all right. good afternoon san franciscoian, fellow commissioners and staff and welcome to the health commission meeting of tuesday january 17, 2023. i hope the new year is finding you all well and staying dry and healthy and safe after this very wet weather. secretary morewitz would you please call the roll. >> commissioner green yes. >> commissioner commissioner giraudo yes. >> commissioner chung. >> yes. >> how chow. >> yes. >> and commissioner bernal. >> yes. >> good afternoon and welcome to the january 17, 2023 health commission meeting. the meeting is held in hybrid format and occurring on here in person. broadcast life on sf govtv. available

to view via webex or listen by calling the number on the screen. i would like to remind all individuals and in person today that all health and safety protocols and rules must be adhered to at all times and wearing a mask and coverings your mouth and news and including when you speak. fairir from the rules may remove you from the room. we appreciate this in the interest of anyone's safety and a hand sanitizer is available in the front of the room. we westbound public comment period. there is an opportunity for general public comment at the beginning of the meeting and to comment on each discussion item on the agenda and each comment is listed to three comments. if you wish to make public comment press star three to make sure your hand is

recognized. public comment will be taken in person and through call n the commission will take public comment from people in person and then remotely. those in person are requested to submit a card to me. please note that policies and law prohibit discriminatory or harassing conduct against employees during meetings and will be lated and public comment is only within the matters of the health commission jurisdiction. thank you. >> thank you secretary morewitz and now it's my privilege to the title. the san francisco health commission acknowledges we're on the unceded ancestral homeland of the ramaytush ohlone who are the original inhabitants of the san francisco peninsula. as the indigenous stewards of this land and in accordance with their traditions the ramaytush ohlone have never ceded, lost, nor forgotten their responsibilities as the caretakers of this place as well as

for all peoples that reside in their traditional territory. as guests we recognize that we benefit from living and working on their traditional homeland. we wish to pay our respects by acknowledging the ancestors, elders, and relatives of the ramaytush ohlone community and by affirming their sovereign rights as first peoples. moving on to our next item. we have general public comment. as a reminder to participants who maybe viewing this is the time for any matter that doesn't appear on the agenda. secretary morewitz. >> yes, press star three if you would like to make public comment. note there are several items about laguna honda on the agenda and if you're making comments on laguna honda this is not likely the time to do it so it's up to you so i see one hand. we'll take them in order. we will unmute you and you have three

minutes. will i'm sorry i'm having trouble unmuting. there we go. okay. caller you're unmuted. please let us know you're there. >> i am here mr. morewitz. [inaudible]. >> you've got three minutes. >> thank you. this commission's august second finance and planning committee reported bugi sanhar noted that ricertification goal was to add sustainable city provisions to took work over of consultants and consultant and measurers. by the end of 2022 the pilot of the new leadership

[inaudible] would bested to determine if the leadership model is effective. commissioner guillermo assumed that the leadership might warrant continuation but as far as evaluation of the leadership model and the timeline for recruiting laguna honda positions. it was claimed that job [inaudible] might be posted by the end of 2022. respondents to my january 11 record request next request staff asserted dph had "no responsive records" for either the evaluation data girl elemento requested it nor the evaluation analysis reported that. >> . >> told commissioner chow it would be conducted by the end of the year to

determine if the leadership model is effective. why is the data and analysis not been completed yet? this commission knows perfectly well that hiring a licensed deeply experienced administrators could take over the work of these consultants. that hiring for nursing home administrator should be a top priority and in the best interest of laguna honda hospital's residents. thank you. >> thank you for your comments. folk on the line i had been told it's hard to hear on sfgtv and so just remember there's an option to watch us on webex because we're having technical difficulties. that's the only hand that i see for general public comment. >> all right. thank you secretary morewitz. thank you caller. our next item for discussion is

the joint conference committee and other committee reports. for this we have commissioner chow who is a member of the laguna honda hospital jcc. >> thank you president bernal. in the absence of commissioner guillermo she asked for me to report what the jcc had done on january 10. >> commissioner chow plastique up a little bit. thank you. >> okay. >> . >> is that better now? >> yes, sir. >> yes, sir. >> okay. thank you. and i will note mark when you're speaking your also quite soft. >> thank you. >> okay. commissioner guillermo asked me to report the following on the january 10 laguna honda hospital ccc the committee reviewed its standards report including the executive report, human resources, finance report and their regulatory affairs

report. we discussed the recent updates on recertification and closure plan updates which are contained in today's meeting update. the committee also discussed the voluminous policies which are on today's agenda and heard comments and concerns from the members of the public. at the meeting commissioner guillermo also wished to set the tone for today's meeting in the following and i will paraphrase she said she would otherwise be here today. the bulk of the necessary work is already in place to move towards the implementation of the action plan. laguna honda is not waiting for cms or dph approval to do the welcome. that work continues daily.

there maybe some adjustments from the action plan or from them in response to surveys. however the infrastructure as we've heard is in place to continue moving forward. we all need to orient ourselves in this positive manner even with the unknown issues and final approval still pending from regulatory bodies. we have the strategies and operational structure in place. the enormous amount of effective quality proven work and ongoing monitoring of that work done by our staff and consultants are an indication of the excellence we're trying to put in place as laguna is reestablishing itself as a high quality high performance skilled nursing facility and that ends that

commissioner guillermo's comments that she wanted all of us to have heard today. >> all right. >> i will answer any questions. >> thank you commissioner chow and thank you also to commissioner guillermo who couldn't be here today and laying out i think clearly and eloquently the extraordinary work that has been done in place of working towards recertification of laguna honda hospital and behalf the commission the laguna honda made dedicated to the recertification in the medicare and medicaid programs and provide care to the most vulnerable san franciscans and bring long-term stability to our community so thank you again for that report commissioner chow. secretary morewitz is there any public comment before we go to commissioner comments and questions. >> folks on the line we're on item three if you would like to make comment press star three and i

see two hands and the joint conference meeting on the tenth to report back. great. call everybody i unmuted you. please let us know that you're there. >> hi. this is dr. theresa palmer.a the joint conference committee the root cause analysis the action plan and the revised closure plan was repeatedly mentioned but the public has not seen -- actually the health department has concealed these documents from the public, and so the public and i think this is against the rules of the settlement which says that there should be transparency, and so i would like to see those document and i am sure others would. thank you. >> thank you for your comment. caller please let us know that you're there.

>> i am. it's sanford. >> yes, you have three minutes. >> thank you. during commissioner guillermo's summary at the jcc meeting she didn't mention of the eight item categories the root cause analysis roland pickens [inaudible] including category number six involving comprehensive care planning, and category number seven involving comprehensive staff training and quality of care. the 26 [inaudible] cms cited in april 2020 to legitimize decertifying laguna honda and suspending new admissions [inaudible] and the denial of new emissions and

staff failures and do you wanted laguna honda residents comprehensive care plans and the quality of care residents had been received, so it's shocking that those very same [inaudible] last april justifying decertifying laguna honda and medi-cal revenue funding was all over again in the december citations involving the 12 patient dates, and the $36,000 in fines. pickens claimed on january 10 that the 12 citations were "by no means account for all of the work that has been achieved since april 2022." the

december citations [inaudible] otherwise. commissioner guillermo failed to report pick epidemics claim and executive summary of the action plan had been shared with laguna honda staff. since it was shared with staff the executive summary should be shared with the members of the public and publically released now. she failed to report pickens claim that laguna honda would appeal those 12 citations on december -- laguna honda received on december 20, but pickens was reporting bunk because by january 10c dph is seeking a window to appeal the 12 citations had already passed and laguna honda had not appealed the $36,000 in fines. thank you. >> thank you sir. thanks for your comment. there's one

more hand. hi. you're unmuted. please let us know that you're there. >> yes, i am here. this is michael lyon and the great panthers and great to hear the optimum reported by the charges and the closing but i have to say i'm not so reassured. the closure revised closure plan root cause analysis and the action plan we haven't seen, and hadn't been revealed, and how can we have assurance that this is really going to be satisfying to cms or ccdph if we haven't seen it? i think there's

election of transparency on this whole thing and from the very beginning of this crisis there was a lack of transparency when roland pickens was only just describing secondhand what his conversations, his verbal conversations, with cms had been, so you guys have to be a lot more transparent. thank you. >> thank you and there's one more hand that popped up. hi. you're unmuted. please let us know that you're there. >> hi. my name is norman daggelman and a long time resident of san francisco. i'm also a member of the great panthers and i under the commission to support services for houseless seniors and disabled accident treatment on demand for substance use and mental illness,

prevent a revolving door of hospitalization -- >> i'm sorry. i'm going to interrupt you. this section for for comments about a specific jcc meeting. >> oh okay. i'm sorry. >> okay. thank you. >> okay thank you. >> okay. that's the last hand. >> all right. thank you secretary morewitz. thank you callers for sharing your perspectives and commissioners do we have any comments or questions for commissioner chow related to the laguna honda jcc meeting on january 10? seeing none we'll move on to the next item which is the laguna honda hospital rehabilitation center and closure plan and cms recertification update. we have roland pickens who is the acting ceo of laguna honda hospital. thank you director pickens and your team at laguna honda for your very hard which i am sure we will see today to reason sure we're able to continue to provide excellent care at this critical

institution. >> thank you commissioner bernal. good evening -- >> could you -- >> can you hear me? >> i think so and i'm sorry mr. pickens both of our mics are the ones have quality issues. commissioners can you give director pickens a thumbs up if he sounds okay. thank you. >> [off mic]. >> so thank you for this opportunity to provide this update to you on laguna honda and we will proceed with the presentation. >> can you please pull up the presentation? >> i am pulling it up right now. >> we can see it.

just start the slide show with the full slide please. can you do slide show and then start slide so it's the full screen? >> i think i have the wrong one pulled up. give me a few seconds. . >> i'm sorry. great. thank you.

>> great. let's move on to the next slide. so as we know that laguna honda is the largest publically runed skilled nursing facility in the country. the institution has been around for more than 150 years and has been a pillar of the san francisco health care system providing health care services to approximately 700 residents at full complement. as you know laguna honda cares for some of the most chronically complex individuals who have skilled nursing facility needs, many of whom have multiple chronic conditions such as stroke, traumatic brain injury and other diseases and have a complement of skilled nursings and rehab services and have models programs that serve as national models. our monolingual units and spanish and

chinese, palliative care, aids, hiv care, memory care. next slide. you recall in april 2022 laguna honda was deemed decertified by the cms program. that occurred as a result an initial self reporting of two non fatal overdoses that occurred previously in the summer of 2021. as a result of several surveys that occurred the institution was found to be not in substantial compliance with all of the cms rules and regulations. as you can imagine that decertification had a significant blow both to the organization in terms of the residents that we were taking care of, but also in terms the financial implications to the viability of laguna.

the federal reimbursement at laguna constitutes about 550 -- $50,000 a day of more than $200 million a year in the annual budget. it's important to note that even at the initiation of decertification back in april laguna honda as remained consistently open and operating, and providing continuing to provide the highest quality of care to our residents as we work through the process for its recertification. next slide. so that path to recertification occurred immediately upon that april decertification. we immediately got to work setting forth our path towards recertification. we brought on consulting general experts, the department of public health instituted an incident command system at laguna very much in the way that the city instituted its

incident demand to manage the covid-19 outbreak and this shows how seriously the department of public health and the city took the situation at laguna. next slide. part of that decertification lead to the requirement that laguna initiate a patient transfer and closure plan. that was a requirement of cms bots in terms of the requirements of institutions that were surcertified and then deemed to be non certified but also a requirement that we submit these mandatory transfer closure plans in order to receive ongoing federal reimbursement. under the terms of that settlement agreement we initiated some initial transfers and discharges from laguna. we're all aware of some of the outcomes of the transfers and discharges, and

because of that those outcomes a settlement was reached between the city and county through the city attorney's office and cms through their legal representatives back on november 10. under that settlement agreement cms agreed to pay for care at laguna up and until through november 13 of this year, 2023. under the terms of that settlement agreement cms also agreed to a pause in involuntary discharges and transfers of residents until february 2, 2023 but you can imagine that date is upon us now and to that end we have been in communications with cms's leadership, and have communicated to them that based upon the improvements that have been made to date that our continued

progress towards recertification we have formally requested that they exercise their discretion and grant a continuation of the pause in transfers and as soon as we receive their response to our request we will definitely make sure that all stakeholders are kept informed. next slide. another component of the settlement agreement was that cms will conduct monitoring surveys with laguna honda every 90 days, so the surveys are unannounced. they are extensive and actually constitute basically trial runs of doing a full cms recertification survey. the first of these monitoring surveys actually began on november 28, 2022 with over 20 surveyors on site at laguna honda to conduct that survey. it

lasted for about three weeks and concluded on december 16. laguna honda worked collaboratively with the cms and cdph survey teams and noted through the survey process by the surveyors that they felt laguna did a really good job addressing issues real time. laguna has received what is called the 2567 on january 9. that is a report that shows what the survey findings were. we have submitted a plan as required under the settlement agreement to address those survey findings and what our plans are to remedy any survey findings. that plan is with cms and cdph and we will be implementing that plan

as it's approved by cms. next slide. another component of the settlement agreement was that laguna honda would engage a quality improvement expert to assess our progress towards recertification. cms approved the identification of health services advisory group as that quality improvement expert. as the quality improvement expert is required under the settlement agreement health services advisory group conducted a root cause analysis that reviewed many of the past surveys over the last two years at laguna including the mock survey conducted in june and july this past year. in that root cause analysis

health services advisory group described in detail what they saw as the reason behind the circumstances that lead to the decertification of laguna back in april 2022. one of the common themes of the analysis was over time that laguna honda policies and practices became out of sync with those of high performing skilled nursing homes, and were more akin to of acute care hospital. next slide. so in terms of our past recertification over the last several months we presented to you what was our then road map towards recertification. for the settlement agreement really reset the clock on all that. the

agreement in terms of the root cause analysis and the action plan really now sets the new path towards recertification because that's what cms is using to determine our readiness, our progress towards recertification. so the proposed the rca was completed and conducted by health services advisory group and shay shared those results with cms. cms had to approve it and then shared the rca with laguna honda. in addition to sharing the root cause analysis the qie was required to work collaboratively with staff at laguna to develop a action plan to address all the areas identified in the root cause analysis. that action plan a proposed action plan has been developed, and has been submitted to cms,

and we are awaiting their response either to approval of that plan or indication back to us if changes or edits are needed before they might approve that plan. we anticipate hopefully hearing by them by the end of today on the results of their approval or response to that plan and we will certainly make sure the commission and other stakeholders are aware of that response. but again this action plan represents our new blueprint for how we will accomplish recertification. it includes eight broad categories in terms of circumstances that lead to the situation at laguna that contributed to decertification, and it also very much like the mock survey that we previously presented has several hundred of

milestones or corrective actions that must be accomplished between now and may 13 because may 13 is the date identified in the settlement agreement by which all actions in the action plan must be completed. next slide. so you will recall several months ago we provided a settlement diagram that tried to layout on one page what the timelines associated with recertification were, so this is our again our new updated timeline based upon the root cause analysis and the rca and the way to read this if you look at the top that represents all of the ongoing cms regulatory certification survey readiness activities, so it includes every 90 day monitoring surveys,

the first of which i mentioned occurred in november. we are shortly in the window for our next monitoring survey which could theoretically happen some time in late february to march or early april. again these are unannounced but based on the first survey we expect the next 90 day monitoring survey, and so in addition to the 90 day monitoring surveys we're still continuing all of the work we had done prior to the settlement agreement. you recall we put in 24 a day observations around where we actually have staff who go around laguna honda looking for opportunities to make sure that staff are following their appropriate procedures

or doing appropriate hand hygiene. are staff wearing the correct personal protective equipment? are staff following rules and procedures and are we answering call lights in a timely manner? are we making sure that residents are afforded the appropriate dignity for example if the patient has a catheter and not that the bag in is public view and a privacy bag so we infused the concept of 24 a day regulatory compliance and readiness. the bottom of this diagram is the ultimate the action plan, our new blueprint towards recertification, so it shows that the draft of the proposed action plan was submitted to cms on

january 6, and that action plan once it is approved by cms will need to be completed by may 13. again it hasn't been approved yet so it's still in draft form but as soon as it is we will share that information widely, but as dr. chow read commissioner guillermo's notes we're not waiting on that formal approval. the work actually has been ongoing, and we're hopeful cms will approve the plan and not require too many changes or edits and again while it is required we get formal approval we're not waiting on that approval. the work has begun and continues. next slide. so another component me agreement was that laguna honda needed to submitted a revised

closure and patient transfer plan. that revised closure plan was submitted on december 21, and we are still -- let's see. all right. we're still in the process of receiving input from cms on whether or not they have accepted the modifications we made to that plan. many of those modifications had to do with the patient -- the resident assessment process particularly in the event that we would be forced to resume transfers which again we are hopeful that will not happen. we have submitted the request and communication to cms extend the pause and hopefully while we're required to submit the updated closure plan hopefully it's just a plan

and plan only and never have to be implemented but again that is subject to cms's consideration and approval of our request to extend the pause much i think it's important to note that our revisions to that closure plan took into account the information that we learned as we did our own internal review of cases of death of former laguna honda residents who were transferred to other facilities. in addition to our own internal review cdph conducted their review of 12 of those former laguna residents who subsequently passed away at other facilities. typically weeks or months after they had left the care of laguna honda. we were

made aware that the california department of public health issued 12 class b citations based upon their review of those resident cases. it's important to note that in the classification of citations that california department of public health issues class b is the lowest level of citation, and is it's also to note that those cdph citations did not find that laguna honda cause serious harm or was the direct or approximate cause of any resident's dealt and i think that's important to note because staff worked hard at laguna while we you know fought as hard as we could not to have to implement transfers. as you know we were forced to under that plan, and so

we felt we had done our due diligence to meet the requirements of the plan that had been approved. it's important to note that while cdph issued these citations laguna honda, and these take them seriously and submitted a plan of correction to cdph we do not agree with all of the allegations that were stated in those citations and that he we started the appeal process to appeal those citations while we further put evaluate the cases. it's important to acknowledge and recognize the impact of those citations on our staff, our residents, and the families at laguna honda. again because none of us wanted to initiate those transfers it was very challenging, and so we

are working hard to again through our advocacy and our request to cms that we don't have to resume transfers but let the staff know by no means are we feeling bad. they weren't at fault in any of those cases. next slide. so that is a high level view of where we are this first meeting of the new year given that we had the settlement agreement, the rca analysis and the action plan all of those things happened kind of during the holiday break. i wanted to update the commission and the public with where we are. the fact that we submitted our

action plan for the root cause analysis are awaiting cdph hopeful approval or response and that we are appropriately requesting that cms continue [inaudible], so that concludes my formal presentation and i am happy to try to answer any questions you might have. >> thank you director pickens for that very thorough report and for really giving us a good sense of where things stand right now and also highlighting the really excellent work done at laguna honda in order to regain certification to continue to support this laguna honda as a critical institution that it is for san francisco. secretary morewitz do we have any public comment? >> sure. thank you. folks on the line we're on item four, the laguna honda hospital and recertification plan and cms update. if you would like to

comment please star three. i was remiss by reading this statement earlier. members of the public will have the opportunity to make comment for three minutes. the process is designed to invite input and feedback from individuals in the community however the process does not allow questions to be answered in the meetingsor members of the public to be r engage in conversation with the commissioners. the commissioners do consider the comments and making request to dph and each individual is allowed one opportunity for each agenda item and may not make statements of others that couldn't attend the meeting. comments may be sent to me at my email. if you would like to spell your name for the minutes you may do so during the verbal comments without taking your allotted time and again please press three for comment on this item. i see lots of

hands. i will take you one by one. okay. all right. callure you're unmuted. please let us know you're there. >> my name is dr. allen cooper and i am a member of the advisory council with the department of disability aging service. it sounds very encouraging that laguna honda will be able to get recertified. we're certainly pleased about that. the part of the certification they said in initial comment that people who are appropriate for a nursing home have to be accommodated. many are going to be seniors, often with mental health disorders, and with substance use, ongoing substance use disorders. unfortunately often people like that end up on the street or in

or discharged to shelters and eventually end up in the street. we have the advisory council prepared a report suggesting a number of services that can be placed by das, and dph and others in shelters and reach out in the street to mitigate the harm that will come to those people and hopefully to allow them to remain while they're waiting for more permanent placements out of the acute hospital and out of jail. i hope someone in dph will be able to look at our report and work with us and hsh as well as others to implement some of the suggestions and help the people who don't belong in

laguna honda because of the acuteness and severity of their illness and keep them -- laguna honda comply and help those people get well. thank you. >> thank you for your comment. all right. caller you're unmuted. please let us know you're there. >> hi. i am try again. my name is norm daggelman and a long time resident of san francisco and a member of the gray panthers and i ask the commission to support services for seniors and disabled treatment on demand for suns use and mental illness, prevent a revolving door hospitalizations that lead to greater illness, death. need for more nursing home bed and thank you very much. >> thank you for your

comments. all right. caller you're unmuted. please let us know you're there. >> hi. this is dr. theresa palmer. i wish to take issue with mr. pickens statement that most of the deaths occurred weeks or months after discharge. 50% of the dischargees were dead at the three week mark and reading over the citations it's obvious that bad advice from cdph and lack of experience on the part of the laguna honda administration lead to panicky inadequate discharges by staff that were fearing for their jobs if they did not obey even though the discharges were unethical. they weren't what we call a warm hand off. in nursing homes discharge to another nursing home is relatively infrequent and more

complicated than just discharge to acute because you're handing over the care of a person for their whole life to the nursing home, and it's pret amazing that cdph found that this wasn't the proximal cause of death. in most cases it clearly was especially the lady transferred unknowing that the nursing home had active covid and quickly died of covid and i think because cdph is implicit in bad advice and bad management that they slap the hand in stead of doing the serious citations that should have happened. that's water under the bridge now. what we need to do is not repeat this exercise even if planning for discharge is indicated

discharges of [inaudible] eligible patients should not occur. these people should remain at laguna honda. there's no justification for jeopardizing their lives like this, and i think it's going to be very expensive for the city in terms of litigation if this exercise in cruelty occurs. please do everything you can to avoid this and i personally will do my best and beg cms to not force it, but i think even if cms advises it it would be ethical of laguna honda to appeal it and drag the feet as long as possible. thank you. >> thank you for your comments. all right. next caller you're unmuted. please let us know that you're there. >> i am. it's

patrick shaw. >> all right. you have three minutes. >> this commission has been propping up the facade dph and laguna honda are actually progressing towards cms recertification. slide nine in the presentation shows that laguna honda action plans were responding to ongoing 90 day surveys will go well past july 2023 and it's that original root cause analysis reports following each survey will rage on through august of 2023. mr. [inaudible] informed commissioner chow august 2 that recertification would occur by december 31. the

stated goal laguna honda decertification in april. pickens' slides "we will take on new projects to align our facility with cms regulations in skilled nursing facility [inaudible] these projects would include ongoing facility and capital projects will contribute to more successful surveys" . this comports with director of public health grant colfax anding on chart that shows that the projects are integral for recertification. [inaudible] immediately a look of the capital projects currently under way or planned to describe how each capital

project will contribute to achieving more successful facility inspection surveys and how those projects will help laguna honda retain recertification. [inaudible] remodeling patient rooms to facilitate eliminating 120 beds. [inaudible] director pickens statement a few minutes ago that staff and residents had been impacted by the citations, and that staff were not at fault. it's clearly the fault of staff who identified all 12 of those patients for discharge, the majority of which, or 10 out of 12 at least had

serious dementia and more elderly, and -- >> thank you for your comment. your time is up. all right. caller you're unmuted. please let us know you're there. caller you're unmuted. please let us know you're there hello. >> . >> are you there caller? >> is that me? >> yes. >> okay. i'm not sure if i'm on the phone or webex, but i want to say that first i'm a member of the san francisco gray pant theresa palmers. i am appalled at the whole process. >> . >> i think this is angunforced error. i am glad that dr. pickens is making progress and laguna honda is making progress towards recertification. it's just tragic what's happened to these resident and i think it's pathetic to

try to absolve yourself for the responsibility for the death that occurred. san francisco deserves a fully functioning long-term public care facility, and i think it was operating that way until mismanagement began to creep in, so once again i applaud your intent and your efforts to make sure that no more discharges occur like the ones that happened last year, and just know that there are many of us here in san francisco that are watching what you're doing and we're going to be very vigilant and we will keep watching and try to make sure you're accountable and do the right thing by san francisco's fragile elderly population that needs

long-term care, good long-term care in san francisco. thank you very much. >> thank you for your comment. eight more hands. you're unmuted. please let us know that you're there. >> yes hello. can you hear me? >> yes. >> okay thank you. thank you for taking public comment on this really, really important, very important issue. my name is donna and my brother is currently at laguna honda in the sniffs skilled nursing facility and it's amazing as i listen to the report that on december 21 there was a -- it was submitted to the cms to request no transfers and there is still not -- what

is today? january 17? there's still not an answer when we just have a little over a few weeks, so the whole thing as it sounds dealing with the cms with having the patient transfers be somewhat of a carrot or somewhat of an extortion of a bargaining chip it is beyond amazing. it's beyond just using people and patients to do some kind of end game where laguna is going to step up. well, laguna is stepping up and we know that and see that, and it's going to take a little while before things get a little better. i would have to say too they think it is still happening that there are no new patients coming into the hospital, and the hospital is a little bit like a morgue

right now. i walk by rooms and see a lot of empty beds and it's horrible to be in that kind of a situation to be sort of blackmailed into keeping the hospital open. i wish there was an open meeting for cms for public comment to let them know how this plays down, how it trickles down to the actual patients and the family members, and how it's trickles down to the people that who could have care but are not having care and even the roommate in my brother's room is gone and they haven't replaced him and there's an empty bed that could be serving someone. very difficult realities to swallow when people are surfing and need help so my hope whoever can do anything to help this process and not have the patients transfer please do that. thank you. >> . >> thank you. all

right. caller you're unmuted. please let us know you're there. >> yes, i am. my name is susan englander and a former rn and a member of the harvey milk lgbtq democratic club. first of all i'm a professional and i understand what it is to come before the public and appear as professional even hands, and neutral. however, the level of discourse they hear from both the health commission and the department of public health borders on being different, lack of empathy. we're dealing not with only human beings which is you know an issue enough but we're dealing with elderly, ill, infirmed, disabled

human beings that have been put on the edge of a cliff dangling waiting to hear what their future is regarding their housing, their health care, their ability to eat and sleep safely. i am just appalled. i'm also appalled that all of the problems that have been dogging laguna honda as a result of public health and health commission decisions [inaudible] only comes to a head when laguna honda is threatened with closure. you have been dragging your feet. you have been misusing the dead. you have been admitting patients. you have been admitting clients.

you of admitting people who are inappropriate to the beds at laguna honda. have no business being there but what has been done to create resources and facilities for these people? nothing, nothing. it's appalling, and the department of public health and the health commission is complicit, complicit in this situation, so i point the finger at you all as you tread water and try to figure out what the heck you're doing. how dare you. how dare you when you should have known for years what you should have have been doing which is paying attention to laguna honda. its residents and its staff, its union staff who does its best i tell you, its best

to keep their clients, their patients well cared for, clean, fed and loved. i have nothing but disdain -- >> thank you for your comments. your time for public comment is -- >> thank you. >> thank you. i'm sorry. i apologize for cutting people off so i have to do that for every person. everyone has the same amount of time. caller you're unmuted. please let us know you're there. >> yeah. we talk about the laguna honda crisis and in deed it's a crisis where 11 died already and perhaps hundreds more if the default plan of closure and deadly discharges actually takes place in 16 days. to see the laguna honda crisis in isolation is a narrow vision is a problem and in silages will lead to

more crisis even if we survive this. the real crisis is the interception of many crisis, the crisis of lack of care for people are mental illness and substance abuse problems and people with disabilities and mental health has been delayed for months and people still wait months for services while the city blames these victims and says it refuse service and need conservatorship. a crisis of lack of housing for thousands of san francisco residents who have been freezing in the cold and rain and are now targeted by police action. remember 71% of homeless san franciscos used to rent here showing that the city's encouragement of luxury housing is the cause of homelessness. a crisis of inequality where dozens and billionaires living in the city while others sleep in the door way says. you individual health commission members are

not individually responsible for the crises but it is true your actions have gone along with the city's agenda coddling the rich and letting the poor huddle in the street and what you call risk expulsion from laguna honda hospital. you let c them close a beaut care in the city and fragile patients to be sent hundreds of miles away just like the laguna honda diaspirra and let them strag off primary care from st. luke's hospital because it pays less. i hope we get through this crisis by the skin of ouring teeth imu you're responsible for going along with the city's agenda of capitalism unrestrained. this is very bad. . >> all right. caller ended the call.

there are a few more hangs i see. caller you're unmuted. please let us know you're there. >> hello yes, i am here. >> yes you've got three minutes. >> okay. my name is rossa and a resident of san francisco since 1973 and fortunate enough to live in my own home but near laguna honda and i like many other people are very much aware of the long the history of this place which is the shelter for those that have nothing and need care long-term care who are frail and have no place else to go, and i have known people who have worked there and volunteered there, and who have loved doing so because of the dedication of the staff, and to think that you would allow anybody to be taken out of there against their will when they need the skilled nursing facility

care is unimaginable and beyond cruel and on par with dumping out into the street and some of the people will probably end up in the street if this happens so i urge you whoever has any responsibility and also the staff to refuse alien orders such as that that people would force people out to simply just not go along because it is a human right to have shelter and it is simply unbearably barbaric to allow anybody to be just thrown out of there who is a resident and i hope that you will soon be admitting new patients again, and recognize that a big cause of the problem seems to be the admissions of people whose problem is drug addiction and they cannot actually be served well at laguna honda. it's

not a drug treatment center. it's a long-term care facility and a haven for the frail, so there's a great need for a drug treatment facilities but this isn't one of them and if drug offenses have been a problem and that's part of the reason you're in this crisis then please review your policies and separate those who can also do harm to the other residents because of their own serious problems with drugs so they do not belong at laguna honda but there's lots of people who could use that help so thank you very much. i don't have anybody there. i don't work there and i don't -- i'm just a resident, one of many residents who are totally shocked and outraged by what is happening. thank you. bye. >> thank you for your comment. caller you're unmuted. please let us know

you're there. >> hi. can you hear? >> yes, you have three minutes on the clock. >> fantastic. my name is giovani and a student at ucsf and representing the environmental advocacy group. i would like to say a few statements on environmental health and how this is relevant for all of us and i hope that hospital systems and skilled nursing facility like laguna honda will be able to practice and advocate good practices around this. quality of life is depending on the quality of the natural environment the need for food, water and shelter and other things depends on the environment around us. there is a balance of cycles of the environment and lives of human beings and animals and with many large systems in place such as hospital systems, skilled nursing facilities and various other industries there begin a tilt in the balance and this is something we have to focus on

sewe can make sure that our environment stays well protected and adequate standards for those that will be after us. human society is just playing this vital role in this. there are many harmful effects on the environment and some are pollution, over population, waste disposal, climate change and greenhouse gas and because of the harm 68 gases in the air. in addition there is tobacco use and other things that are harmful especially when they're used in close proximity to those with respiratory illnesses. i am laguna honda has the tobacco free place and areas for smoking and is important and should be maintained. we also believe that the government there should be at every level of course there must be implementation of strict laws in the industries in order to

reduce the amount of waste as many of the are hazardous and toxic and proper management is a key point just to make sure this is properly maintained. awareness programs should encourage citizens as well to use public transport as possible and using automobiles and other forms are hazardous for the air and something that we all utilize. i want to say that it's really important to spread environmental awareness for society as it affects our health and day to day life. it's something it's the responsibility of every citizen especially those that managing larger buildings and industries to really focus on maintaining that environment. as degradation of that really hurts all of i guess and work together towards a green and sustainable future. thank you. >> thank you for your comments. i believe this is the last comment. all right. caller you're unmuted. please let us know you're

there. >> yes. my name is joseph and would like to highlight the issues at laguna honda and employ to resist physicians to authorize the transfer of residents to other facilities after february 2. i'm assuming you've had a chance to review the citations that was present r presented to laguna honda administration administration. i hope you saw this as heart breaking and i have the dates for the dates of the residents exand i should what learned about them. they were discharged between june 10 and july 13, 2022. the first died on july 1. the longest time one of these people took to survey was 67 days, the most swift death only took 10 days. the average time of death was 29 but the meantime of death was 21 days. while the reporting numbers of eviction at laguna honda was 57 in the number of

skilled nursing facility residents as 41. this is a population to measure the dealts against. 11 out of 41. that's 27% and not the 22% i reported in prior public statements which i believe we can agree is already absurdly high metric. 27% to the estimated 400 skilled nursing residents remaining at laguna honda. over 100 will be dead by the end of this program. over 50 will die within three weeks of discharge. now [inaudible] transfer program was delayed last year there wasn't a robust study to ensure any mitigation procedures are effective. we're assuming that this wave of death of begin on february 3. on july 2022 in 1 of my meetings i heard one of your meetings actually i heard an administrator from laguna honda state that the primary objective was recertification of laguna honda.

shouldn't the primary objective of the officer be the well being of patients under her care. i understand the administrator left the position and not clear if she was replaced with a permanent position. i believe many of you are medical professionals and took the hippocratic oath and the administrative authority is probably now with you. there are health administrators and organizational administrators. i understand this is difficult but prioritize your role as doctors on this matter i do not authorize the physicians at laguna honda hospital to release the patients in their care to be transferred in reaction to the cms transfer and relocation program. you need to play hard ball with cms and cdph administrators on the matter of transfer and the relocation program. thank you. >> thank you. that is the last commenter. >> all right. thank you callers for calling in and sharing

your perspectives with us on this topic as well. commissioners do we have any questions or comments and perhaps i will start with a few for director pickens because i want to make sure that my understanding of some of the issues is correct. this all of course started with the self reporting of reversed overdoses some time last year like last summer and in the fall that's when laguna honda was placed in immediate jeopardy and the root caused analysis that was received and that has been responded to really reflected a snapshot of time between the fall of 2021 and the summer of 2022 and does not reflect all of the improvement work that has been accomplished during that say the last eight months for those who of to laguna honda and spent time there we have seen a lot of the progress. we have seen all the training mod duals that the staff went through and how they do daily and

many times a day huddles and huddle board and look at the care that everyone is receiving. the policy and procedure improvements put into place and the structural and personnel changes as well. i really want to thank commissioner chow for conveying commissioner guillermo's words and perspective about how we are not waiting at laguna honda to be getting the feedback or approval from other things for these plans. we know these plans are submitted. they of submitted. i don't know if there's an expectation that we will see requested changes but it may not be the case but the work is happening, so is that all correct? i want to make sure they have it right? >> yes commissioner you actually did give a correct version as to -- [off mic] particularly the fact that there are root cause analysis does not reflect the improvements that of course made since april of this

year. it truly the root cause analysis as root cause analysises are by definition a retrospective look at circumstances that lead to a particular action. in this case the action was the dicertification that occurred in april and so the retrospective look was two years prior to april and so again does not reflect much of the work, the dashboards, the trainings, the 6,000 observations per week that we're doing to make sure that the institution is in regulatory compliance. that rca and action plan do not reflect any of those. >> great thank you and just in regard to the timeline as well and the 90 day surveys and looking at the chart which was very helpful but the surveys won't necessarily happen if recertification is achieved, correct? so we've had one survey at 90 days and intaraval in 90 days we may expect

another one but at that time if recertification is achieved we wouldn't see what is reflected in the chart at a later 90 day survey. correct? >> you're correct. those 90 day surveys occur up and to the point of recertification, so correct if we were to submit and become recertified prior to any of the subsequent surveys those surveys would be deemed mute and not occur because we would have received certification. >> thank you. i just want to again thank you and director rec colfax. it's critical that the department and laguna honda have made the appeal to cms that the transfers not resume. >> . >> i think we're all in agreement they were unnecessary and really brought up upon a tragic result so thank you for sharing that and also you know i want to under score the urgency ensuring that we learn that decision soon from cms.

commissioners do we have any other comments or questions for director pickens? >> commissioner chow has his hand up. >> commissioner chow. >> yes thank you. can you hear me now? >> yes, sir. >> yes, sir. >> okay. thank you. i thought director pickens that the laguna honda chart you gave was very helpful as an overview, and i remember that when we were doing the mock survey of course we've seen a great deal of detail, but one of the real helpful i guess timelines that you were giving us, and the progress that was being made through the numerous points that mock survey had helped illuminate was very helpful. i am wondering if we're going to do something similar with

rca by sort of parsing out some of the important areas of the rca, and then i'm not sure that related to weight as they were in the past, but some means in which we can follow the progress. i know a lot of everyday work is being done which has brought about an even greater level of care to the community, and even more is coming which will be helpful, and i guess under phase iii as we will see in the new policies and procedures that we will look at will bring about even a greater appreciation on part of the residents of laguna honda as their home, but i'm just wondering from a standpoint as we get all this information and we have been getting a lot of the information of course that you have been

giving us if we could set them into some sort of a timeframe. we know we can't predict when recertification comes but certainly look how you're making progress on these new milestones. >> so thank you for the question commissioner chow and you have been a fly on the wall in some of the earlier meetings today where we had this very discussion how are we going to monitor our new road map which is the action plan? so we are going to replicate those dashboards that we previously produced like for the mock surveys and that we shared with the jcc and the commission. we will be reviewing our first draft mock up of those revised key performance indicators determine with director colmax and staff so it's our desire to hopefully

finalize a new set of key performance indicators for the action plan and recertification efforts and begin to reproduce the same report that we previously supplied. our goal would be hopefully to finalize the report this week, and tweak it and then begin to distribute probably some time late next week or the following week, but to basically keep that similar form at you have seen, the various levels of tags, a, b, c, d, e, f, angaggregate score of the additional points and show -- deficiency points and seeing the aggregate score decrease and hopefully get to answer which means we would have successfully corrected all of

those action plans and deficiencies noted in the root cause analysis. >> thank you. and i think just to reemphasize seeing that we were in the past talking about a second mock survey and all and this actually replace its and becomes the action plan and essentially one that cms has approved. is that a correct understanding? >> yes that's correct. the root cause analysis and action plan essentially became the second mock survey and now the got standard that cms will gauge our progress. >> great. and we're hoping -- i know you emphasized that and we would be opposed to transfers that we're going to get some sort of response and be able to respond if it's unfavorable? >> oh absolutely, correct. yes. that

is our number one pursuit at this time is to do all we can to make sure that pause continues so that we can really focus on recertification, and that no additional residents will have to be transferred to other skilled nursing facilities okay. thank you very much. >> let me see if other hands are up. commissioner green has her hand up. >> vice president green. >> well thank you for the presentation and i think a testament to how committed everyone in this department and at laguna are to the striving and surviving of laguna honda is the amount of work that went into this. the policies which is the size of a phone book but very well done and very

explicit and i think well thought out. the hours, and i want to say i am so impressed that people worked through all the holiday in order to meet deadlines and in order to get the action plan in place, and you know it's really dispiriting to recognize that bureaucracy -- there's a spectrum between bureaucracy and reality. what we have done at laguna and the complexity of the people we take care of on the one hand and the quality and love of the care and when i talk to laguna residents it's so impressive and on the other hand you have a bureaucracy that is partly in washington, partly in sacramento that really doesn't know the details of what goes on in our institution and the complexity of dealing with the number of individuals we have with so many problems and in my own observation a lot of their criticism has more to do, and this is

unfortunately problem in medicine in general. it's not what you have done for people. it's what is on paper. we went from the i patient to the i patient and i think it's a problem that we face so i fear that a lot of what has been written in terms of reports doesn't reflect real quality and compassion. it reflects kind of dispassionate detached words, so i'm curious for a few answers. one would be when this whole -- let me ask two questions. when this whole thing started with cms and they basically demandd that we transfer residents and submitted data. i remember once and might be off by a few numbers and 1,017 snf beds in california and two accepted one

program and a few others and i recognized if the individuals had been in snfs around the country with the multiple comproblems they had including age and strokes and all and whether they would have even been there to transfer, so i think it reflects the quality of the care we have given but i am wondering first of all whether what has happened? do you have any read on what happened has had any impact on cms and their decision regarding closure? and then -- or transfer i should say, and the second would be i know we don't have the reaction to the root cause analysis but do you have any sense for whether there will be major changes? one of the things that struck me about some of the reports that we got it went from things that were really important to things like you know linen

cracks and a crack in the ceiling. in other words there were some things you felt like in an effort to boil the ocean here we were going to miss the critical things we need to focus on in terms of quality of care. it seemed almost too detailed so i am wondering if you can answer the question about whether -- what has gone on and the tragic losses has any impact on bureaucratic thinking? and do you have sense whether the action plan will be more issues that we haven't begun to work on or fine tuning what we already know? >> thank you for that question. i will say it's been a rocky and difficult journey since the decertification in april of 2022. again you highlighted how when we submitted the original

closure and transfer plan as we were required that we said based upon our assessment of the complexity of our patients, residents at laguna and the circumstance of bed availability in san francisco as a community in order to do the process in a just, fair and appropriate manner it would take us 18 months to actually affect a discharge of our transfer plan. as you know that 18 months proposal was rejected and we were subjected to only a four month process which we initiated and then had to pause as a result of the settlement agreement, so very much i think the communication and relationship with both cms and california department of public health started off very rocky but i will say

that particularly as of late i think because they have gotten to know us, us meaning laguna honda. they have now become more familiar with a lot of the work we're doing because they approved the quality improvement expert and now they they have also embedded their own cms monitor on site so now they know laguna better and i think because of that i have noticed i think a greater appreciation now for the work and the care that is actually going on and in particular as of late i have seen i think a better recognition of this is not just a bureaucracy that these are people's live accident, a lot of people's lives. >> . >> 500 plus now, usually 700 plus residents and so i do see that recognition of both by

cms and cdph as of late and shown the ability to work for us and given flexibility when requested. that kind of flexibility we didn't see early on we are now with partnership and collaboration and i am very much encouraged and i am very hopeful we will get the response we're requesting in particularly the terms of the request to have the pause extended. again i work for dph. i don't work for cms. i can't speak for them but i know the communications we've had with them and the case we made why the pause should be legitimately extended and i think it's a strong case and i am hopeful they will see it that way and grant it. there was another part of your question -- >> just do you have

any sense of the action plan and whether they're going to be significant additional issues we have to approach or whether there will be modifications of things we've already worked on? in other words we put so many resources in this department to making sure we're re re certified and we're the best snf in the country and i thought we were to begin with, but i am wondering if you have any sense -- i guess any new work that might be necessary based on the response to the action plan verse building on the excellent work that has been done? >> so my sense is that there would not and probably should not be net new a lot of new work for a couple reasons. number one the action plan really reflects all of the improvement -- much of the improvement work we started back in may that continued through the first

mock survey, and you know we had over 200 milestones associated with that first mock survey, and so everything in that action plan really builds upon that and actually incorporates some of the changes and improvements that we actually already put in place or begun to put in place, so my sense is, and again because we're fortunate that the quality improvement expert is also a group that has been working with us from the very beginning that they were able to incorporate again a lot of the work that they had already help give us guidance on in terms how we could improve operations at laguna into the action plan, so even if there are comments i don't think it will be a complete rewrite. i think it will just be making tweaks around the edges.

that would be my sense. >> okay. thank you so much. >> thank you vice president green. thank you director pickens. are there any other hands raised? >> [off mic]. >> a well, seeing no other hands raised. thank you director pickens. okay. thank you director pickens for that report and we will look forward to seeing you again soon and learning about some of the very important outstanding questions that we have. all right. so our next item is an action item and it's the laguna honda hospital and rehabilitation center policies. they are voluminous for sure and i want to thank the commissioners for viewing them in-depth and providing questions and comments to staff in advance of this meeting so they can be addressed proactively during the presentation and for this we will go back to director pickens. >> thank you very much

commissioner bernal. so as you all pointed out there are volume of policy and procedures that were presented at the last laguna honda hospital joint conference committee. those are now before you as the full health commission. i know that several questions wereit somed in advance by commissioners related to the policies and i will try to address some of the answers or responses to those questions, and please let me know if you need additional, so one of the many policies deals with patient or resident restraints and so there was a request that we further explain the spectrum of residents restraint from the context. policy revisions, and so resident restraints were one of the major focuses of the new

phase iii guidelines published by cms. these are recent guidelines have significantly expanded the definition of restraint. for anything that precludes a resident's independent movement, so for example that includes things like a bed alarm where there's an alarm on the bed so that staff are notified if a resident tries to get up to go to the restroom or something else. well, that may not sound like a restraint but in the cms definition it is. chair alarms similarly. we're always in particularly skilled nursing facility realm concerned with the residents falling so these things chair alarms are the bedside rails on the bed that prohibit a resident from falling out. well that is considered

aretha straint if the resident can't move the rail up and down by themselves so we had to revise policies to include this new expanded definition of restraints, and then we've had to reeducate our staff. the cms the new rules really encourage skilled nursing facilities to go become restraint free again having the least restriction of an individual, so you can imagine that presentses a challenge when you also are trying to safeguard residents from having inadvert falls and other injuries so that represents kind of the spectrum of restraints we had to expand that spectrum and actually brought in additional resources to help define then how we meet both this new definition of restraints. another question had to do with the explanation of -- oh it appeared that there might be some conflict

in'd missions policies related to individuals with behavioral health, mental health, substance use disorders. again the new phase iii regulations really changed the landscape of skilled nursing facilities regarding behavioral health. those new regulations actually hold two things to be true at the same time. they hold that you cannot discriminate from individuals with mental health and substance abuse disorders when it comes to admission and you cannot use that solely as a basis for discharging an individual. at the same time those regulations say that you must provide appropriate mental health and substance use services within the skilled nursing facility, and that if you have individuals who despite having gone through multiple interventions, care

planning, documentation, who are unable to really control themselves and not present themselves as a danger to other residents or the institution there's also been an obligation to pursue try to find alternative placements for those individuals, so the new phase iii again holds two items at the same time that may appear to be in conflict but they try to balance individual and institutional rights. there is was another question about you know given the volume of policies that are coming before you how many of those were related to the new phase iii requirements? and of those hundreds of pages of policies that you have almost half of them, 44%, are related to the

new cms phase iii requirements, so that meant not only did we have to reicize existing policies we had to create new policies in order to meet these requirements. there was a question about what were the forces used to develop and/or amend these policies? and the response is that for phase iii regulations the new california department of public health state operations manual for long-term care from cms was used as a sources for developing those new policies and revising the old ones. most policies are based on regulations from cms and cdph. however, when laguna mes to make a new policy we try not to reinvent the wheel and look to outside organizations and other skilled nursing facilities and the

skilled noshing association and other institutions like csfg who also operates a snf so we too go to the regulatory body itself as the source but we will look at other institutions or organizations for assistance. there was a question are policies kept on the staff internet or how does staff know about policies? so there's a laguna honda internet that has pertinent information for staff and it provides a key word search function in the policy so that staff because we have hundreds of policies they may not need to know the exact policy but do a key word search and hopefully find the policy they're looking for. there was a question how do we explain to

new staff and/or registry temporary staff how are they trained on the volume of policies that we have? so new staff be they new to the organization or registry staff have the same expectation as our regular or permanent staff. they are provided education on policies during the on boarding and orientation process. they are also directed to the laguna honda internet as to where they will find specific policies, and the laguna honda department of education and training worked closely with our quality department so that when new regulations come out that the appropriate policies are then revised and reflected that the training for those policy size trend updated, and they eventually make the way to the health commission for review and approval. >> .

>> there was another question as to -- oh the nursing -- the resident call system. that's a little button you push when residents need something. there was a question as to clarify whether this apply to the acute unit? and the answer is yes. the resident call system is throughout the institution both in skilled nursing and in the acute unit. there were questions about particularly training related to cultural competence and trauma informed care, and it's important to note that it is a requirement at laguna that all staff regardless of your position be the direct care provider or support service worker like the

facilities and environmental staff or administrator like myself we all have to take the required trainings in cultural competence and also in trauma informed care so that is a requirement for all staff, not just direct care providers. there was a question about the policy on effective communication for resident who is deaf and for our residents who are deaf we do provide american sign language or the appropriate sign language assistance that they need either through the video interpretation or through an in person if that is required and there were was a question about --

okay. i think talked about physical restraints and trauma informed care. so please let me know if i didn't cover some of the questions. i tried to cover as many as i could but if there's any additional ones please let me know and i will try to answer them. >> thank you director pickens. secretary morewitz do we have public comment? >> folk on the line we're are item 5, laguna honda rehabilitation policies. if you want to comment press star three and i see one hand. caller you're unmuted. please let us know you're there. >> i am here. i am [inaudible] bernard shaw. >> you have three minutes. >> thank you. notably missing from the policies is policy d. one. zero. restorative care nursing program is of keen interest to cms and u.s. department of

[inaudible]. why isn't that on sort of nursing concluded today? also laguna honda discharge planning policy isn't included which is the grave mistake. narrative in the 12 class citations [inaudible] against laguna honda on december 20 imposing $36,000 in fines involved 12 patients' deaths. had included in this citation narrative that the definitions of transfer and "discharge" in the discharge planning policy wasn't clear to laguna honda staff completing discharge patient assessments and the policy doesn't indicate "not discharge ready" meant

discharge to the community or lower level of care, not discharge to another skilled nursing facility. that discharge followed the cries out for being updated. laguna honda must have known that the nursing home [inaudible] went into effect november 2019 so to the extent mr. pickens claimed that 46% of those policies before you tonight are related to phase iii regulation changes i have to note laguna honda has had three years since november 29 to develop and update these policy and procedures and you should have been doing so all along. why isn't the restorative nursing and planning policies

included today? when are they going to be brought before the commission? before the discharges resume on november 2? it's not going to be [inaudible] because -- i'm sorry, before february 2. that's not possible because you don't have another health commission meeting before those discharges may resume. thank you. >> that was the only hand. >> all right. commissioners again i know you've had an opportunity to review all the policies and thank you again for submitting your questions in advance. are there any additional questions or comments for director pickens on this item before we move to action? any hands raised? >> i don't see hands. no hands. >> all right. in that case -- >> [off mic]. >> yes please. >> i will start with you

commissioner bernal. >> yes. >> commissioner green. >> yes. >> commissioner giraudo. >> yes. >> commissioner chow. >> yes. did we actually move -- >> oh we did not. >> [off mic]. >> thank you commissioner chow. >> [off mic]. >> do we we have a motion to approve? >> i would so move. >> i second. >> i will start again. i apologize to everyone. commissioner chow. >> yes. >> commissioner giraudo. >> yes. >> commissioner chung. >> yes. >> commissioner green. >> yes. >> and commissioner bernal. >> as before aye. >> thank you. so that action has been approved the policy want thank you again to all the laguna honda staff for the work that went into that. >> yes, i want to echo that as well. thank you to director pickens and everyone. this is an enormous under taking and a lot of input into the process as well so thank you for everyone's excellent work and

convey the gratitude of the commission. oh yes director colfax. >> thank you. i thank the health commission and the acting ceo pictins and the team that has been working under severe circumstances and while the focus includes responding to the requirements of cms and the state and ensuring that we're meeting the requirements of the settlement agreement that the primary focus is caring for the residents of laguna honda and their families and every time i have been over there it's very clear from across the organization no matter where people sit in the organization that patient care comes first and i just want to applaud mr. pickens for ensuring that is the focus at the hospital, and that will continue to be the focus in addition to meeting these regulatory requirements in order to ensure that laguna

honda gets recertified. >> thank you director colfax. we will move on to the next item. for this is the fy 23-24 and fy 24-25 dph budget proposal. this is a discussion item and for the presentation we have jenny louie who is dph chief financial officer. welcome ms. lourey. >> thank you commissioners. >> . >> speak close to it. >> okay got it. through the chair jenny louie chief financial officer. i am pleased to be here to present our first hearing on our proposed budget for fy 23-24 and fy 24-25. i do want to note i am joined in chambers by emily gibbs and the deputy finance officer, back filling my former position over at budget and planning and i look forward to working with and you mr. james alexander on the line the budget

director offer the months to develop the budget for the upcoming fiscal year. in terms of what we will go over today -- next slide please. >> no, just speak into the microphone because i'm not the one doing it. >> i will provide an overview of the dph base budget and bake out of divisions and protected salary spending and review the five year financial projection for the city as well as the mayor's budget instructions. then discussed goals and areas of focus for 23-24. 25 this will give context for the packaging and next steps in the following meeting. next slide please. and then the slide after that. all right. so overall dph approved budget in the base and approved of last fiscal year's budget is $3 billion. this slide break it says out by division where you see san francisco general hospital is about $1.2 billion,

behavioral health services is about half of that, the second half largest and 600 million pushing and followed by public health administration about which is our central operations at about 188 million. population health services at 189 million. primary care 123 million. network services 366 million but a portion of the budget expenditures include about $100 million of intergovernmental transfer matching ratepayersments and not spending authority -- [off mic] low audio. next slide please. just looking at our budget by expenditure type overall salaries and fringes represent the largest over half of the expenditures at 1.5 billion dollars and non personnel services and again

this represents a lot of the work with cbos as well as some of the intergovernmental payments that i mentioned before. materials and supplies for us again this is not pens and pencils but pharmaceutical and medical supplies for the department at $190 million. some equipment 2 million and facilities and maintenance and debt service around 26.9 million as well as interdepartmental work orders and services from other departments including city attorney and dpw and others at 160 million overall. next slide please. in addition to our expenditures i also wanted to do overview of our revenue. many commissioners have seen this before but i am proud of this slide. as you know we leverage about [off mic] of our costs with revenues which is

sort of similarly layered so we have general fund that comes in as a subsidy but overall 2/3s of the expenditures. we generate through our own revenue. >> . >> this general fund contribution has been fairly consistent at being a third of our revenue and for the base budget it's about basically about a billion dollars of general fund so even though only a third of our budget when you're looking at a $3 billion budget our general fund support is significant at $1 billion and i will note overall in terms of the city to give you a pers of the city's overall budget i believe the overall general fund is about $7 billion so we're approximately about 15% or about a seventh of the city's general fund support. next slide please. as part of administrative code requirements i'm reporting on our salary savings as part of our hearings. we have an operating

budget as i mentioned of 1.5 billion dollars for salary and fringes and as of q1 projection which i will present after this item you will see that we're projecting about 18 million or 1% of savings in our first quarters. the savings is driven by hiring delay for new positions and assumes hiring in the second half of the year and efforts to hire the new budget positions as well as retaining recruiting and retaining for existing staff will have impact on these figures at year end. in addition as you know we will be providing regular financial reports to the health commission every quarter as we will continue to update those projections every time. next slide please. and then so moving on to the mayor's financial projections and budget instructions. next slide. overall just big picture in terms of summary. what we're seeing weakening financial forecast as a result

of deficit across the five years. basically slow or no growth in local major revenues with loss of federal revenues. there's also increased cost in the form of higher wages as well as increase personnel costs for health benefits and pension as well as new set asides for schools. there's significant risks [inaudible] [off mic] that can alter. as a result all city departments have been instructed to provide a general fund reduction of 5% in 23-24 and 8% in 24-25. for dph this results in about $50 million in the first year and 80 million in the second year. i than commissioner chow has also done the calculation in terms of percentage for our overall budget so if you look at 50 million as it relates to $3 billion budget it's 1.5% in the first year and grows to 2.5 in the second year. over all it's just a percentage

reduction in our expenditure budget. next slide please. so on this table represents the projections of the short falls expected with 29.2 million of loss much revenues in the city overall and then increase use cost of 171.6 million which results in $200 million deficit in the first year. in the second year of the proposed budget the revenues are projected to drop by an additional 24.seven and then the budgeted cost -- the projected cost increases to 502 million resulting in 527 million short fall projected in the second year. this is how the overall two year deficit is calculated at 728 million for the entire city. next

slide. so part of the [inaudible] this is really understanding the pace of the economic recovery and the potential for increasing office vacs and we have high impact in interest rates that the controller's office is monitoring and cut backs in the tech sector and other local industries. i will note this projection by the mayor and the controller's office was done around november and concurrent with a lot of the news regarding major tech downsizing and it would be interesting how it impacts future projections as this develops. in addition there could be the state budget short all and risks to the educational -- i forget what it stands for but basically the funds from the state

back to counties. of course there's a potential risk for a recession in the economy but that is not what is being projected now. right now they're seeing slow growth and not an actual retraction in the revenue growth that we see. next slide. so the mayor's priorities for this upcoming budget is the recovery of the local economy, improving public safety and street conditions, reducing heme home and transforming mental health service delivery as well as accountability and equity in spending. they're the same priorities she has in prior years and remain unchanged at this time. next slide. so the budget instructions as i mentioned before the reduction target over the two year budget. in addition there's instruction to prioritize filling or reclassifying vacancies for functions and remaining

vacancies for budget savings and retain the initiatives and fund more efficiently and prepare for the outlook to worse. next slide please. so with that in terms of dph's goals in area of focus over the two year budget -- next slide -- there's six areas that i think we're continuing to focus on. it's really around financial stewardship and leveraging things and including cal aim and behavioral health services and strengthening operation and service delivery and work force and equity. stringent population health and transitioning the covid-19 response into operations. recertification of laguna honda hospital sustaining long-term improvement, improving access to data and expanding electronic health records as we continue

our implementation and next slide please. i will go into each of the areas in a little more detail so under cal aim as you know it's multi-rear framework for re re envisioning how medi-cal services can be reenvisioned over the last year we have been implemented three new benefits basically additional revenue for services that were never previously covered. it includes enhanced care management which is implemented just over a year ago. community supports where weed respite and sob sobering center and summer rise and this benefit became effective july 22 and then the expansion of justice involved services. this became effective this month. in addition to just beyond creating actual new benefits it also seeks to reform and restructure

medi-cal payments and the following two items while in theory they should be revenue mutual will have impact and shifts the structure. the first one is shifting the long-term care -- it's called the long-term carynin shift services care shift services over to the health plan in terms of payments. in therapy the -- theory the payment structure should be the same but administered by the health plan opposed to the state and organizationally there's a different organization we have to work with again similar processes but again we have been collaborating closely with the health plan as they take over this function with a bunch of other counties so it will take effort to make sure we're transitioning and collaborating with the health plan consistently, and no impact in

revenue but again represents some operational resources that we need to make sure that we're transitioning successfully. in terms of behavioral health payment reform this is also significant shift. again not meant to adjust revenues in any way necessarily but really takes the old way of billing and avatar which is around service areas and minutes and shifts to codes instead. this is a fundamental shift in how providers are recording services and again we will require a lot of operational support. i know they have provided in last year's budget one time funds to support the implementation. this goes live and again there's significant financial risks if we don't implement this successfully, but so the goal is really make sure there's no impact overall to the long-term

revenues as we move forward with the transitions. next slide please. moving on to behavioral health services and i do apologize i think we were i had some control issues and trying of collapse some of the categories and shorten the presentation. overall we have about $98 million of behavioral health services as we invested as part of mental health assess funded by prop c and the true amounts of the categories really is $36 million in additional bed capacity, 29.7 million in services and street and shelter, 7.8 million in targeted mental health services and about $8 million in case management and $13 million overdose prevention. i will [inaudible] send updated summary. it's the same budget as about and i apologize for the inconsistency

in the slide. next slide please. in addition to mental health sf and the prop c funds we projected expected increase in mental health services act funding last year and included $4 million for the need of black african-american mental health support for people black identified and $3 million for the office of overdose response and 12 million for one time capital improvements and had behavioral health investments to strengthen services for people on involuntary holds, comprehensive services, utilization management as well as enhancement and coordination of our system of residential care. next slide please. third our goal is to strengthen work force and health equity. the

central operations has 11.1 million to support contract developments and human resources and the office of health equity and privacy affairs and security and [off mic] these operations operating functions are critical to ensure timely and successful implementation of all of our program and we're working on implementing [inaudible]. next slide please. population and health transitioning. the covid-19 response into operations. the population health infrastructure -- last year we invested 6.8 million dollars annually to strengthen the infrastructure including the public health emergency and preparedness branch and -- [off mic] with the pandemic. in addition we will continue to step down our covid response and our upcoming budget will outline plans for the ongoing 25 million of continuing services in dph operations as well as

public health that -- i'm sorry, network operations in public health that we will be planning and bringing forward as part of our budget proposal. next slide please. as we have been discussing recertification of laguna honda hospital and supporting our patients will remain a top priority. as noted we will continue to work all the regulatory requirements and improvements for recertification and also note that additional ongoing investments will be necessary to determine ensure the long-term sustainability of the improvements that we're making at this time. next slide. and last but not least we are continuing our epic journey. we will be implementing phase iii over the budget horizon and so this represents the largest expansion of the epic hr since

we went live in 2019. most significantly looking at behavioral health services, bringing them on as well as partner agencies for mental health and substance abuse treatment and dialysis and mapling on aggressive and functionality and enhance patient engagement. >> including text messages as well as online consent forms to have the ability to capture with digital signatures. >> . >> next slide please. next slide. so with the context of given what we've seen in terms of budget instructions and the economic climate with the potential worsening of economic outlook and then just sort of recognizing the significant investments that we have made over this last several years overall our approach in developing our budget proposal

over the next few weeks is really focus on maximizing revenues to meet goals as well as support long-term financial stewardship. we'll leverage new revenue opportunities to expand or strengthen our services and the goal is maintain operations and service levels including back fill grants and other revenue sources as necessary and appropriate but really the focus will be on the implementation of prior year initiatives and we will limit new initiatives to maintain that focus. and then next slide please. and so in terms of next steps at the february 7 commission meeting we are presenting a detailed balancing plan and we'll request approval from the health commission to submit the proposed budget to the controller and the mayor's office. if necessary we will have additional hearings and our budget submission is due february 21 and with that i

think that concludes this and i did receive some questions from commissioners i do want to address. let's see from commissioner chow in terms of our effort to leverage revenues is wondering we will not try to have service level changes including non-profit contracts that carry new programs and epic conversion. just as a reminder our goal is maintain the service levels that we do have and for the epic conversion some commissioners will remember we funded a 10 year implementation project we're still working through. we do have budget associated with the cost of it and of course we will monitor the implementation of phase iii and optimize the program effectively but there should be not new investments required as of now for the wave

three implementation. and then commissioner green asked about projections regarding the ongoing staffing and data for continued laguna honda certification. i think this is an area we will look at and again it's a dynamic effort lead by mr. pictins and staff and we have been looking at for budget and the spring as we continue our recertification journey. and then in terms of projections regarding governmental payments for clinical and hospitalization revenues and adjust for inflation. yes. we will definitely look at overall baseline revenue growth as we do every year and adjusting that as part of our budget submission to you next week. with that said i am happy to entertain any other questions that commissioners have regarding our budget submission.

>> thank you. welcome ms. gibbs and thank you to mr. alexander also. secretary morewitz do we have anyone on the extent line? >> we do. i will remind folks we are the budget proposal for fy 23-24 and fy 24-25 and i see one hand and we will go from there. caller you're unmuted. please let us know you're there. >> i am. patrick bernard shaw. >> you have three minutes. >> thank you. a $3 billion budget? wow. it wasn't looking ago dph had a $1 million budget that san franciscans thought was excessive then. laguna honda's fiscal year '21-22 operating budget through june 30,

2022 was 3.86 million and increasing to 336 -- [inaudible] million or fiscal year '23-24. that's a $28 million increase across two short fiscal years. dph budget strategy claims to be included in a focus on maximizing [inaudible] the impact on the general fund. you should have been [inaudible] laguna honda for rapid recertification to resume federal cms reimbursement particularly lost medi-cal revenue. the first quarter [inaudible] for the current fiscal year so you already lost 23.9 million in medi-cal revenue

short fall, and more than likely you would have lost an equal amount in the second quarter. as you head into the third quarter and head into the fiscal year 23-24 budget a priority should be restoring obtaining cms reimbursement revenue. budget slide 21 only stated regarding laguna honda "additional investments [inaudible] to ensure long-term sustainability with these improvements" . unfortunately the itemized investments aren't itemized. does that mean capital projects investments? if so why weren't the capital projects itemized? wave three

enhancements are long overdue and should enhance advanced identification for clinicians of the [inaudible] plan care adjustments and other patient evaluations are coming due, so clinical staff could keep care plans updated timely and i know i was in laguna honda hospital and we developed -- >> thank you. your time is up. all right. that's the only comment. >> all right. commissioners any comments or questions for the team? . >> i don't see hands. oh commissioner green. >> vice president green. >> thank you for all the incredible detail and i may have misunderstood or missed it and i'm sorry if i am not misunderstanding. it you elaborate more about

what working through health plans and codes could mean to our revenues? you know usually with management of cal both moneys goes to a health plan as they see fit, and is our health plan the san francisco health plan? i am confused because i saw a notice to the residents of laguna honda and they could elect a health plan and didn't see make it a san francisco health plan and i am wondering how that comes together and what the implications can be or if you can say them now? i may have misunderstood and i wondering if you can elaborate on that. >> i am happy to and we're joined by -- dr. horton i know you have been working on this too. >> hi everybody. i am getting over being sick and i hope you can hear me. >> can you identify your title?

>> absolutely. i'm the chief medical officer of the network and acting cfo of laguna honda as well and involved with the cal a.m. initiative and at laguna honda and it's helpful because i can be on site and clarify things as laguna honda as a long-term care population rolls [inaudible]. cal aim has a long range of initiatives so the term that the long care population is will rolling into cal aim may seem disconnected to other activities in cal aim but there's many initiatives within the cal aim program. for all of our cases that includes the primary care patients as well and all the patients seen by the network and regulations we are a two plan town which means that anthem blue cross is one of the managed plan and the san francisco health plan

is the other one. in the network we have 88% of our patients are patients who have managed medi-cal are san francisco health care patients and 12% are an then. the state has a system which they assign a managed care plan. >> . >> first of all there's a system with someone with managed medi-cal has the right to choose which plan they want, and we're very used to that process in primary care. if the person does not choose which plan then the state assigns that person to a plan and they is a distribution system that decided is a variety of things including the quality scores of the health plan, and the current capacity and market share in the particular county, so that's really what is determine the 88% versus the 12% sfhap

versus anthem distribution. because the vast majority are in managed care but specifically with the health plan we do tend to have a very close working relationship with the health plan and we work on a lot of initiatives with them so that's probably why you hear us talk more about our work collaborativing with the health plan. we have a good collaborative relationship with anathemas well so one thing work closely with the health plan and work out details of whatever system we're working on and often the anthem partners are happy to use the same system with us. in terms of laguna honda essentially the entire will all of our patients there are going to be affected by the long-term care so 553 patients. they have been receiving letters from the state telling them they have managed care and telling them they can -- and i

think commissioner green you probably saw one of the letters and explainings they can choose between the health plans and if they don't choose by february 1 they will be assigned to one. as you can imagine the letters are conservation fuse -- confusing to a lot of them and it's medi-cal and confusing to a lot of us and our team when someone asks checking in with residents at laguna honda if case they have questions and helping them and choosing a plan and explaining if they don't want to make a choose they can wait until february 1 and receive their designation so i hope that answered the question, but we essentially are going to have all 553 residents of laguna honda be insured by managed medi-cal. we're starting now but by february 1 everyone will transition into one of the two plans in town.

>> so there's only two which helps a great deal. >> right. >> but blue cross it adds another administrative layer so i am wondering if you can elaborate on the c pt component of it and whether the compensation for care is identical whether our own city san francisco network or whether it's blue cross? i mean is there a differentiam and standardize between the two so for us it doesn't really matter. >> yeah that's a great question. my understanding the state has built in -- [off mic] [inaudible]? of the things have been worked out already and now those that don't have it are moving into it via cal aim and a lot of examples in the state how this can work. built into the cal aim legislation is kind of a freezing of the

current costs so that -- i can't remember how much time it's for but i thought it was three years. i can get back to you on this. the managed care plan are supposed to reimburse at least at cost as in the past. however, so for immediate sense we're not concerned about loss of revenue. of course once we get recertified hopefully that will be long-term medi-cal revenue source as well, and we do have some concerns will certain things like if somebody needs transportation to out patient visit at ucsf or san francisco general or somewhere else and are we restricted with the transportation company we can use? that's why we're having a

weekly meeting with the health plan to make sure no authorizations would be in place that would delay care or cause any concerns or ease of patient access to services that they currently have. the other good news we're worried about the formula as well but by the regulation the managed care plans are required to accept the form larry currently at the moderate scale neighborhood commercial transit so we're not anticipating a lot of problems. >> . >> but have the right people meeting frequently and we're going to see over the next three months and hamet out any issues that we find. >> thank you very much director that. clarify its a great deal. thank you. >> thank you. >> thank you dr. horton and i will note for laguna honda there's no conversions to codes. i will referring to the behavioral health payment reform

and [inaudible] service modality and two codes so that's where the significant charting and changes would be and it represents a potential risk and of course our goal is main the -- maintain the revenues if not improve during the transition. >> thank you. any other questions or comments from commissioners? >> i don't see a hand. no hands. >> okay. seeing none we will see this item again on the february 7 agenda as well and our next item for discussion also with jenny louie is dph revenue and expenditure report first quarter of fiscal year '22-23. >> just noting this is the third time we tried to have this discussion. it was from the [inaudible] finance committee and there wasn't room in the

agenda and those meetings ran over and thank you for your flexibility. >> thank you for your patience and flexibility and apologies for any challenge that may have causeed. >> i am pleased to bring this report to the commissioners this evening. again jenny louie chief financial officer. next slide please. and so i'm sorry i know this is second -- this is the first quarter financials. we are projecting as of q1 a deficit in the current here and reduced revenues at laguna honda due to the lower census as a result of pause in new admonitions during the recertification process. illinois that figures in this report are preliminary and based on three months of actual. i find first quarter projections to be the most challenging and working with less 25% of the data try to project over the course of the year so we are doing our best guess in terms where we will land at

year end but changes are likely again to these projections depending on the continued work on laguna honda recertification and as well as hiring over 400 fte that is part of last year's budget process as well as any potential changes in covid service levels due to unforeseen surges that weren't assumed as part of the first quarter projections. i have will remind the commissioners that our covid response reflects the response cost and not about any increase operating costs. those increased operating costs are reflected between the divisions of the network which is a departure from the former year and tried to corral the impacts of covid and normalize the operations in post covid world and [inaudible] [off

mic] and one other change thatsh from prior years and expenditures given the budget isst just under 10 million and under the health network twigs and ambulatory care for simplicity so next slide please. so the first quarter summary overall we're projecting 15.3 million deficit and 16 overall of short falls with the most significant portion related to census at laguna honda 23.9 million with some increase above budget revenue projections at zuckerberg and behavioral health services. on the expenditure side we're projected to remain above budget with savings of about a million dollars with

short falls at san francisco general hospital laguna honda hospitals and savings with the other divisions so overall 15.3 million projected deficit moving forward. as commissioners may recall we do have a management reserve they will discuss at the end that can help smooth these fluctuations in the current year so next slide please. so going into the details san francisco general is expecting a $5 million deficit. the revenue is expected to be $4 million over budget. in total and not 33 million. our expenditures overall is $9.1 million short fall with short fall in salaries and benefits and 3.8 million in non personnel services and including cost for registry and $5 million related to material

and supplies as part of increased inflationary costs as well as additional covid operating costs that weren't accountd and 4 million net and the 9 million short fall gets to a $5 million difsit at zuckerberg general. laguna honda as i mentioned 23.9 million due to reduced census since the beginning the year and this revenue assumption assumes that we will begin recertification process and be recertified through by the end of this spring so we have this projection may vary on our overall recertification process goals. in terms of expenditures there's 3.9 million in salary overages as well as 7.5 million in non personnel costs driven in part by some of the

additional costs related to recertification. next slide please. behavioral health services is projecting an overall 33.2 million surplus. there's about 6.8 of increased revenues projected offset by $3 million of salary savings and [inaudible] [off mic] of course we have seen similar levels of contract savings in the prior year. next slide please. primary care is expected to be essentially on budget. a small projection of savings of half a million. next slide. jail house services and -- [off mic] it's offset by non personnel services of 1.8 primarily to the use of increased

registry contract. next slide please. health network there's a slight revenue short fall due to reduction in healthy san francisco [inaudible] [off mic] of 2 million offset by salary savings of 5.4 as well as 3 million of non personnel savings related to -- i believe this is the -- oh the deficit due to as needed beds related to additional beds needed to support patients flow. next slide please. population health is projecting 1.1 million short fall in patient revenues. this is related to in part due to

lower activity in environmental health as well as the adult immunization and travel clinic. we're looking at the models for [inaudible] in determining opportunities to look at their revenue models as well as lower than expected lab billings we believe is a relate ofuppic and our teams are collaborating right now to dig into the root cause of the revenues but it seems like a combination of multiple factors. some slight salary savings of 1.3 million and savings from the [inaudible] project. next slide please. public health ad min $1.7 million in salary and benefits and all others areas remaining on budget for now. next slide please. so with those adjustments as i mentioned

before with the one projection we're expecting $15.3 million short fall. as the commissioners know we have a management reserve based off of the two year budgeted revenues of 5%. we started out the year with 123 million in this account and should the 5.3 million dollar short fall persist we -- 15.3 million short fall to persists over the course of the year we would expect similar withdraw from it leaving a balance of -- [inaudible] [off mic] and then next slide please. in addition our covid response budget overall we're expecting slight surplus in this project. this is as of q1. this 3.7 million is primarily driven by

close out of prior year encumbrances and a continuing project we can roll over expenditures and the payments from the prior years and close out some of them and recognize a balance in the project. next slide. the most significant ones we really see is 2.5 million in savings of isolation and considered routine unless a member objects hotels. >> . >> quarantine hotels and supporting with civil service staff instead a contracted service. we have bonn .5 million in savings in this unit and offset by one .7 million short fall -- [inaudible] [off mic] and one location through the end of december 20 2. the projection assumed baseline services and does not include any services increases related --

[inaudible]. next slide. that completes my presentation. the q1 financials i will note that the finance team is working on q2 financials and i hope to complete them by the end of next month and we will bring them forward [inaudible]. with that i will happy to answer any questions the commission may have. >> thank you. it means we will see i lot of you in february which is great. secretary morewitz do we have any public comment? >> folks on the line we're on item 7, the expenditure report. please press star three if you would like to make comment? no hands commissioners. >> commissioners any comments or questions? >> commissioner chow has a hand up. >> commissioner chow. >> yes. no, it's just an editorial comment on the powerpoint when you talked about jail services you

actually had a surplus bike [inaudible] but it reads short fall. >> . >> my apologize for that commissioner. . >> i'm sorry. did you not hear? >> i think you noted that i had a riverse, i had the incorrect title on -- >> could you repeat it dr. chow? >> yes, there was an incorrect title under the jail powerpoint slide that says short fall when in fact as she said it was a surplus so i thought if we were correcting the second quarter comments we could correct the short fall comments title. >> thank you. again my apologize for that oversight. >> thank you noted commissioner chow. other comments or questions? the answer is? >> i'm sorry. there's no hands. >> all right. great. well thank you again and we

will see you next month. >> great. thank you commissioners. >> okay. over next item is the approval of the minutes of the health commission meeting of january 3, 2023. commissioners do you have these minutes before you? if there's no amendmentsor changes do we have a motion to approve? >> i so move to approve. >> is there a second? >> second. >> any public comment? >> yes there's a hand up. the person on the line you have three minutes. i'm going to unmute you. please let us know that you're there caller. >> [inaudible] bernard shaw. >> all right. we're on item 8, approval of the minutes, and you have three minutes. >> okay. these minutes were [inaudible] director of public health colfax for

presenting colfax's laguna honda recertification strategy work flowing on chart. the minutes report was [inaudible] infrastructure is in place to address all the complex processes under way to achieve recertification. notably neither chow nor the other four commissioners present on january 3 bothered to ask why colfax's recertification strategy is being presented fully eight months after the three consultants were hired to rescue laguna honda last may. shouldn't the strategy should have been worked out at the time the consultants were hired? as well either chow or the other four commissioners bothered asking about the capital projects on dr.

colfax'sing on chart that are needed at laguna honda for recertification. notably acting ceo pickens asserted that the capital projects will help achieve more successful facility inspections surveys and help obtain recertification. this commission should release the list of laguna honda capital projects under way or planned that you presumably seen and you should release that list immediately. members of the public and the board of supervisors deserve to see the list of capital projects and why each project is essential to gaining cms recertification. thank you. >> thank you for your comment. that's the only comment on this item. >> all right. let's move to a roll call vote. >> could i just ask

however because i didn't get a chance to put this in my comment. i just wanted to be sure is that a typo under the director's report mpx update that says the total cases are november 5? . >> [off mic]. >> that's on page four. >> that is an error. i apologize. so would you like to make that amendment? >> just say the right date. i don't know. i can't remember what date of the presentation exactly but if you just find the right date that's all we need to do. >> error on the slide. >> thank you. i believe i recall correctly there was an error on the slide that may have had the date of november 5 and i believe cases were updated to a different date and i recall during the presentation saying that would be corrected so we can make sure we get the date

that was reflected -- >> [off mic]. >> i can't hear so i'm not sure what he actually said. [off mic]. >> we should double check this and the slide i presented a number of cases to the health commission two weeks ago had november 5 as the date of the cases and i believe that slide hadn't been updated with the correct date. i believe but we should double check that the cases i show on the slide were actually from more recent than november 5. had just hadn't been updated and we had work together to make sure that is corrected appropriately. >> [off mic]. >> thank you director colfax. is is that amendment okay with those that moved and seconded the approval? >> yes. >> all right. >> [off mic]. >> yes.

>> roll call vote. commissioner chow. >> yes. >> commissioner chung. >> yes. >> commissioner green. >> yes. >> commissioner giraudo. >> yes. >> commissioner bernal. >> yes. >> all right. [off mic]. >> thank you very much. our next item is the director's report. for this we have dr. grant colfax director of health. >> good afternoon commissioners. i am pleased to present the director report. i will go through some of the pieces in detail. one and then the covid update will come later so we don't need that slide quite yet but in regard to the director's report a copy which is in front of you i did want to call the commission's attention to the sf city option update and you will recall that the department of public health through its third party vendor the san francisco health plan known as sf hip is in the process of notifying

400,000 employees and 4,000 employers of a new city policy regarding the unused fund in the san francisco city option, sf city option program. last year the health commission passed a new policy in compliance with state laws to addressed compounding inactive program funds since the inception. the new policy which is governed by the california government code sections as cited is to permanently close any sf medical reimbursement account that has been inactive for three consecutive years. any account not activated by that date will be permanently closed and funds will be absorbed into the city's general fund. this option was created under the health care security ordinance in 2008. employers can choose to comp ply with the health care security ordinance

through this option. the program provides accounts with the workers of the participating employers. employees can access the fund and mras and complete registration and submit receipts for health and wellness expenses for the families. funds will never expire if the active isktive. the city never permanently closed any since 2008 and over the time unused funds accumulated in accounts. it's the city's goal to encourage people to open their account and use the funds and make them aware that we will track the activity in mrss in beginning in march 2023. beginning in april 2026 any account inactive for three consecutive years will be closed. prior to the notification to the employees and employers we did outreach to make them aware of the new policy and prepare for questions

from sf hip stakeholders. they will also be posting frequently asked questions for employees and employers at the sf option website. i also wanted call the attention to the next item that chinatown seismic upgrade and modernidation project and the health center is in the major up grade and modernization project and working with public works and arts and others to educated community and includes a full seismic up great for earthquake safety and interior space and increase the number of rooms, expand capacity of the dental clinic and make the center accessible for people with disabilities and improve air quality and ventilationeration. the second in a community meeting is scheduled at the san francisco public library

community room as cited and i did want to recognize staff for their engagement in a award for context each year the department of pesticide regulation honors california organizations for their achievements. this award program recognizes organizations that use integrated pest management to addressed needs throughout california recognize individuals and organizations that are leaders in the use of safe sustainable reduced risk pest management methods and this past summer one of our industrial hygienists in the department in our dph environmental health branches pesticide enforcement program phil calhoun nominateed the san francisco giants for this award and i am very pleased

to say that due to phil's work in support of the giants program they were the recipient of the 2022ipm achievement award which is really a reapplication of the hard work and collaboration of phil and his team with the giants and working with the small business community ensuring that safer pesticide management practices are adopted so congratulations to phil and the sf giants on the integrated pest management achievement award. and with that we will go on to the slide of the covid-19 update. could we have the first slide please? . >> are you there? .

>> hopefully we can get the first slide. they were there for a minute. hopefully they will come back. all right. thank you. so just a quick update for the commission. let's go to the next slide. so you see over here on this slide are trends from the beginning of the pandemic of july 2022 to the far right where we are now and you will see that we've had a winter bump on the surge of the winter has not been as serious as we saw over last winter january of 2022 when we an incredible surge of 272 cases. you see per 100,000. now we're down to 12.9 and this swell if you will in the current local

situation is very much reflected in the sort of u.s. trends want you will see a similar bump up. i do think it's important to point out now in san francisco as we approach our three year mark of being in the pandemic we've had nearly 200,000 people reported with covid-19 tragically 1137 people have died due to covid with our condolences and due to the high vaccination rate and other precautions many, many deaths were prevented. next slide. and you can see in relationship to our increasing cases now familiar pattern and having increase in hospitalizations you will see on this slide we're down to average of 91 patients hospitalized with covid-19. 15 in the icu -- again

far different scenarios than winter of 2022 or winter 2021 and numbers include people in the hospital for covid but in the hospital diagnosed with covid but hospitalized with other conditions. next slide. and in terms of our vaccine and booster administration i will call your attention to the far right of the slide in regard to the% of population boostd and we have 35% of san franciscans who have received a bivalent vaccine booster and 61% of people 65 to 74 and 56% of 65 and over received this booster. while the numbers we would like to see those be higher because we know that the bivalent booster helps the worst outcomes due to the currently circulating variants. we are far higher in terms of

our bihave a iant booster than other communities across the country and the state. next slide. so we continue to focus our efforts and messaging on improving covid-19 vaccination booster rates. these are the best way for individuals to continue to protect themselves from the health impacts of covid. i am pleased to say that the flu numbers continue to decline in san francisco and california overall, and as i already mentioned covid hospitalizations are now also decreasing and they're lower than they have been in previous winters. it's not too late to project yourself and others in winter with the guidance you're all very familiar with and just to say we continue to review our covid-19 policies and health orders and we will begin to remove many of the covid-19 prevention and control

orders as covid prevention and control are further integrated into dph work and in preparation for the end of california state of emergency on february 28, 202022 and that completes my update and i am happy to answer questions or other aspects of the eric mar's report. thank you commissioners. >> thank you director colfax. is there any public comment? >> there is one person on the line. you have three minutes on the clock. >> thank you. great -- [inaudible] for the last time today. the troubling part of the report is pathet only three pages long. he

saiding in about laguna honda extending the discharges beyond february 2. the mandatory discharges [inaudible] per paragraph seven on page eight of the settlement agreement. they're 16 days away from today. it's irresponsible, irresponsible of laguna honda management starting with acting ceo roland pickens along with the [inaudible] and dr. colfax that taken so long to ask the state attorney's office to submit a letter that [inaudible] request an extension beyond the artificial february 2 date. it's absurd pictins hasn't requested the [inaudible] and submit the request long before now. waiting so long

to ask the cao for help is like asking hostage takers, cms, the the cdph to wait before they shoot their hostages meaning laguna honda residents facing mandatory discharge and the potential of transfer trauma all over again. colfax's written report makes no mention of what [inaudible] capital projects are currently under way or are planned. dr. colfax of list of laguna honda a capital projects now. thank you. >> [off mic]. >> commissioners about comments or comments on the director's report or the have you had update? >> commissioners green and

[inaudible]. >> vice president green. >> yes. thank you for the update. you know you may not have an answer to this or in the policy but there was a journal commentary by paul [inaudible] who is one of the well known vaccine experts that young healthy people probably shouldn't get the bivalent vaccine going forward because the variants currently in circulation really have the ability to pibass the immunity the vaccine generates and the only reason i am bringing it up it was picked up by many news outlets. i don't know if it was picked up by the chronicle but we have been getting questions and does dph have any advice and it's vague and i wonder if there's any thoughts or ideas in development? >> yeah, i appreciate that question commissioner and

dr. and [inaudible] is on the line and i will let her respond and we're following the cdc and recommendations for people receiving the booster and doctor i don't know if you have more to add about the specific article or the context which commissioner green was speaking? >> yes thank you dr. colfax and commissioners. thank you vice president green. around the comments and commentary there's a lot of conversation which is good. it's good to be talking about these issues and i think that's really what his piece prompted. there are also a lot of advisers and senior epidemiologists and people following and part of the transition and covid team for the biden white house that differ on their opinions and feel there is usefulness. i mean for one we do know that

vaccines decrease the risk of a possiblization and that could happen in healthy people in more rare occasions. it also decreases the risk of long covid yet we don't know enough about and we're in the process of learning about that. we certainly are really doing our work and trying to emphasize the bivalent vaccine booster acceptability and information to populations that are older and the emphasis on public health and we understand the greatest benefit is there but we don't think we would go as far as not to go to younger ages yet. as dr. colfax said we're following what the advisory committee and cdc and others say in the recommendation and i think this is an evolving discussion and as we're looking in hind sight and so far a milder winter than previous years the conversation about the next booster whenever that is in a year or so maybe a

different one and i think that conversation is evolving and good to have people with different you video points and talk through this in the field of public health and vaccine science so more to come on this but now we're continuing to really emphasize this particularly for older individuals in san francisco but it's a potential benefit to everyone and we want people to know about it and access the sack rein. >> thank you. that was a great answer and a great clarification. >> all right. thank you vice president green. commissioner chow. >> yes. i want to thank dr. colfax for the announcement about the chinatown health center. i know that it was in the planning stages for a long time and so i know that the community is very grateful. it's a very important center. i am hoping that it mentions that

the second of a series of community meetings are at the san francisco public library. i am hopeful that perhaps the first one was in chinatown. i think it's really important to continue to get the input from chinatown and also from our other chinese community to the city as they all use the chinatown public health center so thank you very much. i am looking forward -- i don't know how long tell take but it comes out as nicely as some of the renovations and new buildings this will be really a boone for the community. thank you. >> thank you commissioner chow. >> thank you commissioner chow. commissioner chung. >> thank you dr. colfax for your presentation. i think that following the news there is a new variant that is popping up and it seems to be

invading immune systems but impacts those that are [inaudible] and vaccinated and i appreciate dph staff and the community persons efforts getting as many san franciscans vaccinated possible and we have such a high vaccination rate. >> thank you. >> all right. commissioners any other comments or questions on the director's reports or covid-19 update? >> i see no other hands. >> all right. we will move on to our next item. it's a request of commissioner giraudo we will be delaying the community and public health update to the next meeting and bringings us to other business. any other business? any public comment on other business? >> [off mic] mr.

menet shaw is your hand raised for this item, other business? >> no. i promise you -- this is patrick. i promise you on item 9 that i would leave you alone for the rest of the day. >> all right. thank you sir. no public comment. >> all right. with no other, we will -- >> i'm sorry. commissioner green's hand is up. >> commissioner green. her hand is not up. all right. with that we will entertain a motion to adjourn. >> i so move to adjourn. >> second. >> public comment. none. >> there's no public comment on adjournment. >> well there we go. >> roll call vote. [off mic]. >> yes. >> commissioner giraudo. >> yes. >> commissioner chow. >> yes. >> commissioner green. >> yes. >> and commissioner bernal. >> yes. >> all right. thank you all. >> all right. thank you commissioners, dph staff. members of the public.

we will see you again in three weeks. is that right? >> yes, february 7. >> yes. three weeks. >> thank you commissioners. have a good evening. >> thank you.

>> the meeting began at 936 a.m. secretary fuller, please call the roll. >> good morning. please respond with, here, or present. lynne newhouse siegel is on her way but running late. [roll call] >> with 3 members present, we do have quorum for the public works commission. due to the ongoing covid-19 health emergency and given the public health recommendations issued by the san francisco department of public health, and the emergency de