seeing none. is it one hand raised or just one person there? of course there is a hand raised now. please go ahead and are unmute the caller. this is just on item 15 but let us know if we missed you at another item. item 12-we already closed public comment for item 12. i will leave this up to the- >> if there is one person let's hear it. >> if you can please unmute the caller. you have two minutes to speak. the caller

is unmuted. >> my name is david keenen. my non profit (inaudible) is work wg owners around the development at 1458 san bruno and i wanted to say the expansion of the parking area to 0.18 increase is not something i think would concern the closest adjacent neighbors at 1462 san bruno, and that i just wanted to register that we had no--generally support the compromise there. >> thank you very much. >> thank you. seeing no further callers, public comment is closed. we are on item 16, communications. is there anyone with hand raised to comment on item 16? seeing none, public comment

is closed. item 17, adjournment. >> been moved. is there a second? >> second. >> moved and seconded. all in favor? >> aye. >> so moved unanimously. [meeting adjourned]

>> staff of the public and welcome to the san francisco health commission on february 7, 2023. secretary, please call the roll and make necessary announcements. >> yes. commissioner green? >> present. >> commissioner hao? >> present. >> commissioner duarte. >> present. >> [roll call] >> i have a script to read. good afternoon and welcome to the february 7th, san francisco health commission meeting. this meeting is held in hybrid format with the meeting occurring in person at 101 grove street, room 300 broadcast live on sf gov t and viewing webex or call 415-652-0003. before we begin, i would like to remind all individuals present and attending the meeting in person today that all health and safety protocols and building rules must be adhered to at all times,

this includes wearing a mask covering nose and mouth during the meeting and failure to adhere to the rules and requirement may result in removal from this room. we appreciate your cooperation. please also note that hand sanitizer station is available at the entrance of this room. we welcome the public's participation during public comment period. there will be an opportunity for general public comment towards the beginning of the meeting. and then an opportunity to comment on each discussion or action item on the agenda. each comment is limited to three minutes. folks on the public comment line, press star three for the items as it's being called if that's -- if you would like to make a comment on that item, therefore your hand will be raised and acknowledged in time for public comment. public comment will be taken in person and through call in. for each item, the commission will take public comment for those attending the meeting in person and those attending the meeting

remotely. those attending in person are requested to submit a public comment card to me. note that city policies along with federal state and local law prohibits harassing conduct against city employees and others during public meeting and not tolerated and moral public comment is only within jurisdiction of the health commission. thank you. >> thank you, secretary morwitz and i'll recognize commissioner galowitz for the ramaytush land acknowledgement. [ramaytush land acknowledgement]

>> thank you, commissioner. our next item, item no. two is general public comment. we'll hear comments on matters that do not appear elsewhere on today's agenda. secretary moritz. do we have public comment. >> yes, we do. folks in line, please raise your hand by pressing star. as you're doing that, i'll going to read a comment. i mean a statement. at this time, members of the public may address the commission on items of interest to the public that are within the subject matter jurisdiction of the commission, but not on this meeting general. each member may address the commission up to three minutes and the brown act forbids the commission from taking action or discussing item not on the posted agenda including those raised during public comment. please note that each individual is allowed one opportunity to speak per agenda item and individuals may not

return more than once to read statements from other individuals not able to attend the meeting and written comment may be sent markmowtiz at sfdhp dot org. if you wish to spell your name for the minutes, you may do so without taking allotted time. all right. so, i see one hand for general public comment. let me grab my timer. caller, you're unmuted. please let us know you're there. >> i am. it's frederick. >> please go ahead. >> (indiscernible) claimed on august 2nd, the recertification goal would add sustainable city positions to assume work of consultant administrators and evaluation of laguna honda pilot

program will be done with job postings by the end of december. (indiscernible) asked -- giraudo asked for evaluation data for leadership model and the timeline for recruiting the laguna honda positions. my request revealed that no indict that was provided to giraudo and no pilot leadership analysis was done. that was a huge mistake. see, cms february 2nd letter extending the (indiscernible) on transfers made clear their expectations demanding the laguna honda hiring administrators and they provide detailed timeline by february 15th, next week. to

hire and onboard the administrators rapidly. cms wants laguna honda to prioritize and expedite installing quote, permanent leadership with appropriate nursing home experience, end quote. get rid of (indiscernible) and tony and other managers brought in to acting laph positions, along with jennifer carton. they have no experience in nursing home administration. and (indiscernible) must go before laguna honda gets another remediate deputy or actual harm citations. the cms -- is a complete mess and taken far too

long. both men (indiscernible) the 90-day monitoring survey in the prior life safety survey. you need to get rid of them now. >> okay. >> thank you. >> thank you. that's the only general public comment commissioners. >> next is on the approval of the meeting of january 17, 2022, of the health commission. commissioners, do you have the minutes before you, i believe is amended. if there are no additional amendments to the minutes, do we have a motion to approve? >> i move to approve the minutes. >> second. >> and commissioners, before we do a vote, is it okay if i review because the public hasn't heard -- >> yes. >> sure. so, a member of the public asked me to, i had used they instead of she and she asked me to gender her with a she. and also corrected her name on page four at the second

paragraph. and then commissioner green noted that i had a mistake on page 8 under commissioner comments, second paragraph, i had on the fourth line, i had the word of instead of for, so i corrected that. those are the amendments. let's see. there's a handout for the public comment before we go to a vote. all right. mr. manashaw you're there. >> regarding the minutes, i smoke about the commission, the january 7th minutes noting that giraudo and it didn't meant the root cause analysis. mr. (indiscernible) had discussed comprehensive care

plans that had decertification. the same adequate care plans problem in june and july serviced in this cdgh level along with $36,000 in fines for 12 residents evicted. the same problem yet again during the 90-day monday sms monitored service. they expanded it on transferred stated it not only issued an immediate victory for the prior alarm bill, cms also noted even more ongoing quote multiple quality of care

concerns, end quote, causing actual harm. cms warned on february 1st that any further immediate penalty or actual harm bindings may trigger cms in determining the entire settlement agreement. it's (indiscernible) goal to close laguna honda down completely? wake up! commissioners, get rid of them. i yield the rest of my time. >> okay. that's the last, only public comment and i believe there was a motion, so i can do a roll call vote. >> yes, thank you. >> sure. i'll start with commissioner chou? [roll call] >> all right. the minutes are approved. thank you. >> thank you. moving to our next item is the director's report. we have dr. grant colfax, director of health.

>> hi, good afternoon. good afternoon, commissioners. we have quite an extensive director's report here and there's lots of important information to share, so i'm going to take perhaps a little bit longer on some of these items than perhaps has happened recently. so, i think one is to share the really good news that cms has agreed to extend the pause of involuntary transfers and discharges at laguna honda hospital. cms agreed to our request to continue the pause of involuntarily discharges and transfers of laguna honda residents until may 19th of this year. as you will recall last november, the city and county of san francisco reached an agreement with cms that paused the involuntary discharges of laguna honda through january 2, 2023, and thanks to the hard

work of multiple stakeholders across our care and across the, at the local state and national level, we have now -- the transfers have been paused until may 19th of 2023. this is based on the many months of hard work and dedication to improve our facility and laguna must improve to extend the pause on may 19th. during this pause, discharges will occur which is our right our residents are required to. residents whose continues to stay in laguna hon that endangers their safety and pending cms's approval of our closure plan. as required by the settlement agreement we're working with c mr. s to provide a plan should we have to resume transfers and we're hopeful we'll never to have to put this plan into action because of our

continued improvements. i also want to share with the commission, exerts from a letter that acting co pickens sent this morning to laguna honda staff and other stakeholders because of our, our success next tending beyond the may 19th deadline and toward the path of recertification and keeping laguna honda funded through cms, today, pickens shared a key documents with all staff at the hospital for visibility into the improvements that needed, that are needed for us to be successful and the commission will -- has, i believe, received a copy of this letter as of this morning, but just to provide a quick summary of these. the documents, the links shared in this letter include the original root cause analysis, the rca,

which you will recall has eight key topic areas for improvement. quality insurance and performance improvement, infection prevention and control, behavioral health and sub standings use and medication -- residents rights and freedom from harm, comprehensive care plan and quality of care, confident staff training and quality of care and emergency and the emergency preparedness program. the theme of the root cause analysis is that over time, laguna honda policies and practices became out of the sync with the standards of high performing nursing facilities. this is in part why we're working hard to insure compliance with guidance and align with best practices. the second document that mr. pickens shared with the staff is the root cause analysis in response to the first 90-day cms

monitoring survey. the quality improvement expert developed an rc in response to the first cms90 day monitoring which took place november 20th and december 16th. this root cause analysis and this is very important, this root cause analysis is still a draft and we must await cms approval. however, we felt it was important for transparency purposes to ensure that people have access to this document even though it is not approved by cms and may change based on their feedback. after our first monitoring survey, cms identified through new topic areas, resident quality of care, food and nutrition and fire life safety. in addition to this renew sections, they identified new findings within all of the original root cause analysis categories except behavioral health ask and substance use. it requires a new root cause analysis and then the third

document that was shared, there's quite a few documents there that are detailed, the third document shared is the draft action plan that addresses both root cause analysis. in respond to both the original root cause analysis and the root cause analysis that resulted from the first 90 day survey, laguna honda with assistance from the quality improvement exerts developed a proposed action plan, the proposed action plan addresses the findings of the root cause analysis to 12e7s to align laguna honda with facility best practices and cms has not approved the action plan and it's possible that the final action plan will look different than the document that we are sharing with you today. we will continue to update the action plan to additional root cause analysis from future monitoring surveys and if cms requires any further changes. the other thing -- the other key piece of information that i wanted to

share this afternoon with the commission was -- to extending the cause in involuntarily transfers, for the month january, dph submitted 1230 milestones -- 120 milestones and this is new training and standardized tool to evaluate care plans and 2023 schedule for emergency response drills, job coaching for leadership positions including the nursing home administrator who will serve as the top executive for laguna honda and much more. very importantly mr. pig evens emphasized in this letter, and this is quoting from the letter mr. pickens, we will continue to provide updates to staff on the progress of the action plan. we will also provide changes to the action plan as we receive feedback from cms as well provide root cause analysis after each monitoring survey. thank you very much for your continued effort. we have come a long way and we're confident

that we are on the right path. so i did want to share that information to the commission this afternoon. moving on to another very important issue in the health department. it's the overdose epidemic. we do have some news to share that accidental overdoses declined for the second consecutive year. overdose deaths in san francisco decreased in 2022 according to preliminary data. and again, this is the second year that drug mortality dropped in the city despite climbing rates across the country. the data which is provided by the office of the chief medical examiner says that san francisco recorded 620 accidental -- 620 accidental drug overdose deaths in the 2022 calendar year. certainly, too high and very concerning. but

this does compare to 640 deaths reported in 2021 and 725 in 2020. black african american individuals continue to be disproportionally impacted by overdoses and preliminary data shows overdose death among black african-americans are -- fentanyl is the driver of drug overdose deaths in the united states and san francisco. in fact of the 620 deaths in 2022, 72% nearly three quarters were attributed to fentanyl. just to put this local epidemic in context in a national situation, 7,622 -- drug overdoses deaths

in the united states and increased from 2020. the 2022 national estimates have not been made available but unfortunately national trends shows the crisis abating. so i did just want to add about what we're doing about this. since fentanyl became prevalent in the drug supplies in 2018, dph has been tackling the overdoses. mayor breed and dph created an office of overdose prevention and implemented a prevention plan to coordinate efforts to reduce overdose deaths and mitigate the negative impacts of drug use on individuals and communities. and just to provide you with some key actions happening, this year a lope, dhp will open 70 residential step stone beds for recovery for those leaving substance use disorder treatment and establish weekend hours at the behavior access center to

facilitate entry into residential and other substance use treatment. across the city, within our system, more than 32030 people used -- 3200 people received treatment for are -- and 2700 individuals received methadone. in 2021, dph and the community partners distributed more than 33,000 kits in the lock zone, the life saving for overdose and in park, in partnership with the aids foundation which collaborates with dph and distribution of medication more than 40,000 doses were distributed and and there's 5,127 orioles dose reversals. in addition, dhp trade more than two thousand people on how to respond to an overdose in the last three months of 2022 alone. he we'll continue to scape overdose pre--

we'll continue to hire additional overdose prevention staff, increasing our activities in supportive housing facilities in partnership with the department of homelessness and the dope project and leading the trainings and distribution collaboration with the entertain commission and supporting treatment for stimulant use disorder. in 2024, we're applying to opening new crisis stabilization units to provide short-term urgent care for people experiencing mental health or substance use crisis. and then the next item on the director's report as something that directly relates to the overdose epidemic in the city, san francisco has taken steps to allow privately funded overdose prevention sites to open and this was under the leadership of mayor breed with supervisor ronen who announced local steps that the city is taking to address a recently identified permitting barrier to moving forward with noncity funded

overdose prevention sites. and this was basically in 2020 the board of supervisors approved legislation establishing a permitting structure for city funded overdose prevention programs. this law does not allow for overdose written program to open until federal and state issues resolved whether funded by the city or private resources. since that law is enacted nonprofits in new york opened sites without public funding and various nonprofits in san francisco expressed interest in doing so. so, san francisco's current law would not allow that to happen and thanks to the mayor and supervisor ronen, legislation has been introduced to repeal that 2020 law which we are optimistic, will move forward. in other health care delivery systems news, very excited to celebrate the opening of the new

maria x martinez health resource center. we celebrated the opening of the center, a newly constructed care clinic named as you know after long time dph leader, martinez who dedicated her career to providing the highest quality healthcare to our most vulnerable communities. the clinic is located at 555 stevenson. and has, is one of san francisco's health networks new clinics. it specialized in providing multi-disciplinary services to a wide range of medical psychological and social needs of vulnerable adults. and it replaces and expands on the tom clinic which previously operated at 50 ivy. it's a beautiful clinic. i would encourage the commissioners to visit. it's just a beautiful space and reflects priority we have in making sure that everyone receives the top

quality and behavioral and physical health services and i'm really pleased to say with this expansion, we have not only increased our capacity to serve the population that people experiencing homelessness but last week, the clinic set a record in terms of clinical numbers and the numbers keep going up every week. so, really pleased about that. and then just to acknowledge and celebrate recognition of one of our dph leaders, (indiscernible) received the ache highest individual award and this is a very significant award in the healthcare industry. the american college of healthcare executives announced that mr. sang ha as chief officer and deputy director of health network was the recipient for young healthcare executive of the year of 2023. and really

important, he's the first ever healthcare executive from a public system to receive this extremely competitive award and he will receive his award march 21st at the ache 66 congress on healthcare leadership in chicago. and dhp is extremely grateful for his dedication to health and well-being of all san franciscans and we are very proud to see him receive this well-deserved highly competitive award and the national recognition that again that he so deserves. in terms deof disease -- decease prevention, the population health division received its third year of cdc funding to supplemental our core

s grant. this is to improve -- std grant and this is to advance health equity, so really important and i think when we saw the m-pox outbreak this year and the orn going outbreak of or ongoing high prevalence of still also, this $2.2 million is needed to ensure we strengthen our ability to respond. the other piece going back to now behavioral health, just a note that zuckerberg san francisco general hospital celebrated its 50 anniversary of the opioid outpatient treatment at zuckerberg. there was a celebration of this work and just to remind the commission that located at weissman-ward 93, this -- located at ward local 92, it's to heroin dependence in conjunction and

psychiatric services. this was really emerged during the onset of the aids epidemic and otop is the key cornerstones of helping people manage their opioid addiction through therapy and congratulate them on reaching this i will pressive milestone and speaking of the hiv work we do across our system of care, was pleased to mark the 4-0 anniversary -- 40 anniversary at zuckerberg san francisco hospital. 40 years of serving people living with hiv. there were a number of key leaders in the field of hiv and it was impressive to think of how far we have come and there was a patient panel that was focusing on now long acting retro viceal therapy provided through

injection where people come in monthly intervals or bimonthly or every three months for the retro viral therapy. this is the splash program which is another step of innovations and pushing the envelope in terms of how we care for people living with hiv. finally, last item that i'll cover in this report because i know again there's quite a bit here, but i think it's very important that we recognize black african american history month. black history month offers a chance to celebrate the many black heroes achievements and events that have been integral of the shaping of america's history and we honor that black people in this nation overcome structural institution y'all barrier along every step of the way, the 2023 black history month black resistance explores how african american resisted historic and ongoing oppression in all forms. this

black history month, the dph black african american health initiative, a program of health equity will host four equity learning series discussions on the theme of black resistance and celebrate the accomplishments of those who have helped us come this far. there's a special events -- the special events are highlighted below and you have that information in your packet. and with that, i will move onto the san francisco covid update. >> >> thank you again for this. in terms of our cases per one hundred thousand residents, you can see here that we are past our winter surge. we have a case rate of 7.4 per four hundred

thousand which is pretty much in keeping with where we were this fall. you'll see that peak that we had in late december but thankfully cases have come down and i believe our peak was 60 cases per $100,000. nowhere near last -- nowhere near om kron where you see the -- we continue to ask people -- we see people die due to covid and this winter, we had a significant burden on our hospitals due to covid-19 but due to influenza and rsv and the combination of respiratory illness and it -- and burdened our cases. while we have cases, that peak has

decreased significantly and our hospitals are busy, it appears that the winter surge that was challenging this year, as it has been in recent years, that peak does seem to be over, next slide, in terms of hospitalizations to my point about the peak having peaked, you'll see here that our hospitalizations we have 54 individuals in the hospital including three in the intensive care unit. a reminder with the slide i always say, this is everybody in the hospital with covid-19. it doesn't mean all of them are in the hospital with covid-19. it also includes people who are transferred from other, from places outside of san francisco, but in one of our san francisco hospitals. next slide. and then you'll see here on our vaccine and booster administration rates, we remain

at 86% of the total population having received its initial series. and you'll see on the far right of the slide, 37% of the san francisco population has received a by violent booster. while we would like to see the numbers higher, they are higher than the state or national averages by a significant degree and the trend is for people most vulnerable to covid-19 and likely to receive that bivilent. the rate is 57% or -- we encourage everyone to get that buy violent booster and especially those over, who are over 50. next slide. in summary we focus on improving our booster rate and vaccination is

the best way for individuals to continue to protect themselves from the health impacts of covid. and encouraging people to take the steps to protect themselves. we're reviewing our current covid policies and health orders. and had begun to remove as covid prevention are furthered into our work and as i believe was announced late last week, the white house announced that the u.s. will end the covid public health emergency on may 11th of this year. thank you for your attention and i'm happy to take questions. >> thank you, director colfax. >> i'm going to read an item before the minutes. members of the public will make public comment for three minutes and it's to provide feedback from those in the community and the process does not allow questions to be answered some the meeting

or those to engage in back and forth conversations with the commissioners and the commissioners do consider comments from members of the public when discussion item and making request to dph. please note each individuals allowed one opportunity to speak per agenda item and individuals may not attend more than once. public comment may be sent to me at the name mark dot morewitz at sfdph dot org. if you squish to spell your name for the minutes, you may do so without taking your allotted time. there's two folks with their hands up. caller, you're unmuted. please let us know you're there. >> it's patrick again. >> please again. >> i did hear dr. colfax -- i didn't hear colfax mention the alarming warnings and (indiscernible) other than indicating cms extended the transfers. it's unfortunate. cms

is clearly fed up with laguna honda's delay. they wrote to, they wrote on february 1st on laguna honda closure plan and it has been approved by the cms, cdgh and the california department of healthcare services provided feedback on the plan on january 13th and january 18th but had not heard, they had not yet received a revised version in response to their written feedback. cms warned that you don't kindly complete that revised closure plan, cms reserves the right to (indiscernible) under the settlement agreement including the right to terminate the

settlement agreement. it's unclear that director colfax wants the total management laguna honda into the ground. i'm sorry, it's clear not that it's not clear. it was interesting hearing dr. colfax, finally in the interest of transparency, all of the documents that he mentioned were relief to la state staff today. i'm verbally requesting under the public record's act that all of the documents or links to documents be provided to me at once because i have been repeatedly delayed in my public records request seeking those very documents so i will submit

another public records request when i get off the phone with you folks and formally request it in writing but you have heard the request, mr. morewitz and i want you to work closely with dth's staff to expedite getting me those documents finally. thank you and i yield. >> caller, you're unmuted. please let us know you're there. >> hi. this is dr. palmer. one of the things i'm looking at the cms report and not only did they not accept a lot of the work that has been done, they are very concerned about skilled administrators being hired. and of course, laguna honda wasn't

out of sync possibly with current requirements. there was an absence of management that was experienced in following current nursing home requirements and i would like to know by the next meeting, the laguna honda joint committee meeting that a national search is going on. it's going to be hard to find someone to be as skilled administrator of a nursing home that's this big and in this much trouble but it would be best if they were independent of the san francisco health department since the health department solution for laguna honda is find someone from san francisco general to take care of it like you did with the fire live safety -- and apparently there was no fire live safety when you were at jeopardy and you had to get one, i mean no fire life safety from laguna and you had to get one

from general and why a hospital this big wouldn't have a fire life safety experts is very unclear. and so, i know there's a huge amount of work to do and i don't really want to spread blame. i want to know that things are going to get fixed and stay fixed and so in this spirit, i would like to hear about hiring and making sure that not only is it fixed but it stays fixed. thank you so much. >> thank you for your comment. that is all the public comment. >> all right. commissioners, comments or questions for director colfax? >> commissioner chow has his hand up. >> commissioner chow. >> thank you, dr. colfax for a

very, you know, extraordinary, i think, extraordinarily rich report and certainly the news on laguna honda and the release of the documents are very welcomed and it continues, not only about transparency but it shows the work that's being done to see that we are recertified. i had a question especially as this is black history month and all, in regard to the accidental overdose steps that you, as you had noted, were -- that were disproportionately affecting the black population and i'm wondering what the department is doing specifically on behalf of the black population in this regard? i see a number of initiatives that are, i think, are very important and thereof

course, quite broad, but it would sound like there would be and i'm sure we have a very specific program that try to target a very disproportionately high rate of deaths, overdoses from our african american population, so is there a way that we could understand what special programs there might be that would also emphasize in that population or work with that population, finding out what else can be done locally? >> thank you, commissioner. i really very much appreciate the question and as you'll recall from the presentation in this issue, our goal of reducing overdose deaths, we have a goal of reducing inequiies that overdoses have in this city and

we have specific programs, implemented and for other ones that are planned to be implemented to address this inequity and happy to follow up with you and the commissioners to provide more details and we'll be sure to, when dr. cunnings return with the behavioral health update to have that as one of the key issues that she'll bring forward to the commission. >> that would be perfect and i'm glad to hear that's so. on a smaller point, a more neighborhood point, which is in regard to the vector control program that you actually heard about and glen park, as you know, while i read that in general, there was discussion of vector control. there was considerable publicity about the fact that there was an individual who actually was not only not following that but

encouraging that these vergents receive adequate approval to continue their presence within the community, including as you know, canyon market. so, was there and have there been continued actions that we can take -- the paper seem to indicate that the department was not able to actually do anything about the individual and that -- in spite of what is recommended, individual spreads it around. although it's a specific issue, it's one that certainly has attracted citywide attention and i wanted to know beyond general education, what we might have done for the local community? >> i apologize, commissioner chow. i was -- i couldn't quite hear the last, the last two sentences that i think formed

the basis of the question. i got context but i didn't hear the question. >> oh, the question really was what were we doing more specifically as that individual continued to form recommendations and you know, i don't know what we can enforce but if we know the cause and the individual is continuing to do this, the paper seem to give us the impression that the department or the city couldn't do anything about it. >> i think it's best for confidentiality reasons that i don't specify on this individual. there's a shared approach across multiple city departments to address situations like this. certainly, our work on the health

department side were engaging with protocols to make sure that if there is a health intervention that's necessary that it is offered and applied according to all policies and procedures and if needed, other city agencies are also engaged. >> okay. well, i know this is a -- i just thought this was a fair amount of publicity about our inability to respond and i'm not sure whether and perhaps you can see which department might have gotten her to stop doing this. i mean, it seems it's a public nuisance and it may not be that the health department has jurisdiction over the individual, i was really curious to see that and hopeful that there were ways to stop people who (indiscernible) the public

recommendation and continue therefore to really create an environmental hazard. >> and again, i think without speaking specifically to this circumstance, as i believe the commission is aware, there are public nuisance laws that are enforced by other agencies then dph and if and when needed to be applied, i believe that that would be through the purview of other agencies. and again, we are there to offer and offer the health support and services including behavioral health services as needed and as the commission is aware, there are limited circumstances when people can be compelled into treatment. >> sure. no, thank you. it was just -- because of so much publicity, i was trying to say, okay, you clarified that while

we don't have jurisdiction like that, that others do and that there is a way to try to update the nuisance that's occurring. thank you. >> commissioner guillermo has her hand up. >> thank you, president giraudo and i wanted to note that the director's report in this instance and actually happily note that this is a report that is not documented by the pandemic and the m-pox issues which have been overtaking our agendas and you know, our concerns for three years now. and to hear that there is still quite a bit of progress being made within the department on many of the other public health

issues and healthcare service issues that we have jurisdiction over so i think it's worth noting that the good work of the department carries on in the mist of all of the challenges that we have not -- which is laguna honda's outreach certification, glad to hear that the transfers have been delayed and hopefully along with many others, hoping and anticipating that the transfers will be permanently discontinued. i also want to -- i'll lend my congratulations to fong because the work that i think that he has put into the laguna honda as well as his duties over at zfg,

i think speak to what, how difficult it is, i think in the public sector to get recognized for the kinds of things that need to be addressed and the fact this is the first award going to somebody from a public health entity or a health entity as opposed to private sector, i think it's worth noting so i wanted to make sure that's recognize and lastly, the 40th anniversary of ward 86 and what it signifies in terms of san francisco's leadership in the past and currently around other infectious diseases. has something that speaks -- that speaks to the scope of responsibility and the scope of accountability for our residents' health that we're committed to so i wanted to note

that. and glad that you were able to share all of that with us, director colfax. >> i don't see any other hands, commissioners. >> thank you, commissioner guillermo. director colfax, i had a few comments and questions. some just underscoring what we heard today. with regard to laguna honda, certainly, i wanted to first of all, join commissioner guillermo in acknowledging bazi for press stege us award and his work at laguna honda and the recertification process required change and work and we see their contra because and we're appreciative of it and the difficult work and i'm echoing some of the words we have heard from director pickens as well, so very grateful for their work as well as really their commitment to providing clear and timely information with the release, even in some cases in

draft form of the root cause analysis and of the milestones, which you pointed out, all 120 of them have been met which is impressive. so, and i just wanted to clarify one more thing too because i know we're looking at a few different root cause analysis, correct? the initial one that found the bulk of the areas of concern was based on surveys that happened before much of the restructuring work, the improvement work and training and other things happen at laguna honda, is that correct? >> that is correct. >> great. and two other topics and i'm grateful for the reduction in accidental overdose deaths in san francisco, although even one is too many. and i was wondering in the prevention efforts and the lock zone and training and other things, are some of our community partners doing things like distributing fentanyl

detections? i imagine some of the critical needle exchange work done by the san francisco aids foundation, other organizations continues. >> that's the case. to be clear, this is a shared effort with our community partners who are important to this, so yes, it's ongoing access points that are developed and then working very hard with multiple, of our city partners in this work is just incredibly key, so anywhere from making sure people have access to safer, to the syringes to overdose prevention kits, to know where they can get treatment are all parts of the work we're doing with our community partners. >> thank you, director colfax. i would like to thank commissioner guillermo for her comments about ward 86 and i joined dr. colfax at that event and the collection

of everybody from our medical professionals who are doing the very difficult frontline work in the early days of the crisis to the advocates who are relentless and dissatisfied who were advocating for funding and legislation to support the fight against hiv and aids. most importantly, in addition to our leaders, the patients who are there to talk about the care they had received and the importance in the role that ward 86 played in their lives and as a member of this body, i couldn't be more proud of the work and history of ward 86 in this department -- in addressing the aids epidemic. thank you, director colfax. okay. seeing no additional comments, we can move to our next item. it's the health information technology quarterly review. for this we have our chief information officer eric rafin and deputy

cio, jeff, correct. thank you, thank you. glad i got it right this time. >> good afternoon, president bernal and commissioners, director, cold fax. pleased to provide our quarterly health informational technology update. [mic is off] next slide. our roadmap for this afternoon will cover five areas. accomplishments across the division that are beyond epic. we speak to you about epic a lot and speaking about it today but i wanted to share other work that has gone on that has been significant across the rest of our it organization. i'm going to talk with you about developments around health information sharing. as well as our work to support the improvement work at laguna honda hospital. we're going to talk about epic and our next big project which is epic which is the behavioral health services

and wrap up with our customary update on how we're doing with our epic project and epic finances. >> could you speak closer to the microphone. i'm getting feedback it's hard to hear you. thank you, sir. >> hopefully that's better. next slide, please. okay. we're going to cover a handful of these topics up here that describe work that is going on outside of our epic team and the health information technology division, a little bit about cybersecurity, about how we maintain our fleet and servers and laptops and desktop computers. what we're doing in the data space around supporting the behavioral health services team as well as the mhf services and talk about computing in dph and a major system, a major project i should say that's on course to replace all of the telephone systems across dhp and

a little bit about data and how that pertains to our work in tracking contracts in it. next slide, please. so cybersecurity policy may not be the most exciting topic in the world. i have worked in numerous different healthcare organizations and cybersecurity policy was always something that was highlighted, it's something that was excellent and outstanding but often times, the work itself, the work that supports that policy was weaker. and in dph, the situation was really the other way around. we are doing a lot to protect the information that we gather and use and share and make decisions with and the sensitive information that the city maintains. so, a lot of our work in the cybersecurity space is

outstanding but our weakness was we didn't have strong enough policies that book ended and described that work. and so over the last couple of years, we've been working through the pandemic to implement updated and in some cases brand-new policies, the list you see on the left side of this slide are the policies that were brought forward in 2022. that's everything from how we manage and protect mobile devices to how we respond to cyber incidents as well as how we are working with our partners in biomedical engineering to make sure we protect the medical devices, we have thousands of medical devices and use across the organization. we are about 6 or 7 policies away from being wrapped up and complete and we expect that to be accomplished by summertime. i'll move onto patch management. again, not

necessarily a shiny object but is an essential body of work for us and we learned by our move to shelter-in-place in 2020 that we did not have a sufficient patch management program. what i mean by patch management is ensuring that all of the security and functional additions to the software we use get loaded onto the computers that all of our staff are using on day-to-day basis. i'm please to report that as of now, in 2023, we are able to not just patch but have very accurate reporting on the success of all of the patching we're doing to ensure that our computers are secure as they can and we can apply patches to computers that are being used in remote settings, ali telecommuters. good back office, engine i-t work protecting us

from those trying to do us harm. next slide. okay. so exciting work went on in 2022 with regard to supporting, originally the street crisis response team but ultimately, more broadly supporting mhsf initiatives in the data space. i think as your commission knows, we've been on a journey since 2018 to bring as many data points together into one system, that system being epic as we possibly can. and we have done a lot of work in that area. we're not quite done. mr. scarthia will share our next big project which is to get the behavioral health system from its current elect spintronic record which is called avatar into epic but sometimes we have to needs to incorporate data

from systems that's not in dph and what i would like to share is that last spring, we were able to bring information together from epic, avatar and the one system, which is from the department of homelessness and supportive housing and that is an important milestone for us because what it allowed us to do is bring information and ensure we can match the identities of all of the people receiving services in all three of those systems and then support the analytical work to understand more completely how all of the services we're pro squalid vooing together are serving the whole -- that we're providing together are serving the whole person. as we remain on our journey to bring resources into the epic environment, sometimes we bring information outside of epic and the result of that is that folks who need to make decisions based on data which is

in support of our idea strategic initiative, which is all about the dph way to improving with data to enable and align and support our strategic objectives, we're able to do that now. and that was a relevantly exciting development. i'll move on to clinical computing. that's when our healthcare providers sit down in on operating theater or stand in an operator theater or nursing station or examination room, what kind of screen are they sitting in front of? in all of the robust work to get ready for the epic launch in 2018, the one thing that was decided during the project planning was that the clinical computing infrastructure for the most part was working in stable and that was true. what's happened in the last few years, again, with the great push to being able to

provide telehealth services around video visits, the clinical computing structure is aging out. it's reaching the end of its economic and life cycle so last year we've spent an enormous amount of time in the background creating some new standards for clinical computing and bringing in providers as well as administrative staff to have a look and put their fingers on the keyboard so we could understand if the solutions that we were going to bring forward are going to meet their needs, the good news is we are preparing now to replace about 2800 of those systems starting later on this year. a lot of good work on standards basis in 2022 will lead to a new computing infrastructure in all of our clinical spaces that will support not just the technologies we have today but we expect will support lots of technological services in the

years to come. another major body of work is supporting telephones and i know that that may be not be something we think about often but telephones have become more i-t than anything they used to be. i believe in the city and county of san francisco, way back when, telephones were actually and telephone systems were managed by the department of electricity. so, i'm not saying that we should reinstate the department of electricity by any means but we do need to modernize and we have been on a journey since the rebuild project at zuckerberg san francisco general to replace an aging telephone system in our case, it's really about 30 telephone systems across all of the dph locations with a modern telephone system that doesn't require us to have 30 systems. instead requires us to have two. a lot of work was done at our larger campuses to implement the

back office technology to make that happen and through all of the new construction work we have done, we have made strides in implementing this new telephone system and locations like the maria x martinez health recenter and other clinics -- health center and other clinics but we have a way to go. last year we dedicated planning time to being ready to dive in in 2023 to get us over the finish line and the finish line is still a couple of years away but now weary merging from the pandemic, we have the time and resources to tackle this project and put it behind us and make sure everyone is on a common voice telephone framework. i did want to pause for one second. i think commissioner giraudo, you had a question about the data analytic session. data mark we

create is a separate data store. what we did, we were able to, as mentioned, match the identities of people served across each of those systems and then actually bring the data from each of those systems into this own data mar or you can call it a data warehouse or data store. we didn't have to do anything specifically with the individual electronic health records systems and we created a new home for the data. next slide, please. and on accomplishments and i think that may be a little eye chart for everyone to read and i can tell you with my aging eyes, i'm having trouble reading it but the turn of this lied is not for you to read the material on it, it's to know that even on the i-t, we're doing our best to live up to our strategic objective to improve with data. and one of the things that we do in i-t, another not shiny back

office item of work is maintain very complex contracts. and we've been doing this for years. the implementation of especially you can expand -- -- epic expanded contracts to well over one hundred and as a rut, we realized tracking a spread shift or a list wasn't helping us out because at any one time, we probably have a dozen to two dozen contracts that were -- that are in flight and we're working to make sure that contracts don't lapse, that we're able to get all of the right parties together, our business owners, city attorney, our folks in the business office who are contract development partners, as well as all the approvals that come to your commission as well as occasionally to the board of supervisors and definitely to the office of contract administration in the city administrator's office. it's a lot of work to get a contract done. i wanted to share we have a robust way of tracking our progress and we're planning on

sharing this to some of our other partners who also manage complex contracts across dph departments or divisions. next slide, please. i want to take a few minutes to talk about health information sharing. i had this graphic because really everyone gains something from sharing. the sister sharing the milkshake with her younger brother certainly is great to see, but there building a stronger relationship from -- they are building a stronger relationship for having the data relationships we have, we're trying to achieve what i see in this photo. we have talked before about interoperable and the ability for us in dph without having to do anything, it's automatic to both receive and respond to request for information from our electronic

health records system and -- and we exchange them with other systems. it's a game-changer and helps us close gaps in service and care. but there's some exciting work that's going on that i believe is going to over the next several years get us even closer to closing, i can't say all of the service gaps and care gaps but more. that's because the federal government and the state of california have realized that health information is not the only information that we need to have at our fingertips. we need to have more information that's delivered in a standardized way, so it can be shared broadly between many different organizations about the social determinants of health. we also need to have information that is gathered by entities that are providing and supporting social services and the same is true in reverse. the information that can be shared

legally from healthcare systems can greatly augment the social services organizations who often use systems today that were never designed to operate or share information with any organization. so a few things that are happening, last year, the 21st century cures act was implemented. why that's important because there are very strict rules, in fact, it's called the information blocking rule which states no provider, no healthcare organization, no healthcare vendor can block the flow of information that belongs to the patient or the client. and so that sets the stage for two things that are under development and you'll hear more about in the coming years. the first is the trusted exchange framework and common agreement. the acronym for that is tefca. it is a national level set of standards for the sharing of information. over time, it will

expand from health information to also include social services information but the exciting thing, it is a national standard. there's not a national standard today. this will be the national standard. and on the heels of the beginning of the implementation of tefc, california passed ab133 which establishes the data exchange framework or dff. in today's full board of supervisors meeting, our data sharing agreement with the state of california was passed and is going to the mayor's desk. the reason that this is exciting is that the state has made a very significant commitment to ensure that we can share, legally, health and social services information between healthcare organizations, between social services agencies as well as ultimately public health

departments, like us, and health insurers. this closes gaps in many ways that are difficult to explain in just a moment but what i can tell you is that we do get information from some of these organizations today, but it comes to us in old fashioned ways. it comes to us in files and it comes to us in faxes and what we're talking about doing is making this just as easy as the healthcare information that we exchange with one another today, making it automatic and not having to ask for it but let the system say i see this person will be served here at an appointment tomorrow. i'm going to make sure if there's information i have a bona fide need to know that i'll have it. so that's what the future of health information sharing is looking like and i think it's very timely that, today was the day that the data sharing agreement was brought to the

board. before we move onto the next slide, i think there was also a question from commission geer about social services agency and sharing information. i wanted to address, there's a lot of unanswered questions about how social services agencies, which do not typically operate under the rubric of the healthcare insurance and portability and accountability actor hipa and they have laws that govern how they can gather and share information. i think the state understands the complexities around sharing information between these two different kinds of organizations and all of the different state laws that govern how that information is protected but there's a quarter of a billion dollars that the state has set aside for technical assistance to work through the legal as well as the more i-t parts of the work to ensure that we can get to a place where we can with trust and assurance share

information across borders where we don't typically see that today. we can go to the next slide. thank you. i wanted to take a few minutes to discuss how the i-t division is supporting the work to recertify with cms at laguna honda hospital. i look at most of the work that we do in i-t as enabling or reducing barriers, making experiences, have less friction, so that folks can get what they need in a timely manner and can trust the information of the data they are looking at. so there's three areas we have been involved with the work at laguna honda and from the get-go, it was obvious we needed to spend a lot of time because there were so much information that needed to be gathered and analyzed so we could start tracking improvement in the data and analytic space so we have worked very closely and still do to this day with

the quality management team at lhh and developed any number of new tools to ensure that we are collecting all of the information that we need so we can understand how much improvement we're making and where we struggle, how we can detect where we struggle quickly so that we can act quickly. we also learn a lot about how we deliver i-t to our customers. because there have been so much different people that have come into laguna honda hospital who needed technology and i'm talking about simple stuff like i need a laptop, i need a printer that though the demand was so quick and so large that we've took the opportunity to simply improve how we do this for everybody. and so we put in a number of new request processes that are free of bureaucracy and make obtaining the i-t resources you need

simple and this is helping laguna honda but helping the rest of dph and finally, we are in the mist of a lot of optimizations in our software and those optimizations are occurring in the epic system and they are also taking place in our food and nutrition area and in quality management services. i think there were comments earlier, they might have been from dr. colfax and perhaps a commissioner about the focus on care plans and i know that -- there was a question about care plans and care plans exist -- in epic and the care plan is making sure care plans are individualized to each laguna honda resident and so, my team, including jeff who you're going to hear from next are spending a lot of time ensuring that we are ready to make the adjustments in epic to ensure that care plans

are individualized as they need to be and i believe we are ready to switch. so we can talk about epic coming -- coming to behavioral services. >> please speak closely to the mic. you can move the mic, thank you. >> good afternoon, commissioners. one day i'm going to talk to you other than epic but today is not that day. we're excited about the upcoming bhs epic project. this is about much more than a new module from our epic vendor. it's a while suite of modules and this is a top bhs systems including scheduling systems, clinical document systems, billing systems, case management systems, inter opt ability systems and population

health analytics. we have a team of over one hundred analyst in i-t who will be working to bring on two thousand new users to our epic system across 70 different service locations in this city. this is the largest effort we've undertaken since our initial go live august 2019 for the epic e hr. a lot of work ahead. we are excited and ready to tackle. next slide. we /*. behavioral health in san francisco does not happen in silos and our patients cross from mental health to substance use, to the hospital emergency departments and again with our case management teams as we transition them down the furthest stream of care. our goal is focusing on creating a single patient record that tells the whole patient story in order

to achieve this, our cbo partners will be coming with us on this epic journey. for those clinics that use -- that use avatar, whether cbo, they are transition to standard work in epic with a full sweet of -- of tools and we have been hard at work with our bhs leadership laying the foundation for this project. calling out here the priorities that the team has set, it's going to draw your eyes towards number one and two, focusing on the client experience and the provider experience. this project will improve the patient experience through changes with sms tech message reminders. i pads will replace the paper clip board at

our clinic and accessible visits on your telephone with your provider, and engaging our patients to schedule their own visits through the my chart patient portal. our goal is to put forth a system that focuses on these goals and i'm going to callout a little tie in to our data exchange app with number four. being able to share that information across wherever an individual receives their treatment is also important. next slide. everything comes with a cost. how are we doing managing our budget. a few things i want to callout here to focus on, commissioner chow, a few of these items were for you. we are reporting year five to the end of fiscal year 2022 with five more years to go so we're at the halfway point and the numbers you see represent the halfway mark on our total e hr

investment and total amount is 46% with a projected total of 96%. looking at those numbers, if i were sitting in your chairs, i would wonder, hmm, halfway and we're not at 50% on the budget. i'm going to give you three clear reasons for that, one, covid. while we wouldn't refer to things as a delay, we would refer to that as a pivot, our epic teams were quite busy during the pandemic for vaccinations and testing. it did shift some time lines during the middle of -- covid is not the time you want to replace the laboratory systems. bad timing there. so those shifts resulted in budget savings. vacancies is number two. we are running about a 20 vacancy rate and salaries is a big expense category and

that leads to savings on the budget there. number three, never let an emergency go to waste, grants. we've been able to receive funding that offsets some of the cost, whether that's telehealth investments or public health investment as a result of the pandemic. we have been using those in the i-tt department to apply and advance the city's infrastructure. so with that, i'm going to close with a few questions. i believe the commissioner green, you wanted to know about i-t related contracts. and how we typically handle those. typically, we contract our vendors on a five-year cycle. we use a three plus two model. three committed years and two optional years. those optional years, years four and five give us the ability to make a change if we find that vendor is no longer satisfactorily meeting

departments needs and we can terminate earlier but that gets more complicated so we do rely on the optional aspects. additionally, on these contracts, with the budget information you're seeing in front of you, we do project inflation and rising cost into the numbers that we present to you here, so we have a five percent year over year increase baked into every contract you're seeing in the projections. most years that's enough. this past year, that has been a little bit difficult with the inflation cost but for the lifetime of the budget, that is balancing out. shifting to at question focusing on can our clinicians at dhp see the ehr's of organizations that do not use epic? there's always a little nuance in the answer there but it is yes. we can see patient records from providers

who use ehr's that's not epic. as eric mentioned, we use a federal operate standard to exchange this information. we participate in multiple sharing networks. epic care everywhere is one of the multiple networks in which we participate. whether or not we can specifically see that chart from an cbo depends on the system that cbo is using and whether or not they are compliant with those federal standards. taking a look at our data here at dph, our top, not epic training partners include common spirit and dignity go health. chinese hospital, di vta dialysis center and the va. groups you would expect to see in san francisco that we would exchange with much the other big names that you might recognize,

use that epic and thus didn't make our list. we'll close with a quote and take your questions. life doesn't make any sense without inter department znswer. we need each other, and the sooner we learn that, the better for us all. eric. >> thank you very much. before we go to any additional comments or questions from constituents do we have anyone on the public comment line? >> folks on the line, we are on item five. i don't see any hands but clause press star three if you would like to make comment. i'll wait a second to make sure you have time. there's no public comment. >> commissioners, any additional questions or comments? >> let me see if anyone has their hand raised. >> folks -- i do have two. quickly, you had mention, you talked about the cbo clinics transitioning to epic, is that a cost they avail themselves or is

that part of the department's budget? >> the department budget will cover the cost of the systems itself. we're working through budgetary planning to figure out how we will aid those organizations as they go through the journey itself. >> okay. and my second question, this is a question i have often asked at the commission, you mention you have a 20% of your -- you mentioned that 20% of your positions are vacant, can you tell me candidly what the impact of that is on your work, the sequencing and time of your work and scheduling the work and the toll it takes on the existing staff who are already doing excellent work in your department? very candidly. >> it's hard. >> yeah. [laughter] >> i hear everyday from our team members they would like to see a full team there. ultimately, the reason we put these i-t systems

isn't to meet the rollout timelines and show you the chars that are there, it's to use them, to derive the data that helps us make our decisions as our entire department works around the city. the challenge without the resources is that we focus on completing the rollouts and we do less of using those systems. a full team means more information to make better decision that will drive the outcomes we're aiming for in dph. >> thank you. and then there are some factors that are out of the department's control or the city's control such as cost-of-living, such as an already very tight labor market with almost full employment, historically low unemployment, what are the factors hindering those positions. >> i-t systems aren't your make

to san francisco. the skill sets we search for, those individuals can work anywhere, the remote work environment, especially in the i-t landscape does make it a challenge. we've had multiple offers, two individuals that we would like to hire who accept elsewhere due to the one hundred percent remote flexibility schedules. >> got it, thank you for your candidness. all right. any other questions or comments from commissioners. >> commissioner green has her hand up. >> we'll go to commissioner green and director colfax would like to say something as well. vice-president green. >> thank you for your great presentation. i also loved the way you present -- very positive attitude, even when i know you encountered unexpected -- roadblocks and you come to us with -- i had a question to what

president bernal asked and one, we have all these layoffs in tech and recently today. does that have an impact on your vacancy rate and we read these individuals get snapped up fair lead quickly, but there has been a significant number of layoffs in the tech industry and wondering if we can capitalize on that and if so, see what you can enact and whether there's barrier to prevent hiring just because of the whole aspect of being a public entity and the second thing is, i wonder if -- if you could elaborate on staffing and we're going to work with laguna honda. my observation is the issues at laguna documentation rather than the bedside work and it seems one of the keys to recertification is going to be rapidly improving documentation,

and you've said, i thought that we were the first facility to use epic but it turns out what you said from the other meeting, there's several. with that being a priority, how can we identify best practices and incorporate them as soon as possible and of course, there's an educational element of helping staff seeking to use the tools and i know that can be very challenging so i wonder if you can elaborate more on that? >> if you don't mind, i'll go in reverse order. the, a lot of the challenges that we face as i-t professionals is that adoption and improvement of the information systems is something that we're not the resident experts about. we know what we need to do to set the stage for folks to adopt a change. in this case, epic represents a very

large change in how staff are documenting the experiences that their residents are having at laguna honda. i think the road to success includes strengthening support at the unit level so that staff who certain lear have gone through training -- certainly gone through training where they encounter a situation where they may not remember how to do something and this happens to me all the time and this happens to everyone and do i click here or there or do what i click and pull the health chain and say i don't remember, but can somebody help me who is around here, just a colleague who we know that model of being able to have either somebody you might call a coach or just a super user, somebody who has and is comfortable with the technology who can help others right in that moment, that type of adjustment is -- it brings something in and usually folks

remember how to perform that task in an informational system when they get that on the spot learning verses sitting through a course, which we have been through a lot of training, sometimes it's not the most exciting experience and of course, it's not real. the training is always in a testify or a fabricated environment but when you're on your own being able to rely on someone to provide assistance and support, i think that is the secret sauce and that's something that we're working on right now. we're working with folks with nurses in particular on how do we make an environment that, where we can hear more about changes that staff want to make and make it easier for them to use the tools, but also to make sure that there are folks that we can provide additional super level training to so they can help staff at the unit level as soon as there's a question or

concern. i think that's the most powerful recipe to being able to improve documentation. and now i'm blanking on the first question, commissioner, green, i'm sorry. would you please repeat it? >> i really appreciate that and you're so right about the learning and i wonder, just as you respond to that, dez epic have so-called best people because it takes a while to train super users and one of the things i have experienced in two or three now, i think, epic introductions, it's possible to get people from corporate to help and be there for a week because it takes a while to train the super users and i wonder if that's something, again, i think that pivots on whether and i think it is a question, how much there is given that we're not the first system to use epic. how much is there off the shelf that we can

quickly incorporate into our own system because that would mean that super users as well as people from epic would be able to help us out in training? >> so lots of great suggestions there. and it goes back to our big go live in august of 2019 where we had lots of at the elbow kind of support and that's the type of help i'm talking about but probably with less intense -- intensity and the epic system you see when you're at laguna honda it's a built system in epic but thing to appreciate is that the system that staff at laguna honda came from to epic was nothing like that. so this was a really remarkable change. if you compare to say ambulatory care clinics or san francisco zuckerberg clinic, they were

using more robust workflows that were custom built or purpose-built for those specific setting but there wasn't anything that was built directly to support all of the regulatory requirements and all of the differences or nuances when you are both basically operating a hospital but you're also operating a hospital with folks that have very long length of stay and so, and care plans for instance, it's talked about frequently with our work is one of those areas where that's something you can't have a care plan that last two or three days. it's a care plan that last a long time which means the folks who are making the notes and the changes in the care plan know that that's something that's a living, it's a living document and it's trying to help tell the story about how to provide the best service to that person and we, that's an area where we can definitely improve. we've had a lot of talks with

the quality improvement expert, with nursing staff and we understand, we can get there and i think it's just -- it wasn't -- it wasn't that it wasn't thought of and it wasn't that it wasn't implemented in -- 2019 and the adoption didn't stick the way it needed to stick. >> thank you. and the other question was whether we can capitalize on all the tech layoffs that are going on? >> yeah. you know, it's funny, i worked in government my entire career and at any time there's been tech layoffs, i get this question and it's amazed me how infrequent that happens. i'd like to say it happens all the time but it doesn't. some of it is salary based. folks are still looking for the salary that they were earning at a microsoft or

goggle or facebook. it's not a pay parity situation. working in san francisco is rich but if you're midway through your career, the likelihood of you capitalizing on the pension benefit is lower because you're not going to have as many years as of service. what i found in my experience is people, if we can find people that are mission-driven, then there's usually, that's usually our attractant and the mobile next we have in public health and that seems to get people's attention does -- and occasionally we bring folks in who haven't had previous government experience, such as the gentleman standing to my left who is willing to give government service a try. there's no correlation when the layoffs occur and when we see a major influx and some of that is

also due to the fact we have a lot of specialized software applications and a lot of folks that are experiencing unfortunately these layoffs situations, we need people to come in ready to work on those applications in many cases and a lot of these folks are senior enough but they don't have the health, relative knowledge or experience on those platforms and that can be a struggle. >> thank you for that thorough answer. it makes things much easier to understand, thanks. >> director colfax. >> thank you. i want to thank you and your team for the incredible work that you've done. i really am glad you have mentioned covid and all the work that took and also just to highlight the fact that where we are with behavioral health, i mean, this is incredibly important especially given the focus on behavioral health as you know from the overdose deaths to the other issues that

we're dealing with. this is just going to be a huge improvement for us to be able to serve people better and make sure that our systems are really working for the priority populations with regard to people with, especially severe and serious behavior health needs, so it's a big deal and also just to acknowledge that it took some creativity and some really -- some deep thinking about how to get behavior health system to a point to where it is now ready to adopt epic and again just want to thank you for that leadership and that work. >> thank you, dr. colfax. >> thank you, director colfax. and i apologize. i believe commissioner chow has a question. >> no, thank you. actually, this (indiscernible) dr. colfax was talking about -- my question is, i was looking at the issue of

the behavioral health was -- i believe that being that many of the cvo clinics actually are probably working a very large portion of their -- are clients for city, is there a program, for those, i'm looking at those clinics that say they continue to use their own ehr and my question is whether or not we can encourage or are we going to have a program to encourage that they also come onto epic because i think that will actually improve the care overall and because i don't know which ones those are, but if they are really people that are very dependent upon us, it might be

that there would be a way of also then helping to either support or loan them something so that they could come into the new behavioral health system, so is there a strategy for that in terms of trying to move as many people as possible within our cvo population into, from whenever they are using now into the whole epic program for behavioral health providers? >> certainly. of the 70 plus cbo's we have, there are nine that use their own ehr's. or will be transitioning to our shared epic system. for those nine, we will be, the door is open. we'll invite them to watch our demos and help us design our

epic system and continuing through the process to talk about whether or not using our city and county of san francisco epic system is appropriate for their care. >> won -- wonderful, thank you very much. >> seeing no additional questions or comments from commissioners, thank you for the update. we look forward to having you here and we'll see you in about a quarter. >> thank you. >> thanks. take care. okay. our next item for action is dph fy23 and 24 and fy24 and 25 budget proposal. we have jenny louie, our chief financial officer. hello, ms. louie. >> please speak closely. >> good evening, commissioners. jenny louie, chief financial officer here to present the second presentation on the budget. next slide, please. at our first hearing, we provided a

budget overview as well as a five-year outlook and presented major themes and goals that we were working on for this upcoming two-year budget. at today's hearing, we are presenting detailed proposed initiatives for the two-year budget and requesting a health commissions approval of the proposed budget for submission to the mayor and controller's office. next slide, please. as mentioned in the last meeting, our goal really for this, for our budget proposal this year in light of some of the historical investment we have made in the prior year as well as the financial climate that the city is facing now, our focusing is additional revenues to meet our general fund targets and we have to getted proposal to expand programs where they are revenue neutral as well as investments to sustain improvements that are happening at laguna honda hospital and overall by limiting

the changes in our budget to maintain focus on implementation of prior year initiatives over the next two years. next year. we have baseline revenues for the health network in zuckerberg general. they are 59 and 31 million over the two year budget. the health network revenues because many of our medical waivers include support for public hospital systems of which zuckerberg san francisco general is centerpiece to that because it's a public hospital system and there's small amounts that are drawn down by other areas outside of the acute care hospital, primarily, within primarily care and ambulatory care. the change in notation is a bit of a nod to the fact that some of the revenues are really

for the public hospital system. but the bulk of these revenues are related to san francisco general. second, we have an expansion of the c for service model. this is worth net of about $37 million over the two-year budget. this is a change that is taking place in the current year where we're switching from a portion of our members from a capitated model which includes the loss of out of network cost as a part of that capitate. we're being paid directly for the services being provided inpatient at zuckerberg san francisco general. this is really a change in the payment methodology for a portion of our patients there. does not in fact, how we deliver services or the quality of services. there will be ain't many pact to some of -- there will be an impact to some of our changes including docc and patient financial

services and special care where they will have to prepare claims and authorizations so we had added staff to ensure we can hit these revenue targets. but this is really a change in the model with the health plan approved by the state. it couldn't have come at a more timely moment and we'll look forward to implementing this over the course of the year. the next initiative is around behavioral health initiative. this is around 2011 realignment which is driven by states sales tax and it's $8.5 million going on in the base and there's some small settlement. in addition, we're levering a new program we haven't tapped in before for quality insurance and utilization. we're adding 7 fte to support our cleaning work and management work. within behavioral health and this is particularly important as we

switch, move forward with behavioral health payment reform which i mentioned in our last meeting. it goes effective july 2nd and the additional -- july 1st and the staff can support our claim to ensure there's no loss in our -- there's a question regarding improvement with an incentive for quality improvement. and there is, there's a quality assurance component and there's the quality improvement program for behavioral health under telling which really was designed to support the shift from behavioral health to behavioral payment. it's not a quality improvement where you expect to see data and changes and being rewarded for levels of data, of improvement as reported in the data. this quality improvement is around hitting the milestone necessary for, to

achieve behavioral achievement reform. it includes hitting milestones for creating trainings for cpt codes, a shift as well as developing contract templates that comply with the new reporting requirements and ig -- intergovernmental transfer protocols to make sure that we're ready for it. i think once we get to the other side, i do expect that possibly the state will look at more specific quality improvement programs for behavioral health revenues. last on the revenue is the backfill of a handful of population health programs. under the deem ordinance which is showing reduced revenue and small grant program, so this offset our revenue growth by 665,000 annually. so over the course of the two-year budget, what we're proposing for revenues is that 105 millions in the first year

due to one time settlements is in $187 million. next slide. moving onto actual expenditure initiatives. this first one is actually, it does not result in a net increase in cost but as commissioners, they recall from last year, we're stepping down initiatives from covid response. we did include $25 million in the base budget as part of last year's budget process but we did not detail it out because we're still trying to find out more information about how we approach our response to the pandemic. we're coming back this year with not a net new ask but to detail out what that placeholder budget includes. we're really looking for core level services to insurance and

-- to ensure surveillance. we're trying to respond to emerging and urgent public health threats, covid, monkeypox and we're looking to maintain the hospitals and clinics whose operations have been changed over the last several years. next slide. by ware of comparison, this is a high level to show what our step down is. in the current year, we have 57 and a half million budgeted for the covid response and we're proposing $25 million with some adjustments in the fte during the annualzation of new positions, but all over, that's how the item shifts. next slide, please. going specifically into some of the line items. we are

continuing our information and guidance at just under a million dollars and this provides timely access to information and allows us to bring subject matter experts to provide clinical policy and recommendations. we're maintaining our equity and community engagement team at about a million dollars annually with continued focus on our community health equity and maintaining the partnerships that we have built with the community and maintaining those networks to be ready for, to support population health overall. for testing, we have a portion of the contract for $3.7 million to provide approximately 4,400 tests in a month and a pop up and community settings and we're backfilling cdc grant that's ending, that's supported our expanded public health lab capacity that did run a number of our tests for both the public as well as some

members of the network. for isolation and quarantine, we did bring this down significantly from actual hotels that we used to manage to basically a position to coordinate efforts as well as $100,000 for hotel vouchers and support should there's individuals who cannot isolate and quarantine safely. we maintain a million dollars of surveillance funding to continue our core epidemiology and surveillance and reporting as well. for vaccination and our covid resource, we're providing prevention, intervention services for disease investigation accident vaccination procurement and providing treatment services and maintaining our vaxx contract with outside vendors. we're

providing 2,200 vaccines in a pop up and community setting and these are rough averages and we do expect those numbers to probably fluctuate over the course of the year. last but not least, two positions to support ongoing coordination of all of these functions within the population health department. next slide, please. on the network side, dr. zuckerberg san francisco general will continue 8.9 million of services to maintain access primer lead for nurse staffing ratios and regulatory requirements. we maintain the expanded support of the occupational health clinic that supports dhp staff when they test positive for covid-19. we also are maintaining a psychiatrist in the emergency department, which was started in the spring of 2020. it supported the screening and testing protocol for potential

pes patients. we're increasing capacity in the infectious disease clinic. i know that commissioner chow had a question about zuckerberg general where it went from $11.3 million to 8.9 and the fte did not seem proportional. our focus for fg was staffing which was permanent staff and temporary staff. as we hire on those permanent staff or i'm sorry, pertinent staff, we reduced our temporary staff and replace some of the cost, expenditures with these physicians for, for the emergency department as well as infectious disease clinic. there's more than just fte in our original, in these numbers so that's why the numbers aren't exactly proportional. at laguna

honda hospital, we maintained 1.8 million for outbreak management control and continued testing for patients and test as well as sanitation requirements at the hospital. last but not least, ply mayor lead care $2.3 million for increased staffing to support clinic access and vaccinations in the clinics. also to expand call center support for patients who may have symptoms and exposed or test positive with covid. next slide, please. next initiative is the mental health services act. and as you know, this is based on a one percent tax to -- there we go. one percent tax on personal income over a million dollars. this tend to fluctuate significantly. we do have the ability to rollover funds per the state requirements and counties tend to manage spending over multiple years and so, what we are expecting in this

upcoming budget is 32 million of revenue in the first year and about 17.6 ongoing in the second year. these -- we'll put these revenues towards supporting programs and for the continuation of pilot programs and supporting a cost of doing business for contractors funded through the mental health services act. we are adding some targeted -- some positions that will target black african american clients within our clinics. we'll have a small initiative around medical billing for capacity building. we're starting a three-year telehealth pilot project with the human rights commission. this is part of our prevention and early intervention funding category within mental health

services act and i know there was a question whether this is a separate line of funding and it's a part of mental health funding act but it's coming -- there's a line item for prevention and early prevention. we're taking advantage of the one-time dollars in capital improvements for our behavioral health pro facilities, $2.5 million. we have a small amount for innovations and $1.35 million for -- $1.5 million for early intervention around peer work and because of the fluctuations and we're trying to follow the state recommended reserve requirements and putting away the one-time dollars towards our reserve for that rainy day should the revenues drop and it would enable us to maintain our spending plan. next slide, please. the next initiative is around expanding services and

trauma compliance. this initiative adds staff that expands the castro and (indiscernible) rooms and improves access and creates revenue. in addition, as part of this revenue, we have two fte to meet regulatory standard for staffing performance and it's required under the gray book. and so overall, this is approximately $1.8 million of expenditures offset by revenue which is a small amount of general fund savings. next slide. the next flishtive is cal aim and expansion of the enhanced care management program. we're continuing to rollout and enhanced care management program and expand the population of focus, so last year, we did start this program and this year -- the state is ex panting the eligible --

expanding the eligible population of at long-term institutional. in 2024, we're expect they will expand this to just system involved people. so, overall in preparation, we're adding 12 fte that will serve exiting the hospital -- people exiting the hospital and offer fte for those entering the system incarceration and we'll expand the services for people living from the street to housing. overall again another 1.8 million of expenditures offset by revenue. next slide, please. last but not least, we have -- we're investing 2.5 to sustain improves at laguna hospital. we're implementing an action plan as a part of our

recertification which has hundreds of process improvements and so while not all of the process improvements have a financial impact, some areas we want to make sure we invest in to sustain these efforts and it includes three positions for the care experience and grievance team. five fte to support department of education and training for our staff and medication safety officer, a quality management analyst and two positions outside of laguna honda but the chief nursing officer and the director ever patient care experience at the network level. this is something that was identified as part of a working review for the recertification process. i will note that there may be an additional request that may be developed as our efforts progress, this is based off our current action plans, what we know best and it's a dynamic situation and we'll make sure

we'll agile to support laguna honda as they go through this journey. next slide. last but not least inflationary cost. and it got a lot of questions about this which i don't usually do. and so these are two inflationary cost we see every year. the first one is around the ucsff agreement cost that provides clinical services at zuckerberg san francisco general. as part of our agreement, we do -- they provide the services, we cover the cost of providing those services and we do two-year budgeting so we just budget the second year of the inflation but because last year, ucsff was in labor negotiations with one of their bargaining units and didn't complete and didn't have the dollar amount until after the budget process was done, we are

putting in $2.9 million for some of their staff cost increases in the first year to make sure that we cover that and then increases it by $15 million to the next year. overall, this contract is in the base budget about $225 million in growth over the two-year budget to $240 million. it's about 7.5% increase annually year over year for the affiliation agreement. and then next is our dph farm suitable where we have $2.9 million for supplies at the hospitals and again, we're -- as due to your budgeting, we have budgeted the first year increase and asking for second year to maintain the cost of doing business for these

expenditures. next slide. so, with all of these initiatives, when we consider our general fund reduction targets of $50 million and $80 million, some of the revenue that was assumed as part of the five-year projection, $20 million and $35 million and then we look at the revenues and that we're proposing all in all, beer a little lopsided. we are always lopsided in our proposal but i'm still net positive in meeting our general fund reduction targets. next slide, please. and then just as important what is in our proposal, i wanted to note items not in our proposal but being developed and will be developed over the course of the spring. the first is similar to last year, it's the proposition, our city, our home revenues. we are in the process of working with the mayor's office and the

oversight committee to update the proposition c budget which supports about $100 million annually for we live y'all health services for people experiencing homelessness. currently there's a projected shortfall in revenues of approximately 30%, so about $30 million give or take annually. at this time, we do believe we have sufficient one-time savings for prior years to carry the programs through a two-year budget but long-term budget will be needed to sustain our planning. next is care court and this is a new program that was proposed by mayor or governor newsom as part of his last budget be and it's to connect clients struggling with behavioral health issues to develop a court ordered care plan. behavioral health will be responsible for -- for individuals that are referred.

this program is set to start on october of 2023. but there's much work to really determine sort of what the program design is, the expected case load and then the collaborations with city attorney, the courts, to understand what the program is, in addition, the governor's budget does include some amount of money to support these services but it's unclear how that will fold out so over the course of the spring, we'll be working with the mayor's office and the state to understand and develop a plan for care courts. next is wellness hubs. and again, this is a draft in setting that provides overdose prevention services and linkages to treatment, housing and benefits. this is again, as you know, pending program as well as legal implementation review. so, nothing to report yet but we will continue to work with the mayor's office and the city

attorney's office and the board of supervisors on this item. last but not least, the city is in the process of settling some legal -- legal cases around with opioid manufacturers. we believe there will be one-time funding that will be disbursed over multiple years and the possible uses can include addressing our preventing the misuse and risk of opioid products or treating or mitigating opioid use and mitigating the effects of the opioid pandemic and we're working with city attorney to understand all guidelines. there are multiple settlements that are being rolled out and we will be collaborating with the mayor's office to determine a spending plan for these funds. all right. next slide, please.

so with that, that concludes my presentation on the budget proposal. our next step is to submit the proposed budget to the controllers and mayor's office on february 5th for your approval and march through may, we move into the mayor's budget and we work with initiatives i just mentioned and monitor the citywide budget and i will note as part of the budget instructions, they did instruct departments to be ready should the financial climate take a downward turn so we need to be ready for that and we'll be working closely with the mayor's office on that. and then on june 1st, the mayor proposes her budget and then we go into board and board hearings in june and july. with that, i'm happy to answer any questions you may have. judge >> thank you, ms. louie. secretary morewitz, do we have public comment? >> i don't see any. those for item six, the budget proposal,

press star three if you would like to make a comment. star three. i see no hands and at the moment i don't see commissioner hands. >> this is our second review of the budget and i know that commissioners had submitted questions in advance. >> yes. i realize there are a few questions if i can respond to them. i addressed some of them but i realized i didn't address all of them. first around covid and the question around federal funding. this is the situation we're monitoring closely but with the expiration of the federal public health emergency, at this point we're not counting on additional federal funds to support our covid response, so at this point the $25 million we do expect to be general fund. again, there's a possibility it could be expended and that's something that we will continue to work with the controller's office on closely. and i think i covered all the other questions in my

presentation, but if i missed any, please just let me know. >> all right. i apologize, secretary morewetz, i took the process out of order before public comment. we should have a motion to approve. is there a motion? >> i so move to approve the budget. >> second. second. >> all right. public comment. >> there's no public comment. >> all right. seeing as we have had questions addressed, thank you ms. louie. we'll go to a roll call vote. >> sir, commissioner chow raised his hand. >> yes. i'm sorry, i was wondering if the budget also does include a question about the covid treatment dollars that with the -- apparently with the ending of the federal support for that, there's been a lot of discussion that covid treatment

is going to be requiring dollars that are not coming from the federal government, so does our budget here in the covid -- the covid budget include potential dollars for treatment? >> commissioner chow, are you referring to the pharmaceutical that we're currently receiving and provide -- [multiple voices] >> yes. yeah. >> this is a great question and one of the things that we're looking to monitor. we don't know the value or cost of these treatments moving forward and so, one thing that we're looking at is as you recall from our first quarter financials, we bring projecting a small bit of savings from prior year in our covid budget now, about $3.7 million so our plan is carry forward those dollars into next year's budget to be able to cover some of the cost that may be incurred that we didn't

previously incur before and we'll continue to monitor the situation and work with the federal and state to see what opportunities may be available for leveraging the new dollars for the cost we haven't seen before. >> no, thank you very much. >> i believe now we can move to a roll call vote. >> yes. [roll call] >> the budget has passed. >> all right. thank you, ms. louie and thank you to your entire team for both the excellent presentation in preparation of the budget under difficult circumstances. >> thank you. >> thank you. all right. our next item is resolution making findings to allow teleconference meeting under california government code section 54953e. commissioners will be familiar with this resolution. we had to pass monthly to conduct our

meeting in a virtual or hybrid format. secretary morewitz and we'll turn in person for the march 7th meeting. this is the last time we will be considering such a resolution. would anyone like the privilege of moving it for the last time? >> i so move to approve the resolution. >> second. >> is there public comment? >> i see no hands. folks, if you would like to make public comment on this resolution, press star three now. seeing none, i'll move ahead and do the roll call vote. >> thank you. [roll call] >> the last resolution is approved. >> okay. and look forward to seeing you all in person in march. so, our next item is the finance and planning committee update. and secretary --

commissioner chow will be handling that for us today. commissioner chow, thank you for that. >> thank you. we had actually four contracts to look at. one was the plow share while during the pandemic, there were tilties with delivering the contracted numbers of services. the department co's said many issues have been resolved and this very important program for veterans and it will be one that is to be extended, or recommended to be extended for four more years and there's a 2.9 percent increase in the annual difference related to the cost of living in expenditures. the next contract that we reviewed was basic, it was on the alliance health project and that included the,

getting to zero and while it appear there's an annual difference that was negative, there actually is an increase of funds that is being recommended for continuation of the contract related to additional funding from the general fund board of supervisors funding for the long-term survivors and the cost-of-living and the details are in your packet also that we are -- that we reviewed. our third contract was from our cross country staffing and we saw before, which was further temporary radiology

registration, registry services for the vacancies that we have and the needs of registry and radiology personnel which is going to be continued for three more years being recommended and the annual difference of the contract is about 1.25%. this is related to the fact that we have filled a number of radiology positions during this time and it's hope that there will not be possibly the same level of need and so, the contract is reduced in terms of its annual allocation of one point -- approximately $1.5 million. and remember this is as needed. lastly, also is

another as-needed contract with tri-facta and that's a change in the proposed contract. this is related especially to the needs of additional nursing personnel at laguna honda and we heard there were a number of personnel that's off on leave, as you saw in the new budget which added more positions. in order to respond to the action plan needed, personnel needed and this allows for additional personnel to quickly come and fill positions that are needed, while we continue to look for (indiscernible). so, those were the four contracts that -- and then there was one new contract, which is for hr 360. this is a

result of the baker place problem that we have all discussed. its passed and it transfers two programs to hr 360, which are drug related. there's short-term opioid withdrawal and for residential drug medi-cal treatment for those homeless who are needing a temporary site for these two programs that take place when administering. it turns out that hr 360 has similar programs, and of these two programs will be separate programs but going into facilities that hr 360 already

has to care for them. (indiscernible) is going to be from -- people accepting offers by hr 360 and a slight increase in cost are compared to that of which they could place that as a previous contract much it's related to hr 360 pays a little more. and so, hopefully that will be good for retention staff and along with these are recommended for your approval under the consent calendar. i'd be happy to answer any other questions and thank our commissioner guillermo for organizing this. >> thank you, commissioner chow. >> any public comment.

>> press star three if you have comments. none. >> commissioner, any questions with the consent calendar for both the finance and planning committee as well as the zsfgjcc meeting? >> yes. as i mentioned earlier, we spoke about the contracts, on the financial contracts and therefore the committee recommends the approval of those. i was noticed -- i understand we now at the commission will approve procedures, policies and procedures, also just as we did for laguna honda and perhaps

commissioner will like to explain that so we know what's on the consent calendar for. zfg and it does include the nomination of the chief a -- chief. >> thank you for that thorough report you completed. every meeting, the committee -- you receive detailed information. we receive all rules and regulations and review them and the staff section pert at answering questions we have and we -- once we have gone through those, we approved the jcc, and as commissioner chow said, this has to be brought to the commission at-large. we're happy to -- they are detailed pages of rules, regulations, and it

expands from the number of (indiscernible) someone has to do to have privileges to very detailed information about the roles of every provider within the system. so, very well done and very extensive and i think i would recommend that we approve that along with the incredible detail of dr. sherrie like so many years at the general, just beyond pure in terms of their accomplishments as well as their leadership skills, so it's a privilege to hear about these people and to know they are working for the san francisco dph documents. >> thank you, commissioner green i'll look to commissioner moorewitz and this is a consent calendar considered on mass, correct?

>> yes. >> do we have a motion to approve consent. >> moved. >> second. >> those wanting to make public comment, this is the time to do it. please press star three. no hands. i'll do a roll call vote. >> thank you. [roll call] >> all right. consent calendar is approved. thank you. >> all right. our next item on the agenda is other business, do we have any other business? >> let me make sure. i see no commissioner hands. folks on the line, if you would like to make public comment on a business, press star three. i see no hands. >> okay. we did have a brief summary of the zfsg joint committee meeting led bay vice-president green. is there

anything you would like to add on the consent calendar? >> that's the items we have recovered. we looked at some of the work that's being done and some of the strategy goals but this is the main core of what we discussed. >> thank you, vice-president green. any public comment? >> folks online, if you would like to make public comment on item 11, press star three now. no hands. >> no hands from commissioners. so we'll move to the next item, item 12 on the agenda, sorry, item 13 on the agenda. a report on the january 17th community and public health committee. we have the chair of that committee, commissioner giraudo. >> thank you very much. we had two items on the calendar and the first was the tuberculosis update and what was presented to

us over the last past five years, we have had 470 cases in san francisco and in 2022, we had 55 cases. the highest birth country was china. in san francisco, the ethnicity of those with tuberculosis was asian, pacific islander followed by non-hispanic black. it was interesting to note that our numbers, 8.4 per one hundred thousand and it is four times higher than the state and others in the u.s. the 50% of those people with tuberculosis are 65 and over. 87% of the cases are

due to reactivation of blatant infectiouses so what are -- infection so what's the approach to prevention? it is with health providers, community partners, one of the areas is working with the sro's and congregate settings for prevention for education testing, care linkage, it has been operational in eight buildings which is 500 rooms and a lot of people to educate and contact and also other health systems. so, the tb prevention is central to the work as well as last year, 470 cases were

initiated with treatment and 14 contacted investigations at community eastside where initiated so it was, that was the update and i thought it was very interesting statistics. i don't know if anybody has questions about that report. >> thank you, commissioner giraudo. >> anyone on the comment line. >> if would you like to make comment on the january 17th community public update, press star three. no hands. >> commissioners, comments or questions? >> i don't see hands. >> none. we'll move onto the next item, item 14 on the agenda, which is a public or close session. >> commissioner guillermo, i have one more report and it's the update on primary care.

>> thank you. >> it is important. in primer a care, we have 59,000 active primary care patients. and from july 2021 to june of '22, there were 271,000 encounters. and within primary care, there are 14 clinics, all have integrated behavioral health and linkage to specialty health. there's a short waiting list only at two out of four which is good positive news. the scope of services, i think, according to note too, it includes ancillary treatments and dental and primarily care and the

population care of elders, adolescents, transitional youth, behavioral health and cal aim enhanced case management for complex care and care experience team. the central weekly update data outreach and celebrations of top performances, generally, the mma's are really, i think an important morale booster within the primary care position where a weekly basis, an employee is celebrated but san francisco health network reached the goal of three depression metric screening of age 12 and up which again is really important for the integrated behavioral health within primary care. the 2022

chronic care highlight was the diabetes chronic care that was piloted at the maxine hall health center. the 75% of patients are seen in person. 25% have been telehealth but as has been mentioned before, it's the i-t report too, it is -- continues to be a challenge to hiring providers within the primary care system as we are familiar with. that's the end of my report. >> thank you, commissioner guillermo. we'll move onto our next item is a closed session. do we have a motion to go into closed session? >> i move. >> second. >> and i'll check for public comment. any public comment on

the closed session? all right. commissioners, i want to note there's going to be two votes you have to do. one is go into closed session and separate vote to assert attorney client privilege. let's start with the closed session and i heard that motion and second already. we'll do a roll call vote. [roll call] >> great. and then could you all consider a motion and second for asserting attorney/client privilege in the closed session? >> so moved. >> second. >> i'll start with you, commissioner giraudo. >> yes. [roll call] >> all right. great. please give us a few minutes to have the sfgovtv staff leave to move over with the camera and get into >> all right. we're back into

open session and commissioners, please consider a motion to disclose or not disclose the discussions held in closed session. >> move (indiscernible). >> second. >> we'll do a roll call vote. [roll call] >> all right. now we'll move for consideration of a motion to adjourn. >> i so move to adjourn the meeting. >> is there a second? >> i'll second. >> i will do a roll call vote. [roll call] >> thank you, everyone. thank you dph staff, members of the public, commissioners, we'll see you in two weeks. >> thank you, commissioners, have a good night. >> bye. >> thank you.

february 10, regular meeting of the san francisco ethic's commission. this hybrid meeting pursuant to the proclamation declaring a local emergency dated february 25 of 2020 dp held to the conditions of this proclamation.