>> good morning the meeting with come to-order. welcome to december 8, 2022 of public safety neighborhood

service committee. thank you to john carroll as the clerk today and also like to thank colina mendoza at sfgovtv. >> thank you. the board and committees are convening hybrid meetings that allow in person attendance and allowing public comment. the board recognizes equitable public access is essential. public comment will be taken on each item. those attending in the chamber in person will be allowed to speak first and then hear from those waiting on a telephonic public comment call in line. those watching on channel 26 -thf had call in line is streaming across your screen. the phone

number is 415-655-0001. when you are prompted enter meeting id. today meeting id is 24948082920. then press the pound symbol 2 times. when you are connected you will hear the meeting discussion but muted in listening mode. when you item of interest comes up and public comment is called those in person should line up to speak along the curtain wall. and those on the telephone line dial star 3 to be added to the speaker line. if you are on your telephone please turn down your television, computer, streaming device. we will take public comment those in person first and go to public comment telephone line. you may submit your public comment in writing. you may send your written comments to my e-mail address. the public safety neighborhood service committee clerk. my e-mail address is

john.carroll@sfgov.org or send to city hall address 1 dr. carlton b goodlett place, room 244. if you submit public comment in writing i will forward to the members of the committee and include your comments in the file on which you are commenting. all this contact information is on the front page of any agenda for this committee. mr. chair, finally, items acted upon today are expected to appear on the bord of supervisors attenda of january 10, 2023. >> thank you mr. clerk. please call item 1? >> hearing to consider

that the transfer of a type-21 off-sale general beer, wine, and distilled spirits liquor license to luke's local inc., doing business as luke's local, located at 580 green street (district 3), will serve the public convenience or necessity of the city and county of san francisco. members of the public who wish to provide public comment call 415-655-0001 and 2 (494) 4948082920 press pound twice and star fallowed by 3. >> thank you. welcome officer from the sfpd to present on the item. officer. >> before you have (inaudible) luke's local. this allows them to operate off-sale general premise. there are 10 letters of protest, zero letters of support. located in plot 130 considered high satchuation area. they are in census tract-plot 130 which is high crime and census tract

106 which is high satchuation. central station has no opposition and alu recommend approval. monitor the area to prevent loitering of persons on adjacent to the license premise depicted on abc (inaudible) >> thank you officer. officer can i ask-you mentioned there were 10 letters of protest for this one. can you- >> yeah, the letters of protest i don't get. those are with abc. they need to be verified through the sacramento office before we get a chance to look at them. what i understand most of them are due to high satchuation. that is what most of the protests are. >> thank you. i believe we have a representative from luke's local. take remotely. >> we have scott stern

remotely. >> mr. stern. >> yes, hello. can you hear me? >> yeah, we can hear you. thanks. >> my name is scott stern the business controller for luke's local. thank you for inviting us. we are requesting a type 21 off sale general license. background on that for anybody who doesn't know, we are a local grocer in the san francisco area. we have a location in (inaudible) and north beach and this will be our third retail or sorry location in union street and this will be our third location in north beach. we are full service grocery store so 9 opercent of what we sell is food product including have a full deli and butcher. we sell

preteared foods. grocery frozen, dairy. we also sell currently at the other 2 locations (inaudible) it does make up a small portion of our total sales, so less then 10 percent and we expect the same thing as north beach. never the less, it is a important offering for us. it is complementary to the rest of our business as we are full service grocery store and we do feel we serve the community well. if we are granted this license we feel it is important for the community to do all their grocery shopping in one trip. is serves the community. we also feel like we are a pro social business. we have not had any issues at our

two other locations in regards to the sale of alcoholic beverage. we do follow the abc rules and guidelines to stop any sort of consumption alcohol on premise and we have systems in place to keep loitering from happening in or around the store. so, we really hope to serve this community well and we hope to be granted this license. thank you. >> thank you mr. stern. actually just thank you to luke's local for being what sounds like a great local full service grocery store here in our city in cole valley and (inaudible) and plans to expand in north beach. colleagues do you have any questions? why dont we go to public

comment on this item? >> let's check to see if we have commenters in room. if so please line up along the wall. seeing none let me repeat the instructions for folks who may attempt to connect. if you wish to provide public comment dial 415-655-0001. the meeting id is 24948082920. pound twice and star fallowed by 3. delaying for a moment and receiving word from susanna we have no callers in the queue, mr. chair. >> public comment is closed. colleagues, i--supervisor stefani. >> thank you chair mar. i want to say i worked very hard with luke's local to bring them to union street and it has been one the best addictions to union street in a very long time. they are a outstanding business. i have nothing but

love for luke's local and thrilled to know north beach will be getting this incredible grocery store. it serves the public so well. i had no problems what so ever, so i dont know exactly what the letters of protest are about but i can assure you i had nothing but positive experiences with luke's local and can say the same for my constituents. >> thank you supervisor stefani. colleagues i understand that supervisor peskin is support of the transfer so i make a motion to prepare a resolution determining this license will serve the public convenience and necessity and that we send the resolution forward to full board with positive recommendation. >> this is committee report. >> okay. >> motion offered by chair mar that resolution prepare that finds public convenience or necessity would be

served by the premise and that resolution be recommended to the board of supervisors. on that motion- [roll call] 3 ayes. >> this will be sent to full board with positive recommendation. congratulations, luke's local. >> thank you. >> mr. clerk, please call item 2. >> thank you. two is hearing to consider that the transfer of a type-48 on-sale general public premises liquor license to future bars group, doing business as south sea dipper, located at 270 columbus avenue (district 3), will serve the public convenience or necessity of the city and county of san francisco. members who wish to provide comment on this remotely may do so dialing 415-655-0001 and meeting id 24948082920. pound twice and star fallowed by 3. mr. chair. >> thank you. officer

(inaudible) would you like to present the report on the item? >> okay. future bars applied for type 48 license and would allow to operate on sale premise. zero letters of protest, zero letters of support. located in plot 140 considered high crime. in census tract 106 considered high satchuation. central station has no opposition and alu recommend approval with following conditions: the petitioner monitor the area under their control in a effort to prevent loitering of person on property ajais tonight the premise. no noise audible at any nearby residents. >> thank you officer. do we have a representative of the applicant here today? >> yes, chair mar, supervisors, my name is mark reny here with

brian shehy president of future bars one of the most successful bar outfits in san francisco over the last 20years. this is very exciting project. it is in the old italian american building on columbus and broadway. they changed the name to branch of america (inaudible) the first to wish happy birthday the first of january. this building is 100 years and excited that brian and future bars are going to reactivate the space. it has been vacant 2 years. brian why don't you tell us what you are going to put in there. >> thank you for your service being supervisors. all most a tough job to have as being a bar opiatorerator. we are excited to be opening another cocktail bar at this location at the beautiful

italian american bank building. (inaudible) a lot of closures happened along broadway and if we continue with it service it should be positive foot traffic to north beach. our idea for this location is something that is very different for bars in san francisco. it is constantly changing. it is like a (inaudible) the first port of call will be havana and operate as havana experience for 6, 9 or 12 mujt months and go to the next port, sydney, london, dublin, who knows where we will go. it will be changing experience up there and again we are requesting your approval because we will be serving the public necessity no longer have closed storefronts and

generate positive foot traffic and thank you so much. >> thank you so much. it sounds like a wonderful concept. you will be opening next door to devils acre? >> absolutely. it is separate license from devils acre. the buildings are adjacent but not connected. >> thank you. why don't we go to public comment. >> do we have anyone in bord chamber who wishes to provide public comment on item 2? seeing none, we'll turn our attention to the remote access line. if you wish to provide comment on item 2 via telephone you may do so. 415-655-0001. the meeting id 2 (494) 808-2920. press pound symbol twice and dial star fallowed by 3 to raise your hand to speak. and we have no callers mr. chair on item 2.

>> public comment is closed. colleagues, i understand that supervisor peskin is supportive of this license transfer so given that, i'll make a motion directing the clerk to prepare resolution determining that this license will serve the public convenience and necessity and we send the resolution forward to full board with positive recommendation. mr. clerk. >> thank you mr. chair. on the motion by chair mar- [roll call] mr. chair, 3 ayes. >> great and congratulations mr. she he and best of luck. item is sent to full board with positive recommendation. mr. clerk, please call item 3. >> item 3, ordinance

amending the police code to require private employers to pay employees who are military reservists and are called for military duty the difference between their military salary and their salary as employees, for up to 30 days in a calendar year, and to create procedures for implementation and enforcement of this requirement. members who wish to provide public comment may so dialing 415-655-0001. the meeting id is 24948082920. press pound symbol twice to connect and dial star 3 to raise your hand to enter the queue to speak. finally mr. chair, i'm receipt of a memo from the desk requesting the matter agendize adcommittee report for potential crrz by the board of supervisors at their next meeting december 12. >> thank you mr. clerk. colleagues, i want to thank you for cosponsoring this legislation which i'm really excited to be able to move forward as one of my final pieces of work here in my term as a district 4

supervisor. just a little description, the military leave pay protection act require large employers in san francisco to pay the difference between the military and suveilian pay military leave up to 30 days each year. this will insure military reserve and national guard personnel are not income burden by the service to the community and country and it mirrors a similar paid leave protection public sector employees who are military reserve enjoy. in the city we have approximately 2,000 san franciscans serving. these are workers across all occupations and industries and background who also made the personal and professional commitment and sacrifice to continue serving our country and community through the military reserve. military reserve are deployed

to overseas mission and increasingly as cretical responders to domestic (inaudible) deployed and played a critical role responding to increasingly severe wild fires in california and also quite frequently during covid-19 pandemic. the national guard reserve defended our federal and state capital from right wing extremist following the 2020 election. because military reservist and national guard serve on part time on-call basis they are likely to be employed in civilian sector and face income insecurity and financial strez because they had to leave their job temporarily for training and maybe called up for duty on short notice and losing time from their civilian job. srf workers make a commitment and sacrifice by serving in our millty reserve shouldn't have

to suffer income loss to due service. i did want to cite an example of the impact that this currently has now and what this legislation is trying to address. in e5 sergeant with 5 years service would get paid $99 a day and if they get paid $30 a hour or $240 a day in san francisco in the private sector they would be losing $140 per day during their annual training or service. i did also want to point state and local laws also protect the income and employment. military and veteran code get up to 30 days of pay while on military leave each

year. the san francisco administrative code grants 30 days of pay while on military leave in each fiscal year. in addition to our state and local government sales force, the largest employer in san francisco also provides military leave pay for employees military reserve and national guard personnel up to 12 months, which is very commendable. some private employers such as sales force stepped up, military reserve and national guard in the private sector have far fewer protections which is why we brought forward the military leave paid protection act to protect our private sector military reserve and national guard personnel in income security. so, again thank you so much supervisors melgar and stefani cosponsoring. i also want to thank supervisor dorsey preston and walton as cosponsors. want to

acknowledge deputy city attorney vicky wong for her work and veteran leaders advocates one vet one voice, jenny perez, the veteran affairs commission and especially commissioners (inaudible) steven martin (inaudible) nicolas (inaudible) han ly chan, courtny (inaudible) bill barnacle and finally i like to acknowledge my legislative aid ellen wong who is a national guard officer himself and is on service rights now. i'm happy to bring this forward and it has been a honor working with our veteran community on this and so many ort important policies we worked on over the years. i

think we have here today (inaudible) office of labor enforcement. mr. mulligan, wondering if you can speak how olsc is going to approach implementation and enforcement of this new paid leave and workers rights and veteran benefit policy. >> thank you supervisor. per the treasurer tax collector office there is 3400 emploeees. it is difficult to know the overlay of how many of them may have reserve military reservist and employment, so some of this will be wait and see where the operations are. we'll have a focused informational outreach to all effected employers and work with veterans groups to reach potential employees who may be impacted by

it. review the language and probably have administrative guidance or formal rule making process in order to best define some of the terms for ease of implementation. but we don't think that it will be-the impact will be too great to the office but welcome any budgetary support at the discretion of the board. >> thank you so much director mulligan for that and all your work the ofc does on implementing and enforcing all our worker rights and labor prexz protection in the city. thank you. >> thank you. >> we have worked closely with veteran affairs commission on this policy and wanted to invite-is (inaudible) or is she going to speak remotely? i believe (inaudible) the president of the veterans affairs commission was

going to present. >> that's right. looking on line, i'm not seeing (inaudible) here but did receive and acknowledge the invitation to attend remotely. >> great. okay. want to express my appreciation to (inaudible) veterans affair commission for their work on this. why don't we go to public comment. >> thank you mr. chair. do we have anyone in room who wishes to provide public comment? if so please line up along the left of the room. i will give access instructions for those watchs on television. dial 415-655-0001. enter the meeting id that is

24948082920. press pound symbol twice and star fallowed by 3 to raise your hand to speak. while folks are doing that, we invite our first in person speaker. please begin. >> good morning supervisors hanly chan veteran affair commission. thank supervisor mar, melgar, stefani dorsey preston and walton for championing this and supporting this code amendment. i wish that it was back in the days implemented, so when i was in a national guardsman serving our country wanted to get paid enough to pay by bills. i got to pay mortgage and serving our country doesn't make it. i wished it was implemented then, but i highly support this and want to thank all the

supervisors that support this legislation and support our veterans community. thank you. >> thank you commissioner chan. can we get the next speaker, please? >> hello, courtney elington, veteran affair commissioner and ceo of one vet one voice. i want to say that national guard and reserve soldiers especially the national guard they serve a dull mission. they can be called on by their state governor to respond to floods and hurricanes and for the government they can call them to deploy overseas. in 2020, the army reserve soldiers mobilized to active duty and experience significant pay problems. imagine being deployed due to global war and home land security and make a sacrifice only to have pay problems. the california national guard have been deployed overseas more then 38

thousand time s since 2001. our soldiers need more then just government support, they need support from the state the city and the community. passing this private sector military leave pay we are only asking that you support up to 30 days. i dont think that's asking for too much and i do appreciate all the supervisors who support this, and all the community leaders who support this and i think this will show that as a community we support our veterans. sometimes we just need to be educated on military veterans and this is a great way to ask community leaders if you don't know but this is a great thing. thank you. >> thank you. seeing no further commenters here in the chamber, i see we have one caller on the

telephonic queue. could we please be connected to that caller? >> supervisors, my name is francisco decosta. welcome john carroll. (inaudible) we accommodated the reservist from the 12 western states. (inaudible) was deactivated, there was a vacuum, so i commend the city for stepping up, working with the veterans to do the right thing. you know supervisors we have a lot of our veterans who

are homeless. we need to step up and provide them the best services that we can give. i do what i can and i'm happy we have veterans who work for the city and county of san francisco . (inaudible) contact monitoring division. so, we do what we can to help the veterans. thank you very much. >> thank you francisco decosta. checking if we have further callers in the queue. hang on just a moment, please. mr. chair, we reached the end of public comment for item 3. >> public comment is closed. supervisor stefani. >> thank you chair mar. and just wanted to say a few words. very happy to

cosponsor this and want to thank our vet hanly chan and courtny elington. thank you to your service not only to the country but on the veterans commission. you is done so much to further cause for veterans here and we appreciate that. i also want to thank you chair mar for everything you have done and all the legislation put forward for our veterans. you know it is something i care deeply about. you and i were together just the two of us at memorial day celebration in presidio and it is a issue i care deeply about being a daughter of a vietnam vet. knowing everything he went through and keep bringing the ideas forward when we can help our veterans. i think we have to do much more and very happy to cosponsor this and allen wong and his service. >> thank you. supervisor

melgar. >> thank you so much. chair mar thank you for always championing the rights of veterans for everything that you is done in the last 4 years for veterans, and of course thank you to courtny and hanly for being here and always advocating on behalf of veterans. i think often times we talk about veterans and their service and we do the memorials and commemorations which is of course important, however, economic issues are very important, and veterans we know have real needs, economic needs, also needs of support in terms of housing, mental health, all kinds of thingz we could frankly do much better as a country. i'm so glad as a city we are starting to meet these needs and i look forward to doing much more to

make sure that folks can live in the city and thriv thrive in the city after having served the country they way . thank you chair mar and your aid allen wong for all he has done. >> thank you supervisor melgar. i wanted to thank my colleagues the two of you and other colleagues for cosponsoring this and the veteran affair commission and veteran community for working with us on this really important new workers rights and veterans support policy that will insure that our military reservist are -income security is protected while suving serving community and country so thank you so much. i did want to also mention this policy as far as we know is a first of its kind in the

country and attracted attention nationally. our office has gotten inquiries from people around the country interested in seeing if they can move something similar and on a state-wide level there is interest moving a similar policy on a state level as well so excited to see how work that we have done here in san francisco can also help spark similar work more broadly. also did want to mention that is also the case with the previous policy we worked on, the veterans affordable housing access act that has sparked a lot of interest more broadly as well, including in oakland where the new mayor of oakland was already working on developing a similar policy in the city of oakland.

again, really excited and proud we can move this forward now. colleagues , i move we send this forward to the full board with positive recommendation as a committee report. >> on the motion offered by chair mar this ordinance recommended to the board of supervisors as a committee report- [roll call] mr. chair, 3 ayes. >> great. [applause] >> thank you so much everyone. this will be moved forward to full board for a vote tomorrow--or- >> vote tuesday next week. >> yes. alright. please call item number 4. >> item 4, hearing on

the state of jail health services, including a report on the overall mission and services provided at each county jail; the staffing levels of medical staff, particularly nurses, available to treat the incarcerated population; the roll out of epic (an electronic medical record database) and how it's impacted the workflow for jail house staff and the discharge-planning program; and how many individuals are engaged after release; and requesting the department of public health and sheriff's department to report. members who wish to provide public comment call 415-655-0001. 2494808 2920. pound twice and star 3. >> thank you. thank you supervisor stefani for calling for this hearing and really glad we are able to get it on the agenda for this final meeting of the committee before end of year. the floor is yours. >> thank you chair mar. just a few opening remarks before we get to our presentations. thank you chair mar for scheduling this. when i asked

you to i appreciate that. as i shared when i called for the hearing, jail health service workers are the front line of the city medical psychiatric and substance abuse crisis. our jails play a role of psychiatric and social service for one of the city most under served population and over the past 4 months there is steady increase in the inmate population in the jail and dph and our sheriff department are facing significant staffing shortage and despite the challenges i want to acknowledge that i understand providing health care in our jails is not easy. stays are often short and unpredictable releases complicate care strategies and of course resource constraints only exacerbate those challenges. i also want to take a moment and commend dph for all their efforts to keep jail

health clients safe during the pandemic. over the course of the pandemic, there were no deaths or hospitalizations from covid in our jails and dph worked tirelessly to vaccinate the san francisco county jail population so commend them for that. today we are looking forward to drilling down into what exactly is happening more broadly at jail health services. given recent and well publicized leadership issues at jail health services i'm very interested providing dph and sheriff department a opportunity to present on the following : the overall mission and service provided at each of the county jails. overview on staffing levels of medical staff, particularly nurses available to treat the incarcerated population. the roll out of epic and electronic medical record database and how it impacted workflow for jail house staff and along with the

sheriff department the discharge planning program and how individuals are engaged after release. enjoying us today for the hearing we have representtivals from the department of public health, d haly hammer, she is director of ambulatory care for dph (inaudible) deputy director public health attending remotely and believe tonia (inaudible) director of jail behavioral health and reentry is here and available for questions and from the sheriff department we have under-sheriff cathy johnson presenting. with that, i see dr. hammer is at the podium from jail health service actually department of public health to start us off. dr. hammer. >> thank you supervisor stefani and good morning chair mar, supervisor melgar and members of the public. it is honor to be here this morning to give you a brief overview of san

francisco's jail health services. as supervisor stefani mentioned haly hammer director of ambulatory care for the department of public health and jail health is one of 5 sections which i oversee. joined today by alyssa riker director of programs from san francisco sheriff office who will present at the conclusion of my presentation and also other members of our department of public health team. next slide, please. thank you. today as mentioned by secretary carroll and supervisor stefani i will present overview of jail health services. i will talk a little about our service model so what services we provide in the jails, and then drill down into staffing in the jails as well as the roll-out

of epic, our electronic health record. we'll talk about outcomes for people in custody at the county jails and then be available to answer questions. next slide. i think it appropriate to start with the mission statement of jail health services. jail health services provides comprehensive compassionate and respectful care for incarcerated people while mitigating the effects of structural racism and historical injustices a a fully integrated and collaborative member of the san francisco department of public health. in addition jail health services is guided by the principle incarceration is a public health issue. passed by the san francisco health commission in 2019,

this resolution recognizes the impact of incarceration on individuals, families and communities and particularly, individuals families and communities of color. we also confirm our commitment to keeping people as healthy and safe from injury illness as possible during the time they are in custody. the following slides i'll introduce to the jail health services and illustrate how we do that. next slide. (inaudible) close collaboration with the san francisco sheriff office. each year there are-this year we anticipate there will be approximately 11,000 intake into the jail so 11,000 people the staff will assess as they enter the jails. to give you context, this is

similar to the number of admissions annual admissions we admit to zuckerberg san francisco general hospital each year. we run jail health as one entity and staff all 3 jails but they are different programatically. county jail 1 is where intake and releases happen. so that's where our nurses assess people as they come into the jail and will talk about that assessment. county jail 2 houses our medical beds where we are able to care for people with higher medical behavioral health needs. the vast majority of people in custody in the jails are housed at county jail 3. that's where people are who will be in jail longer and also quhoo

who will be going back and forth to courts. isolation rooms in all 3 of the county jails and those isolation rooms as you imagine have been critically important to our work to keep people in custody safe from transmission of serious respiratory and other illnesses, especially over the last few years. next slide. this slide shows and i apologize it is a little hard to read, it shows the structure of jail health services. jail health sits in ambulatory care which i oversee, part thof san francisco health network who's director is mr. rolland pickens and mr. picken reports to director of grant colfax. the director of jail health service is dr. lisa prat who management executive team of leaders over each of the clinical areas as you can see in the

organizational chart. dr. prat is medical director and the clinical leader responsible for all clinical care that happens in the jail. we have some clinical leaders who have-who report up to other clinical directors in the department such as dental and pharmacy but they have matrix reporting to dr. pratt. next slide. diving into the service model, i'll start with physical health and then mental health and reentry planning. we take care of patients with serious mental health and medical health problems in the jail. for example and this is one small example, we currently have 3 people in jail who are-with cancer who are currently receiving radiation and chemotherapy during their incarceration. we

assess people on intake. we identify whether they have any urgent needs or whether they have chronic physical health or mental health or substance use issues. and then we also take care of them during incarceration in terms of managing any urgent problems, managing chronic illness like diabetes, hiv, addiction, like cancer and hypertension. all medication in the jails is administered individually to people in custody. in addition, i'll call your attention to that last line of the slide, we have innovative groundbreaking programs which are tailored to particular populations or particular illnesses. we do a great deal of prevention in the jails. prevention around hiv

. we work to prevent ovdose both for peep in custody and also for people who are at risk overdose as they leave the jails. i'll also mention in terms of physical helths, we work closely with zuckerberg san francisco general hospital which provides higher level of care that we need-we often need for people in custody, so that is both in the medical emergency room, inpatient hospitalization, psych emergency and specialty care, surgical care. the whole range of care provided at zuckerberg san francisco general. next slide. we have robust behavioral health services in the jail both mental health and substance use services. behavioral health program enthe

jail is overseen by jail health service deputy director and director of jail behavioral health tonia mara. our approach to behavioral health in the jail can be summarized in three words. screen, stabilize and link. our aim and stabilizing people in custody is to initiate appropriate care that may be individual or group therapy. it may be beginning or continuing psychiatric medications. it may be beginning initiating or continuing medications for addiction treatment. it may be connecting people to other supports for their mental health substance use issues like na, connecting to na and aa groups. so we provide really a whole range of services but with the

intention to stabilize people while they are in custody and then we hope to connect them to ongoing care both outpatient mental health, substance use and primary care on their release from the jails. a big part of-next slide. i'll shift into discussing reentry planning. a big part of the work we do in jail health services which we do in close collaboration with the sheriff office and other community partners is, discharge or planning for release from the jails. as mentioned this may include connecting people to ongoing routine care, mental health care, primary care or may mean referral to residential programs. in fact, we have seen more referrals to residential substance use programs in recent months then we ever have in the

past, and we are currently referring people to programs which i think you know well such as salvation army, trp the new ministry planning, harbor lights and other residential treatment programs. next slide. i will shift now you have a sense very broadly a sense of the services we provide in the jail. i will shift to some of your specific questions about staffing and various impacts on our staff and patient care. the first i like to discuss is our epic implementation. epic is our department public health wide electronic health record. this is a huge project that we have been working on over 5 years starting with building the existing system so that it's tailored to our

specific needs across the health department. we began with implementation work of epic with our 2 hospitals, laguna hospital and zuckerberg san francisco general hospital as well as primary, the clinics and some of our homeless services and are whole person integrated care. our first kick-off go live was epic was august 2019 and then with as you know, the covid pandemic, covid hit soon after that and we had to shift a ton of epic resources to covid-19 and city wide response. epic was a key part of that response, and really enabled us to track and monitor the new clinical services we provided to san franciscans

during the covid pandemic. there is certainly advantages of having epic now live in the jail. we went live beginning of october of this year. sorry, last year. again delayed because of covid. the advantages are it gives jail health staff access to records from elsewhere in the department and sometimes other health systems. it allows us to better coordinate care between care providers in the jails and people outside the jails. there have been bumps in the road. major issues we have encountered in this first year using epics in the jail. i will not go into too much detail about those but i want to mention that some of the issues are that when people are booked into the jails they enter into the sheriff department jail

management system, and then there is a interface we built connecting the jail management system to epic. unfortunately there isn't seamless matching of people from the jail management system to the electronic health record so when nurses go or care teams go to chart in epic they often are charting on somebody that pops up from the jail management system but can't link immediately to their records elsewhere in the department that are already in epic. that's something we have been working on. our-nurses are incredibly adept finding records they need as well as other members of our care team, and we have been working on this issue. the other big big issue is not having consistent wifi at county jail 3,

which as mentioned is where we house-most of the people in the jail are housed. again, we are very grateful for our partner with the sheriff office, which has been hosting us on their wifi at county jail 3, but it has been a big barrier and there's intermittent--the jail helt staff intermittently can't access the epic system when they are out using tablets to document medication administration for example, and that has caused a real hardship for our staff which we are working hard to address working with dts, with our it team from dph and hope will be resolved soon. that has resulted in having to do work-arounds to

make sure we are correctly and timely as possible documenting medication administration in county jail 3 and i have confidence that this issue has been elevated to the highest levels and i hope will be resolved in the near future. the next-please go to the next slide. now i'll drill down to staffing in the jails. hopefully easier to read compare d previously. this shows how services are divided into different clinical areas and staff positions we have in each area. to start, i just want to say again that nursing is a backbone of jail health services. jail health services is open and functions as i'm sure you know 24/7, 365 days a

year. our nurses are the consistent clinical staff who are in the jail all the time. they rely on physician backup and so constantly in touch with our physicians who are there clinical council and do a lot of management over the phone when they are not in the jails but we have nursing staff staffing the jail all the time. next slide. so, this slide is a little confusing but let me see if i can explain it. this slide illustrates how we try to set staffing levels in the jails. seiu, 1021mou sets minimum staffing levels for count y jail. minimum nursing staffing level for the county jail which is what you see here. there is

language around staffing based on census and regulatory requirements. in fact, we staff the jail first and foremost to insure safety for our patients, insure safety for our staff as well as full coverage of all 3 jails. the next slide shows you actual numbers of our nursing staff in the jails in recent months. in terms of the comparison between these numbers and the required numbers per the seiu 1021 you see the numbers are higher so we consistently meet those standards and in fact, we know our jails are staffed fairly robustly, especially compared to other county jails throughout california. we had

contracted health consultants hma who did a very deep analysis in 2015 when the jail census was much higher then it is now, and actually had fewer staff and they determined that our number overall number of rn's per people in custody was 2 to 3 times higher then any other county jail that they looked at. and that analysis again was done when the census of the jail was closer to 12 or 1300, whereas now it's usually between 800 and 900 and i'm pleased to report that this morning i heard the jail census is under 800. the next slide shows some of the recent interventions that we have done

to try and stabilize nursing staffing. in july the nurses per their mou voted to move from 8 hour shifts to 12 hour shifts and that transition really presented some very significant scheduling complications, so in anticipation of rolling out 12 hour shifts we did beginning of september, we put in a number of measure. among them contracting with a nurse registry organization so we can have some access to registry nurses when we are not able to staff the jails. we now have standby pay for nursing staff, so that can be available to come in if needed.

we have also pleased to say worked with our hr department so after the hiring bonanza in behavioral health services earlier this year, they prioritized jail health services staffing and invested resources in filling our jail health vacancies. we still have a large number of vacancies and i'll share that data with you, but we are madly trying to fill those positions. we also took a look at the tasks that our nursing staff have to do on any given day with the patients under their care and try to distribute those and distribute staffing so that there is a better match between across the different jails. so, next slide. shows the number of

vacancies that we are currently trying to fill. unfortunately the high turn-over among jail health staff is a very real problem and really impacts our ability to keep the jails appropriately staffed with well trained and experienced staff who are committed to caring for this population. burn-out is very very real and very high among jail health staff, so our ability to fill positions as they become vacant as well as we are not able to fill positions and have lots of people out on leave or out sick able to draw on the registry contract has been essential in order to keep the staffing levels appropriate. next and

finally i will shift over to health outcomes. i start with this slide because to start it is very very hard to measure health outcomes in the population of people in custody. part of the reason for that is that over half of people who come into our county jails leave within 24 hours-48 hours. and all most half people are there less then a week so very hard to show how we impact the health of people in the jail when so many people are in and out after only a few days. but this slide i think really speaks a thousand words. this analysis that was done in 2019 showed that san francisco county jails mortality numbers were a fraction a small fraction of the rate

of other california jails and certainly acrauz across the united states. done in 2019 and i'm incredly proud of the work done by jail health staff done over the last 3 years of the pandemic that we have continued to have this very very low mortality rate, so it is not just 2019 as a outlayer, we have a very low mortality rate in the jail. as supervisor stefani mentioned, our work to protect people in custody from covid-19 is exlempary. we had no hospitalization or deaths due to covid people in custody because of covid-19 and that's really incredible if you know the situation in other county jails. i again want to acknowledge our

partnership and appreciate our partnership with the sheriff office and the commitment of everybody working in the jails to keep people in custody safe from illness as much as possible. we put a number of things in place. i remember a saturday in june of 2020 and talking to the director of the lab and dr. pr pratt to figure how to use the rapid tests for people coming into the jail before they enter the general population. efforts like that and the fact the dph and san francisco as a whole values the health and wellbeing of people in custody and devoted the scarce resources to the jail, those efforts saved hundreds if not thousands of lives i believe in

our county jails. so, we were able to quarentine people who came in based on symptoms or while awaiting test results. we did a ongoing tetraseen of the scare resources which is isolation so we can isolate people with covid, isolate from the general public and until omicron this year, we hadn't had any known transmissions of covid within the county jails. covid i want to say is really the ultimate stress test for our county jails and really for any health system, and the fact that we had this incredible success in protecting most of the jail population from covid, transmission, infection, hospitalization and

deaths is a testament to the integrity of our jail health system and the commitment again of our staff and leaders in the jail to keeping people as healthy as possible while in custody. this gives you some data on covid vaccines in the jail. the shift shows vaccination status of some of the jail population in october. we worked hard to educate people coming into the benefits of covid vaccine as well as ort preventive health care and see as success when we can educate people coming into the jails so they agree to engage in any of the preventive

interventions we are offering including covid vaccination. our next slide shows the challenges we continue to face as i wrap up. staffing continues to be a challenge. again, multi-factorial. burnout, vacancies a lot of people on leave, sick calls and as well as just a hard labor market, hard to fill clinical positions, both in the areas of nursing but also behavioral health clinicians, physicians. our jails are densely populated even though the census today is low. still not as low as it was at the beginning of the pandemic when we saw the big dip in bookings and it is much easier for us to keep people safe and healthy if the jail is less densely crowded.

densely crowded. i mentioned the technical issues that we are having and really big barrier to us optimizing epic and the experience of our staff using epic so hoping we can have that resolvedads soon as possible. we have a large turnover of patients and again that presents a challenge in terms of getting them on the road to recovery or engaging in ongoing health care. and then last, i want to mention because this is forefront of all our minds in public health is constantly ready to respond to the next public health concern. working with our partners in the sheriff office and others throughout the city, again to make sure people in custody in the county jails are being

cared for and we are protecting their health and wellbeing. with that, i'll close and turn it over to my colleague ms. riker or answer your questions. >> i do have questions but i will hold on the questions for you dr. hammer and have the next presentation. >> sounds good. >> hi. good morning. alyssa riker director of programs for the san francisco sheriff office. i also under sheriff johnson is on the line if there is questions for her. you could start my slides. i was going to just focus mostly on the discharge planning with the sheriff office but also want to highlight a couple programs in custody that focus on substance use. canned you do the next slide? we have two legacy programs, roads to recovery program and the sister

program that provides case management and group interventions and custody for folks. they do a lot of linkage and referral to residential treatment for release and these are legacy programs. we also have other programs that do cover substance use such as cover program, recollect which focuses on veterans in custody and works closely with veteran justice court and violence prevention program covers substance use. can you go to the next slide, please? but, i wanted to focus on our reentry programs and on the discharge planning. it is complicated because there are 2 discharge planning efforts happening but we work with jail health. the way we managed with our sheriff office discharge planning is we focus on three populations. one is the folks when we know when they are leaving. in san francisco we have a unique

challenge in that 96 to 97 percent of our jail population is pre-trial,s which means we do not know when they are going to get released. so, that's a big challenge but we do follow those with release dates. the way we have kind of compensated for that is using technology to inform us who's pled guilty in custody and assume at the sentencing they will be released for time served. and then the other focus population is the persons arrested the most in the previous fiscal year. every year we do analysis of bookings and identify a cohort and set up an automatic alert in our jail management system that notified discharge planning staff when those individuals have been arrested so we can try to link them to services. we

also have a collaboration with the human service agencies to do medi-cal enrollment. over the past 8 years we have been doing this it focuses on the backdoor population but with cal aim we shift starting in january that will focus on everybody who is coming in the front door identifying who needs medi-cal. next slide. we also have a contract with bayview senior services to have older adult case management that is one full time person. we monitor the jail population for everyone who is 55 and over and we try to make sure that they are linked to services, particularly that the 3 3 populations, sentence, post plea and persons frequently booked. the biggest tool for discharge planning is our nova

program. that has been around many years. we have contracts with multiple community based organizations to provide individual case management and reentry. they interview folks in jail who we think are going to be released and meet them at release. we have sober living housing programs and we work with city wide forensics and they have mental health services and there is a flex fund so that the case managers can address any barriers whether transportation whether that is union dues whether that is tool s for a job or whatever the client needs we try to step in and provide that for them. next slide. part of the discharge planning is we are also-the staff of discharge planning access to the one system which is the department of homelessness and supportive housing system that where they

have the assessments of persons who are experiencing homelessness and prioritization who is referred to permanent supportive housing. a exciting thing starting in january the department of homelessness is contracting with non profit to embed staff in the jail to do these assessments. that's-we are just super happy so the jail is going to be access center for department of homelessness so that's huge and wonderful. we also have a program that focuses on reentry for survivors of domestic violence and trafficking that staff are based in our women resource center around the corner from county jail 2 where all the women are housed. they go into the jail and seeking safety groups and individual case management and try to work on linkage to services post-release at the women

resource center or other survivor restoration program. we also partner with department of children youth and families. they fund a transitional age youth program. multiple programs. some of them have a justice focus and so we work with them for the folks who we know who are being released. we create like a priority list for these case managers and say, these are individuals we want to make sure that they are linked to services or at least go into the jail, talk to them and offer services. so, that's an important partnership. next slide. and then finally, we have a program that mayor office on community development housing community development funds which is for a case manager focusing on the transgender population and also housed thin women resource center and go into

county jail 2 and do groups. there was something-i should mention i thought it was going to be on the jail health slides there is a new program called project juneau that works on setting up patient navigators for folks who are on medication assisted treatment. i didn't put that on my slide but thought it would be on yours. those are the programs that the sheriff office operates. >> thank you. since you finished the presentation i will start my questions with you if you don't mind. so, i recently received information from the sheriff department that we are 192 sheriff deputies short. is that correct? >> i couldn't speak to the number but sounds right from what i heard. >> my understanding too is that shortage is having a real impact on the

programming in our jails, is that- >> that is correct. >> so, i also know that prior to covid or when we did not have the staffing shortages we are experiencing, people from the outside could bring aa meetings in or na meetings in and my understanding is that is not happening anymore? >> the programs i just described to you that had a variety of community based providers whether funded by the sheriff orfunded by other city agencies they have been coming in since the shelter in place stopped. so, they have been coming in. things like aa, na, we have not had and that's kind of combination both of staffing and of-i guess mostly staffing. our pre-covid our model was taking folks from different housing units into like a corridor which requires a lot of staffing. for things like

na and aa. when covid happened we really pivoted around public health concerns of not mixing people from different housing units because we were also concerned about contact tracing. so, when we-as we emerge from the covid protocols we have staffing issues that have prevented us from doing those kind of groups, but my understanding is that na is going to be starting up in county jail 3 in san bruno, but we have to do it in one housing unit. so we have been worked with hospitals and institution leads from the organizations so we are trying to bring it back in, it is just going to be like i said, it would have focus in each individual housing unit. >> i would imagine there is limitations how many people could be in one of the meetings based on the staffing available? you can't have 30 people (inaudible) there is

limitation. >> right. >> one program i have been a fan of for a long time is the therapeutic (inaudible) my understanding is that program is not able to function right now because of the staffing shortages is that right? >> all of our programs that prioritized. during the pandemic they had access to the tablets to do zoom classes then any other groups. right now that program for several months has been operating. they have two groups a day. it is not as-used to be 48 individuals in the housing unit. i think we have like 26 right now and they come out for groups twice a day. our staffing is such that at 11 a.m. the people who have been drafted get to leave and so we can

definitely-we have been able to maintain the morning class but the class after 11 a.m. the staffing goes down and that class is often canceled. it definitely had a impact but the program is still happening. >> okay. i actually this is a separate inquiry i have done to the sheriff office about all the programs that have been impacted by the staffing shortage and that's not where i'm going today with this hearing but i like to have a better understanding of the programs that have been impacted. obviously there was reporting on this and sunny schwartz said something about people getting anger management packets andt noable to have the interaction in a program that encourages change behavior and it is hard to give someone anger management packet. i think that's for a later conversation, but i'm glad some of them are still continuing,

but with 192 deputies short in the reporting some are just not happening or happening at such a limited capacity is not really meeting what we need to be doing for our incarcerated population in my opinion. okay. thank you. thank you for the presentation. dr. hammer i have a few questions for you. i just want to set the stage. thank you both for your presentation. one reason why i called for this hearing was because of a lot of rumbling after we heard about the director of jail health service having secondary employment with a non profit that was going under. under circumstances that raise eye brows at it board of supervisors and public. those are taxpayer dollars so a lot of questions asked whether the secondary employment had impact on the origial job, director of health service. there are questions out there about how many people might be

applying for secondary employment. might already have it and whether or not that could have impact on what's going on at jail health services. complement what i was saying there is, i heard from people who work inside the jails, particularly some nurses about the stresses and about the issues with staffing issues not only nursing staffing issues, but also of course impacts again of the staffing shortage in the sheriff department and how that plays out for the delivery of health care to the incarcerated population. i really want to like i said to you dr. hammer and department of public health. i want to drill down on those staffing shortages and how we as a body especially as budget discussions come up can assist with anything that needs to change. you said that you had

11,000 intakes. was that last year? 11,000 intakes to the jail last year? >> we anticipate in the neighborhood of 11,000 intakes this year. >> okay. and how does that compare to prior years? >> the last couple years intakes have been lower, but it gets us back up to the level, 2019 level before covid. >> okay. how many nurses are responsible for intake at county jail 1? >> we have-so, county jail 1 is staffed 24/7 with nurses and in terms of the exact staffing patterns how many we staff in each shift, i don't have that number with me, but i can certainly get it. we have in general we have redundancy so we have 3-in general we want to have 3 nurses on per

shift. it is hard to anticipate how many intakes there will be, so 3 per shift, 3 shifts per day so 9 in general. but again, if we have somebody call out sick or we may over-staff or sometimes have 2 but in general try to have 3 at all times. >> can you walk through what is involved in the typical stay on a individual in each county jail? and know there is cj1, cj2 and county jail 3. you mentioned cj3 as the san bruno jail. those typically are longer stays. if you can kind of take us through a typical stay in each one. >> sure. so, people coming

into the jails as we mentioned coming to county jail 1 they go through a full health assessment screening. if there are any acute medical problems, anything we are very concerned about, we or for example they are detoxing or in any sort of crisis, but not requiring hospitalization, they would go to county jail 2, and for people who--the much more general public who don't need that level of medical supervision, they would go to county jail 3, and people can move back and forth between county jails 2 and 3. if on intake we are concerned about symptoms, about somebody may

have illness, we work with the sheriff department to have them be in a quarentine or isolation cell until we have sure they don't have a disease of concern to the general public. >> do you know capacity of each jail? >> i will go with county jail 2 is close to 300. i want to say 290. county jail-hello. county jail 3-i will call on my lifeline behind me. about 700. there are areas of county jail 3 that are not open because there is not staffing but can be opened if there was a huge influx of people into the jail, so that is why those

two numbers add up to closer to a thousand, which is what we have been seeing since the closeier of county jail 4, and the lower census we had in recent years. >> okay. do nurses who interact with the incarcerated population receiver specific crisis intervention training? >> they do. we do crisis intervention training. i can't tell you in detail about that but we can certainly get back to you about that. we think of ourselves as a trauma informed system, and so our approach is from a trauma informed perspective, but we are as i think you mentioned concerned about the safety of our jail health staff. we rely on our sheriff department partners and certainly when the

sheriff department is so stretched in terms of staffing it impacts our staff, so we want to make sure everybody is trained in how to respond to crisis. i want to welcome. we have a number of guests who just walked in. thank you so much for being here. being san franciscans. >> you mentioned before the nurse registry to complement staffing efforts to meet of course the minimum staffing requirements. so, is there a contract and when is that nurse registry contract set to expire? >> the nurse registry contract that we now use as well is the one of the ones used by sucker zuckerberg san francisco general, so we-i dont know the

date of expiration, but we do go before the health commission board when we are renewing that contract. >> okay. >> and also can i say in answer to your last question about trainings and how we train staff as part of trying to keep people say and healthy and who work in the jails. on the line is also tonia mara, director of behavioral health service and if you like to hear more about that she is happy to speak to that i'm sure. >> okay. perhaps when i'm done with these questions. do we know the cost to the city using a nurse registry versus hiring permanent nurses? >> i can get that information. i don't have it off the top of my head. i are think as you saw in the slide showing the number of registry hours we are not using a huge number of registry nurses, it is

really to mitigate the impact of people calling out sick and being on leave and unfilled vacancies, but it is a huge help. i don'ts have the exact cost. happy to get that for you, and-what else was i going to say? i believe that contract is in place for 5 years, but it is really a bigger contract with the general that we use as well. >> that's good to know. thank you. looking at one of the nursing staffing in county jail slide trying to get a understanding of how many doctors nurse practitioners, lvn and rn are at each jail any given time. would this be the nursing staffing minimums? >> yeah, that's the nursing staffing minimums. that's what the rolled out numbers

get you to. it is really hard to say. it is like an incredibly complicated staffing spreadsheet how we staff the jails, and it is all based on census. it is based on aqueuety and who we have available, so >> the minimum staffing requirement at each jail will change depending on of course how many individuals are in the jails and what type of illness or- >> the minimum staffing requirements are spelled out in the mou and as you saw we exceed those numbers, so we staff based on primarily based on census in the jails, but-again, if we are fully staffed we will exceed those numbers in the mou. also to say those numbers are that i showed you for the

actual staffing is a combination of rn's and lvn's serving the jails. >> okay. you exceed the numbers but the same time you need a nurse rejsty to deal with the fact there are people calling in sick or you can't meet the staffing and any given day that is why you have to mandate people stay longer then the regular shift and i understand that happens in our jails. >> that does happen unfortunately. i will say that nobody likes mandatory overtime. nobody likes to mandate people stay after their planned end of shift and certainly impacts our staff. we do it only when we need to insure that our people in jail get their medications, get their nursing care that they need. we have worked

with jail health leadership to set mandatory overtime and reducing that as one of our what we call our true north goals this year so we should see that number continue to come down. especially as we can work with this registry the registry nurses and try not to keep people there past-also 12 hours. nobody wants to keep staff after a 12 hour shift. >> it would be is a 16 hour shift when mandated to stay longer? >> it might be. >> okay. how is that documented? does the department public health document or jail health service document on a daily basis? >> we do. >> who has to be mainidated to stay. >> we do. that is managed by the director of nursing and the three nurse managers in the jails. >> okay. i like to

get a sense how often that is happening because what i'm hearing and i don't know make policy decisions based on here say, i would like to know whether or not this is happening at a rate that i hear it is happening, which is stressing nurses. as i mentioned my sister is a labor delivery nurse at uc davis. my other sister is respiratory, mom retired nurse, the health care industry is not new to me based on the impact it has on family members especially when they work 16 hour shifts. i would like to get a better understanding how often that is happening. >> we can give you the data. i am happy to see the numbers coming down. i share your concern. it st. not good for staff, not good for their families and i dont think it is a good way to run a health care system. that number should be coming down and i would hope approach zero. there

is sometimes completely unavoidable, but the jail health leadership knows that we need to keep that number as low as possible. >> we need to figure how to help you do that so we need a better understanding. >> it is interesting supervisor just last night i was reviewing data from jail health services and i saw the tracking numbers for mandatory overtime. it really is the trend is going in the right direction, and i thought about scrambling and trying to add that graph this presentation, but didn't, and happy to share with you afterwards. we can add it if to the slide deck for public. >> okay, that would be helpful. i just wanted touch on the secondary employment issue really quick, because i know we did receive an e-mail and thank you anna for that, and

of 142 approved additional employment requests prior to october 21, 2022, none are for employees working in jail health services, but since october 21, 2022, 282 additional employment request submitted for approval, and it said this may include full time or part time dph employ ees. these arepeneding review or under review and may include employees at jail health service. since tay are under review it would seem to me there would be a number or somebody would know how many people are seeking secondary employment approval. >> yeah, we know that a significant number of the jail health employees have secondary employment, but also counted in the 282 are people for whom actually their dph

work is secondary employment and primarily employed by another health system or health care provider. those are counted in the 282. those numbers also include as needed nursing staff. we have i think 16 p103 on staff so all likelihood those people's primary employment might be elsewhere and so but they-if they work full time let's say for ucsf and pick up shifts at the jail we are very grateful. they have to apply for approval of the secondary employment even though again, we are the secondary employment. so, that includes those. we know that a large number of clinical staff in the jails as well as throughout the health

network dph have secondary employment. the requirement is that they be approved to have secondary employment and in order to be approved they have to show there is no conflict. demand for clinician s as i think you all know across the country but especially in the bay area is just huge. our nurses, our behavioral health clinicians who may work outside as social workers, therapists, physicians and nurse practitioners are in huge demand and sometimes supplement their family income with secondary employment. our commitment is to as much as possible make sure as much as able to make sure everybody applies for approval and people only work in another job if they are approved to do so, and they are not any

conflicts. >> thank you. i understand that. my focus now is jail health services and if i could get a understanding based on this organizational structure how many people in this org chart are seeking secondary employment approval. i ask this question i believe in the budget finance hearing we had. just to get a better understanding of what does that look like in terms of the demands on their time and how that might impact issues jail health services is facing. i want to find whether it is documented-on the days that minimum requirements just are not met. i would imagine that happens the minimum staffing requirements are just

not met. >> since we had the registry contract i don't believe that we have not been able to fully staff the jails so we have coverage everywhere. >> okay, can we just get conformation then whether or not that actually happens? my understanding it does and the impact on patient care- >> we will confirm, but again, my understanding is that we have been able to fully staff the jails since we have been able to rely as a sort of safety net under the safety net on the registry contract. >> i did have one question on the epic roll out in terms of you mentioned wifi issue. that seems something we should be able to take care of and you shouldn't have to deal with. given that and my understanding is the nurses now have

to give out medication differently based on the epic roll out, and that with these issues with epic sometimes those receiving care get frustrated because whatever is happening with the system they are not getting their medication when they would like and therefore are getting frustrated with nursing staff because of this new system that is preventing them getting the medication when they are used to getting it. i love a opportunity it hear whether you think that is a issue or that is something worked in as you work out the issues with this new program. >> yes. so, certainly in the first as a epic user i will say at least 2 years using the new system. it definitely makes some tasks take much longer. it is hard to learn a new system and i think especially

for experienced clinicians who are very adept at doing their tasks to have to really think about a whole new workflow and how to do them is challenging. it takes longer and nurses are under a ton of pressure to get it right. so, even though you may think about how you are documenting something, you are most important thing is you give the right medication to the right patient. and, so things do take longer. there are occasional delays getting people their medications. i say for any who had family members in the hospital recently, a lot of hospital systems are facing severe staffing shortages and often people dont get their medications when they are used to or when they want them. that's just unfortunate. i am

optimistic. i'm an optimist especially when we resolve the wifi issues and our nursing staff is more comfortable they have consistent wifi and do the bar code medication administration, i'm confident that the workflows will be easier. will be simpler then the old system, but we are not there yet. >> okay. i did hear that was a issue that the nurses sometimes didn't feel comfortable because people were very upset they were not getting the medication on time and want to make sure nursing staff is protected in that situation and there is a way to address those issues. one last question i'll turn over to colleagues if they have questions. you mentioned and this concerns me, the high turnover rate among jail health staff and burn-out is very real. we know this is-health care workers everywhere i think covid and everything you had to go through was very

difficult. having been a department head, it wasn't over jail health service,er it was just a county clerk, but i interacted with my employees in a way to address issues that came up for them, and i am just wondering what is being done to address that burnout. are there individual meetings? is there mental health offered? what is the director of jail health services doing to tackle the issue and help those struggling in this field? >> thank you. i think that is a great question and top concern of mine and other leaders throughout the health network and department. i think i will ask our director of behavioral health tonia to speak to that because she is the lead on addressing this. i think we like many health

systems rely on behavioral health leaders who's primary concern is behavioral health and mental health of had people we serve. they often are also experts on addressing issues of staff wellness and preventing burnout so i will ask my colleague tonia (inaudible) to speak to that. >> thank you. good afternoon everyone. so, it sounds you are familiar with the fact workplace violence for health care professionals is a real challenge across the country. in recognition of that and based on a lot of conversations i had with or nursing staff, we have been working very hard on developing a new policy, workplace violence prevention policy specific to our jail situation and then definition of violence is broad. it isn't just physical

violence, it is verbal assault and these are things we unfortunately deal with on a daily basis in the jail. it is sadly a part of the job particularly when people come in off the streets (inaudible) people coming off the streets they may be under the influence. they are upset and angry they have been arrested so we spend a lot of time training staff on managing that, providing support for managers and working closely with the sheriff department and making it clear that we have to make sure the patients (inaudible) medical needs are being met, but there is support you can get when you are mistreated or a experience that is traumatic. that policy hasn't been implemented yet because it is still in draft format but hope to have it implemented before the end of the year. a part of that policy is going to be

developing a brand new peer support program. the behavioral health staff has always been a informal peer support program when there is a incident of a nurse being assaulted or there is a particular patient that has behaviors that are problematic and challenging to deal with. we have gotten involved, offered support to the nurse and also to develop multi-disciplinary behavioral plans to help give everyone guidance how to more effective work with there patients. we recently started a weekly meeting called a complex care meeting which all the nurses are invited to-all staff invited to bring forward patients to discuss that are either complex in terms of medical needs psychiatric needs and in terms of behavior, and that has been a great opportunity to involve

the nurses, give them a opportunity to convey concerns and what we do is develop a plan to help them be able to work more effectively with that client and also to know that if there is a situation where you are unsafe we have a way to avoid that individual having to interact with the client. we have one thing that started a couple years is supervision groups for african american staff is clinical support group because our african american staff are often particularly treated poorly by our patients and who experience racial slurs. that group meets regularly and it is open to all staff. not everyone has taken advantage of it but it is a strong group. we also have occasional support groups for women working in the jail and

the specific issues women deal with, and that's lead by our psychiatrist dr. (inaudible) and that is helpful support. and then lastly, in addition to our regular complex care meetings, any patient that presents with problematic behaviors that are causing distress for our staff we will take the lead developing a multidisciplinary plan and that include working with the sheriff department because we need them to be safe when we serve our patients and unlike other settings we don't have the option of having a patient go somewhere else. we have to care for them in this setting and that is very challenging at times. these are things we are putting in place to address burn-out, provide people with support, and create a sense of community and culture

that is valuable to people so theypt to stay and be a part of this community. >> thank you. do my colleagues have any questions? >> first of all i want to thank you supervisor stefani calling for the important hearing on jail health service and touched on a lot of important issues, which you delved into more with your questions particularly around staffing and patient care. i wanted to thank also dph and sheriff office for all your important work and i think the health outcomes highlighted in dr. hammer's presentation are really impressive in terms of low mortality rate and the really incredible work that was

done managing covid for the thousands of our most vulnerable community members in custody. i had one question more around reentry planning and discharge planning and just wanted to understand--so i think the health outcomes while folks are in custody have been impressive thanks to the great work you have been doing, but how does that translate to them when they are discharged and i think somebody mentioned that the overwhelming majority over 90 percent of folks intakes are very short term custody pretrial, so just wondering if--i know the sheriff office has what sound like great programs for older adults and transitional age

youth, domestic violence victims, but i was curious about the broader health outcomes around discharge and reentry planning. >> i will mostly ask my colleague ms. riker to those. most of the programs are run by the sheriff department. i would say that to the extent that we can successfully engage with people while in custody and create a smooth engagement which continues when they get out, that's when i think we have some hope of improving people's health and connecting them to effective care and services outside. the example mentioned the juneau project where people actually meet navigator before they release from jail and then who

then helps them navigate upon release to accessing substance use servicing continuing the medication started in the jail, medication for addiction treatment, those are what i see as having the most potential for changing lives for getting people in the pact to recovery and path to improving their health and wellbeing. so, it is unforch-footly is challenging for jail health because we don't know when somebody is leaving the jail, so if somebody is released at 6 a.m. it is unlikely that we will have a warm body show up is connect with them and help guide them to a place where they could receive ongoing care immediately after

release, but i think those are the kinds of things that will-the more we can do that warm touch engagement in the jail and then a familiar face or familiar program engages people as much as possible as much as we can find people after they release, that's what i have the most hope will work. anything you want to add to that? >> i would say the way we set up our discharge planning office, it is right outside the sliders, so everybody who exits the jail exits one door so that often is staffed monday-friday between 2 p.m. and 10 p.m. which is the timing when most releases are processed, so with the idea of trying to be able to offer services and we do things like offer cab rides or emergency hotel stays for folks who just need like bridge housing to go if had to the

next piece. set up to go to a program but released too late to do intake at that program we can put them in a hotel room for the night. >> thank you. just maybe one final or more specific question for example for substance use disorder and treatment for that, which is a huge issue that we grappled here in the city and you guys certainly do-i don't know if you have any data or anything you could say about how jail health services might be a opportunity to connect folks that really need access to that treatment and services. >> i don't have great data right at my fingertips. i am pleased that our new office of coordinated care and behavioral health services prioritized the population of people leaving jails for getting care

management coordination services upon release. i don't have the numbers for the number of people who we get immediately into substance use treatment programs but we can get that to you. i think that's ideal when we have somebody who is interested in getting on the road to recovery and that includes residential substance use treatment and like i mentioned before, we have been much more readily able to access those services as we expanded substance use treatment beds. >> thank you so much for your important work. supervisor stefani. >> sorry i know you-i wanted to ask a quick question that related to that chair mar. how many of those referred are still waiting for a program because i know referral doesn't actually mean getting into a program. it is my understanding there is a waiting list and people are not

getting in. >> that's just a really challenging question. >> could you (inaudible) >> that is a very challenging question because there is multiple ramps to go into residential treatment from custody, so i would say the biggest one is the collaborative courts. there is behavioral health court, drug court, veterans justice court, community justice center, there is probation, intensive supervision court. all those different collaborative courts are working very hard to link people in custody to treatment upon release as part of that court treatment plan. they all have separate wait list and separate treatment teams. jail behavioral health does work primary contact for the behavioral health court, but these are other courts, so we don't have data. i

know the superior court did an analysis a few years ago that looked at the number, but i don't think we have that recently. there is something called in custody referral, san francisco pre-trial diversion so other criminal courts also make referrals to them and ask them to come up with a release plan often including residential treatment and so they are also monitoring wait lists. the data is kind of diffuse and hard to capture. >> okay. thank you for that. a quick follow up on that. so, with the sheriff office, if you are referring someone to one of the programs you mentioned or collaborative court, is that information documented somewhere? release papers? can that data be captured? >> definitely the courts capture how many are going to collaborative courts, yes. >> we are talking

about the incarcerated population being released to follow up on what chair mar was asking about. as you release them into possible programs, and recommending programs or whatever is happening, is that documented? >> whether or not someone goes to residential treatment is not documented in our jail management system. it isn't in data that the sheriff captures. >> i think if we go to tonia (inaudible) she has data she can share with you. >> okay. it is just a question-when we release somebody from county jail, is there documentation that says what is happening next? especially if you refer to a program we have been discussing? >> to residential treatment specifically, anyone going to residential treatment has to

collaborate with jail health because we are the ones that do the tb and covid tests, the physician report. everything required as part of the referral packet. what we have in collaboration with behavioral health service have begun tracking all referral from the criminal justice system to residential system so that includes substance use disorder programs, dual diagnosis, mental health, everything. so, recollect it is difficult to track everything because a lot of other people are initiating the referral but since they come to us for supportive paperwork we are now documenting that, and we hope to have good data within the next few months. we have-we started in july and i can't promise it will be a hundred percent comprehensive but it is the closest we have gotten to trying to

track the work that everyone is doing. we did get funding to enhance our discharge planning (inaudible) so having someone from jail health actually see each individual prior to them leaving custody and checking them with them on a plan (inaudible) for those that dont trying to do everything we can the hour we have to provide them with support and we will be documenting that. that will be something we can start tracking when we bring those new staff on-board. i agree the data is critical. i can tell you the wait list for substance use disorder programs is about 2 weeks. we see longer waits for psychiatric

facilities and (inaudible) mena and billy holiday, harbor lights, salvation army the wait is all most nothing for billy holiday and mena and there is other programs that you can get not necessarily residential program but it is a place to stay with some support. we can get that within 24 hours. we are working on collecting all of that. >> thank you. >> supervisor malgar. j >> thank you i had follow-up questions about the issue and implementation of epic. the thing about the wifi is one of the san francisco things that are utterly ridiculous at the heart of silicon valley we don't have consistent wifi but i don't totally buy it. i have been also like supervisor stefani head of department and executive director and i know that implementation of

a database and new technology can be really tough so it isn't a technical issue it is a training and cultural value. you have individual value of people not falling through the cracks and going one state to another and the issue of the global data and accountability that comes with. i wonder who is managing the implementation of epic, the staff training, and you also in the presentation said a little bit about how epic is being used by the department but also some non profits so did i hear that right? who has access to it? who uses it and how are their staff being trained and supported in this? >> the epic implementation in the jails as wells a in all areas of the department is managed by our epic team, dph wide epic team, and

they also work with business leaders so section leaders like the jail health managers to make sure that the build is correct so when they open epic the templates they are using reflect and task list reflect the work we do. that is a lot of the pre-go live work and then they also coordinate with our section managers to get their staffed trained and as you imagine with the amount of staff turnover we have, that timing getting people hired and trained and quickly ready to start seeing patients is a significant challenge. jail health as well as the rest of the health network. so, and then in terms of troubleshooting issues as they come up, so like the

issue with wifi, we rely on our it department in the dph to be our leads and working out the technical issues. in terms of the on the ground information that may be needed or adjustments be need to make, that's dr. pratt jail health service's team that works with our it department and then other involved city agencies like dts to try and address problems as they come up. i hope that answers your question supervisor melgar. >> the non profits- >>x the non profits. so, there is a application in epic called care everywhere and through

very strict compliant data sharing agreements people who work for other contracted partners can access the limited records from within epic. that's what people tend to use. if they are-for example, we have tons of non profit providers and behavioral health services and when behavioral health services implements epic many of the contracted partners will be charting directly in epic and they will go through this really stringent requirement to both use epic to enter information and then share data. so, that's strictly monitored by

our it department, the office of compliance and privacy affairs as well as the city attorney office to make sure that is compliant. so, if we have a community partner, a non profit partner they may be able to reach an agreement so they can see some of the records in epic or chart in epic, but it is usually pretty limited and only after they sort of jump through a bunch of hoops and reach that agreement with the city. so, the health information in epic is very protected and so in order to log on to epic you have to be approved and go through certain train ings and securities. we have annual security privacy trainings and all those things. >> thank you and thank

you supervisor melgar. why dont we go to public comment? >> thank you mr. chair. reaching out to the chamber to see if we have anyone with us who wants to provide public comment on item 4, hearing on jail health service. seeing none, let's turn to folks who connected to the meeting remotely. i understand there are 4 of them who wish to provide public comment. if you wish to join them and have comments on item 4, you can provide your comments by calling us 415-655-0001. meeting id is 24948082920. press pound symbol twice and star fallowed by 3 to enter the queue to speak. could we be connected to the first caller for their 2 minutes public comment? >> hi. good morning commissioners. i am a d2 resident. calling to say i support supervisor

stefani and her efforts to address the dph and jail staffing issues. first of all, the care of incarcerated population is important to human rights issue and i specifically applaud all the hard work that the nurses and health care staff workers are doing. at the same time in my opinion it is a massive conflict of interest to have city employees also being paid by non profits the city supports financially. mismanagement and lake of oversight is all too common in san francisco and resident of san francisco are losing faith in city hall and that is to no one's benefit. again, thank you supervisor stefani for looking into this important issue. i hope it results in improved oversight in the future and you get all the information you are asking for from the department of health and i think we need to

end this situation where employees are having multiple jobs that are not authorized and i also support the board of supervisors overall doing everything they can to support the sheriff department and increase hiring there, because that clearly is a big part of this issue and we need our law enforcement to be fully staffed. thank you so much. >> thank you for sharing your comments. next caller, please. >> good afternoon. (inaudible) a district 8 resident in san francisco and (inaudible) of the last caller comments. but i would like to just take a brief moment to express my gratitude to supervisor stefani for her efforts specifically and i yield the rest of my time. thank you.

>> thank you for your comments. next speaker, please. >> good afternoon supervisors. i also echo the comments of district 1 in san francisco was alarmed to see the news reports recently about the double dipping of city employees, particularly in this-in our health system, which is so over-burdened already to know that staff and highly paid staff are using it as a opportunity to launch other careers and not focus on what needs to happen here is concerning and can disappointing and i hope it will be looked into. and it seems like there are rules against this and so i think more then (inaudible)

a lot of time holding hearings and talking about it, i think really just the rules need to be enforced is what it sounds like. i think someone just enforces those rules we poith be in good shape but i thank supervisor stefani for bringing this hearing up. it maz has been wonderful to hear of the hard work and positive work that is being done in the system is and applaud all the people who have spoken and shared their work with us today and all of the front line workers who are doing such critical important work and thank you again supervisor for raising this and everyone taking this issue seriously. thank you so much. >> thank you for sharing your comments. next speaker, please. >> hello. my name is tonia tillman with the group

mothers against drug addiction and death. i would like to thank supervisor stefani for bringing the issue up. it is extremely important that it is spoken about, heard and listened to. i am absolutely just floored. i'm trying to think of the right words to say how angry i am there is absolutely no data as far as how many people who have been in custody and linked to services once they left custody. i just are finished listening to dph say that san francisco has a robust approach to behavioral health service and use three words, screen, stabilize and link. talk about the word link. let's talk about linking people to services. i was told you linked people to services more so this year in the previous years, however you have absolutely no data as

my son sits in jail right now waiting to be linked to services that apparently you guys are supposed to do, however he was told he should take the approach and link himself to services in which i do not understand because it is my understanding that this is the position jail health reentry services should be doing for him. my question is, how many people actually are referred to services, sitting in jail waiting to referral s? i think that question was asked and you have no data on and how many services that you linked people to-sorry, how many people linked to services were actually linked and have those services sitting in the beds right now and probably not asking that because i'm really upset about what's going on

here. >> thank you for sharing your comments with the committee. sorry to cut you off. all speakers enjoy the same 2 minutes to provide comments. could we be connected to the next speaker, please? >> supervisors, first and foremost, this presentation was very very very convoluted. according to the department of public health, there are over 300 employees who are double dipping. that should have been said frankly so that we the citizens and taxpayers could have some faith in the presentation. that presentation was grim. you have to learn to give a very

(inaudible) keep it simple, stupid. having said that directly and indirectly is (inaudible) many of the seniors died and that institution hopefully will not be closed. hopefully. as to our jails, jail number 1 and 2 (inaudible) pathetic. you all know the jails have to be-one of them, 850 bryant has to be torn down. it stinks. sewage linking all over the place in the year 2022. some people got the money but did not want to build a jail. but we have

to think outside the box. 850 bryant has to be torn down. yesterday. you cannot have the prisoners in the stinking jail because the environment is not conducive to- >> thank you for sharing your comments with the committee. i understand we still have two callers waiting to provide comments on item 4. could we hear from the next speaker, please? >> yes, this is joe (inaudible) first, i want to join all the speakers and thank supervisor stefani for the hearing. that's not why i'm calling. i am really concerned during the conversation i too (inaudible) supervisor stefani (inaudible) there was no conversation about preventing recidivism. i think we need to have it

conversation today. i think we need a conversation about preventing recidivism because we had tragieds serious starting with the baby that all most died from fentanyl (inaudible) that is extremely serious and for the lack of hearing on this, before the christmas holiday speaks ill of the supervisors not (inaudible) i think a lot needs to be said and think these things need to be done to fix that. also (inaudible) is quite frankly there is a (inaudible) going around san francisco attacking photographers with guns stealing cameras and trying to sell on the black market. it is huge keep out (inaudible) around the world that san francisco is very beautiful because of the architecture (inaudible) and i know (inaudible) it is

really important you focus on addressing recidivism because your economy is in trouble and community in trouble and i really think that we need to help addicts recover and that needs to be your (inaudible) i want to take a moment and have class and dignity and thank the chair for public service to san francisco and america and wish him well in retirement and (inaudible) stood up to the nra (inaudible) very brave and noble and very- >> your time concluded. thank you for sharing your comments. reaching out to see if we have further callers in the queue. hank hang on a moment until we received the info. mr. chair, no further callers. >> public comment is closed. thank you to all the public commenters about this

hearing and thanks again supervisor stefani calling for the hearing and all the leadership on the issuesism . >> thank you chair mar. i thank the colleagues for outstanding questions and all those who called in. thank you for your comments and of course to those who presented today. thank you. i think we furthered the conversation, i learned a lot. my whole point as i said in calling for the hearing is to really get a better understanding of the nursing staff and health care workers in the jail and get a understanding whether they need more support. what is happening based on concerns i heard and whether or not those individuals that are incarcerated are availed of the programs that they have had in the past. i know that is hard right now because of the staffing shortage on the sheriff part. it is all intertwined and i think we could do better and know there is a lot of challenges we have to overcome to get there and of course we have this

secondary employment thing that is causing people concern. as you know and could expect. if we can just get more information on that. i will outline some things that i asked for in follow-up just to conclude and summarize. definitely looking for more documentation on how many times people are mandated to stay. over the last year documentation on how many times minimum staffing cant be met with nursing registry or whatever. when that happens if it happens at all. how many jail health service employees are seeking secondary employment. we asked that question, particularly in leadership. maybe we can get a better org chart. it is very hard to see. i know those are under review so seems since

they are under review it should be easy to determine who in jail health service might seek approval for secondary employment so if we can get that soon as possible that is great. from the sheriff department, i think linking to services that really hit me through this hearing and obviously our caller mentioned it as well. one of the callers. to get a better idea what this linking to services-when when i started i talk ed about discharge planning program and how individuals engage after release and to get a better understanding of if you refer someone to somewhere where are they going? the linkage to nowhere is a popular term because you get referred but if you are not going anywhere there is no follow-up, are we doing our jobs? could we do better and could we help you do through bet data? whatever we need to do that i

think that would be helpful for us as policy makers to understand if we have these programs and people are waiting or on wait list or referred and not getting there, how can we do better? also list of programs not occurring in the jails because of shortages and again, this is something i did in the letter of inquiry sheriff mimoto to understand the impacts of the rehabilitative programs. we had a plethora of them. we have been bold in san francisco and offered a lot in the past and know covid has made that difficult. our staffing shortage, 192 sheriff deputy short. we know that it is having a impact on the jails and i imagine programming there is article about it, but get a understanding from you what programs are not happening and then if programs are happening are they happening at a limited capacity because of those shortages and are there programs not happening

at all and if they are happening are they happening through zoom? we heard packets on anger management which i assume is not all that effective. so, those thet is what i have for follow-up. also, when i mentioned how many referred are still waiting to get into programs and the whole context around difficult to get the information, i will follow-up with you on that to get a better understanding how we might be able to document that. but again, thank you. i think we could file this hearing. it is a issue i'm not going to file. we will continue to work on it and as we get follow-up and more information we'll continue to work with department of public health and our sheriff department to make sure that we are doing the best we can with the team we have right now and if we need to increase our staffing levels how do we do it, can

we do it quickly, all those issues we face at sf general, whether we need to do that here. thank you everyone and again thank you for your excellent response to covid in the jails. i think we probably did better then anybody else in the country so thank you for that. >> thank you supervisor stefani. mr. clerk. >> on the motion offered by vice chair stefani this hearing be filed- [roll call] three ayes. >> the hearing will be filed. is there further business? >> there is no further business. >> colleagues before we convene this final meeting of the public safety neighborhood service committee of the year and us as members of this committee i wanted to express thankss to both of you for not just your engagement in this important committee and work we have done but for both

for your passionate thoughtful leadership on the issues that we considered here in this committee over the last 2 years and yeah, i know-i also wanted to say that it has been a honor to serve as chair of the committee during some really challenging times in our city the last few years. definitely new challenges and public concerns around public safety, rise in anti-asian hate and violences and ongoing challenges with really big issues around drug addiction and behavioral health challenges and homelessness. we grappled with a lot and important issues in the committee, vetted important policies and had important hearings and public discussions including today in the final meeting. just thank you to both of you and thank

you to clerk john carroll and all the staff from the clerk's office that have really staffed not just this committee but all of the meetings and committees of the board. i know the work will continue. thank you. and we are adjourned. [meeting adjourned] lea

it across the city. [♪♪] the tenderloin is home to families, immigrants, seniors, merchants, workers, and the housed and unhoused who all deserve a thriving neighborhood to call home. the tenderloin emergency initiative was launched to improve safety, reduce crime, connect people to services, and increase investments in the neighborhood. >> the department of homelessness and supportive housing is responsible for providing resources to people living on the streets. we can do assessments on the streets to see what people are eligible for as far as permanent housing. we also link people with shelter that's available. it could be congregate shelter, the navigation center, the homeless outreach team links those people with those resources and the tenderloin needs that more than anywhere else in the city. >> they're staffing a variety of our street teams, our street crisis response team, our

street overdose response team, and our newly launched wellness response team. we have received feedback from community members, from residents, community organizations that we need an extra level and an extra level of impact and more impactful care to serve this community's needs and that's what the fire department and the community's paramedics are bringing today to this issue. >> the staff at san francisco community health center has really taken up the initiative of providing a community-based outreach for the neighborhood. so we're out there at this point monday through saturday letting residents know this is a service they can access really just describing the service, you know, the shower, the laundry, the food, all the different resources and referrals that can be made and really just providing the neighborhood with a face, this is something that we've seen work and something you can trust. >> together, city and community-based teams work daily to connect people to services,

>> the regular board meeting of tuesday, december 13, 2022. roll call, please. [roll call] >> okay. at this time, before the board goes into closed session, i call for any speakers to the closed session items listed in the agenda. there be a