>> hello welcome to the meeting of the san francisco health commission on tuesday november 15, 222022. sect, call the roll. >> commissioner chow. >> present. >> commissioner green. >> present. >> commissioner giraudo. >> present. >> great and commissioner bernal. >> present. >> i have a script to read. give mow a moment. good afternoon welcome to the november felony health commission meeting it is held hybrid with the meeting occur nothing person recommend 300 broadcast live on sfgovtv and listen by calling. the code is the agenda. joy would like to remind all

present in person today that all health and safety prosecute cols and building rules adhered to all times. wearing a mask at all times during the meeting including when speak. failure may result in removal from this room. we appreciate your cooperation in the interests of everyone's safety. note that the a hand sanitizer station at the event real of the room and i have masks available. we welcome participation during comment. there will be an opportunity for comment toward the beginning and an town to comment on each discussion or action item. each is limited to 3 minutes. public comment in person and call in. each item the commission will take first from in person and then from people remote. those attending in person requested to submit a comment card to me.

and those remote, consider pressing star 3 at the beginning of the item in dh you plan it comment so your hand goes up in time for us to see it. press star 3 the beginning of item in which you would like to comment. pols and state and local law prohibit harassing conduct and will not be tolerated. public comment in the jurisdiction of the healing commission. thank you for joining us. >> thank you, and now i will recognize commissioner giraudo to offer the ramaytush ohlone land acknowledge am. we acknowledge that we are on the unceded ancestral homeland of the ramaytush ohlone, 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 community and by affirming their sovereign rights as first peoples. >> thank you, commissioner giraudo. next is general public comment we will start with those in attendance in the room. the first person we have is carington osbourne. i have a script to read. members of public may address the commission on items of interest in the jurisdiction of the commission in the on the agenda. each member may address the commission for up to 3 minutes

brown academy forbids commission for taking action not on the agenda. each is allowed one opportunity to speak and may not return more than once. written comment may be sent to the health commission. >> thank you, mr. osborn. >> i live in prc baker place co-op administered through contract with the department of public health. i'm here because well is a lot in the press around prc mismanagement of baker and prc and there was a letter sent from the ceo to the director of behavioral healing explaining bake are intended to with draw and breech contracts to the mull pull contracts to the city including those who have lose agreements with prc bake are

accomplice for our place and co-op. and this merger has been a problem for yers i 1.9 million dollars deficit in 2017. and i'm concerned how we got to had place where a major contractor for a mental health program was in trouble and no alarms went off. i lost trust in prc to arrangement the best interests of baker clients we are told no decisions regarding co-op it is complex. but our lives are complicate exclude complex. we have done work to make it to co-op to maintain our wellness moving forward with our treatment and -- we need member to really put our interests as a priority. because i just don't have a

trust in prc to do it they are announcing they are cutting programs because they can't afford to do it. so. i'm asking the commission to put pressure on prc to make decisions sooner. they are talking about january decision, june decision and people are nervous, triggering for some and we need to know that somebody is putting us as a priority. thank you, commissioners. >> thank you. next is enrico. >> good afternoon and good evening. health commission. i'm a client of baker places. and approximately 10 years or more of instability my life homelessness and alcoholism and

mental challenges i found heeling at bake are accomplices. for 4 years i have been not been homelessness and sober. i am trying to get become in my life. i have also found a home a family and room mate, it is more than just is a community. a family kind of atmosphere. and i have seen the wonders it has done for myself and others the type of program that should not be scrapped but should be copied and implement in the other cities. also -- i have found in baker places encouragement and compassion and not because of them i don't know where i would be today. i would be in a very bad

situation. i would be dead. so, please, if you can help us out and keep this program running. and it works. i mean that is all i can say. thank you. >> thank you inform will secretary morewitz do we have folks on the comment line. >> is anyone here hope to make comment at this time? we received 2 forms you are welcome to make comment. >> folks on the line if you like to comment on this item would be on topics not on the agenda. press star 3 now. star 3. this is all the public comment that we received in terms of requests. >> thank you secretary morewitz. we will move on to our next item laguna honda rehab closure plan

and recertification update. we have the chief operating officer of the san francisco health network and try williams the chief quality officer of san francisco health network. >> thank you. commissioner, good evening. so, happy and pleased to before you this evening to present the update for the laguna honda hospital team report. what we can do is advance to slide 5. 5, 2, 3 and 4 are background the commission is familiar watch we would like to start off with here is an update on settlement agreement and the impact on extended payments and the closure plan pause. the city reached an agreement on behalf of laguna honda. the board of supervisors and the mayor's office approved settlement and now this agreement transmitted to cms for final signatures. under the agreement, cms agreed

to pay for care at laguna honda until november 14 of 23 exactly a year from today. the extension would add a year of federal payments beyond the agreement which is critical. cms continued to pause the discharges and transfers of residents until february second of 23. would have the option to extension the pause date depending on progress toward recertification. during this pause, resident transfers and discharges would occur. which is a right our residents are entitled and alined with the hospital policy. here i like to talk with the pass of recertification. the quality improvement expert in required in the settlement agreement is completing an analysis on behalf of cms. they endorsed laguna honda to participate in aspects and would

include findings from surveys, factors that lead to the dessert sxifkz when we need to do to get recertified. based on this laguna honda would develop an action plan that builds on the plans in place we have been working on and with everything we have done for recertification up to when we have left. >> that action plan influence an updated road map to recertification and i will bring this become to you provide an update. one thing the main take away here we are in a great position thanks to the work from mock survey one and the other initiative hospital wide. we are looking forward the ability to show case the work done. the successes to date and what continues to be on the path forward. >> william this slide i like to update you on the scientists the corrective options for mock survey one. after laguna honda had 10

fwiendings required we distinguish 371 corrective actions. one could have multiple associated with it. each correctef okay a short and long-term tracking progress. we wanted make sour we fix today in the moment and completed and that it would not pop become up. do we make changes and ensures we have fixed the issue at the root cause. we implemented all corrective actions in the major are now on the tracking phase with 55 fully resolved. if you look at the color here, the yellow is the fact we implemented the correctef actions. the next goal to get to the green bar up it 100%. 55 and over the next weeks the goal is to get that up to 100%. >> the next 3 slides will show case how we are dog on 3 areas

of focus. this slide shows environmental care. it is what we do when round to ensure well is a safe and hazar free environment call light response. medication cards are secure. what this means during the observations on the unit this is we have the most recent bar 13 of 13 units are exceeding 90%. bench the to dot right thing with environment of care and adhere to our requirements. the mechanic is the same concept to hand hygiene that is enis done before and after activities and all gloves used and ppe adhereed in the correct fashion. the next shows our infection prevention and control effort it is. we are showing 11 the 13 as meeting our requirements of

being above 90%. now the wait to read this is the trend line shows we are above 90 the red line. what that money system that of the 11 units above 90 they are the high 90's and remaining 2 are arnold 86-89% and when you average this this is why you see the high 90's and 80s normal to above the threshold. we know there are 2 units that have not exceed the 90% for this time frame. jot next slide i will turn over to try. good afternoon, commissioners. wanted highlight some accomplishments since the last time we presented to you. over the last month. you know in, linement with the

revamping and you know irrelevant refocused on the program we have proactively addressed topics of care planning, pain management. call light and physical restrickens. this is important we identified the issues that have come up a part of activities, we are actually now chartering a team putting together concrete plans and holding ourselves accountsable to make sure we are improving in the areas. that is exciting. we are work with h sag on those organizational [inaudible]. this is also very xoit exciting had a workshop around space. and one of the most vexing issues we had with front line staff is doing work is you know we are doing the eoc rounds and -- we don't know where

everything guess. getting the findings and where does this lift go and where december this piece of equipment go. we really decided to take a really systematic approach using 2 units and our lean tools to really develop model units where these things the equipment and things are put in the same place on the 2 units temperature has been great we have been engaging front line staff and managers and have been excited and looking forward to spreading the learnings to the, units. we as i think we talked about here we joined the california association of health care facilities who is a strong partner with us. i have to say h has been really valuable. we have 6 staff members this have been accepted in cast leadership, cad me will strengthen the laguna honda

skilled nursing knowledge and leadership they has been great partners since we joined their organization. completed the infection control and quality assurance performance program it aline with the new updated cms regulations. phase 3. we received expert consultation from cap. regarding our emergency preparedness problem. sitting down. going through the documents and our plan. . helping us think about what property sdrils would be that has been helpful for us. >> also work to update visitation policy for security for family. visitors and training staff to report safety and regular latorrey comlines. more about next slide. one more. nursing updates. which are -- really excite to talk about under the leadership

of terret cno, we continue to build on the huddle board program this . is irrelevant great and important and in terms of really engaging front line staff in improvement solutions. i think we want to make sure that our 41 line staff are, wear of the challenges and the unit this is is a way to engage them in a different way around problem solving in a standardized way. have an improvement huddle that uses the board in standard work to drive the discussions and happens every shift in every unit. a positive improve am the nursing town hall is fantastic creates a space for nursing staff and bring up questions and occurrence.

another example of a venue where we talk to our frontline staff and engage them in person discussions. >> the development of care coordination the patient flow program and management and social services and residence den assess am and the minimum data set under nursing doing a great job of putting that together. reviewing the acuity system important in terms of really helping us to understand the level acuity for residents can then help us drive appropriate staffing and skill mix on those unit this is is something laguna honda had not had this terry brought with her that were irrelevant moving forward. >> staffing in bidding we emphasize building i strategy unit culture as we have been making the changes, we wanted aline the strengths of nursing leaders that can benefit from

strengths. there has been changes of nurse managers over units in alignment with the new nursing structure. has been positive. new employee orientation returned in person this is good allows new employees coming in to in a different way, ask questions and that is an improvement. addressing all of the nurgs related plans of correction through spoke about it around our executive huddle and that we are clearing for mock survey one. they have done a great job staying on track and putting property intervention in accomplice and next slide, the organizational structure which i will not go in detail we have done that here. showing the importance of accountability where we have 2 director of nursing each

responsible for one tower to report to terry the cno. it has been helpful you know in terms of really making sure we are keeping traction on these improve ams. this has been working out well. the quality management updates. the were work hard to prepare for the new cms phase 3 regulations and the surveyors as of october 24th last month, will now be. assessing skilled nurse facilities around phase 3 requirements. we are wing diligent low to ensure we are in compliance. preparation includes reviewing educational materials against new guidance. they are doing. remember policies to make sure they are updated to the new regulations and developing communications around making sure the new regulations are

available. and just of note the education for all of these the new regulations is currently in the process of being created and plan for the education is to go out in december. next slide. important around our change management and experience work. really ensuring we're engaging front line staff in the work. frontline managers all of the important piece that goes in changing a culture of engagement and improvement and also leadership presence and, counsel automobile. leadership rounding and other peer to peer recognition you know guess a long way to acknowledge someone for a job well done. that has gone over well throughout the organization.

we have ends of year celebrations excited for the final event of the year where the activity therapy hosted pumpkin patch for residents. counsel really excited report much more engagement. we have been working closely with that group and h sag a part of that with us and jennifer who give credit for engaging residentses and making sour they have a seat at the table and able it voice you know the good and bad. here are things we need to improve and great things happening it has been grit. improving the grievance process is something that we have been working on that is improving. residents know how i do file a grievance. something i have not done verbally how i do file that and a time low response this is

appropriate. so -- and finally the residents survey we are planning for mid december will be helpful again. in terms of getting information krilt cal information to improve from the resident's perspective as well. and then a couple words on you know the bed situation. there is reduced the number of besd we are currently with the new regulations. preparing the organization for that but we are not delicensing the beds. we got our new license and they are in the license. and we want to keep all options open through the recertification process with cms. and you know we are hopeful that through that hopeful low we can make progress.

again, no beds have been taken off the license the beds are on the licenses. with this. i think we are happy to take questions. thank you very much. >> thank you very much, and mr. williams. upon i understand secretary morewitz people on the comment line >> folk on the line this is your time to make comment. we are on item 3. laguna honda hospital. closure plan and recertification update. if you like to make a comment press story 3 now i see 2 hands you will each have 3 minutes i will read a statement. each item members have an opportunity to make comment for 3 minutes it is designed have input from the community. the process does in the allow requests to be answered in the meeting or the members to engage in conversations with the commissioners. the commissioners do consider comments when discussing item and making requests.

note that each individual allowed one upon know opportunity to speak per agenda item. if you wish to spell your names you may without taking up your time >> i see 3 hands. start with the first i saw. first on the line, let us know you are there? >> hi. can you hear me >> yes, please. go. >> this is doctor theresa palm i worked at laguna honda for 15 years and a board member of the gray panthers it is lotable that the city of san francisco is funding this effort in laguna honda is making this effort. to fix laguna honda. but i think one of the problems with the effort is so many levels of government are involved. what i hope to be part of

organizing is a unified round table where city and state are city and state represent in government and the health department insists that recertification is decoupled from closure, discharges and bed cuts there is enough death and sickness from this cruel exercise. laguna honda has enough work without more discharges and deaths. and without losing more beds and a region well is a dire shortage of medical beds. san francisco general the department of public health and laguna honda needs to do its share in not further violating admission's criteria. i have not heard a plan of correction for a patient blowing

mouth to smoke in another patient's face. methamphetamine smoke. i have not heard a plan of correction for active use of illegal substance. this lead to this mess. add mission of patients who have controlled substance abuse is geans admission guide lines they have to be funded in the city. these people need care but cannot guest the care they need at laguna honda and this needs to be publicly stated and other plans need to be worked out. gray panthers and i are meeting with state legislators now and open to engage the mayor's office and board of supervisors and health department in really assertively asking the state and the federal government to decouple recertification from closures, discharges and bed

cuts. beds the sweep that laguna honda are spacious, well ventilated and private. there is in reason upon not to wave this new rule. cms stage 3 are not new they are newly intercepted there since 2016. there were is a new building built in 2010 it is unreasonable. and i ask you to work with the community. time it is up. next speaker, please. i am [inaudible] >> i got 3 minutes for you. >> thank you. slide 13 on the presentation, mentioned the project managed by the new department of care

coordination. the slow project implement in the 2004 to transfer behavioral challenged [inaudible] to laguna honda. who are largely responsible for the trauma at laguna honda during the past 18 years. they should not be, cohorted at laguna honda. the healing commission should immediately step inform and stop the [inaudible] project. community advocates have urged. attorney david chiou settlement agreement approved by health commission and board of supervisors repeatedly references a revised lha closure plan to the extent that chiou negotiated terms of the revised plan with the california

department of public health before the sethment agreement was approved by cdph. health commission should release the resunrised plan immediately. it is struggling the settlement agreement roars laguna honda to resume [inaudible] on february second. am by the way, i'm back at home, following a stay at jewish home. following my surgery. thank you. >> thank you. let's see we have one more hand up? first on the line let us know you are there. >> my apol joes my call in have so much to discuss the situation around bake are places.

>> and this is about laguna honda. >> i'm sorry this item is not that item and i apologize you missed that you were able to submit a written comment but this is not the time for verbal they are specific rowels around what can be commented on. i need you to thank you very much, and i on the agenda. >> thank you. >> okay. >> that's all the public comment. scombro commissioners do we have comments or questions? i'm looking for hands. commissioner chow. >> commissioner chow. >> yes, okay. thank you. for the presentation and i was trying to clarify i think that you were clear on number of things happening. could you speak up. i'm sorry you are on our ends i are very low. will in terms of volume. joy will try this. is this better. why much better, thank you. >> okay. now you are very loud.

[laughter]. we will work this out. i was trying to get clarification on the nursing department update. because and the nursing town hall. you mentioned it was was every 2 week this is is 3-5 month could be every 2 months and -- i like the idea of meeting more afternoon what was the intent every 2 months or 2 weeks >> twice a month. >> twice a month. >> thank you very much. >> you are welcome. >> and i knowledge the other question i had was in regards to doing the resident survey, it is that you will be using i pads what about residents when don't use i pads or have difficulty in even visually in order to use i

pads will there be an alternative. >> thank you for your thoughtful question. yes. so, will not be i pads is one way which we think will be helpful and having people go to the bedside to assist with the survey. is the plan. >> okay. thank you those are my 2 questions from the your clear presentation. moving in the right direction. thank you. >> thank you. commissioner. >> other comments or questions? >> commissioner guillermo. >> thank you for am the concise and clear update. i just had a question about the root cause analysis process. you will indicated that laguna honda will be able to participate in the root cause

analysis froesz. could you describe that more with that would entail in terments of laguna honda's participation? >> thank you. the engagement around the topics of that were shared in the slide hayou know a root cause analysis is answering the question, what are the factors this contributed to us being here. or the factors contributed it a certain outcome? in order to make that determination about laguna honda, we want to make sure we have folks that have worked there and part of the organization and the process. this will be entailing verbal conversations, reviewing the data and reviewing previous submitted plans of corrections that were submitted to the state. we will be an opportunity to review those and have verbal dialogue around thoughts and get nothing more of a kanldit conversation around true drivers and factors >> thank you, and given the many

of the investigations from the facility reported dinltss from the past have not yet been started even. on the part of the state. will those how will they be incorporated or will than i in this process of root cause analysis and the findings from that as it relates to recertification. joy believe you are referring to the facility report incidents. >> yes. >> okay. the skelthsment agreement lays out the specific surveys and dates of the surveys that are part of or within the parameters of the root cause. that said, the multiple prize are not listed in that settlement agreement. i will share is this the emengagement on the cms as they

w through gaffigating the rca if there is additional did the they are looking for we hope this collaboration with them will allow us to the opportunity to speak to those. these are facility reports incidents in the facility lie the laguna honda staff to have a seat in that conversation. the goal is not to have those brought up and part of rca without engagement. >> my concern and point was you know upon the am fries have been in limbo. for it up a couple years now and if there are findings related that that may you know somehow impact what we are doing on recertification and what is require instead settlement that will does not require laguna honda to again restructure the

way it is approaching its -- take another look at the plans that were put in place. in order for us to progress toward recertification. why a great point and i point of -- i would say notice and concern for us. what i say in the settlement gleam the dates of service and plans of correction and surveys are called out specific low. cms reserves the right to research these we than they are not part called out but your point is well taken f. upon and when making sure that any engagement or outcome rci driven by a fry it alines on the path we are on. >> great. thank you. >> thank you commissioner guillermo. other questions. secretary morewitz

>> no the bed reduction update you mentioned that the entire tah facility was relicensed including the bed system this state licensure? >> yes. >> what the interval. joanneual >> okay. >> received a couple weeks ago. >> great. thank you. >> all right. no other comments or questions. from commissioners we will now move on to the next item which is a closed session regarding laguna honda as well. did we have a motion to enter closed session? >> i move to mutual to closed session. >> i second. >> and before the vote we will take look at the public comment. i will clear the comment if you want to press star 3 again you can now. star 3 for the item 40 closed session i see worn hand. we will start there. first on the line you got 3

minutes. >> can hi. [inaudible] go ahead. as you go in closed session i would like the commissioners to remember determine curves article in the november [inaudible] laguna honda settlement agreement, um -- his article noted 18 years ago in 2004, san francisco long-term care [inaudible] benson [inaudible] [inaudible] healing commission that laguna honda is a scyllo, when they were trying to break down various scyllos within the health department. to facilitate the [inaudible]

project in laguna honda. and were will showed knowing laguna honda is required to comply with cms's [inaudible] if regulations. which are a scyllo. you long ignored nadell's warning in 2004 and failed to follow cms's regulations, which lead to [inaudible] decertified by cms in 2022. which is this commission's own fault. remember that. while you were considering your closed session. >> thank you. >> thank you. >> one more hand. of >> a person on the line let us know you are there.

>> hi. doctor theresa palm are again >> you got 3 minutes. >> i just -- you know commissioner bernal points out that it is the state who licenses. can we can we unify to ask the govern and our state representatives to. doctor palmer it is about closed session. we can allow it. why this is getting with the requirements of the closed session. right? >> and one of the requirements is to [inaudible] lose beds and so can -- folks get together in the city and the state and can we work to reprimand given the bed shortage that these rooms be

not be lost. and that there be a waiver for the 2016 requirements. we can't afford to lose nursing home beds. thank you. >> all right. thank you that is all the public comment we have. there was a motion and second before. >> roll call. commissioner green. >> yes. why commissioner chow. >> yes. >> commissioner guillermo. >> yes. >> commissioner giraudo. >> yes >> commissioner bernal. >> yes. why members of public the commission will go in closed session for an hour from this time and you will not be able to see our hear us we will be back and we will continue the meeting along with the agenda. commissioners and folks on the meeting open session

discussion. >> i'm sorry of second? >> great. we will do a roll call. commissioner giraudo >> yes >> commissioner green >> yes >> commissioner chow. >> yes. >> commissioner bernal. >> yes and guillermo. >> yes. why great. thank you. we are back in open session. our next item is approval of the minutes of health commission meeting november first of 22. commissioners you have the minutes if no amendments do we have a motion to approve? so moved. >> second. public comment j. no one on the comment line. commissioner guillermo. >> yes. >> commissioner green. >> yes. >> commissioner chow. >> yes >> commissioner giraudo. >> yes. >> commissioner bernal. >> yes. why minutes are approved >> direct's report. doctor grant colfact director of

health. i will be brief for this report limited partner is a lot on the agenda. happy to ask answer questions. with regard to -- covid-19 and other viruss that are circulating in the community we are encouraging people to appropriate for the holiday season by taking measures it protect themselves and others against covid and the flu you will see that the many steps we are take nothing messaging to members about wham to do including getting covid vaccine and flu vaccinations quickly as possible. practicing good hygiene and tests kits for covid and knowing how and where to access a make provider to say that we are seeing increases in flu. that we did not see last year. rsv situation and then i

mentioned our covid cases are creeping up a bit. >> other item i wanted highlight for the commission an update not in the written report to provide an report on bake are place. prc and bake are accomplice agreed to prioritize transfer of 4 programs joe heely with drawl acceptance place and forgiveness place and inspect living program. since october third working with bake are place to identify other providers for programs and announced yesterday effective monday on november 14 joe heely deto being program transfer its hr360. on november third presented bake are accomplices with a financial plan it allow for transition of services through june of 2023. bake are places confirmed the cash flow projections and agreed to the plan.

our on going goal to preserve stability. find services for existing clines, plan for programming and supportive planning for properties and receipt rolls royce. i want to thank d ph staff working to ensure this transfer guess smooth as possible. without interruptions to service the covid cases and a brief m pox update. . perfect. thank you. next slide. you see here that our cases per 100,000 ticked up a bit. 10.6 per 100,000 manageable but the case rate is going up and when we are seeing in the united states you receive this on the

far right on the inserted slide. with regard to hospitalizations, really have been pretty steady between 50 and 60. search icu and our hospital capacity remains robust. and agains we start it see cases tick up with cooler weather and winter propping, we believe this our cases in the hospitals will go up and reminder that this is all covid cases in the hospital. including people hospitalized for noncovid reasons. with regard to vaccination status by age i will highlight the low are part. 86% of the pomp lagz received their initial serious. you will see here that on the far right the 23% offer

population has received the booster. this is double the national rate and among people 65 and older rates are 65 to 74 are 42%. and the team is working hard to get the booster rates up. as again the upon winter were months approach. we are higher than national rates but need to get vaccines in arms >> with m pox case a success story here are case her day now. 0 opinion 1 a case per 10 days. this is huge and 834 cases. and we have vaccinated 28 thousand for p pox. important to celebrate work to

really reduce the cases quickly and hopeful low the gains will be sustained. we continue to work on m pox vaccination with second doses at high risk. covid rates say this should be changed they are tick up a bit. and with flu and rsv increasing we monitor the pediatric bed availability. we know that the national situation is series for the pediatric beds and w width partners to monitor that and place plans if needed. and implement plans if needed and our check list for safer holiday season and we are work

width state plan for the end of the california state of emergency which governor you in some announced i will stop there and take questions. thank you. no one on public comment line. hands from commissioners? i don't see any. >> all right. thank you. director colfact. our next item is sexual orientation if you recall sudden front health network. i want it, pol joiz for having to delay the presentation proposal and thank you for your understanding and patience. >> sure. thank you. good afternoon director colfax.

secretary morewitz and members of the commission. it is an honor i am compete with a big announcement happen happening right now. first president yell candidate for 2024 announcing now i will keep going. and with the sirens. it is an honor to present the department work over the last year. and to comply with section chapter 104 of the city code the collection of sexual orientation and transgender ordinance. and i'm presenting the work of staff across the department. as well as manager who is have been lead this complicated work. and next slide, please.

approximate today, i will present our data on the sexual orienization data collection and it will show improve inspect performance and collecting the data. since last year's repor provide an example how we used the data to meet the department's mission, which is to improve the health and well being of all people in san francisco focusing on our patients and clients who come for care. our time is limited this evening i wanted i will not go in too much detail about the obstacles in collecting the data for everybody served. in the ph you can read about

it in the report on the office of transgender initiatives and the mayor's office about an among ago. go in detail when we have been doing to get past those obstacles come unfortunately resulted in less than optimal data presented leftier t. is xoit to see improvement. as you all know you all saw in reviewing the data and the report, there is a lot of data here i will not go in too much detail about the data you can review that and welcome to ask me questions but this slide is the key gives the take home point you look at the last year's data we improve in the all sections across the department where we collect

data. big shout out to laguna honda, which has had really been our standard bearers in terms of consistent data collection. over the past the ever since it passed and then to primary care and zsfg, which and those 3 bars on the right are all vsfg which buckle down over the last year. and a couple years and resumed their work. of improve the frontline staff checking the data. . i gallon through the data and highlights by section in the department. storying with next slide laguna

honda. i. to caveat which is that all the different sections collect the data different low and use different electronic healing records and reporting software. this is particular to the section we don't have a standard way of reporting or a standard definition or categories for sexual orientation it is interesting you will see for each section we categorize the different responses differently. here is laguna honda's and as i said before they have consistent low collected sexual orientation did the for all patients admitted to of the laguna honda

will lead the department in terms of trainings for upon staff. correct pronoun and correct name and also in terms of their education and support w than i do directly with laguna honda patients around their rights as rescue noise in the their medical record. this shows a little fall off in terms of the rate of complete gender identity data for people add mitted as mental health client and substance use

clients. it is not clear to what weave attribute this fall off. i think -- many of the sections of the d ph which transition it telehealth to many telehealth visits during the pandemic saw the numbers go down. because the workfullies set up for registration for front office staff and telehealing bypasses that step in the out patient visit. there is not a way to collect the did thea we set up in a telehealth visit. the next two show behavioral health services. break down of self identified this is -- jendz and the next slide is sexual orientation for

11,000 mental health clients served our behavioral health services. we did get a question on these 2 slides about the large and subsequent slideses large number. clients response were categorized as declined to state or not listed. that's interesting to track through the different sections and where stigma plays an important role for patients when we are collecting demographic data at the point of admission. for example. you will see that it it is a higher number of people who decline to state their orientation versus 30% in behavioral healing versus gender identity. and also -- for hospital adding

missions we look at the data well is more people who decline to state in the ambulatory care sections there are pisht in and clients not wanting to -- compromise their care potential low by correctly identifying theiring sexual orientation especially. . population health. this is the first report the population health clinics gave pulled from epic dast at categories are hard to read and hard to understand. those top. the top 2 embarrass represent city clinic basically. both general city clinic and the

blue bar is their hiv proirm care clinic a special clinic offered through city clinic. third is tb clinic and the last the fourth is the adult immunization travel clinic. that last ma gent line represents a comparison this is everybody else that was pulled from at this time to show how than i were doing compared to other sessions based on the epic definition. next shows that the dast that i referred to compared to the other sections we saw, reftive low number of people. reporting a sexual orientation other than straight. and we are not sure of the reasons for that but -- can sort

of guess this it has to do with the stigma or people fear being admitted to the hospital. okay. and then -- next slide. more of the data this is gender identity. and then the person integrated care this went on live on epic. and a bit later or started using work flows a bit later. you see the last 2 years impressive to improvement in their collection of data and integrated care. it is our section of different 8 different programs serve adults experiencing homelessness like street medicine and medical

respite sobering. the jail house information is collected at time of admission the sheriff's department and only jenld are identity sexual orientation is in the information not collected. at the time of intake to the county jails. and interesting to see the relatively large numbers of blank or higher than expected number people who identify as family or male. next slide and the remainder i will focus primary care this slide shows an example of the work primary care has done to really get the improve the data

collection across all 14 clinics sharing workfully and tool and working with the staff on the questionnaires and also their population help team sharing the data with the clinics this shoes week by week data share in the a weekly population health report with the primary care teams by the population health team. and that bar graph on the right shows -- the break down by clinic. each gets their own data week by week. they took a lead in working with the it team to reconfigure the registration window so it was easier to get the field where we

collect the data. at the time of when somebody registers for an appointment and last, to provide developed missad opportunity report which has been part of our secret sauce in excellent population health w in primary care. missed opportunity. that means that you know when we ask people to use work flows and give a feel of where did we miss an opportunity to collect that. that improves processes. the next 2 slides show the break down in terms of gender identity boy clinic and the next is sexual orien tigz boy clinic. the how each clinic breaks down.

that was helped drive our the next thing i wanted share, which is the best example we have of using data to do population healing improve am work. and so if you go to the next slide so -- with m pox, about -- 2 month evermonths after we first had our first case and 9ly had more ready access to vaccines. the leadership team worked with the population healing team to figure out how key could do targeted out reach to primary chairman patients based on the data they reported.

identified 5,000 patients who identified as male or transfemale and -- um male and clear by sexual and sent targeted texts out you may be eligible for an m pox vacs eastbound they sent the texts to 5,000 primary care patients to invite them to come in for vaccines. this was building on the incredible work our network teams did during the covid response. early on when we had the limited number of tests and limited number of vaccines when we would open up our vaccine clinics or

testing cites there was a deluge of people from all over the city and outside of san francisco coming in upon demanding service. our patients experience barriers special less likely to take advantage of those services we as a health network offering to the city as a whole. this was an effort to get ahead of that when we had a good supply of vaccine and sort of invoted our patients we thought might be a risk for m pox to come in to get vaccine and obviously the education and the prevention work we -- am we think was part of what helped us so quickly turn around that spike. in cases in the city. proud of the work by the primary

care leadership team. who is really a leader in safety and population health. this guess in ideas for future improve am work we have some areas we need to improve the data collections. working on -- with those sections to use some of the best practices that we we seen employed in other areas of the department to make the collection more consistent. there is also a form terrible for epic build to use a new field, real name, promotes use of patient or client's legal name. which we are looking at as a potential new epic build. i think we need to resurrect our

focus on training. we gotten away from that the past few years. and need to buckle down on that and make sure that all of our staff before it was in new employee orientation and staff introduced not the work flows when they start to the new position but to how we use pronouns and how we am and real names -- in our work with parents and clients. so, i think that is the end. feels like i flew through that. hope i answered the question this is came until and you in happy to answer more. >> thank you, do we have anyone on the comment line >> no one on the line >> all right. i like to start area wearing my mask you can't see my smile thank you for the penitentiariation the progress in collection and application of the data.

of i had a couple am questions or comments long the way and may take them in order on the slides. the progress in data capture in this fiscal year is fantastic. the barriers have been lifted. covid is not over but purned less restrictions and opportunity to collect data. purple line for partial year. do you expect upon that you know those numbers may look better the time we get through the full year and into the future. >> absolutely. >> can especially for primary cares you saw weekly data top out in the 90's consistently. this is one of those things you gota get over a hump. there is a tipping point. once you are used to do it and using the new epic fields, where to finds them. yea, i expect we will plateau in

the 90 percentile. >> when you are looking at the data came out on the vsfg slide 12. the large number of no entry is this because of folks declined to provide an answer or there are still training issues in the questions are not being asked fully. the no entry is skipped. people get a questionnaire awe verbal or paper kwng questionnaire when they come to the hospital or clinic and it is an if they skip the question then it is code noent row entry. person doing intake skips the question rather than the person? >> which points training issues. >> actually that's a good question. that would be with a verbal

intake. it is usually on a paper form for someone whop can read or have it in their language. for the verbal intake questionnaire, i am not sure whether the decline it state would be the declining to ask or the patient just not answering. >> the fact that a lot is done on paper -- yea. probably mostly paper and not answering that question. >> i did 2 exclamation points. at the top you are 100% that is great and coaching the registration team. applications on m pox first doze is impressive you show the additional patients that received their dose as well as you know sure it is hard to sort

of isolate what it is that brings member in because of the public attention and everything. the data shows that ewe likewising the data has been effective. i want to thank you for this. yea. it was an opportunity to use all the data we are collecting for approximate a program reason. we have dhan obviously you know -- when in other public health measures for since the -- smoke was bad. wildfire smoke we did texts to people for diagnose. you know giving them prevention techniques. this was the first time we use third degree did thea for out roach y. with m pox when there was concern and lack of supply to learn the supply was coming and available to them gave reassurance that san frap is

serving and working hard to get them the services and prevention they needed >> exactly. >> thank you. >> thank you. >> those are my questions. commissioners other questions or comments? i have a comment. really pleased see the progress over just a short period of time. and grs to show you know how much of a consciousness that is -- apparent and carried through, throughout the network. i yea. i don't know but i imagine that our health department and our associated care cites are probably ahead of many other county and care site in terms of collecting this data.

in a very conscious and deliberate intentional way. so congratulations and look for progress. >> thank you. commissioner. heavies heavy lifting at the beginning now it is satisfying to see how much it is part of the normal work flow admission. director colfax. thank you for all the work and driving this and changing the culture and acknowledged maria martinez leadership until this it over eye dpkd ago this is something she prioritized and xoiting to see how far the department has come. >> thanks for saying that about our clothe. she would be pleased. >> commissioners other comments for doctor hammer >> i don't see other hands. >> thank you and apologies for

the delay but worth the wait. >> thank you. >> all right. moving on the next item is the commune and public committee update. we have chair of the committee commissioner giraudo. >> thank you very much. we had slant presentation on the bridge hiv research over view. and this was an update on the nih clinical trials unit that is one of the only two in the united states. that is within the department of public health. and so its quite special and should be lotted as well. the areas that were covered were the heart attack iv prevention network that include research on

the vaccines the prep agents, support tools and the what was most interesting are the exact same clinical cites that are currently on going and the clinical cites in the united states , mexico and per eye, argentina, poland. italy and spain. they are recruiting well is no end to the research until the process gets going. it was an extremely informative and excellent presentation and i know that the material was in your packet on the presentation and i really recommend you look at it. because it is excellent. and i don't know if commissioner

chow has anything more to add? thank you an lent summary. we are talking about county health departments obviously the state's and [inaudible] but we are impressed that only king county was the other county and there is a different level of research. ours works with clinical people and actually are transitional in the w they are doing. so. thank you commissioner giraudo for allowing mow to be in attendance. thank you commissioner giraudo and chow. public comment. why no one on the line >> comments or questions? >> i see no hands >> other business. do we have other business?

seeing no hands and no one on the comment line. we will move to the joint conference committee and reports i sum row of the november eighth lhh-jcc middle easting chair guillermo. >> thank you president bernal. we dp of have our regular executive team report. part of the meeting and i think was the first time we broke out from the report. the items on hiring vacancy finance. and had in the past been intgrit instead over all screwive team report. there was a question that commissioner chow raised around the process. the speed and concerned around vacancy hiring at laguna honda and -- we did get a very nice

presentation from kerry johnson on i think the process and the work that the laguna honda is doing and the department is doing with the city personnel department in terms of expedite hiring and also described the issues around upon brought up to the civil service commission that will help speedup the process for that. in addition to the those items, we did get a presentation on the annual review for the performance improvement and patient safety committee. and it is an annual review provided to the jcc and as you can imagine a number of the items that were presented coincide with the same items this are being monitored and --

worked with regard at this time recertification process and settle am. we did get an update on remember a number of the items. some were which the goals were met some were not. it is a mixed bagful progress. again are moving toward a better picture. performance improvement and ebb patient safety the team is working hard it modernize the monitoring process and more precise around the issues as relates it skilled nursing facility. and went inspect closed session and there we did our regular review of the credentialed approval of the considerable's report. the -- medical squat improve am -- report and -- the regular

patient improve am and safety report. and when -- and as you know there were a number of things that we were able to discuss and bring some i guess on going dialogue around that. so. that completes the report. and if commissioners chow or green have any things to add to the report do so. >> okay. all right >> nobody on the public comment line. any comments or questions. >> i see no hands. >> we can go to our next item we completed closed session. we don't need to continue and our next item is consideration for adjournment do we have a motion to adjourn? so moved.

>> second. roll call. commissioner guillermo. >> yes. >> commissioner giraudo >> yes. >> commissioner green. >> yes >> commissioner chow. >> yes. >> commissioner bernal. why yes. >> thank you. we will see you in 2 weeks. thank you, commissioners.

>> i went through a lot of struggles in my life, and i am blessed to be part of this. i am familiar with what people are going through to relate and

empathy and compassion to their struggle so they can see i came out of the struggle, it gives them hope to come up and do something positive. ♪ ♪ i am a community ambassador. we work a lot with homeless,

visitors, a lot of people in the area. >> what i like doing is posting up at hotspots to let people see visibility. they ask you questions, ask you directions, they might have a question about what services are available. checking in, you guys. >> wellness check. we walk by to see any individual, you know may be sitting on the sidewalk, we make sure they are okay, alive. you never know. somebody might walk by and they are laying there for hours. you never know if they are alive. we let them know we are in the area and we are here to promote safety, and if they have somebody that is, you know, hanging around that they don't want to call the police on, they don't have to call the police. they can call us. we can direct them to the

services they might need. >> we do the three one one to keep the city neighborhoods clean. there are people dumping, waste on the ground and needles on the ground. it is unsafe for children and adults to commute through the streets. when we see them we take a picture dispatch to 311. they give us a tracking number and they come later on to pick it up. we take pride. when we come back later in the day and we see the loose trash or debris is picked up it makes you feel good about what you are doing. >> it makes you feel did about escorting kids and having them feel safe walking to the play area and back. the stuff we do as ambassadors makes us feel proud to help keep the city clean, helping the

residents. >> you can see the community ambassadors. i used to be on the streets. i didn't think i could become a community ambassador. it was too far out there for me to grab, you know. doing this job makes me feel good. because i came from where a lot of them are, homeless and on the street, i feel like i can give them hope because i was once there. i am not afraid to tell them i used to be here. i used to be like this, you know. i have compassion for people that are on the streets like the homeless and people that are caught up with their addiction because now, i feel like i can give them hope. it reminds you every day of where i used to be and where i am at now. mayor's

disability commission, welcome, everybody for [inaudible] today is friday november 18, 2019. welcome. for roll call we have madrid. >>