2023 health commission vacation. i have the privilege of chairing the meeting today. will you call the roll. >> sure this meeting is fully remote today and the health commission is buying new equipment which will allow us to have less equipment issues. the first round of that will be installed this week. and we'll be seeing more folks in the room. oh yes, roll call, commissioner greene. >> present. >> commissioner. >> present. >> commissioner chow. >> present. >> commissioner chung. >> present

>> and commissioner andrado. >> present. >> great. >> the land ak novemberment. acknowledgment. >> we ak recognize indigenous stewards of this land and in accordance with the commission, they have never seeded or lost or forgotten the responsibility as care takers of this place. as well as for all people who reside in their traditional territory. as stressed, we recognize that we benefit from living and working on traditional homeland. we wish to pay our respect by acknowledging the ancestors, elders and relatives of the ramatish aloni community.

>> thank you commissioner chung. the next item on the agenda is general public comment. i think there is a statement to read. >> clerk: at this time, they will may address the commission but on on the agenda. each member of the public may address the commission for three minutes. the brown october prohibits those--please note that in each individual allowed wub opportunity for agenda item individuals may not return to restatement to individuals written meeting. written comment may be sent to the address, commission, dphs--if you wish to spell the name for the minutes you may do so during your verbal comments.

and i see some hands up already, a couple of things, as you listen to the agenda, it's the best practice for to you press star-3 if you would like to raise your hand if the item is being called. right now, i see two hands available for general public comment. but i will take others as they move forward. all right, caller i've unmuted, please us know that you are there. >> speaker: i'm very angry, you didn't call me on finance committee meeting on emerging issues and the public comment period. i don't know how you could have missed my hand was raised, mark. >> clerk: you're on three minutes on this clock, would you like to continue? >> speaker: yes.

>> you got it, go. >> speaker: honda across the consultants, totals 26.6 million. first amendment, the agent contract to laguna honda improvement and now shsa second contract. the 17.3 awarded, includes one million in hourly increase of

up to 23%, that has occured in the six months between july 20, 2022 and now with some of the funds up to 450 an hour. november finance committee meeting, mr. sangis hal did not tell commissioner chow, new second contract was even coming before this commission today. the board of budget and legislative analyst was told lah hoped to regain recertification by december 2020. why are the new contractors in december 2023, why? if going to take another year before lha resumes admission? thank you.

>> clerk: thank you for your comments, i will move on to the next. hello. [echoing] >> speaker: hello, can you hear me? >> clerk: yes, please turn off the monitor so you don't reburburate. >> speaker: okay, is that better? >> clerk: yes, that's fantastic. i have three minutes on the clock when the buzzard goes, please know that's your time. >> speaker: i'm i'm part of the black and jewish coalition. and i'm here today to confirm or a price the commission of the activities that are going on

which is a project or activity wnt human rights commission. it includes the recommendation of the committee which are in their final stages of being drafted and presentation to the board of supervisors. before this meeting i went an emailed copy asking that it be circulated to the members of the commission so you're aware of the many overlapping ideas and implementation scenarios that they have device which also fall within your jurisdiction for execution. and i think it would be helpful if they're commission at some point perhaps soon invites a member of the operations

advisory committee health committee to make a presentation as part of their agenda. the recommendations reads for a number of different scenarios, including some of the mental health and substance use that will be talked about later during this agenda. training of health professionals, staffing. that's why i spent a copy of by email because there are too many to articulate. i hope you look at those when they get passed over to you. thank you that's my comments. >> clerk: and i received that email during the planning committee and i forwarded to you about five minutes ago so that is in your box and director i will also forward to you. we have one more caller, one more hand.

caller please let us know that you're there. >> speaker: good afternoon, i'm michael lion, in one exactly one month laguna honda will close and more residents will die unless you can show substantial improvement and resource investments. what have you done? where is the root cause analysis for each of the 26 deficiencies you were hit with? where is the hit analysis of the training that you will do to prevent their recur ans? recurrence. where is the action plan that is due three days from now? where is the revised closure plan that you've been working on ever since the settlement? why was the settlement approved before the supervisors and approved withouter us seeing it.

why are you doing all the business about the closure and resuming discharges in secret closed meetings when hundreds of lives are at steak? are you so da looted that we're going to trust to you dot right thing? or are you hoping to plan to close the hospital and disburse the residents to their death so late that they cannot do anything about it. we don't know what you have up your sleeves but rest assure that we demand on behalf of san franciscoians, no sct see, no disclosure, no discharges and no bed reductions. in vietnam they said we had to destroy the village to safe t.at dph, you say we have to close laguna honda to open it. no way, no closure, thank you.

>> okay, that's the last comment commissioners. >> we appreciate hearing from you. the next item is approval of the minutes and i believe there is a revision that has been hosted. >> commissioners i added on page 10, the community update, i had a very brief statement on commissioner jer ar do and i added the following. regarding the city agency and partnership with which dph is involved and response activities, three separate programs were highlighted including high care preparedness and operations and logitics. they conduct exercise to ensure the city is prepared for crisis. there is a staff of 14 that

plans to increase to 28 staff later this year in an effort to respond and community resilience case. update noted that with most of the uni staff were deployed to covid activity in the first year of the pandemic. returning to normal operations. >> thank you. >> thank you. given that addition, are there any addition or corrections to the minutes? hearing none, is there a motion to approve the minutes? >> i so move to approve the minutes. >> second. >> public comment. >> i see one hand. we're on item 3, the approval of minutes. if you would like to make a comment, press star-3. i see one hand up.

>> speaker: it's patrick. >> clerk: you've got three minutes mr. menetras >> speaker: regarding the december 20, minutes, although i testified during a public comment period, and submitted 150 word testimony, mr. moore wits included in the public minutes, i did not have time or roof in the 150 word testimony commencement contract through december 2022, were reported, 3642 hours at $400 an hour for a total of 1.4 million. during the administrator and home administrator position, view s staff.

the new contract ads another, 300 hours up to 485 an hour for cost of another 1.7 million for nursing home and assistant nursing home position. 268 hours or 3.1 million for the two nursing home administrator positions. that equals 3.61ftes over an 18-month period. again, this commencing required lag no honda duct a search higher to two nursing home

administer to significant money. those should be delt with immediately. thank you. >> thank you for your comment. should we take a vote on the minutes. >> clerk: yes. >> gillermo. >> yes. >> yes. >> yes. >> yes. >> yes. >> the item is approved. >> i think the next item is the director's approach, director coldact. >> thank you, director of health. number 1, wanted to highlight the fact that mayor breed announced a nearly 34 million dollars stake grant awarded to the department to build new

patient for youth at san francisco hospital which will include a 12-bed inpatient program and a 24-intensive outpatient program. the grant awarded by the california healthcare services will address the regional need for treatment options for adolescences who are uninsured or on medicare and at least 900 outpatient clients annually. they will use the fund to go renovate, remodel and bring to code two large unused spaces at the hospital. the 6th floor will include a outpatient and intensive

capable of treating as treating as many as 24 young people at a time. i also want to share that this season has been a an intense one including general and therefore included a message that zuckerberg sacramento hospital, dr. suess an you areling to the winter surge just to highlight the fact that while we're not seeing the number of covid cases last year, we're having a surge of respiratory viruses as well as other illnesses.

hospitals other hospitals are facing similar challenges. including through the holiday season, for many of us is a time to take a breath and our frontline workers at zuckerberg don't do that during the season, in fact it's a very busy season. i just want to call your attention to the message that she and her team sent out. the other piece i wanted to highlight for the commission was during the holiday season this past week, we pushed out a holiday season, to create specifically to promote safe new year's eve celebrations, the team developed and published social media campaign.

preventing drug overdoses and the dangers of fentanyl and how the deadly ingredient has been found in cocaine and other things. how to have tools including overdose medication. we also provided tips on mindful drinking and how to access resources for problem drinking. and we will now go on to covid update slides. so i will run through the slides quickly for our covid update, next slide please. so you'll see that we've had an increase in our covid cases.

we're at levels of 23.9 cases per 100,000, again nothing like we saw last winter whereabout this time, we were approaching that high level of 272 per 100,000. i will say as we remember the cases, lag a little bit from high-risk activities, it takes a while for the case to see show up after holiday seasons and long and busy weekends. i would not be surprised if we saw another bump hired in 23.9 in the next cup the of weeks. we saw this how many winter surges? several winter surges where we do see infections increase. what is remarkable this year, because of the higher level of immunity in our population including due to vaccine and

the booster, we're not seeing the increases cases that we've seen in previous years even with highly infectious variants emerging. next slide. we have 132 people hospitalized in the in our hospitals across, the state. i believe that date needs to be fixed. i believe that is not december 1st. we'll correct this on the slide. but we have over 100 people in the hospitals across the city with covid. this again includes people to be hospitalized for covid as well as people who have been found to have covid and transfers. a number that we're watching carefully but nothing like the numbers that we've seen in our winter surges of 2022 and 2021, next slide. and then in terms of vaccine booster administration, you'll

see we are continuing to have some challenges in terms of people take accepting the bivelin booster, we're at 34% of the entire san francisco population. 59% between the ages of 65 and 74 and 55% of people 55 and up have received that important booster and continue to go emphasize the need to get that, that booster for everyone eligible. next slide. so our covid cases remain high. available surveillance data suggests that the influence peeked in san francisco. so our we're hopeful to take that our hospitals will not be

overwhelmeded by this triple demic. we want to emphasize whether or not the holidays are over for you and your loved one, please continue to protect yourselves and others this winter. get the bi villain booster and get the flu shots and all other steps that we're all familiar with at this point that we know reduce the risk of transmission of respiratory viruses and covid in particular. and again we're working with the state to mrab plan for the end of the state of emergency in february of 2023. just with regard to the m-pox update. i do not have update to show you at this time, because there have been very few cases of covid.

i did want to share that in december again our reporting may not be 100% complete which point because it's only january, 3, we had a total of 2 cases of m pox and no cases recorded since december 16th. a public health success story there. some that has been going on in lag no honda to make sure that we're responsive to the leadership of acting honda ceo, the team has been working hard to put into place a structure to ensure that we have the

outcomes needed to be recertified at log na honda. and i want the commission to see this put into place that we're meeting the goals well focusing on that ultimate goal of getting recertified. so i will just go through the top level of this chart so that the commission can understand, how the work is being structured and for meeting our goals. with survey readiness, survey readiness, the chief quality officer and the chief nursing officer. lead bit administration of operations and dph chief

operations officer, that the action plan for the root cause analysis and response will be lead by the chief executive for the laguna honda recertification. revised closure plan. and top to bottom, is honda, on health management and lead by executive officer and commanders for laguna honda recertification. xwen the holidays for many of us are, while the laguna honda team is there. also making sure that very hard

throughout the holiday season. significant progress on recertification. and are ready and responsive to will require of us. next i was able to meet with laguna honda and the focus, the committed to ensuring to get the quality of care. and then everyone, the family and staff work with each other towards recertification on this very challenging journey. and achieve our goals. so thank you, that concludes my

director's report. i'll stand for any questions. >> my fellow commissioners will agree that, they have worked tirelessly,; we're very appreciative of that. of reassurance as well. stl* any public comment. if you would like to ask question, raise your hand.

members of the public. each individual, for individuals to the meeting. public comment may be sent to the public commission. >> folks on the line when the buzzard goes off, please know that your time is off and i'll be meeting you within a second or so. first caller. >> speaker: hello my name is medically grossman, i'm a restierd social worker and president of san francisco older women's league. i'm here to speak for older

women at laguna honda who's population is reduced because of the slow project and it will be reduced by the reduction of beds through the new regulation allowing only two persons per room. i would like to know where things stand with this particular issue? we have heard about steps for recertification, but we have not heard anything about the bed reduction which is very critical. this reminds me of when i was a young social worker and the push for the closure of state hospitals was the issue of the day. of course, we were all for it because everyone knew that state facilities were bad. but the devil was in the

details after the institution were closed. was the beginning of the homeless tragedy that we have today? i met a woman a party over the new year, she was a resident of the laguna honda and she was fabulous that she was there, she was paralyzed in a wheelchair was with a an aid but she came to the party and it was wonderful to see her. we were talking about recertification and reduction of beds. but this is my home. where will i go? what will happen to me? so i ask you what is the plan to keep laguna honda open and preserve the beds? there is a shortage of beds in san francisco, and most of them do not offer half the services available of lag no honda? let's not reduce and close our

facilities, let's improve and expand them. thank you. >> thank you, for your comment. next caller, you're unmuted, please let us know that you're there. >> speaker: i'm norman did he goleman and a long time resident of san francisco. i would like to urge the commissioners to continue funding lag no honda hospital through the certification project. thank you very much. >> thank you for your comment. >> clerk: caller you're unmuted please let us know you're there. >> speaker: hi, it's patrick. >> clerk: you've got three minutes mr. minuteshaw. >> speaker: thank you. dr. goal fax one slide on the

laguna honda center. but it does not show that revised closure plan or or the action plan may be released so that people can comment on them intelligently to the health commission. new stopped a year ago on january 14th. those who have been admitted in san francisco to stilled nursing facilities, far from their family and friends and medical and support networks.

hope to have obtained recertification by november or december. hired to perform has not been conducted yet. this organization chart has dr. coalfax referred to it, does not provide any kind of inside as to when recertification is going to happen and how laguna honda is going to be staffed by an organization structure.

mr. pickens has released a high level orchard last june. but we don't know how many of those positions have actually been filled and what the structure of the hospital and is going to look like or what kind of patients are going to be served there. it's, it's, kind of trouble some that this slide doesn't indicate how lag no honda is going to be structures and what kind of an operational structure it will have. again, we really need to see this closure plan that you've kept secret for months. >> clerk: your time is up. thank you for your comments. next caller you're unmuted, please let us know that you're there. >> speaker: hi, this is dr.

teresa palmer, can you hear me? yes, please begin, you have three minutes. >> speaker: i'm great thafl great efforts have been made and made over the holidays but you're really leaving us in the dark. is resuming of closure going to happen? are you making any head way to waive the bed cuts? it should be a public document. as an elder who may some day need a bed at lag no honda, i can say that this whole thing is a nightmare.

for people who need a bed, it is it's a life and death issue. and how can you make sure to make sure substance users and seriously mental people who don't do well at lag no honda go? where is in the revised document? you have not shown us the revised document. this should be a public document. please let us know if you're going to continue to continue with the bed cuts and continue with the force discharges and deaths in early february. thank you. >> thank you for your comment. caller, you're unmuted please let us know that you're there. >> speaker: i'm on the board of panthers. i'm going to object the secrecy

where this body conducts this meeting and violates the brown act. secondly, laguna honda is a precious and long term care facility that we would all want for ourselves and our loved one and stands out as a good alternative to the for profit nursing home industry.

for what people in san francisco want and need which is a safe and adequately staff and funded nursing home and the staff to run it. please do all you can in your power to keep laguna honda going. improve it yes, shut it down, no. maintain the pause and transparency on this issue. thank you. bye-bye. >> clerk: thank you, that was the last item, the last hand on

this item and i'm going to be clearing the hands right now before we move on. there we go. commissioner, i think you're muted. >> thank you everyone for their input. all right, i think the next item on the jaebd is dph behavioral health services update with dr. kaonz. >> clerk: i don't think we had any questions or comments -- ~>> commissioner, sorry. >> clerk: that's okayersinger, i don't know if there are but let's make sure that we're giving them a chance. is see commissioner khau hand. >> i want to thank dr. hole tax and that is comforting to know that there is a large strategy a, a health on our strategy to answer a number of the issues that have to be addressed.

what i wanted to ask was, with the ending of the california state emergency, how does that affect and what are, you have indicated that we're working towards being able to respond to that end. what will that actually, you know, entail and what does that change for us here at the department? >> thank you, you're referring to the covid state of emergency. >> yes, that's true, there are several. >> i believe that dr. philip is available to provide some details about how that the team is preparing for that and what the potential implications will be. dr. philip? >> yes, i am thank you dr. cole fax and good afternoon commissioners. we're waiting to hear more from the state. they have just given us the

briefest of outlines so far about what this could look like. but likely would be rescission of some of the orders that loud efficiencies and contracting and use of the additional funds that were coming from the federal government. so we're waiting to hear more about what that state, change can look like. we're also looking as well as coordinating around the bay area with other health officers to understand what if any changes we would do to our own health orders locally. so for information to come. but we're looking at those critically. we have made changes before the holidays to align some of the wordings with the state's order and clarify some definition but

no substancetive change but we will follow suit as many of the other county in the bay area have done. so we'll look at isolation and quarantine orders and directive and general health orders as well. so that will all be in process over the next couple of weeks to really prepare for the end of the state wietd covid--state wide covid emergency. so this would be leading up to covid becoming another one of the respiratory illness that's we do prepare for, that we boost vaccination rates for and that we're working with our community partners on. but i would no longer have the special status of emerging pandemic. : >> i just want to clarify at

the end of february or the beginning of february? that they're intend to go end the state order? >> i believe it is mid-february but i will double check that and make sure that the commission has the date. >> okay, we're coming up on it and if we can get continued updating us to the department. thank you very much. >> certainly, thank you. >> i do not see any other hands, i realize i had one question for director colfax. what the next key dates in terms of expectations on laguna? >> so let me bring up my notes here, we're scheduled to provide

action plan report to cms. for february. so that's one. >> that does give us time from now to february 10. >> that's correct, yes. >> good, that was the only question i had. so now, we can move on to the behavioral health report.

>> good afternoon, commissioners, very nice to see everyone. i'm very pleased to be here to provide a report regarding behavioral health services and to provide an update and answer some of the commissioner questions that we received. next slide, in today's presentation, i'll provide just a brief overview about some accomplishments focusing in some of our key metrics that we're still developing for san francisco, and overdose prevention update and update with care course and an update of which you heard from dr. colfax about children family and youth expansion. i know that you and i'll be presenting a shortened version, i know just for the sake of time.

next slide. you have seen this slide before, just to ground us, that the mission and vision for behavioral health at dph is to promote, aiming to intervene early and promoting intervention that promotes outcomes in a fashion. when healthcare is needed, we're aiming for it to be proactive and timely and available and equitable and outcome driven, next slide. i'm pleased to announce a new member joining from yous alameda county but rejoining the department of public health working previously worktd as director of our equity group

and mental services act group. he's now rejoining us as a role in the managed care director. and with that t the full intended compliment of senior staff members is complete and you can see the leadership team for behavioral health in front of you. next slide. i'm now turn to go performance metrics as all will recall the performing metrics is to help people with serious mental illness who are experiencing illnesses get off the street and into care. what is you have is current operation analysis of using both dph data as well as shs

housing home assistance housing data to understand that mong people people experiencing homelessness, 8700 of them, this is focus population for mental health sf. 40% have and 51% have a serious mental illness and you can see that there is significant people that have both. you have seen this slide before and these are the 11 selected for sf. what i'm sharing with you today are metrics that are highlighted in yellow.

i'll be sharing number 5 decreased wait times. and you have seen the rest in your packet. we're waiting to get initial reporting and then regular reporting on each of these he 11 metrics going forward. and that is for intensive case management. i wanted to remind you and us about what icm consist of. it's a level of care that provies intensive outpatient behavioral healthcare treatment. so it's a treatment klugmanagement, with disorders. clients who are elgabling for icm level of care must have a

mental health diagnosis causing functional impairment or symptoms as well as imminent rick of worsening without treatment. and you can see these there, which are measures of the reverity of their illness and impairment. these include behavioral health treatments, and psycho therapeutic or counseling. case management, they offer services in community or in the field.

at the moment, we have a total of 14icm programs serving adults. this includes just for your awareness, sub type of program which has been type of program that the mental act. and target that focus on people who rebuild the system. 1,000 and 177 new clients began icm treatment in the last fiscal year.

for the first time we have calculated what is the median wait time for new clients, i'ming to understand how long people were waiting to get into care. we found that the median wait time was 35 days. the wait time begins the clients's referral is received and when the treatment episode starts. for clients that waited longer than ten business days, other health dale whiler they're waiting to they did get some care. what you can see here, is that

by age older adults have longer wait times than other adults and age use that men waited longer for care than women. asians have longer wait times than historic and latinx folks. just know that we perform specific analysis on most of these, they were non significant, meaning no difference except by stratified. next slide. by language spoken to speak english is a primary language, had a longer wait time than folks speaking other languages and people experiencing

homelessness had a lower median date of wait time than folks who are housed. we are, let me go to the next slide and then i'll save my wrap up time. we're waiting to reduce the wait times and understand the differences among groups to reduce the differences by enlarge they were not significant except by gender as i mentioned. we have a number of counter measures that we're aiming to complete implementation including increasing workforce. and helping and by expanding the provider contract to add staff. we're also aiming to issue rfp to establish new services and increase capacity, we're hoping to get that rfp out by the end of the month.

additionally we're working to step down care into routine outpatient care. we're working to step them down as a appropriate, and with support in order to free up more spaces, in order to increase their support and outpatient care. we have added some resources for better retention. as one of the commissioners asked, we, we are in the process of setting goals for the wait times and as we add resources we'll be able to understand the impact more closely and tweak our plan. to really make a dent. we believe that they are present. we're hoping to do a data on a

six-month basis. so we will have before continue to go present this. examine overdose data to you all. i know that you all know that this is a crisis, being driven by fentanyl and substances including cocaine and methamphetamine. twaoeb january and february, there have been 556 overdose deaths considered a preliminary count done by the office of chief medical examiner. we did see a decrease in the final numbers from 2020 to 21,

and we anticipate that we will not exceed 2021 numbers but need to wait for finalized numbers here. i want to share and review our department's approach to reducing overdose stuff and reducing problematic substance abuse in the city. i think you'll all be familiar with the stages of change model that inform, really all scientific work around the substance use. and match different intervention by person stage or readiness for change ranging from your left free come ten placing which means the person is not even thinking about

change, come ntemplatetion the person is thinking about change and maintenance means that the person made change and they're trying to nain tain that. our goal with our overdose prevention work is to strengthen that continuium, continuium of evidence base services in order to save lives. matching services for a person state of change. as you can see on the left, syringe aiming to engage a person in life saving activities that may or may not require them or demand of them

that substance use significant decrease or cease. as the person moves along and as the intervention helps move, we get to the right hand side in which it is the most formal including intervention and outpatient treatment. in the case of opioid addiction, ought to use medication or medication offered this is true for alcohol as well. this alsoing includes environment that is not formerly treatment environment but called sober living or recovery housing, all of this helps i person be in a maintenance state of change. next slide.

so we've had a lot of question and i know commission is aware of the conversation. one part of this continuum of services which i just updated, san francisco along with your commission support have passed, adopted policy in 2000 and the board of supervisors passing overdose prevention recently in 2021. i want to just remind all of us that it's not stand alone approaches in the system of care but need to be part of and mixed together with the continuum of services so that the as the individual changes a range of services, a range of interventions are available to

meet those needs, prevent overdose and keep the persona live and mitigate other drug use. reknow from decades of research and you know, reduction save lives have been chosen to reduce the drugs associated. into formal drive treatments, we know from other scientific studies that people who are user of and overdose prevention program have a two to five fold increase. so we know that the harm reduction approach can serve as an entry and linkage to treatment.

next slide. some have asked about some of the metrics around the overdose plan including that in one to two years, we want to have dieloxin distribution. within three to four years, we're aiming to increase city wide distribution to 100,000 kids annually and have noloxin available. we are also ambitiously aiming city wide by 2025 and reducing racial disparities which i did not mention.

so these are important metrics that we are really working very hard to achieve with our our broader overdose prevention plan including strengthening the entire community of services, okay. all right, next slide, i wanted to provide the commissioners. just this past september, the community assistance community and empowerment care, court legislation.

that would be likely to resolve. there is a rollout that will begin next october with the first cohort of which we are a member along with six other counties. they are mayor's office and other key stakeholders. our planning team is in progress, we are estimating both the population what we anticipate to be eligible as well as resources that may come a long with that, that, we are we have wide population estimate sxz will anticipate more clarity as we further

refine enrollment and investigation processes. next slide. we're very excited about the grant award from the california department of healthcare services which has the promise of expanding both in and intensity outpatient programs for youth in san francisco. two other updates is we're in the process of developing a medical contract with ucsf in for their services in their new psychiatry building. this will have the capacity to serve as well as for specialized evidence as well as

eating disorders and other conditions. additional low, we're excited about our family first prevention services act which. and further expansion of services. thank you for your interest here, the ucsf program will focus on outpatient services using evidence base practices. we expect the programs to be able to treat with severe illnesses. but also have capacity to treat specialized conditions.

and then, the we are aware at ucsf has been long. so not youth with medical or uninsured. this is a new contract, so we expect that we will expand services, but they still need to get medical services. there is still a lot that stands alone. the main objective of the is to prevent you from entering the child welfare system. and it includes, or has potential to includes practices

that are non clinical that community settings can prevent. we should have more information and happy to update the commissioners as we have it. next slide, that was lightning speed, thank you. >> thank you, thank you for that update. is there any public comment? >> clerk: folks on the line, if would you like to make a comment, please press star-3. we currently don't see any hands, give it a second to make sure. all right, no hands. >> all right, commissioner questions, commissioner guillermo. >> thank you. there were a couple of

questions that i realize that a number of people served and a number of folks served in another service and we have to get back to you on all those questions. we were not able to get them today. >> thank you, and thank you for that report, the new data that provides us with some very important information as we continue to monitor the progress of all of our initiatives. and good news on the funding. i had a question on the arm reduction slide or the piece that you were talking about. that proof the ethicacy, i'm wondering are there data or any

research that is specifically focused on our efforts in san francisco? and the policies associated with it, it would be, i think just an important contribution to the field. >> that is a great question and others on the line know the answer. i will just say, that one of the successes in terms of h.i.v., including the data from san francisco, is that there is an extremely low prevalence of h.i.v. starting from really much earlier in the hiv-aids epidemic that was attributed to

the establishment of syringe programsing in the san francisco. that is an example of san francisco being relatively early adopter in distribution of high genic. we've been increase the number of people receiving the medication that's you've been working which has been shown to decrease. over the last 8 or so years.

as well as our other innovative programs including our street medicine program including something called our bridge clinic and thanks to our colleagues at zuckerberg as well as pop c funding as well as our addiction cult team. so these are all speeding up to what we're seeing at a city level of increases and working treatment. and really a doctor and part of an published on the distribution and successes. and prior to fentanyl, the

early adoption and really innovation and getting out in the locksoon, into the hands of people who themselves were at-risk of overdose or in social networks. where their friends or family were thought to delay and increase over death. here in san francisco our very strong systems of care. and increases of overdose death that we've seen. but it's clear that we're not a match against the entry of

fentanyl into the the supply here. i think that is through the, part of the point that i was trying to solis tate here. singular strategy when in fact, it's quite complex. and if there was researcher data focused on that reduction played in the constellation of approaches and outcomes that could be something that could be shared sort of more publicly, the masses, as

opposed to sort of, the understanding that we may have as those who you know, you know, is part of our responsibility to kind of better understand all of this. i don't know if there is a way to carve that out, but i do think that from a communication and public from the policies that we have, it would be really important to try to i guess make it clear the relationship or non relationship that this particular strategy has to the overall issues that we experienced in san francisco around those those issues that are related. >> thanks, very helpful, thank you. i appreciate the question and

comment. this report which is really helpful. and also just traoug to answer with my question on the ucsf program with the medical contract. but i guess my, you know your answer totally understand those with private insurance, it's, you know, it's a six to twelve month wait list. but then with this new medical contract? are there going to be any other disorders? i guess i'm not concerned whether or not we've got two

doors are are they then for the specialized services high more people and have more of comprehensive, let's say eating disorders program, no matter private or medical. that's what i guess i'm concerned about. and it's worsening, is that also what do i hear what you're implying there as well? >> possibly but it's like, okay, if you have medical. how this program which is absolutely needed, i think it's wonderful.

but i'm just concerned with the overall direction for the purposes which are great and extremely staff very staff limited. from in patient to outpatient with a secondary specialized condition. do they supercede somebody else. and ensure care for kids and

adults who are publicly ensured or uninsured and that is as you know our primary focus and responsibility. there has been a dearth of these kind of specialized services. and that is obviously of concern to all of us. i also hear what you're saying which is large in the city is a problem for commercial surers.

and experience that the people are seeking their services have timely access which i'm hearing from you, is the problem. for many of our kids, their wait list is really long right now. you know, there is just a lot of kids needing services. so i'm just concerned with this funding that in the planning na is going to feeder to the fire so to speak to make sure that the kids are served in the timely manner. and thank you. but thank you for all of your information.

>> i see commissioner chaz's hand. >> thank you, and thank you for this presentation. i was really struck that you were able to decline the key population that you're really trying to target. i would like to suggest that as you are looking at your metrics whether it be in the lock zone or 75,000 or 100,000 that we can then see this as what your final goal is when what you are when we're looking at your core

measures. and and if not, what are some of the challenges and impediments and what else you may need in order to get them. i find that your core metrics are really importance and they're drawn out and kind of looking for a more of a i guess, quantifiable achievement which then would help us understand the progress being made. thank you for laying this dpoun and continuing that.

i was curious about two things. while you have statistics showing that certain groups did or did not have a disparity then, you sort of ended saying they're not statistically significant. i'm concerned because i was going to ask you, if you're saying that those who don't speak english were able to get services faster than those who did, then, but it's not really significant does that mean that, we didn't have a big enough without work oning that and like wise, the other very important questions you raised. you raised them, you presented what sounded like opportunities. i don't think they are because they're not significant. so are they, opportunities or are they not significant? and/or inetiquette sampling.

that is my first question. my second one is, when you say we had a continual grant, what are those conditions? let me take the second one first. >> the second one is, we have, we received the grant, it was a pardoned to us, we need to go through the and final approvals so we have been asked to call it continual. i think that we don't fully know because this is the first time that we're looking at the data in this way, whether it's

a sample size problem and the differences we're observing don't holdup statistically. so for sure with gender and we want. we want to take these opportunities and not ignore them but as we continue to a kaoum date data points, we know whether nair stable this way and the whole sample is 177 people once you cut it into smaller sections, it's not as stable as we would like to see. the fact that we can look at these see if they're stable on changing and not changing, we'll see this to understanding

how our programming is or isn't reaching people in a timely fashion. and perhaps i should have just been silent on these issues. i think we'll know more and be more confidence in one or two differences that we're seeing that we really need to address. >> great. so you're not giving up on the measures. >> at all, at all. >> thank you. that's, that is very helpful. core metrics and clarity that, i think is so helpful. but i would be interesting in knowing when and if you'll have

goals and stretch goals to accomplish some of the percentage increase as part of that. i'm curious to note, years gone by we've had such staffing issues and emergency declaration has helped a great deal. i'm wondering what your thoughts are and discussed in this whole use of uc staffing. to what extend will staffing will be a fact like intensive case manage and shorten the days. and another question, i'm wondering if you have another data, there is a number of, so as we look at the numbers of you know, homeless persons and individuals who may qualify for the program, do you have any sense for what the up take might be. and if it's great, great, and if it's not how we may take steps for people to participate.

overdose prevention dose and for sure stretch and ambitious goals that we think we have the means to push on aggressively. we're still working through our goals for decreasing wait times. i think seeing this data for the first time, really gives us a starting place.

as you know, we're undertaking a wage analysis as one of the drivers to staff and gaps. we're in better shape than we were before the emergency declaration that is for sure. examine undertaking a variety of, we don't have the capacity to do what you're describing. i'm not sure we're going to get there soon but we have a related measure which is we're going to be as you saw in our

metric list, looking at people who have a crisis service. or 5150 what proportion end up in routine care. and who the proportion of people who call off, whether they have a timely appointment whether they're not able to be found because they don't have a fixed address, they will not be able to capture. but the outcome is, we have to be in regular care, routine care, and that we're aiming to measure. and that guess importantly what you're suggesting. if we cannot get people into care, we cannot help them. and so that is vital importance. as we're learning and as you can imagine, the data streams

are complex and we're working to validate some of these define by what we mean. validate the data that we do have no todayer get a base line and obviously improve that we're work to go improve and we're not waiting to improve but to have measures that we can follow in that regard. >> thank you, when you look at norcan where do you put them in the spectrum of harm reduction and ethicacy. where does that land. >> i think there is not one answer to that question. i think that i would frame it as a harm reduction intervention.

and spectrum, that said, we know as you all know that return to drug use or relapse is common event among people with substance use disorders. and often it's for people in treatment or recovery, it's really important because should a relapse occur, we want the person to survive. and with so many fentanyl in the drug supply these days, what would probably historically has been a lower risk event can be fatal because of fentanyl and we want to make sure that everyone at-risk has access and people who know people of risk have access to it. it should be, we think an intervention that happens

across the continuum of services. >> thank you, thank you so much for this presentation. thanks so much. >> thanks. >> so the next item is district received in fiscal year, 2021 to 2022 and mural will present. >> good afternoon, i'm happy to be here in acceptance of gifts. please find in the commission materials, report detailing 3.1 million dollars of gift dph accepted for the course of fiscal year 21-22. and other sorts of equipment in supports of covid response. details are in the commission meeting materials but happy to talk through any questions you

may have. >> is there any public comment for this item? >> we're on item 6, the annual reported gifts received this is not an action item. please press star-3 if you would like to comment. >> i see no hands let's give it a second. >> no hands. >> commissioners. >> all right, are there any questions or comments on this item? >> i do not see any hands and we're obviously grateful for the gifts and recognition of great work that is being done that these gifts represent. thank you.

the next item is the resolution making findings to allow tele conference meetings under government code section 54393e. >> this is the same resolution that you've been passing for 18 or 16 months, it a louds you to have hybrid meetings. it's the act language i just change the date every month. >> all right, and are there any comments? >> clerk: please let us know if you would like to mack any public comment. i don't see any hands. >> all right, is there a motion to approve? >> i'll move approval. >> i second. >> i'll do a roll call vote. commissioner jer ard o. >> yes. >> commissioner chung. >> yes. >> gil jer month. >> yes. >> chow.

>> yes. >> and gray. >> yes. >> okay, the item passes. >> okay, the next item is finance and planning committee update. commissioner chung. >> thank you, the finance and planning committee met earlier today to go over the january 2023 contract report and also 5 contract, and we ran out of time to financial report. so we have tabled it again, now for the second time until february. and also, we are stipulating that if we continue to run out of time because of the number

of contracts that we have to approve, we will consider bringing that to the full commission, commission for the presentation. and also, commissioner green has questions about some of the hourly rate of the health services advisory group which they have two new contracts that we reviewed.

train new staff to replace them, you know, like when the--and that they only pay only for the services that they rendered. it seems luke a lot of hours but it may not take that much hours for them to complete the job. can until the consent calendar for the report, we'll have to extract the chinese hospitals contract report separately because commissioner chow had mentioned conflict of interest and will have to recuse himself

on that particular item. >> okay, let's see, i know going to run us through this especially through the item that needs extraction. >> before we get there, we need to take public comment. >> yes, yes. >> is do see a hand. so folks online, if would you like to make a update, press star-3, again i see a hand. you have three minutes. you are unmuted. >> speaker: i'm speaking on item 8 and later on item 9. >> okay. >> speaker: on item 8, the first quarter report notes fully 23.9 present million of laguna honda 27.6 million third quarter deficit was drnted to

the shortfall. produce quickly, quotes to one year, present the first quarter report. new admission to laguna honda stopped a year ago, four quarters ago. to note, lag no honda will not resume before the end of the third quarter at the end of march. this suggests 5 quarters of

lost medical revenue, possibly over 100 million lost. it should have been a priority to get lag no honda recertified before the end of december, his first plan. so that dtna would protect its funding trend. i'm not buying it, hsav is the only contractor qualified to do this level of work. for one thing this contract was not competitively bad, and it's showing on the first quarter revenue report. and the third and fourth quarter of the fiscal year, january 1 to june 30, 2022, you

need to own up and tell exactly how much medical revenue is actually lost fwhauz was not itemized in the third or fourth quarter reports. you need to be more honest and less secretive holding the reports from members of the public. thank you. >> commissioner comments on this item? >> i want to understand fully what i heard is that h-sag is the organization approved by cms and that is the sole organization on the west coast that would meet the stipulatelations required of us, that part of the charge

would be to not only give a job of every leadership posted but also to help identify and hire the replacement in an expeditious manner as possible. and that the contract is kind of the most that we need, we may not need all of those hours with them. is that an interpretation of your report? i think you're on mute. >> i believe so, because there are two contract reports. one, two new contract. one of the contracts also included write cause analysis. so some of the services are, really have the time constraints to get them done.

>> thank you for the clarification. and the next item is consent. >> sure, i'll note on behalf of the commissioner, the committee recommended that we approve all items on the consent. and before we get there, we'll take comment. foexz on the line if you would like to make a comment, press star-3. i do see one hand. mr. minutet, i've got three minutes. >> thank you. the only contractor, that is nonsense. this is a bold attempt to cram

through the contract. i'm going to listen carefully of the audio of today's hearings because what you guys are saying, is nonsense. regarding the consent calendar contracts, the 7.7 million contract purchase, total contract for 17.3 million per date, including that rotten price increase for one million for billing rate of less than 23% higher than back in june. to produce analysis report, did the report include,

significance to the commission last august that lag no honda had been following the wrong regular guidelines using guidelines instead of using cmsing skilled nursing facility guidelines. therefore causing non compliance. mention was not included in the rca report, terrible job and route cause analysis because, following long regulations was obviously a substantial contracting. should have provided the rca

report in this commission and you know how have an obligation to release the report to members of the public can see it now. >> that is the only public comment that i see, thank you very much. so commissioners here's what we do this. consent calendar is usually one vote for the en shire consent calendar. because we have a contract with the chinese hospital contract, what i encourage is for commission to make a motion and extract from the contract reports for a separate vote. once that is done, we can put that on the shelf, the full commission including commissioner chow can vote on the commissioner calendar minus the chinese contract.

so let's take abstract the chinese hospital from the contract reports. >> is so move to extract the chinese hospital contract from the current contract vote. >> second. >> great. commissioner jer regard o. >> yes. >> commissioner chow. >> yes. >> chung. >> yes. >> and commissioner green. >> yes. >> okay, i'm put ing the chinese hospital contract on the shelf. so taking the en shire calendar except the chinese contract, please make a motion to approve at calendar. >> so moved to approve the consent calendar. >> i'll second. >> again, commissioner chung can't vote on this. commissioner jer ard o. >> yes.

>> commissioner guillermo. >> yes. >> commissioner chow. >> yes. >> commissioner chung. 12346789 yes. >> so everyone except commissioner chow can vote on this next item. we need a motion to approve the chinese hospital contract. >> i so move to approve the chinese hospital contract. >> i'll second. >> i'll do a roll call vote. >> commissioner guillermo. >> yes. >> yes. >> mr. chung. >> yes. >> and commissioner green. >> yes. >> so that's everything on the consent calendar is approved. >> thank you for guiding us through that. we would still be in the first motion if it was not for you. i guess other item is other business? is there any other business? >> i do see a member of the public with their hand up, we'll go there first. >> excuse me, point of order, i

think that there is full approval of laguna honda policies. >> that's differed. >> okay. >> that will was earlier version that was taken off and that will be considered at a meeting in two weeks. >> my mistake. >> sure, all right, back to item 10 other business, i'm sorry, mr. mineezsaw. >> speaker: thank you, i just want to beat a dead horse about whether shap is the only consultant qualified to write job descriptions and assist with recruiting to fill the hospital staff positions. it sounds like you guys are making up excuses along the way to justify this contract. but i'm not buying what you're selling.

as far as other business, i don't understand what commissioner chung just said. i would appreciate it if you would repeat what it was that she stated, thank you. >> commissioner, you all can comment on this item if you would like to comment on this item. >> i don't see any hands. >> okay. >> okay, so the next item 11 is committee report on which we have none because of the holiday. >> commissioner green, we have to ask for public comment and there is a hand up for this item. that hand. mr. minutet ?nd shaw would you

like to make a comment on item 11. >> speaker: yes, i thought you had a jcp meeting that you had first and then reinstated it, i would have thought that you would have commented today about how that meeting went. and i will look forward to audio both today finance meeting and commission meeting and if you would kindly shoot me an email telling me where i can find the audio reporting, i would appreciate it sir, thank you. >> thank you. >> that is the only comment. >> all right, then, i guess we move to the last item which is adjournment.

is there any public comment on this item? >> we don't take public comment on adjournment. >> so moved. >> i'll second. >> roll call vote, commissioner jerardo. >> yes. >> commissioner guillermo. >> yes. >> commissioner chow. >> yes. >> commissioner chung. >> yes. >> and chair green. >> yes. >> thank you for attending the first meeting, we hope it's a healthy year for everybody. >> thank you, thank you mark, >> py new year.

>> shared spaces have transformed san francisco's streets and sidewalks. local business communities are more resilient and our neighborhood centers are more vibrant and lively. fire blocks and parking lanes can be for seating and merchandising and other community activities. we're counting on operators of shared spaces to ensure their sites are safe and accessible for all. when pair mets, firefighters and other first responders arrive at a scene, they need clear visual access to see the building entrances, exits and storefront windows from the street. that

means parklets should be transfer in the areas above inches above the sidewalk level. it's best if these areas are totally unobstructed by transparent materials may be okay. you can check with fire department staff to make sure your site meets visibility requirements. emergency response crews and their equipment need to be move easily between streets, sidewalks and buildings, especially when they are using medical gurneys, ladders and other fire fighting tools. that means that parklet structures need a three foot wide emergency feet every 20 feet and 3 feet from marked parking spaces and emergency access gaps need to be open to the sky, without obstructions, like canopies, roofs, or cables and should always be clear of tables, chairs, planters and other furnishings. emergency responders need to use ladders to reach windows and roofs to buildings and the ladders need

unobstructed overhead clearance and room to be placed at a 72-degree angle against the building. clearances needed around the ladders to move equipment and people safely up and down. so not all parklets can have roofs ask canopies depending on the width of the sidewalk in your area. please make sure that your electric cables are hung so they are out of the way and (indiscernible) to the structure, they can be pulled down by firefighters. cable connections need to be powered from an outdoor reciprocal in the building facade because hard wire connections are much more difficult to disconnect quickly. these updates to the shared spaces program will ensure safety and accessibility for everyone, so we can all enjoy these public spaces. more information is available at sf dot gov slash shared spaces.

meeting at 10. . 02 a.m. call the roll. good morning respond with here or present. >> segal. >> present. >> lauren post. >> here. >> paul woolford. >> not present. >> fady zoubi. >> present. >> 3 members upon present we have quorum for the public work's commission. due to the on going covid-19 health emergency and given the recommendations issued by the san francisco d. public health and the emergency orders of the