impact. ♪ [ music ] ♪♪ >> >> we'll implementing several changes to our meeting that's based on requirements set forth by the city attorney and the office of the city administrator for all city charter policy

bodies and and the summary of the changes which was included in the meeting agenda. all health commissioners are required to attend meeting in person at any health commission meeting including committees in order to be counted as present and take part in any action. next, all health commission meeting including committees will include options for re moat public comment. the health commission decided to go beyond the minimum requirements and offer visual and audi of each meeting and committee to ensure the public can participate. sfgovtv will continue to live stream full health commission meetings in addition to the meetings being viewable via the webex and thanks to sfgovtv. health commission meeting, committee meetings will stream on webex with the assistance of a portable audio-visual system to be taken to each site in which health commission meetings are held. the requirement communicated from the office of the city administrator -- which

are, which will be as follows, public comment for each item will be first heard from those individuals attending the meeting in person. each individual continued to be given up to three minutes to comment, there's no time limit on the amount of time, total in person public comment. again, that's in person. next, the commission will receive remote public comment on each item from individuals who contacted the health commission secretary, no later than two hours before each meeting to request accommodation for disability. each individual continue to be given up to three minutes for their comments. and again, there is no limit on the amount of total remote public comment from individuals who have received accommodation for disability. and third, remote public comment will be taken on each item from all other individuals. the new requirements limit the amount of

remote public comment from individuals who have not received an accommodation for disability. the health commission has chosen to accept the recommendation of 20 minutes contained in the guidance from the office of the city administrator. this means they will be a 20-minute limit on remote public comment taken on each item from individuals who have not received accommodation for a disability. these new requirements do not give individual policies authority to mandate mask at meetings and the health commission encourages individuals attending meetings in person to wear masks as you'll see all the commissioners are masked as well. finally, webex has discontinued the plat form we used for remote meeting and the city mandated we use a new webex plat form. there are minor changes on how members of the public are unmuted for public comment and our commission secretary, mark will walk everyone through the new procedures during each item. so,

i hope that was all very clear. we're happy to repeat them over the course of the meeting. if anything needs clarification, i would like to hand it over to secretary morewitz. >> i have a quick addendum. due to changes in the public remote process, do not raise your hand to make remote public comment on an item until your category is called. the order of remote public comment will be first those who have received accommodations for disability and then everyone else. again, please do not raise your hand for any item until your category is called. thanks. >> great. all right. and secretary morewitz, we'll call to the meeting to order. >> i'll call the roll. [roll call] >> thank you, secretary morewitz and to commissioner susan to offer the land acknowledge of ramaytush.

the san francisco fire commission acknowledges that we are on the unceded ancestral homeland of the ramaytush ohlone who are the original inhabitants of the san francisco peninsula. as the indigenous stewards of this land, and in accordance with their traditions, the ramaytush ohlone have never ceded, lost, nor forgotten their responsibilities as the caretakers of this place, as well as for all peoples who reside in their traditional territory. as guests, we recognize that we benefit from living and working on their traditional homeland. we wish to pay our respects by acknowledging the ancestors, elders, and relatives of the ramaytush ohlone community and by affirming their sovereign rights as first peoples. >> thank you, commissioner darado and next item is general public comment. back to secretary morewtiz. >> all right. one second to get to my script. 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 agenda. each commission, sorry, each member of the public may address the commission up to two minutes. the commission cannot discuss items not on the posted agenda. including those raised during public comment. please note each individuals allowed one opportunity to speak per agenda item. individuals may not return more than once to read statements from other individuals unable to attend the meeting. written public comment may be sent to the health commission at the following e-mail address, health dot commission dot dph at sfdph dot org. if you wish to spell your names in the minutes, you may do so without taking your allotted time. policy and federal prohibit harassing conduct against city employees and others during public meeting and not tolerated. we will first take public comment from individuals attending the meeting in person. we'll take remote public comment from individuals who received an accommodation for disability.

prior to the meeting, i only gave accommodation from one person for disability. just fyi. i have been, i've given each individuals a code to speak when they begin their comments to prevent others from speaking at this time. we'll hear remote public comment from other individuals. there will a time limit of 20 minutes on remote public comment that can be heard on each item, beyond public comment, general public comment. because of the two tiered remote public comment proceed tour, please do not raise your hand to make remote public comment on items until your category is called and the new webex plat form requires that members of the public unmute themselves and when i call you on to comment, you may unmute by pressing star six. let's start with, in the room, is anyone here to make public comment? great. >> thank you, can you hear me >> yes, we can.

>> hello commissioners. jessica layman with senior and disability access. i'm going to try to squeeze in three items in the three minutes. first is i really came because every one of our organization is very upset about the decision to no longer require masking in healthcare facilities and homeless shelters. we are really shocked by this. seniors and people with disabilities have been hit the hardest by the covid pandemic. i have lost so many friends and other people and our communities are always disregarded. right. we've talked about the headlines that said, oh, it only seems to be older people and people with health conditions that are dying, right. as if that was okay. and that could make everyone else feel better and now we are here again with people desperate to go back to the way things were before the pandemic except for people in

our community. people who are disabled and at high-risk of getting covid because they are immune know compromise or have consequences if we get it. for us, that's untested. there's not research on what will happen, so it becomes very dangerous then for us to go and seek medical care in a healthcare facility when we know we have to be around other people who may have covid who are unmasked. this is not okay. and we will see the same thing we saw at the beginning of the covid pandemic, which is people then make the rationale choice not to seek care. certainly not preventive care. sometimes even necessary care because of the risk of covid. please reverse this decision and keep requiring masking. the other two things i want to say is i know a lot of people are outraged from this issue and people were also very frustrated to hear that there's a limit on public comment. just two hours ago, the board of supervisors made a decision, ten

out of 11 supervisors voted to keep remote public comment open and unlimited. as the commission secretary was saying, what you have is a two-tiered system. as a disabled person my whole life, i am so tired of being put in a separate category. today, just to get into this building, i had to find the accessible entrance, come up the ramp and the door at the top of the ramp was locked and the power button was out of order. i had to call the number on the door and wait to come inside to the meeting and you know, many of you, i'm sure have also dealt with this, right. people deal with it with any number of reasons of being marginalized. we do not need to add another to say disabled people have your own category and you have to disclose the disabled, some people don't internally identify as disable ld because of the intense stigma, right. and then you've said that the first people who speak, we're going to know are going to be disabled so we're required to announce it to the

world. for everyone else who has valid reasons for remote comment, maybe they are taking care of a child at home or an older person, they should also be able to share their views. >> your time is up. >> thank you. >> thank you. is there any other remote public comment. i'm sorry, anymore public comment comment of people in the room? okay. so, folks on the line, if you -- if the one person who received accommodation would like to raise your hand. i see two persons so the person who did not receive accommodation, put your hand town. the person who did receive accommodation this have a code and i'll hear from that person when they unmute themselves. please press star three to unmute, star six to unmute your self. and then call -- and then caller, let us know you're there. >> hi. can you speak now. >> excuse me, sir, you weren't given accommodation for disability. >> certainly not, no. it's a new

system. >> please mute yourself, great. all right. person who i have just requested to unmute yourself, press star six to do so. okay. so, currently, one person with their hand up again. please press star six if you're -- seems like the person who received accommodation is not raising their hand. so now we can move to general remote public comment. so anybody who is remote, you can raise your hand. i'll start a timer for 20 minutes. at the end of 20 minutes, whoever is speaking will be allowed to finish their comments. okay. all right. caller, please unmute yourself by pressing star six and let us know you're there. >> yes. zz, yes. so, i'm disabled and i requested remote

access in advance and i really don't like i had to do that for the reasons that were given. a separate reasonable accommodation process is bad for disabled people and bad for non-disabled people. i don't like being put in a separate category either and as it was pointed out, everyone here, like everyone has a right to speak. maybe there are people who have to bus down city hall and can't do so or may not want to risk getting covid. i do not approve of this two-tiered system and i don't think less democracy is better than more. i would like to see that from mitch mcconnel and not in san francisco. i hope you go back to the original method of allowing everyone access to remote equally and i don't like i had to identify as disabled but this is important. i did anyway but it's really terrible to make people do that. my name is elizabeth. we need to keep the universal mask requirement in healthcare. if this isn't an ada violation, it should be one. you're terminating safe access to

healthcare. i don't know what the plan is to provide access to healthcare. one one making goes so far. six months from my booster, no longer protected by -- what are the safety precautions for people like me and what about environments where people can't reasonably mask, can we sue hospitals if staff give us covid while they are for a broken leg? it's just, we really have to keep healthcare facilities safe for everyone to access and homeless shelters. this is not a decision based in science, reverse this immediately and bring back the universal healthcare in homeless shelters, thank you. >> thank you. all right. now, we can move onto other remote public comment. each of you have three minutes up to a 20 minutes in total. please press star six to unmute yourself. caller, are you there >> yes, i'm here. >> all right. please begin. you

have three minutes. >> all right. thank you. i'll start. my name is doug young and i'm a san francisco native, current resident. calling in to strongly disagree with the latest orders of the health officer that requires mandatory masking and covid vaccination for personnel in healthcare and jail settings that happened last week. this order goes directly against the new california state order, which was reported by the l.a. tiles on march 3rd, that is ending mask requirements in healthcare and other high-risk indoor settings including correctional facilities starting on april 3rd. now, in terms of masking, the review that was recently published, a meta study covering 70 control trials, the gold standard of scientific studies including 13 during covid shows that mask didn't stop respiratory illnesses. they do not work. this was an update

from an earlier review they published in late 2020 which came to the same conclusions. also, even though this order recognizes the best covid-19 reason for vaccination is to protect against severe disease, not stopping transmission or infection, if you're ordering this for people for their own good, why don't you ban smoking and junk food for the employees who are going to be affected by this. i want to quote a journalist that used to write are the "new york times" named alex barinson and don't think of this as a vaccine by a variance pewter with a limited window of efficacy and terrible side effect profile that must be dosed in advance of illness and we want to mandate it. that's insanity. the evidence and science is moving forward and we're figuring things out and we're taking steps back in san francisco, even when the state

of california is going forward. masks do not stop transition. thank you. >> thank you. all right. next caller, i'm going to put in a request to unmute yourself. please do so by pressing star six. i see one hand at this point. caller, unmute yourself. there's a system change and this new system you have to unmute yourself by pressing star six. there we go. >> sorry, can you hear me? >> yes. >> i'm the one that -- this is dr. teresa palmer. i totally support on others who spoke of masking in medical places. i'm

elderly and immuneo compromises. this threatens me getting medical care. i would like to protest the disability that -- the remote comment rule that you've made. why does the public, why do i have to call mark morewtiz and beg to speak because i'm an immuno suppressed. this is discrimination against me. i should give public comment that's safe for me. follow the board of supervisors and not have limit on remote comment. thank you. >> okay. thank you. next caller, please unmute yourself. caller, please let us know you're there. >> i am, can you hear me. this

is cedric. >> you have three minutes. >> for me? >> yes, mr. manashaw, go. >> i want my pull three minutes. this testimony is not about the laguna honda rebuild. do not interrupt, mr. morewtiz. laguna honda plan is full of problems in every department. it has -- the mbs system and coordinators and mbs department aren't doing their jobs with comprehensive care plans and quality of care, vmbs is mandated by cms for every step. one of the 21 milestone around the mbs problem is create a quote, charter to establish a new quote, resident karen in, end quote, above the

ibp structure. the charter relies mbs therapy must be approved by march 14th or at the next meeting because it involveds a new policy. that policy must be scheduled for the jcc agenda next week. the plan plan planning materials need to be developed with conflicts including nurse, reader, oral, individual of the care plan including updates based on patient's conditions and how to complete mbs infections. it's shocking. (indiscernible) it needs rpp quote oversight

(indiscernible). this is ridiculous. thank you. >> okay. we've got one more hand. caller, please unmute yourself by pressing star six. let you know you're there. caller, you're unmuted. let us know you're there. try one more time. caller, are you there? i'll do my best. all right. one more person. press star six to unmute yourself. please press star six to unmute yourself, caller. >> yeah, this is (indiscernible). >> oh, don't need to hear you

manatashaw, we already heard from you. the last person who has their hand up, please press star six. and caller, you're unmuted. please let us know you're there. >> this is patrick again. >> all right. the system is wacky. i think that's all the public comment, commissioners for general public comment. >> all right. thank you, secretary morewitz. our next item is approval of the minutes of the health commission meeting of february 7, 2023. commissioners, you have the minutes before you. upon review, if there's no amendments, do you have a motion to approve. >> motion to approve. >> second. >> second. >> all right. >> we'll check with public comment. folks on the line, if you would like to -- anyone in the room who would like to make public comment on the minutes? all right. anyone online would like to make public comment on the minutes, please press star

three? all right. one hand. caller, press star six to unmute yourself. you have your hand up. >> hi. this system isn't working well. i didn't have my hand up. it's a messed up system and go back to the old way. this is ridiculous. >> it's not possible, dr. palmer. the new system is all that exist. the old system doesn't exist anymore. commissioners, there is no more public comment. and commissioner chung pointed out no longer do -- do roll call vote. you all do the old way where you do ayes and nays. >> okay. there we go. so, any commissioner comments or questions, otherwise, go to a vote. all right. all those in favor. >> aye. [multiple voices] >> opposed? all right. minutes are approved. thank you for that reminder, secretary morewitz. our next item is the director's

report. we have dr. grant colfax, director of health. >> hello. is this on? >> yeah. >> you can hear me, okay. get as close as i can. good afternoon commissioners, members of the public. welcome back commissioners, to in-person meeting. >> welcome back to you as well. >> a number of things to cover in the director's report that, to highlight, i'll summarize and happy to answer questions. first item is san francisco covid health orders were rescinded and issued to align a new order of issue -- to end with local, state and public health emergencies and the covid local public health order -- health emergency ended february 28th along with several health orders including health order, the safer return together. state masking requirements will superseded local health orders. if the state is more restrictive and the health officer issued two ors that affect hospitals and nursing facilities and other

healthcare and jail settings and it makes it less restrictive. staff and the above referenced setting are required to wear a mask when interacting with patients or clients or those incarcerated and the masking for the general public will end. in addition, masking requirements in homeless shelters for the general public and staff will end. those who operate the facilities can decide to be more restrictive than local guidelines and they implement their requirements. dph will monitor the national discussion about covid vaccinations and reevaluate vaccinations once federal and state recommendations are made. and dr. philip is here to answer questions that commissioners have on this item. item two, legislation to allow privately funded overdose prevention sites to open was approved by the board of supervisors. the board of supervisors unanimously approved legislation introduced

by mayor london breed and -- prevention sites in san francisco with, with private funding. the vote removes a recently identified barrier to moving forward with a non-city funded overdose prevention program while the city waits for federal guidance on whether it can fund such programs with public dollars. while federal and state legal issues on publicly funded overdose plea vengs sites in san francisco are yet to be resolved, the city continued conversations are leading nonprofits around opening a privately funded site. as part of this process, the city fewed a significant issue to be addressed for a funded site to be move forward. to address this issue, mayor breed and supervisor ronen repealed the 2020 permitting structure. the mayor asked president peskin to expedite the ordinance so the city could adopt as soon as possible. the law as written

didn't allow for overdose prevention to open until the city authorized the city to do so whether funded by the city or private resources and the change to the law allows prior resources to be used to open an overdose prevention site in san francisco without the state making, making, taking the action it was previously required to do so. item no. three, mayor breed join state leaders this support the legislation for statewide conservative ship. mayor london breed joined susan eggman for conservative ship and support mental health bills including senate bills 43 and 363. mayor breed is cosponsored as the big city's mayor's coalition. they advance support for those in need. in passed into law, these sb43 and sb363 would greatly support improvements to san francisco's conservative ship

program and create efficiencies in the data they work as practitioners. this is the latest to preserve the conservative ship law by mayor breed. the mayor and state leaders are joined by representatives from the national alliance on mental illness. the california state of psychiatrist and psychiatric alliance of california. you can, there's a link to the press conference in you would like to see that at the bottom of this item. next item is zfg ore though trauma institutes celebrating its 16th anniversary. february 24th, oti via -- they celebrated this anniversary, cl commitment to clinical care and research and outreach activities are changed the lives of many for the better throughout the greater bay area. and it's one of our flagship programs at zuckerberg san francisco hospital that provides

good clinical care, but it's recognizes research model nationwide. next item is the very important, 2023 employment engagement certificate survey opened through march 22nd. we begun our 2023 survey, the survey will ask questions related to gph staff experiences and equity and management and burnout and support and other employee engagement indicators. our hope is that 70% of employees will answer this survey. and it is the first survey that has been done since we've gone through the challenging aspects of the pandemic so important to get input to better understand how we can support our incredible workers. and then one item that's not on the director's report before i get to covid update, i wanted to let the commissioners know, we recently,

with regard to laguna honda, we're honored to have secretary of hhs, health and human services secretary desara visit laguna honda last friday. accompanied my mayor breed and our city attorney and the ceo of laguna honda hospital, the secretary came to visit at our invitation and he toured the facility. talked with staff and with employees and residents, visited one of our wonderful neighborhoods and really asked a lot of questions about the incredible work that's going on there with regard to our quality improvement as we move forward toward recertification and i can't speak for the secretary but i can say the staff were inspired to be able to show off the great work that is being

done there and very much appreciated the mayor sharing her experiences and supporting the team as well. and roland pickens provided information in response to both the secretary and the mayor's questions and we had a number of really wonderful staff who were very excited and helpful in sharing with the secretary the quality improvement board, the dashboards that they support and look at everyday and then of course talking to the residents. the residents told the secretary and the mayor how much they appreciated being in laguna honda and living there. so it was a really appreciative of the secretary for coming here and making that visit. then in terms of our covid-19 update, as of march 1st, the san francisco 7-day rolling of new cases per day is 94 and 86 people are

hospitalized including seven in the intensive care unit. 86% of all san francisco residents have been vaccinated and 65% have received a booster dose. and then i do believe one, commissioner chow, you asked for us to include the buy vail and booster result. a total of 38% of san franciscans received a buy vacant and that's higher for those 65 and older. there's a slight increase in our covid-19 cases, hospitalizations have been averaging between 80 and 90 but certainly compared to where we were three years ago with all the unknowns, we are in a better place today and that reflects, that's reflected in all of you being here today and in other parts of this report including the health order revisions. thank you, i'm happy to answer any questions. >> thank you, director colfax.

do we have public comment on the director's report. >> is there any public comment in the room on this item? okay. folks on the line, is there any public comment from the person who received accommodation for disability, please raise your hand. i see two hands. only one of those received the accommodation. checking. we'll do both. caller, please unmute by pressing star six. >> hi. this is dr. palmer. i would like to know what is going on with getting the 120 beds at laguna honda that's threat threatens with closure. mr. basara can give a waiver if the county asked for it. roland

pickens said this was possible. if i'm interpreting his words directly in the january 31st board of supervisors meeting and we have not heard anything about it. i would like to know that the needs of the people of san francisco are being honored given the extreme shortage of medi-cal nursing home beds with every effort made to save those 120 beds for public use. thank you. >> all right. next caller accident please unmute yourself by pressing -- next caller, please unmute by pressing star six. >> mark, can you hear me >> yes, mr. manat shaw. >> you guys screwed up on the meeting minutes agenda item. i had my hand -- >> this is the director's report. you can speak to the item. >> i had my hand raised and you

didn't -- >>[coughing] >> okay. i had my hand up and you didn't call on me, mark. this is a (indiscernible) system. [coughing] here's my testimony regarding the meeting minutes that mark didn't call on -- >> that's the last of the puck public comment on this item. >> any questions from directors. commissioner chow. >> i would appreciate if dr. susan philip can discuss what the department of public health facilities are going to be doing in terms of masks and vaccination. >> please closely to the microphone, dr. philip. >> i will. good afternoon, commissioners. it's lovely to see all of you. commissioner

chow, thank you very much for the question. as you know, the policy of each health system including our very own san francisco health network is determined by that health system. it's separate from the health officer orders. only in that we set as the health, the health officer, we set the floor in the local and the state orders but any health system can go beyond that. so, i'm speaking now, just in my capacity with listening to colleagues, not because i've decided this. i understand and other colleagues may be able to expand on this, that in our medical facilities, for the time being, staff and visitors, everyone in those facilities will be required to mask. >> and is there a change in the need for vaccinations in the department or in the city? >> again, similarly, the city requirement, the city and county

of san francisco requirement through our department of human resources is entirely separate from health officer requirements. they do intersect in certain of our setting such as laguna honda and zfg, but they are the same. in terms of the health officer orders, as of now, we are keeping our current requirements in place under the health officer orders, requires completion of a primary series and at least one booster. and what we're keeping that in place to do is understand in the coming weeks, the requirements and the guidance that may be coming from our federal agency auch fda and cdc and california department of public health. at that time, we'll reevaluate our local orders and make any adjustments that are needed based on any changing recommendations for a repeated boosters, annual boosters, those types of things so we're waiting to get more of that information

before making any adjustments. >> thank you. and finally, this would be in your role as the health officer, what do you believe is the logic that the state and yourself, as health officer have decided that the general public need not have a masking, even when they go into healthcare facilities? i think it's very clear from what you're saying that our -- all of our healthcare facilities in san francisco and offices in all can go beyond and have different mandates, just as we have had for our san francisco health -- health system. but if you could explain if that's possible, logic that the state is now saying and the city is following, except that within our own facilities, we said that isn't going to happen, that

members of the public visiting in health facilities do not need to have mask, do not need to have masking. >> i won't presume to speak for the stay health officer and the discussions that have happened there but i'll speak to my way of thinking about it and the expert input that we've been getting as we make these decisions. as director colfax said, we're fortunately at such a different time now at three years into this pandemic than we have been before and again, in particularly in san francisco with the amount of vaccination with the ability of people to utilize high-quality mask, if they choose to and knowing that mask requirements in general settings are no longer, are no longer common and no longer utilized. we really are moving to more of a phase of people being able to choose to use

those mask, particularly members of the public. in the new orders, what i'm recognizing is that we still do have a little more ways to go, to understand what the vaccination requirements or recommendations might be for staff. what the seasonality of covid might be, as far as sar2 virus. is this going to be like influenza and i like our staff to mask in the short-term period to understand those factors more and to present any, and to prevent devastating outcomes of transmission from staff to patients who are coming to seek care. so, it is allowing the public more flexibility and more options but really focusing very narrowly on certain set setting and preventing staff premission

to patients and again, as -- we'll keep reevaluating this as we get new information and as new guidance comes out from our federal and state federal partners. >> thank you, dr. philip for your thoughtful discussion here and we'll look forward to future iterations of these policies as they evolve. thank you. >> thank you, commissioner chow. >> thank you, commissioner chow. thank you, dr. philip. vice-president green. >> the other question i had is whether the department or even the cdc are taking guidance to institutions about how to explain to the public what their policies are? where i work, it's not even clear and i have seen a mixture ever people with mask and without. i think people who work in the hospital understand but there's not any real direction and i'm not sure whether we're getting guidance. i know as a general, they are having everyone mask and whether

there's any verbiage or piece [mic is off] that you have sought through so the expectations are clear. and the other question i wonder is whether you have given guidance about testing patients who is about to be admitted to the hospital and our institutions abandoned all covid testing unless someone is systematic. wondering -- symptomatic. we want to better understand the possible benefits of one way masking and anecdotally, i think a lot of us who work in healthcare who have been exposed with covid and 95 granted avoided the disease and so i don't know what the body of evidence is, but when you look at families that have separated, even (indiscernible) and one has not. is there any body of information forthcoming and currently existing that will

reassure people if they are in a situation where there's one way masking with a decent mask that can confirm protection. >> thank you, vice-president green. for your first comment about how do people know when they are going into different health settings, what the rules are. for now, the state order is still in place. it will be until april 3rd and that does still continue to require masking for the public and for staff. but you're raising a good point. i don't know what the plans are. in is becoming more decentralized in that regard in terms of how health systems would like to notify the coming onto their premise and their patients. but i'll keep eyes and ears open for how that might proceed, but at this point, we're not planning to issue any guidance or any constraints about how they choose to do that. your question as well

about one-way masking and the benefits of that. i think it's a really important one. it's challenging, many times people draw the inference or draw conclusions from large studies such as we have heard from one caller and it's challenging because in those studies, we know not everyone used the mask, even though they were randomized to a mask use group in those randomized controlled trials and i think it's challenging to sift through all of this. so i'm not aware if there are national or larger body collections of the evidence, as you've said, we know that masks are helpful as healthcare providers, people are wearing them all the time for their own protection. it's one of the standard ways in which people protect them selves in those higher risk occupations. so i think it's a good point and we'll continue to look to see if there's accessible and clear

ways in which we can disseminate that information for people. >> thank you. >> thank you, vice-president green and thank you, dr. philip. commissioners, any other questions? i did have a question. director colfax, regarding laguna honda, just wondering what the next steps might be in terms of the recertification process? i know that in reading through various reports and other things that laguna honda is meeting all the milestones set forth today. what are the next steps in terms of surveys and other things like that and interaction with cdph -- >> thank you, press bernal and pickens seen the certification and i can share general information. >> thank you. >> we have an action plan a part of the agreement and there's milestones in that action plan that laguna honda is required to

be, so the good news for january and february, there were a total 2659 milestone -- 259 milestone and we have our independent expert determining that we've met a few of those, the february milestones, confirming we have met them but it looks like we're on track. that's good news. in march, there's a total of 77 milestones for us to meet. we're continuing down that route as well to make sure we are on track to meet those 77 milestones. i think the big, one -- there are many things and one of the key things that we are prepared for everyday is surveyors coming from the settlement agreement and surveyors are expected to come on a regular cadence. they don't know -- they don't tell us when they are coming so the team is

prepared as we can be for that visit. but i would expect, again, i don't know, but i would expect a visit some time relatively soon. >> so, we're kind of coming up on that interval. >> we're coming up -- you said it more he will wantly than i did. >> questions or comments. thank you, director colfax. next item, which is the 2016 public health and safety bond update, we have a multi-agency presentation today from mr. mark premo and terry and joe chin. the first two from dph and mr. chin from the department of public works. hello, mr. primo. >> good afternoon commissioners and director colfax. we changed the presentation and inserted what alisa have. the cost of what's happening and what's

trending that terry will talk about. also thanks, commissioners, chou and giraudo and green for your advanced questions. i would like to kick it off with the commissioner green's question and there was a shift of contractors and contractors perceiving less risk of projects so they found themselves going into commercial and residential and away from the hospital and medical sectors. what we're seeing now is a slow return of some subcontractors, i think part of it is the high-tech reductions and the projects that have been cancelled so we're drawing more attention which joe and terry will talk about, which is actually going to be really good because if we can get three to five bidders, it keeps the cost down as opposed to what we were getting a year, a year and a

half ago, zero or one. so alisa, could you go to slide five. i'm going to turn it over to terry. after slide five, it's a new graph that gives you an idea of where cost indicators are trending. >> terry, zuckerberg capital planning. >> it's hard to see. [laughter] so the good thing i know it's on there. the, so that's the current look at the budget showing that deficit of an uncaptured deficit of $85 million. it totals to 105 but we have additional funding that we have supplemented the budget

with. thank you. that we supplemented the budget with it reduce it to $85 million. that's what we're working with right now is the deficit. this is a number that will -- it will change over time as new information is gathered. as things -- the changing numbers include the (indiscernible), the cost that runs beyond our contingencies, rescoping, reducing the scope of projects, to reduce costs and how we package up new bids, do we reduce the numbers so as each of those items happen for a particular project, we'll update this list and reducing that deficit number. in relationship to questions being asked by the commissioners, mr. chow, you

were asking about the significant financial challenges for the building five project and will there be changes in the scope of the project? so, you run into a situation where we have to change the scope. of course, that will change the outcome of the project and it will have and the financial challenges will drive that. so, and then follow-up question to that question was, does the master schedule reflect that. all the ones known are reflected in the master schedule and the master schedule gets updated on a monthly basis so any decisions that have been made that impacts the schedule will be incorporated into that master schedule. with the pes project, i think the pes project is a question, if it will be completed in august because it's showing 93% complete. so, pes is

a perfect example of where we thought that we had an opportunity to reduce the lays during construction by doing early demolition and construction. demolition is 93% and complete by august. the other project, the build of the pes. it won't start until we have a permit, it's going through the permit process right now and the estimated completion time that have project is late 2025 with occupancy in the early 2026. the, and then there's a question from commissioner giraudo, what are the next steps of cost containment and risk management -- >> speak really close. >> thank you.

>> really closely. so what are the next steps of cost containment and risk management do not meet the goal. we don't know move forward. we have several projects that cannot move forward if the funding isn't in place. we can't jeopardize going in the contract with a contractor and not having the funding to back us up. there's a lot of work to exploit supplemental funding sources as possible and that's what the chart is showing down below. so for instance, it infrastructure is a perfect example of a project that we may have to rescope if the bidding environment doesn't provide us, provide -- we have gone through ve ask reducing the scope and hopefully to align it with our budget. we are currently patching it up and going out to bid. if the bid comes in at a number we can't support with our budget, we have to rescope it

again. family health center and specialties are two projects that we don't, we haven't started yet and we'll wait until the funding is secured before we move forward with it. so that's how we control the and contain the cost overruns verses the scope. i believe i've addressed, let's see. i've addressed, that addresses all the questions from the commissioners. i do want to draw attention to the, do we have, alisa, do we have the addendum document we put on the screen? we do want to share with you this construction cost indicators. this is late information we entered in to provide you to give a more rounded description of what the current environment and what we

anticipate on the current bidding environment. >> actually, mr. sultz, can you make it bigger and make it go down, so the commissioners can see it. we don't have a copy for the commissioners. is that okay? >> you can zoom into the top part. there you go. so this is data that has been gathered or information gathered in the, in the last quarter of 2022 which is used by -- used to predict our future. so, what it says is the construction cost indexes indicate that the increases experienced over the last two years are slowing. so we would think that would be good. but with that slowing, there are some headwins ahead of us. we're seeing a slowdown in demand for design services, we're seeing

material costs ranked as a concern in 2023. even though the material cost are levelling off, there continues to be higher interest rates as well as persistent in elongated lead times and materials shortages. the logistics of transporting materials is a problem. cement cost are going up. construction faces skill trailed workers. that's a real issue for us everywhere. it's the labor force. and then labor gaps are affecting project timelines as well as how much work engineers and contractors can take on. and as for workarounds, companies are asking workers to do more and put in higher bids and letting schedules run long. while we see, we're projecting a softening of the cost indicators, there's still these other troubling issues that's going to drive the bidding

environments. we do have, as mentioned we have the it infrastructure project going out to rebid after rescoping it. that will be our first project that we'll see the impact of the bidding environment. and so, that's -- that's expected to be completed by late may, early june. so, mark, where are we on our presentation because you jumped me into slide five? >> alisa, please go to slide six. >> okay. these are the strategies we were employing that we -- imploring that we were talking about. i'm not going to read the whole thing but these are -- these are tools

we're using to reduce the cost of projects. a lot of tiles we find out the bids are coming in because the contractor sees a level of risk so we do a lot of communication and outreach to reduce the risk and if we have to rescope the project to reduce the perceived risk, we'll do that. creating a large trade bidding pool, again, using it infrastructure as an example that the electrical contractor bid on that came in very high, about 3 times more than we had estimated. so, we rescoped it. we're reaching out to more subject contractors and we believe that we have a pool of in access of three. before we had one. so we do hope that will have a reduced cost benefit.

early demolition, so pes is an example of that where we went in, we did the early demolition because what we learned in our rehabilitation project is once we did the demolition, there was all this old infrastructure. we had very leaking waste pipes in the space that had to be addressed and it slowed down the project and a delay. the hopes by doing early demolition, we can identify hazardous materials and poor infrastructure and address that prior to construction so it does not turn into a delay. value engineering, that's reducing the scope of the project. and then again, hunting for alternative funding. did you want to talk about alternative funding, mark? >> yeah. so, you have seen some of the sources of funds that we've been able to put towards the project. there are two new

ones that you did not hear about until now and under the last two bullets, last month, we got a state grant for $33.7 million. which focuses on behavior health and psychiatric services for children and youth. we're going to study this grant. even though it's focused on health delivery to see if there's infrastructure that can be also benefiting the 2016 program like it or plumbing or electrical. the one on the top is a climate change related to extreme heat and cooling, which, as you know, we are impacted by it and there's only two states right now that have a program similar to the federal program and that's california and oregon. so, we're tracking this. there's legislation going through congress to amend the

stafford act which controls fema's eligibility and defer next, to add extreme heating and cooling. so, we're aggressively working with carmen chiu, the city administrative's office to put a team together to get a grant towards both campuses. >> alisa, can you go to slide 7, please. thank you. good afternoon, commissioners. joe chin, public works program manager. the next two slides will be focused on providing updates on the after projects in both the zuckerberg building five component and the community health center. first slide on slide seven, it's just a focus on, it has seven projects in active construction and the first project, the rehab phase iii, as you may recall, we

completed phase i and phase ii last year and now the main rehab department relocated inform the third floor and that's currently -- to the third floor and it's in operation. we started the phase iii project which is a follow-up to that and that's in the early stages of construction. the next six projects, i grouped them together just to show that's under one construction contract and that's primarily to allow better coordination among these six projects that -- there's a lot of intersections between various, for example, size and upgrade, clinical -- (indiscernible), there's a lot of scope interrelated do we grouped them under one construction contract so we can work with one contractor and subcontractors so the work can be better coordinated. so i won't go through all the projects but i'll take a few. seismic upgrade is currently 23% complete. it's one of those

projects that, it will take a long time to complete. it's roughly about 900 calendar days to complete the project. one of the reasons is because we're doing seismic work in all parts of the building. there's roughly 206 locations that's doing seismic upgrades and we're slowly going through each scope and finishing it and moving on to the next scope. we're currently 23% complete, focused on who it's column strengthening, adding structural fiber wraparound columns to make them stronger or making a column thicker, adding concrete to that. also, the biggest scope we're doing and working from the basement up is building a new seismic joint. that could be the end of the day from what currently is five inch seismic joint to a 24 inch so that's a substantial undertaking that, this takes time to work from the bottom up. other than that, i

think pesd was a project we talked, terry mentioned earlier, this is a project that is almost complete. we're in the early, it's early demolition project. the successor to that project, the starting of the main project is not limited by completion of the early demo. it's driven by when we get the permit for the main project, so under the project and design, we're tracking additional backtrack from h-ki during plan reviewed and we're expecting that project to be planned approved, third quarter of 2023. once that's done, that allows the project to proceed with the bidding and that was in drive when we can start the main project. next slide, please. this is a pretty quick summary of where we are currently with the community health centers. there are three main health centers that we were undertaking as part of the 2016

health and safety bond program. they are all completed now. fully operationalized as of last year. southeast health center was a brand-new build out, 22,000 square feet health center and cash omission and maxine hall were existing clinics that were retrofitted as part of the project. and those are all completed now. and that concludes my part. mark, back to you on usff. >> thank you, jeff. so, alisa, the next slide. so this is just a snapshot of the research building that's about 94, probably 95% complete with the move-in between summer and fall of 2023. if you haven't had a chance to go through it, it's a beautiful building on the outside and inside. i think with that, if we can open it up for additional questions.

>> cigarette morewitz -- secretary morewitz, any public comment.? >> no. any public comment in the room. any public comment from somebody who has received a comation for disability, please raise your hand now. i see one hand. i'm going to ask that person -- if that person has accommodations? hand is down. great. there's no hands from that group. so we can go to anyone else from remote public comment. raise your hand by pressing star three. again, i'll call public comment one more time from anyone from the remote group, press star three. i don't see hands, commissioners. >> great. commissioners, any questions or comments? all right. commissioners submitted questions in advance so thank you for addressing that in your presentation. thank you very

much. next item. thanks, all. which is overview of dph contract monitoring for this, we have michelle, dph business office director. welcome, ms. ragos. >> hi commissioners. greg wagner, can you hear me? >> yes, mr. wagner. i'm speaking close enough. a couple of brief words before i turn it over to michelle. you all, on the commission know the topic of contract monitoring has been a consistent conversation and i think it always will be because we're constantly evolving. and it's a big, it's a lot of territory when you start talking about all the aspects of how we work with and monitor our vendors. we're not going to hit all of that today but we want to start. those of you on the finance and planning committee know that a months ago, we had a

long in depth conversation that was prompted by the issues at baker prc but also a lot of the other organizations that we work with that had been going through challenging times, pandemic and the overall environment. and so, this is in some ways a follow up to that conversation. we took a lot of the thoughts and things that we've talked about there and had been trying to feed it into the department's work on how we relate to our vendors. i will say that there is, there are a lot of challenges but i actually feel like we're at a moment where we have a lot of momentum happening in this area. in the business office, ms. ragos and her team have really been working on analyzing and refining a lot of our processes and i feel like we're

really moving in a good direction where we'll have quicker warning signs and flags, quicker escalation and quicker intervention when we identify problems through the process, and the other great thing is that -- the city controller's office and a lot of city leadership are engaged on this issue and dph is actively participating and michelle and team have been leaders in that process. so, i just wanted to set that context that we're not going to get to all the issues today, but i'm sure there will be more conversation and we're looking forward to hearing the thoughts and feedback from the commission to advise us as we try to plot forward. i'll turn it over to michelle. >> hi, ms. ragos. >> hello. good afternoon. >> good afternoon. >> i'm going to take off my

mask, this makes me nervous talking up here and that makes me hyper ventilate. [laughter] anyway. thank you. commissioners, my name is michelle ragos and the director of the dpl business office and the acting director of the business of office compliance so today's presentation is going to focus on what the business office of contract compliance does and i'm going to refer to that as bocc for short. and i'm going to reference some of the other efforts that are going on in the department because it's not just bocc and just in case you want to learn about that or just to give you information for future follow-up presentation. we were starting this, i was struggling a little bit with the purpose of this presentation. i mean, obviously, the purpose is to provide you with an overview of the business office. how we do programmatic and performance

and compliance and fiscal monitoring and why is that? i've brought a lot of contracts to the health commission and you ask insightful questions and i think a lot of it boils down to, is this a good contract? how do i know? are they stable? are they good performers? we don't always have all the answers but i think by sharing some of the basic information, it will help just to provide a baseline of what tools and what we are doing and then the other purpose that i didn't write down is that every time something gets into the news, it's like a shocking headline and if you know the details behind it, it's enraging but i want you to though and i want, that dph is a model for program monitoring and a lot of the department, city processor following behind, so when you see these headlines, know you should ask and hopefully through this you should feel comfortable

knowing a lot of stuff is going on behind the scenes. all right. with that, you can go to slide, i guess it's one. yeah. okay. actually, we can skip that. i, basically, i said what we're going to cover today is performance and fiscal monitoring and then some new tools. so, moving to this next slide, this is basically the primary, not everything but the primary functions that the business office of contracts compliance does, which is fiscal monitoring, annual program monitoring and fiscal compliance monitor and the program monitoring, just to make a point because it's a wield concept until we point it out or it was to me anyway, we monitoring programs and not contracts so we're monitoring the individual programs within contracts but across the board and so, it's the fiscal compliance monitoring that's done at the agency level.

and so, i can't see that up there. okay. we do those two things and then there's also, i gave you a document that's labeled, what is it labeled? let me go back to my notes. the next -- it doesn't look i excel to you. it's called dph contract monitoring compliance and quality management function. and i gave you that document, it shows you what other parts of the department are doing. it looks like this, this green colored document. and i think some of it, yeah. i think it's a good document to see what other things are going on in the department and i know from some of the questions that you asked, like, how did you performance monitoring and where's the system data rolled up to? that isn't happening in bocc but it

speaks in that document. behavior health services, for example, they take the per foam znswer objective and rolls it up and post it on a dph website and i'm sending you that link and shows you systemwide data. i know some of what your questions are so i wanted you to know where some of these things are happening in the process. so, all right. okay. next slide, please. our monitoring goals -- the information is shared and people are aware of it. and so that's increasing communication and making it easier for staff that need this information to get it all-in-one place. to make sure the findings because a lot of work goes into the findings, actually inform changes in the

contracts or allows system changes to address problems that have been identified. i'll talk about how we're doing that more intentionally through the new form that is part of the part 2. but next slide, please. okay. next slide. okay. so, this slide shows you, i'm talking now of the program monitoring piece. we monitor in cycles and monitor in buckets that represent different parts of the department and again, i'm focusing on the nonprofit vendors today. but we focus on and then sometimes within a cycle, there's -- it's broken out again by the funding. and so, that is who we are currently monitor and that coming soon box, i think it probably should have been labeled differently, but what

we're doing with the coming soon box is being more intentional about a new monitoring cycle or additional monitoring cycle that represent these sections. it's not to say that some of those, the contracts within those sections aren't already being monitored, but for example, population, behavior health is a new box on the org chart so some of the contracts are being monitored but it's a new box and we want to reflect that and the same with whole person integrated care so that's what coming soon means. they will be getting their own intentional cycle. it's rolled up to how their section brands, whatever we're calling that particular place is doing. we're hoping to -- we're working with those programs now, the leaders of those sections to have the comprehensive set of their contract and mcaa is actually,

they have exploded in the number of contracts. it wasn't that long ago they had one and now there's maybe 20, so bringing that in, designing the performance objective with them. that's going to happen this year and monitored the year after. next slide, please. that these are the comb points ever how we go -- these are the components of program monitoring and we have program performance and deliverables are, and compliant satisfaction. let's see. so we monitor over 450 individual programs in those four categories. the compliance, one of the questions, so under performance -- program performance, there are standardized objectives that go across or mental health

outpatient. everyone will have the same objective. all the objectives get developed by their section and then they get posted to a website. i've sent to you through mark, you'll get an e-mail, a copy, an example of the performance objective for one section. and then, they get posted on a website. one of the reference or a couple of referenced documents actually slides 30 and 31, if you want more information about performance objective, how they are developed, who develops them, that's in there. and then, compliance, the way compliance works is a program declaration of compliance is sent to the individual program, it's very comprehensive and they -- it gets sent through docusign and they sign they received it. when we do the monitoring though, we check, did you do x or do y and

then monitoring is divided into, onsite, some the things. did you post your hipaa poster or a binder. there's a lot of slides that show you the 51 items that's checked or plus. okay. so that -- yeah. so, i think that answers one of the questions that came up. and then, yeah. so those are the four. next slide, please. the way we monitor is either as a site visit or a desk audit. you can see the components that are covered in the site visit. during, because of covid, actually and creativity to get work done, virtual site visits entered into the picture, so virtual site visit and unsite visit are the

same variables. like the camera, here's my poster. a desk audit has slightly less items but that's mostly what we do now is the site visit or the virtual audit. and i just wanted to also say that the staff, the bocc compliance managers do also, not a typically go out and do technical assistance to bring a new program director up to speed on what the expectations are, in addition to the regular monitoring. next slide, please. right now, the biggest change during pandemic was nothing was onsite and the other change was how we were scoring or not scoring. and i'm going to show that more in the next slide, but moving forward, we're going back to the scoring and back to site

visits. some will be virtual, just based on staffing, but not desk audits. may i have the next slide, please. this is an example just to explain visually, what was the difference and so during the pandemic monitoring cycles, which would have covered fiscal year 19-20 and fiscal year 20-21, the scores, there was no scores signed to the overall program, so that's the first line, like, everything rolls up it a four, so that didn't happen and then we didn't score the individual category, so you didn't get a roll up score for performance objective and the reason is, there was so much chaos during covid and programs had pivoted in what they were doing to support covid response, so it didn't necessarily reflect what their objectives were and it just, so that didn't get scored but down on the bottom

level, we did go through and score all the performance objectives individually. did they turn in their client satisfaction? you know, we covered all of it so there was a record of what was happening in the program. it didn't get that high level score. now, everyone will be getting scores, category scores for 21-22 because right now we're in -- we're in 22-23 but they are monitoring last year. the only exception is the community health education and promotion section of ph.d. they won't have scores through this year because the programs remained pivots and staff to covid response weighed into some through fiscal year 21-22. that's catching you up with what you may or may not see in the, in these reports. next slide,

please. one more. now this is the agency fiscal piece. so, we have an analyze in our office and what he does, his name is wesleigh samara. he does these categories and assess the contracting agency, ensuring the proper board governance and proper billing and insurance tax filing and answer one of the questions provided to me earlier, the way that board governance is determined is when they go out, which we'll talk about on the site visit, they ask for three board minute meetings, one of them to demonstrate that they reviewed the audited financial statement, one to, that they reviewed the budget and then one that, they've talked about financial finances at the meeting. and

then they also check their bylaws such as how many board members you need for a quorum. if you don't have any, what are you doing about that? so, next slide, please. okay. so this is just another summary. it's in two parts. we do two different things. this isn't new by the way. one is that all audits financial statements are reviewed and documented in these different categories so that's ongoing process that happens. when that review is done and these ratings are given, they are assigned a risk level. that risk level carries over to the citywide, it's a really long name, citywide fiscal and compliance nonprofit monitoring and capacity building program. this is the controller's process. it has going on for several years which standardizes the city's financial monitoring process so that when the vendors

don't have to hear from us individually but we're asking the same things and all aware of the same processes. so, that -- actually, we can go to the next slide, please. so, with that risk assessment, it rolls into this citywide process and i really added that slide for description, but so you can see the things checked when they go out on that monitoring. we have, i wrote this down. in the last round which is the current round, we had bocc had 67 or we had 67 nonprofit agencies included in the joint fiscal and compliance monitoring and we were the lead for 27 of them so the lead is split between the

departments. dph has ten nonprofit this past time. they were not in the controller's pool and not because of the size, so what happens in that -- when those ten aren't included, the audited financial statement is still reviewed and if there's issues, then it gets brought into, the risk assessment shows risk, it gets brought into the controller's pool and the same assessment is done, so it isn't that -- you know, it's not looked at, so it's still looked at and if there's an issue, then it goes further and then there's still part of the monitoring. okay. next slide, please. so, this -- this is part two. we have established an agency performance and financial stability report and we are re-implementing, which hasn't

been for a while, a monthly contract oversight meeting. this performance and stability report, it's like a no-brainer. i'm not sure why we never did it before, but what it's doing is right now, if you're a program person, like the business owner, you can see there's lots of pieces of information. there's lots of flags or but you have to kind of get it and know and sometimes the contracts have more than one owner inside a contract, so it haven't been a great centralized system to see everything in one place. so this is going to be a great innovation. it's a lot of work to get it started but what we did is created this forum and talked to staff to include all the things we can think of that someone would want to comment on or contribute to the picture of

an agency, do they need technical and in the slide, you can go one more slide, thanks. you can see it. what you're seeing in that slide is the front page and those are the flags. and for each one ever those items, if you have flagged it later down in the report, it's going to tell you a lot more detail about it. and then there's just generic information, all the contracts and programs, but so, i can't see. okay. so, sometimes the vendor asked for funding or a delayed repayment or something like that, cash flow, then you know there's probably an issue. so that's a flag. that's always been out there, not -- anyway. it hasn't been centralized that way. anyway. that's what all these items are. all of them, if

there's a technical assistance plan or corrective action plan, there's backup. there's a plan that has been developed and there's objectives and there's a timeline so the deliverables and what the expectations are on a schedule and so what we've done is we polled, we found 14 agencies, that we're considering higher risk from early warning on up. those are the first 14 that we're doing. and then -- >> bless you. >> thank you. we'll move onto the too big to fail contract vendors. and then just keep going. there's probably one hundred of these we have to do, so that's -- we're going to reinstate this contract oversight committee meeting, which has high level and just people that should know about, like -- doctor colfax will be invited but anyway, it's

reinstituting a meeting we had regularly that really died on the vine during covid and died before that. but i think it was, it did work. it's time-consuming, right. but it brings all of it together and we're going to use these new agency documents at the meeting as a point of discussion, so i think these are really good innovations and they seem so obvious but happily we're doing them now. but i still think that we have done a lot of monitoring a lot and i think we're uncovering where there's room for improvement and communication is making it easier, it has been the biggest improvement. so. that's all i have. do you have any questions? >> thank you, ms. ragos. before we go to commissioner questions, we need to take public comment on this item should there be

any. >> no public comment in the room. any folks who have received accommodation for disability would like to raise their hand, press star three now. all right. seeing no hand. anyone else who would like to provide remote public comment, press star three now. again, star three to raise your hand. i do not see hands, commissioners >> thank you, secretary morewitz. i have a few quick questions, ms. ragos. thank you for this presentation. there's been a lot of talk about this and you're right when you see something in the press and it's frustrating and it's good to know the important work being done. you know, serving -- i'm no longer on committees i went to the finance and planning committee, it was helpful and thank you for this, to get a little walk through of examples of how program works from a client perspective or something like that. in that same vain looking at the fiscal stability monitoring or some of

the new tools, can you just give a couple of examples, not being specific to organizations, just of the kind of flags that come up that might lead to a deeper examination of an organization or contract. anything offer the top of your head. >> right. yeah. we even have a flag, so you don't have to remember. you can reference -- >> oh, okay. >> ms. ragos, speak closely to the microphone. >> okay. so, slides, it starts on slide 25. >> okay. >> follow-up remediation to address identified problems. >> okay. >> and so, you can see it's organized into typical triggers for a technical assistance, so plan of action. that's the items that go into a program monitoring review and then there's corrective action. there a-tab. there's, like, you know,

staff turns over a lot so there's slots like that. if they don't have enough board members, they can't sell their board members, if they are asking for funding, if they -- if their performance over time isn't getting better, then that's a flag. >> okay. >> and then this is really tiny print but it's in that same series. it's a couple of pages later. it looks like a flow chart. >> got it. >> that's kind of a good summary if you can read it. here's the issue and then there's decision points, do we do a technical assistance planning, do we do a corrective action plan. corrective action plan is very formal. there's guidelines and the controller's office is involved as well. and then, i added to this under the purple, the box of restarting our contractor oversight committee meeting. these are the types of

flags that we get, warnings we look at. >> those watching, there's specific things we look for to ensure tax dollars are spent reasonably and effectively and when we see those things, they are very specific actions we enter into to make sure they come back into compliance or meet expectations or other action is taken. >> right. the review of the audited financial statements is very detailed in what they are -- and what is being looked at so that assessment that's done from that is also a big piece of information. >> great. my other question, you mentioned and i want to make sure i understood this right. there's 14 organizations that kind of sell or contracts that fell into a particular get gore needing mormon toring and the

context, we have more than 3400 organizations we contract -- we have more than 400 organizations we contract with. >> we have more than 400 individual programs so i think, i'm sorry about the lack of data but there's 125 unique vendors, not all of the vendors are nonprofit. and so, for the citywide fiscal compliance, the fiscal part, like the uc's, we're not monitoring them and we're not monitoring homes and the controller's office has any vendor that's a million dollars or more even if they go with one department, before you had to have more than one city department. now, if you're that high, but so of all nonprofit contracts, it might be otherwise available, ten of them don't reach any of the threshold but we don't ignore them. we still

review the audited financial statement, which is still the indicator that drives even how they are going to be reviewed in the controller's really formal monitor and so if they are showing risk, they will get that level. we'll bring them up and add them to the process. >> great. great. thank you for that clarification. >> sure. >> commissioner giraudo. >> i first want to thank you very much for answering my multiple questions, which you did and i also appreciate your example that i had requested that i haven't taken a look at yet but i just want to thank you for your responsiveness. the second or whatever, to you or mr. wagner, which seems more expanded monitoring in the system that's in place, do you

have enough staff? i guess that's one of my concerns. it's more finite work and more expanded from where you were since, you know, covid is -- so in the future, you know, i just -- >> yeah. >> i want to make sure that you've got the staff to be able to support the -- to support it. >> well, one thing i neglected to do, i want to introduce michelle o'neal and then there's nick hancock and my team and (indiscernible) reyes on the screen who have been -- on the screen, remote, that have been a great, great team. the business office of contract compliance. it has been hard as covid. the person that retired for acting director did, he had his own case load of, i don't know t. was a lot of contract programs

and i haven't gone out to do programs, so i think, this does add a lot of work but on the same hand and the new director, hopefully in a couple of months and two new staff will start monday. it's replacing another person who retired. we'll see how it goes. it's a heavy lift. i hope after we get all these update, data entered that that's the heaviest part but we'll see. >> okay. thank you. >> yeah. thank you. >> i appreciate just -- the continued looks and it seems to take so long to higher somebody that maybe think ahead for whatever has this process has been revamped so thank you.

>> in that same vain also, we always invite folks to speak with candor about the challenges they may be facing in terms of staffing and the strain of that places both on the existing staff as well as the important work that needs to be done and i wanted to acknowledge you, you're dual role at this time so is for that. >> you're welcome. >> you're hope. that position gets filled soon too. >> me too. >> commissioner guillermo. >> thank you, president bernal. i want to add my thanks to those who have already thanked you and acknowledged your presentation and all the hard work that goes into it. i think i've been on the finance and planning or program committee for a couple of years now and it's a lot to learn and i appreciate about what all you do. i had a couple of questions in two different vains. one, a vagus asian on commissioner giraudo's question

about the staffing. i'm wondering, what the load is on each individual analyst? if that is assigned in a systematic way. the efficient rise, if there's expertise that's developed in particular types of programs or contracts that might be, that you might see as sort of a way to -- until more staff is available and hired, might ease some of the, what i think might be quite a heavy load up until then. what is -- how is the work distributed? and then are there efficiencies by -- asiding by expertise. >> i think the efficiency,

there's two few people. like everyone is becoming an expert but they are just divided but i'm going to let michelle o'neal speak to the, how it's assigned. >> good evening, thanks for your comments and support. i have been a compliance manager for six years. next month will be my seventh year. my anniversary. >> happy anniversary. >> so right now, as michelle was talking about our current staffing and with her stepping in as the interim director, we have carried this load ourself and when -- when you look at all the programs coming soon, for us, we've monitored a lot of the agencies over the years. we have, several of us go to the substance abuse meetings and mental health meetings. we get very familiar. hiv, with all the

requirements and so, we may monitor the programs, several programs several years in a row but we like to rotate to get to know the other services that are being provided in the community. we are very impressed with the level of services that are available. we are doing this and doing our very best to meet these timelines being short staffed. and we sit in a room together as a team, as michelle acknowledged jegern and greg and newest addition, lisa and see how we're going to monitor these programs and as michelle said, we're doing our best. we are have a goal for the timeline and we're doing our best to get there. and we hope when this new staff, we understand when new people are hired, it takes a while for them to understand what the role is. i think there's an assumption that when

you monitor a program, it's an easy thing to look at the contract and look at the invoices and go to the program, you have this checklist and there's so much work that goes into that because we need to verify that information that we put in those reports are accurate and so, it takes time and you know, our newest member, alisa, she comes with a lot of expertise from the substance abuse world and she was, like, i didn't realize how much work goes into doing these reports. but we're very proud of what we put in our report and so, it's just, it's a lot and we know it's a valuable service so i don't know if i have answered your question and sorry for the rambling. >> we're doing our best to get through them. >> this answer gave us a good qualitative flavor of how things are working there and i'm thinking about, as you monitor some of these other programs that's coming online with this

centralized process, the teamwork probably makes it easier or more, creative some more supportive environment. the other question i had was around the programmatic content monitoring, there's a lot of emphasis and a lot of work here on the, some of the more tangible aspects of fiscal stability and governance and those kinds of things. one of the things that came up in our finance committee meeting had to do with how do you assure the outcomes of the programmatic or monitor, maybe not azure but monitor the -- with the sugar tax, there's a number of units and services provided through there's policy implications in those contracts and the program. how are those tracked and what, you know, what process do you have internally to document

that. >> we look to see what the requirements are. we look to see what objectives are in, that are posted on the website or listed in the contract. we have lots of discussion with the program at each agency to get a better understanding of the services they are providing. we look at their objectives. their findings and we look at their data source to making sure that whatever we put in that contract, we can, there is, what do you call it? we can document it where we're gather that information so we like to include that data in our report. did that answer your question. >> somewhat but i think it probably goes to how the contracts themselves are actually developed in terms of -- does 100 units serve or result in a change in behavior over time? that really speaks

to what the funding was used for. i don't know if that is an objective for instance that might come up initially in the contact development or even in rfp so those are the kinds of things that we, as i think members of the commission don't necessarily get and so, it's just one -- are they there. how are they monitored and then how do we get the information about the effectiveness of the funding for particular program. >> right. i think that the program owner, i'll call the business owner is responsible for setting the objectives, some of the objectives are, come from the funding agency but i do think and then that -- if those get developed and bocc will determine if they can be monitored and there's the quality management sections like in behavioral health that's developing the report. i think,

i can speak a little bit more to behavioral health services and right now, there's a whole change going on called cal aim that's going to result in different performance objectives that's trying to get more at, i always mix up the terminology but the outcomes of someone getting better so it will be changing, so the outcome objectives are going to be changing, somewhat looking at that, but one of the things that i sent to you or that mark will send to you in an e-mail is -- because i wanted you to see it, so as an example, there's one objective in an acronym and it's looking at the strength of the child or adult and it's a test, i don't know if it's called a test and assessment tool that's given at different periods of time to see how they are

changing and their strengths are increasing and so that's one of the performance objectives. quality management for behavior health services will give us the individual data, so that the objective can be scored but the thing i sent in the e-mail is you can go to the public dph website and see where they posted and they post it quarterly and they post how it's worth, like, the results for the whole system. and then it's the first page and backed up by individual programs and by -- they meet and talk about that with the providers so i think there's a lot of work and i would encourage you, if the interest is on the performance objective that it's probably worth having a meeting that includes the quality management staff from the different units to ask those questions because i think they are the ones that's setting the goals. business office of contract compliance can say, you hit it. you made

the accomplished goal but whether the person is getting better as a reflection of that objective, i think is, it's a system look and i think the system look will become more from behavioral heal, in this example that rolls it all the way up but you think -- there's a couple pages in the reference document about performance objectives but i think that's a great question and it's something that the systems of care are looking at right now and that would be where you would want to get that information. >> that was helpful. thank you. >> i want to follow up and thank you for indulging all my questions on this. [mic is off] one of the things -- one of the things that, like, the healthcare industries and consumer rights advocates are

moving into this quality-of-life, so when we talk about these outcomes, you know, like, i think that you know, it also would be helpful moving forward to look at how it's designed, you know, like, when we look at that as quality-of-life improvement. so, yes. i'm curious, like, how this is going to transform and the way that we talk about healthcare is not just about, like, free (indiscernible) but instead, it's about economy, it's about, you know, like, other aspects of social determents. >> yeah. i think through cal aim and through the quality management in this section, he'll be able to get a good flavor of that. i'll send one more link. think it's -- i think it's public to everyone but i'm

not positive, but it's -- you can look online and see all the performance objectives because we post them and reference them in the contract and post them and you can see whether the standardized objectives and then whether individualized -- >> [mic is off] >> i don't know if it's $0.02 ask in response to both questions but -- this is getting that the cosmic questions about government. so, and i wouldn't pretend i have the answer. but i would definitely say that michelle described for each program is attempting to set some kind of outcome metric and they are -- in different parts of the department, there are different environments that

we're operating in where in some cases we may have better imposed quality measures that we are forced to use for reimbursement and it may also be good or we may not be thrilled. in other cases, there are fewer of those and we have a little bit more latitude to define what our outcome measures are going to be, but even in those cases, we still have the issues of, we have to have something that is measurable in the sense that you just heard a little bit from the team here about how are we going to collect and verify and document in a way that we can actually implement through a contract. so, there really is nothing easy about it. we've gone through, i know, in my -- >> close, close. >> i'm not close enough. i thought i was doing it. kiss the mic, okay. thank you, mark. in

my time here, a few cycles of trying to approach this, sometimes through the rfp processes where we use large rfp's that go out to define what we're attempting to purchase and rethink a little bit what those services could look like which flows through into the contract. so i think what you all are pointing to is something that is a huge topic of discussion and we're happy to try and facilitate some of these answers to it and i know some of this goes back to ongoing, the ongoing dynamic we budget and finance committee, you want this meta picture, but you have one contract in front of you with a few things and it's hard to strike the balance between the two. >> yes. from that was really helpful clarification and first

of all, i wanted to say this is such an extensive body of work that you've done and i'm not sure i understood it all but we really, really appreciate that. it's just a testament to how complex this is and how really stretched your team is to be able to check all these boxes. it's quite incredible. just in thinking about our trying to understand this because we always approve the consent calendar, this slide six, i thought was really helpful where you have divided into program areas and i think if there were a way that -- it's clear some of this is coming from cal aim. some is coming from within the department, i think, where some of us are confused when you go to the county, you get the triangle and true north. everything is lean ask there's a structure you're acclimated to. this is far more diffused so i think if we understood where the metrics are coming from, which

was that -- that four-box slide you also have, and where your perimeters are, it would help as we approve these things to better understand. if there's a site we can go to in advance, it's wonderful because this is a lot more diffuse and complex than just going to the hospital and knowing what the cms metrics are. >> i have to work on that or work it into a standard part of the presentation to, we always have the program monitoring reports and then we report, we don't usually pass them out. we do a summary but we can pass them out. and you'll see the objectives, what they are. so i think, you know, we can, i think that would be worth another discussion to figure out what would be helpful and if there's couching the information into

something or bringing a slide to -- it's organized in a way, i'm happy to talk more about how to do that that's helpful. >> well, thank you. because we see we approve contracts for transitional aged youth. it sounds like there's a lot going on at a higher level that integrated them all and doesn't create redundancy where you have different agencies doing the same thing but it isn't clear to us as we look at the contracts that we get and it is incredibly complex so none ever us would want to create extra work for you but if it's off the shelf ask we can understand it, we'll do the leg work because what you're doing is important and so difficult. >> yeah. i think you're in luck because we have about 15 contracts going to the board in the next few months and so doing that, that's exactly what we're trying to put together are some

system slides to, like, put the contract in the context of the system. so, hopefully, we can align all of that because it's the same challenge -- your challenge isn't unique. it's hard. you're looking at a piece, how does it fit? that's something that we're thinking about how do that and what standards would be. that would be incorporated in the future presentations. >> thank you. no extra work for us, please. i had one last question. when you started to windle it down to 125 vendors and not all were nonprofit and there's the 14 we're watching, how many total are nonprofit? >> i'm going to double check this and i can eyeball each one but we think it's 79, i think. let me look. >> you're talking about the vendors. 125 vendors.

>> yeah. >> and some were for nonprofit. >> you have big vendors and hospitals so not every single thing falls into monitoring category. i was collecting numbers and i got this here and this here and i want to make sure they line up, but we believe that of our nonprofits, ten of them were too small to fit into the, or didn't fit the category of the fiscal and compliance monitoring. >> your 134 agencies in -- the 14 hospitals in question, what's the denominator. >> the 14 what i did and let me answer the -- you can tell me if this answers your question. i said where do we start? there's a lot of contracts so i asked

the staff, the bids office contract -- the business office contract, is there vendors you keep seeing the same problem? let's pull them out and do this really comprehensive document first or i asked the finance, the fiscal, is there anyone that you've got a high risk in your analysis of their audited financials. so that's how we polled 14 of them out. one is a vendor that had, it's new and there's a programmatic question, so it got stuck in there. i'm not sure that it's going to be at the level of, you know, i don't know that it will be another more than an early warning, but anyway. we highlighted 14 that we wanted to start with to get the comprehensive picture. i don't know if there's a denominator that's common. >> thank you.

>> 14 out of the 126. sorry. >> let me go on. [laughter] >> thank you, commissioner chow. >> yes. i'm impressed with the extensive work that the bocc does and as a matter of fact, it was after i sort of scanned what you had sent us from rams and then also looked at your green chart. >> uh-huh. >> there seems to be an enormous amount of information that we are getting on all these contractors and they are probably all very important for each of your area. like finance and so forth. and i thought that your last comments were really important and struck me to be something that could be helpful to us, which is, the idea of

putting all these into some sort of context about where they came from and where they fit. and what they are. so, that at least from the big jigsaw puzzle that we have here in 130 pieces, we're looking at this segment or this segment and perhaps i know, mr. wagner, we'll remember what we did with epic with their multiple contracts and we put them into a big wheel and said they were contracts related to specific it or software and here's what it's going to do and for that wheel, there is a limited, you know, amount of money through we're talking about spending. >> yeah. >> maybe we could do something similar for each of -- larger

components of this. mental health or children services or whatever you were talking about in terms of probably trying to present to the board. put these into components. while i think we could all do our homework, i imagine reading, not just rams, but all the other 120, it's far more than, even we would be able to absorb and appreciate. but we would appreciate that the rams objective to perhaps have 25% of the people going out and getting a job is rarely what we're looking at and all the data is there. i through earlier today, we talked about the potential that it be perhaps a brief paragraph about the important outcomes and if that was wrapped

up into, oh, this is part of substance abuse and, you know, and therefore it also represents 25% of our effort or something. that's where i think it would help us in perspective to understand where these contracts sit and that they have been valuable and as i think commissioner chung said, we can celebrate what was coming out. a good example might be, since what, 2019 or whatever it is, nems has been doing the gambling project on the chinese community. well, when this contract comes before us, now in these last common years, the point is, well, how are we doing and what has changed in those years, it's really part of our question, right. >> yeah. >> so, that's kind of what i think would really help us

without it becoming a 20-page thing or sending us documents that are very important, very impressive and needed for management but, you know, doesn't quite give us the information that we're talking about. >> we have 125 contracts but they are vendors but there's probably 250 contracts and growing, so i think that's a great idea. one thing that we're going to do, this isn't an immediate fix to get that because i think what you're saying is an excellent and perfect idea and the problem is, we don't have an electronic management system so each of those great ideas is a project to pull it out and so, what we are though designing and we're going to go out to bid for is a new system and in that, we'll

have a vendor profile and with that, we would be able to lift the program, list the section where it comes from, list the modality. list the same solicitation, so at some point, i believe that we will have the ability to very easily sort information, so it actually wouldn't even be a project when you say how many contracts do you have and i say, oh, gosh. i'm not sure. because it's different people that have different things, so i think you're exactly right and i think that is the goal and the vision that we don't have all the tools to make it super easy but we're definitely putting information together now that i think will give you some of that. i don't think at this immediate point get down to the tidiness of the chart that you had from it which

i remember seeing it as -- it was good. but certainly there will be something and we will think about how to anchor the contracts into some bigger context that's visual. we just to talk about what that's going to be and do it. and then know that in the future, you'll be able to have a lot more robust information easily >> thank you for your continued effort. >> commissioner chung. >> i have more of a comment. >> please turn your microphone on, commissioner. >> this is more about a comment and a praise to all the work that you, the directors and the entire department of public health had been doing. i think that's a story that's -- it isn't told very well outside

because dph has always been sought leaders and a pioneer in must modality and cutting edge services, you know, the best example i could give was when we were -- the care council when we first came up with the whole idea of, what do you call them, central of excellence and so, that model now became the standard model of care for the entire, you know, care systems. and you know, now we start talking about whole person care. it all came from the work that we do and so, i think that you know the contract department is the weather forecast and also the dashboard to really help us, you know, look at where we can improve and where we can actually reward good collaborations amongst service providers. so, it's a tough job because like you said, there's a

lot to look at but i think that ultimately, hopefully, you know, you'll be able to see that impact as well. >> thank you. >> director colfax. >> thank you. can you hear me? >> yes. >> sorry. thank you. i want to go back to one of the areas of discussion about staffing and just to be really candid, since that was asked for. i think that -- given where we are three years after, almost exactly the first case of covid was reported in san francisco, it's important to recognize how disruptive that period time was and the department including in nonclinical areas such as contracts, sorry, it's disruptive and we have a lot of work to do as michelle is pointing out to move forward but

i don't want to underestimate the incredible challenges that the pandemic put upon this team and our providers and you'll recall that through the emergency declaration and other mechanisms, there were allowances that were made but we just -- it's not as though, unlike a public health order we can't turn it and off that quickly and then i think the other piece is part of the pandemic, it was epidemic before the pandemic and now with so many other complicating factors, hiring continues to be a huge issue and the positive part of the is we have some positions that have been vacant for a while that we're optimistic that will be filled in the next couple of months as in other parts of the department, the business office, the contract's office remains relatively short staffed and as i think the commissioners know, getting the right people with the qualities

and skill sets needed, it's very competitive out there right now. so just to appreciate the work, appreciate the vision, appreciate the excellence and the comments and also making sure that we're level setting in terms of the challenges that also lie ahead. i'm optimistic we'll get there but i wanted to make sure the commission heard the additional parts of what are being challenged here and just reinforce what has been said about some of those challenges and obviously the opportunities that michelle has presented are incredible and i think we'll realize them. it's going to take longer than i think any of us want, including because of the pandemic and the other pieces that you've just mentioned so thank you. >> thank you for pointing that out, director colfax and thank you for your candor and we'll continue to dive into issues of hiring and the amount of time that it takes to fill positions. seeing no other questions or

comments, thank you, michelle for your presentation. thank you so much and michelle's colleague, happy dph anniversary in advance. we're happy to have you here and we'll move to our next item which is the finance and planning committee update. we have the chair commissioner chung. >> thank you. [mic is off] >> please turn on your microphone, commissioner. >> the finance and planning committee met before the commission meetings and we reviewed the march contract reports and four any contract, i believe. yeah. four contracts, five contracts and within the contract reports is actually

three contracts that added, you know, like, added more years to the contract terms and for the new contracts, it is crazy self explanatory. one of the, the contract, we have a little concern with contract that was, like, retroactive through july 1, 2021, and you know, we were trying to figure out whether they have been paid, like, when -- before this contract was approved by the city attorney's office recently. so, we're hoping that we're not doing business without paying people especially when they are doing meaningful work as a nonprofit organization, so you know, and we had a discussions about that. so, that's it. yeah.

that's the information of the meeting. >> excuse me commissioner, you heard about the dph quarterly report. >> i shouldn't forget about that because we keep postponing ms. louie from presenting that to us, so we finally get to hear about the second quarterly report and i think that -- some of the numbers, the deficit numbers were expected because of what is going on right now and especially with laguna honda and the reductions of services. so, yes. everything looks on track. >> thank you, commissioner chung. do we have public comment on this item? >> folks on the line, we're on item 7. if you have public comment for this item, please press star three. star three. no public comment, commissioners. >> no comment from

commissioners, we can move on to consent calendar. >> i move to adopt the consent calendar. >> there we go. is there a second? >> second. >> public comment. >> fok folks online, we're on item 8, please press star three if you would like to be acknowledged for this item. no hands, commissioner. >> all those in favor of approving the consent calendar, say aye. >> aye. >> opposed? all right. consent calendar is a proved. next item is other business. commissioners, any other business? all right. any public comment. >> folks online, we're on item nine, other business frp press star three if you would like to raise your hand to be acknowledged. star three. no hands. >> all right. our next item is the joint conference committee and other committee reports. we'll hear a summary of the february 28th jcc meeting,

commissioner chow. >> yes, thank you and thank you for your confidence in approving our consent item. perhaps, in the future, we should probably present the rational ahead of time for the benefit of the commissioners, but in any case, as you approve the path ongoing gee rules, we reviewed the staff report that related to this small but mighty department and had recommended to you and thank you for your support of the, our consent calendar. we also then, we had also done our usual regulatory affairs report. we've heard the ceo report. we worked on the hiring and vacancy

reports and understand the changes that the department continues to face, but that there seems to be some hope in bringing more staffing on, staffing continues to be a real challenge in the emergency room department for example, which has been sort of a chronic problem. we also heard a wonderful appreciation called harmonizing and synergizing access and flower cross to cfg campus which is an important comprehensive strategy update and it will have a great impact upon how leadership will be able to find a means in order to continue to address health disparities and inequities. likewise, we also addressed the issues of the diversion rates and as i've said, staff

vacancies and on the diversion rates at the hospital, they did achieve a modest decrease and got below their benchmark last month at 44% and we'll continue to work on that as an objective and there's coordination with the ems people and so forth about that. so, in our closed session, we did approve the credentials report and the pep minutes report. that's my report. >> thank you, commissioner chow for pointing out the consent calendar. i had not recalled it included an item not from the finance and planning committee, would you like to offer the rationale for that or is there proposal to pull that out of consent calendar. >> no. what we might do in the future, if possible is to explain a consent calendar item, prior to accepting the consent calendar. >> agreed and again, that's on

me for not remembering there's an item that was outside of the previous discussion from the finance and planning committee. all right. thank you. our next item is other -- >> excuse me. sorry. i have to ask for public comment on that one. item ten, folks online, if you would like to make public comment on the jcc report, press star three to let us know. no hands commissioners. >> all right. our next item is consideration of adjournment. commissioners do we have a motion to adjourn? >> so moved. >> second. >> public comment. okay. great. all those in favor say aye. >> aye. >> all opposed? all right. we are adjourned. [gavel] >> i changed my mind. >> i was just excited.

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>> welcome to mayor breed's balcony here at city hall. for those of you who don't know me i'm joann haze-white and i'm happy to be host of flag. the flag has played a role including building, engineering, science, mathematics, education, and public service. my father emigrated from ireland in 1949 and like so many immigrants here to california spfi