usually asks for you. see the overall layout of the epic schedule. i just want to draw to your attention briefly to the vertical dotted red line which looks like in the center of this diagram. this chart. this reflects where we are today with the roll out of

epic. we are about 2/3 way complete which means we still have a long way to go, but what is amazing is that in the last 2 years we have kept up with everything wave 1 and worked through wave 2 to the point now where you'll hear from jeff coming up next that we are ready to move on to the phase beyond wave 2. next slide, please and we'll move over to jeff. >> thank you eric. (inaudible) main theme for us to continue forging ahead throughout the pandemic. would be remiss if i didn't say that the plan may reflect some changes from its original (inaudible) in 2017, but i think you are hard pressed to find anyone who knew what 2020 would look like and adapt for those changes but we adapted

our plan on the it side and continue to make progress. the challenges we face that are barriers to progress include our vacancies on the team. it takes people to do the work. wecurrently do have a 30 percent vacancy rate and that one of our greatest barriers to continue ahead with the road map. additionally we have stand and deliver (inaudible) things that require our attention the same as they require attention from department leadership. covid-19 (inaudible) tenderloin center is a project we worked around. (inaudible) those are all projects that have it components to them, epic components as well as we support operational counterparts. however, progress again is our theme. we are proud to complete wave 2 and welcome many parts of

department of public health on the shared electron ic record. i wont read them all, it is long list but we had a large phase 2 that are complete and looking forward moving ahead. next slide. with progress we do expect roi. we have (inaudible) and we want to make sure that we receive a roi on that investment. the data before you have for san francisco health network that includes (inaudible) laguna honda, primary care and specialty care and we have given a baseline of 5 prior years before (inaudible) and we are comparing and looking at cash collection after epic. you can see in year 1 jumps are small but remember that includes a lot of 2020 pandemic and a lot of shutdown around the facilities but you see we continue to grow cash collections for san francisco health network. the

money supports the mission so we want to make sure we keep a eye on that and we are looking at investment return with epic there. next slide. we onstay on budget for the dhr program. (inaudible) represents the money spent, how much has already gone out the door and been spent. i will draw your attention to the projection over on the right. we have a long way to go. we still have payment plans in progress for vendors but we are keeping track of every vendor and future projected cost and projected to come in at 95 percent of the allocated budget for the dhr program. this is our 10 year total budget as we roll out epic. next slide. the roi isn't always about

money so we want to take a look at crossing the digital divide. when we look at equity those in the it department think about digital equity and how we play a role. we are happy to share we have taken on a project and completed providing appointment reminders via e-mail in all threshold languages in san francisco so insuring the information about future appointments is making to all patients in preferred language and we are not stopping there but working on a project with epic that will come along next year insuring that text messages or sms messaging on the phone will also support all 7 san francisco threshold languages so that is making sure the information patients gets focus on digital equity. next slide. we also like

to cross from the digital side into the real world when it comes to equity and acknowledge that driving across town for a face to face appointment isn't always possible for a number of our patients so we want to insure telehealth options are accessible for dph patients because they are private providers. this month we went live with telehealth project which (inaudible) difference with integrated (inaudible) bring those patients on as part of the video (inaudible) see what the messages look like and we did focus on the patients experience with this project. patients do not have to remember a user name. they do not have to remember a password and they do not have to download any special software in order to be able to engage with us. we

send the link and they are able to click and join with none of those items. on the right side you can see the departments introducing the option dramatically increase (inaudible) that is good thing helping our patients reach their (inaudible) quick tour of the roi and what we are working on with epic to increase digital equity and send it back to eric who will tell you about what is next. >> next slide, please. what is coming next? we have a lot going on as jeff and i have both spoken to. coming up next year we have a lot of work around the patient experience. specifically on being able to be ready to handle electronic signature on epic on mobile devices such as tablet said. exciting

and helps set the stage what is coming in 2024 as dr. kunins mentioned a few moments ago, it is our work to bring behavioral health services into our epicverse and a major prerequisite is have e signature available so we aligned the work and very much excited and looking forward to working with dr. kunins and her team with a roll out in 2024 for behavioral health service and epic. things just going on where we can be innovating and optimizing epic. i'll touch on a couple of high level items. the first on the list in the middle of the screen is hyperdrive. the good news i will not try to explain hyperdrive to you but what we will get out of that epic project is that when we start to work with more community based organizations that are providing services to our patients and clients and i think our behavioral health

roll out will greatly depend on this, much as telehealth video visits don't require a lot of special technology for our patients and clients to join video visits, hyperdrive affords a community based organization that is providing services to our clients to join epic without any special technological changes beyond having connection to the internet so we are excited. this is work epic has been working on for many years and it is rolling out next year for us and that allows us to invite more people into our epic program without having to do nearly as much technology work, which takes time and significant amount of funds. the other items on it had list deal with mostly with being aible to take advantage of tools that make using epic more efficient. being able to move through

work flows that may take many clicks to do sometimes in one click. in other cases we can envision a future where the evaluation and management coding for all encounters we have could be done automatically, meaning when the provider is complete with their encounter with their appointment that epic will select the most accurate e & m code relieving a lot of work in the revenue cycle process. if we look forward beyond 2024, you see we have major activities going on there and are the biggest one by far is something that has taken a couple years to get to a point where we are fully aligned to bring our 3 lab tore services together in the epic beaker lab information system. that unifys lab services from the pathology lab clinical lab and public health

lab. the interesting thing about the epic schedule is that as you may have noticed when i showed you a few minutes ago, everything to the right of that red dotted line there were still white space in that chart. we would imagine most of that is going to get filled with other work we just don't know about yet and we are excited to be able to continue to provide that support to the many thousands of users of our epic instance. next slide, please. we would end today with acknowledging the fact that august 9 was international day for the world indigenous peoples. this quote caught my eye. it happens to be from morning dove who was the first native american woman to publish a novel in 1927. with that, we'll wrap up our briefing for today and pleased to take your questions. >> thank you very much

to you i your team. any public comment on the item? >> folks son the line if you like to make comment on item 10 the dph it update press star 3 now. i don't see hands at the moment. >> alright. commissioner, any comments or questions? >> commissioner chung has her hand up. >> commissioner chung. >> hi. thank you for the presentation. one question in terms of (inaudible) you mentioned we are going to (inaudible) are outpatients able to access the lab (inaudible) [difficulty hearing speaker] any of the network? >> thank you commissioner. so, the way that we do the laboratory work today is we use electronic messaging to move information between epic and those lab

system. what the change will look like is the integration of all labs within epic itself. today they are all external to epic. our patients who say use their patient portal are able to get to their lab results. this will make it a much more seamless activity, especially on the provider side where they will have a much more streamlined experience and it removes a lot of extra overhead that we have to maintain to keep the three labs connected separately to epic today. jeff, i dont know if you want to add anything more but feel free. okay. thanks. let's see. any other hands up? don't see other hands commissioners. >> (inaudible) i

understand. (inaudible) >> correct. >> i think this is very impressive and i remember when this all began. i cant believe not only has it been 3 years but longer then that in the planning phase and it is really (inaudible) particularly struck on the consumer side that you are going forward also on the threshold languages, which was really one of the big values that i think in a multi-ethnic community face. the fact you are simplifying families can actually help the consumer, the patient to get on with that (inaudible) i think that the system will still need to deal with the people who can't navigate through this, but i think the fact we have worked on

the multi-lingual is really amazing and dhr (inaudible) we might have spanish but no other language, so it is really great. my only request is going back to (inaudible) not just look at a percentage to try to understand where the dollars are--we had (inaudible) expenditure of the budget, but i dont know what the budget is, so perhaps the next time that we are doing this it is useful for us to understand not just the percent, but the dollars. appreciate that and appreciate your presentation. thank you and look forward to seeing how the language issues will (inaudible)

>> thank you commissioner chow. not a problem on the budget request and the lessen we learned during the pandemic was the importance of trying to get those screens that patients were going to interact with translated so that anyone could be able to get online, on a website and make their vaccination appointment and this is carry forward. we pushed epic really hard to make sure they are paying attention to languages not just in countries where epic exists, but obviously for the languages spoken here in the united states. >> very good. thank you. >> thank you commissioner chow. i had a few questions and comments. congratulations to jeff on your promotion. look forward continuing to see uhere in your new role. also who could get for get august 3,

2019 go live. >> apparently i can. >> it was a big day. this brings back to a time i ask a question a lot you stated in the presentation you have a 30 percent vacancy rate. wanted to acknowledge the impact that of course has on the existing staff and the amount of work they have to do to make up for shortages in staffing and also the work that is potentially cannot be done because of that shortage. could you just give a thumb nail what the impact of that 30 percent vacancy rate is on both your team and on the work of your- >> it certainly puts stress on our all the impacted teams. i think more then anything it means that as jeff mentioned, we have to make a lot of adjustments and so work we may have agreed to perhaps start a month from now might have to be pushed and other cases

we might need to be able to hold off on supporting really great ideas about optimaization and improvements and getting better with epic as i talked seberal times with the commissions and means we had to make critical adjustments to make room for either the stand and deliver pivots. there is a huge chunk in the epic schedule where it just said mass covid vaccinations and made a decision with the governing body the epic leadership team to make those choices and so thankfully i think our organization is very understanding that while we continue to make progress, because we are not done implementing epic, that is still is our primary priority because that is what helps bring us together and that's where we are headed. >> particularly with positive impact of the folks we serve, as well as the positive impact on revenue it

is important you have the folks you need to do your work so please keep us posted on that as well. >> we will. >> great. commissioners, other questions or comments? alright. seeing none, thank you very much to you and your team. congratulations again jeff. director colfax. >> i just wanted to thank the epic team and leadership of the team for all the work they have done. it is hard to believe 3 year anniversary. (inaudible) on a slide the other duties as unexpectedly assigned and just to emphasize those included covid, those included theteneder loin center and m pox so not sure what will await us for the next epic implementation but i'm really proud of the

team for being where we are because they have been asked to do a lot of other things in addition to what we thought we would be asking everyone to do 3 years ago. thanks everyone. >> great. >> thank you. >> thank you again. moving on to our next item on the agenda, which i believe is finance committee. >> yes. >> finance and planning committee meeting from today. commissioner chung. >> yes, good evening commissioners. the finance planning committee we met at 2 o'clock this afternoon and we reviewed the contract reports which consist offunding adjustment for three different organizations. (inaudible) reduction coalition. the second

is epic health foundation and then the third one is (inaudible) also we have reviewed one request for approval for (inaudible) [difficulty hearing speaker] buying out the equipment that we have previously used. (inaudible) they are all listed in the consent calendar for approval. that concludes my report. we . >> okay, we can move to the consent calendar. >> there is nobody on the public comment line at this time for comments on either item. >> do we have a motion to approve consent calendar? >> i so move to approve the consent calendar.

>> is there a second? is there a second? >> second. >> alright. great. roll call vote. [roll call] >> the item pass. >> the next item is other business. unless we have other business, there would be no public comment. if there is no other business then we move to our next item which is joint conference sxhitdy and other committee reports. we will hear a brief summary of the august 23zsfgjcc meeting. commissioner chow. >> thank you president bernal. the august meeting we included the (inaudible) including the regulatory affairs report, the ceo report

and human resources report. the medical staff report committee approved neurology rules regulations and emergency department registered the standardized procedures for (inaudible) chest pain protocol revision. in our closed session we also then approved the credential report and the (inaudible) that concludes my report. thank you. >> thank you commissioner chow. our next item on the agenda is closed session. do we have a motion to move into closed session? >> so moved. >> second? >> second. >> i will do roll call vote. [roll call] >> alright. give me-give us 10 minutes to get the room ready

and we'll be right back. folks on the line, if you are-there is only one person that popped in. we'll go away in closed session but come back. thank you for waiting and folks who are on the line who are not going in my personal evaluation i will e-mail when it is time to come into closed session for you. alri [roll call] >> thank you all so much. >> thank you. >> thank you commissioners. >> take care. >> get your boosters. >> rest. have a good night. [meeting adjourned]

>> you call this meeting to order. my name is bob fuller, man tear jr the sanitation and streets commission. welcome to this commission's first standalone meeting. i will facilitate this meeting until a commission chair is elected as scheduled in item 4. i will now call the roll. please respond with here or present. >> thomas harrison? >> here. >> harrison is here. kimberlee hartwig-schulman? >> here. >> commissioner hartwig-schulman is here. >> ike kwon? >> here. >> commissioner kwon is here. >>