>> tuesday march 21, 2023. we can hear the wind gusting outside. we hoping everybody is taking precautions to stay safe during this weather. secretary morewitz, please call the roll. >> sure. [roll call] >> commissioner chung will offer the ramaytush oholone land acknowledgment. commissioner chung.

the san francisco health 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 chung. our next item on the agenda is action item health commission officer elections. we will open this item. do we have nominations for vice president? >> mr. presidents, i would like to-and have the pleasure and privilege of nominating vice president green for another term as vice president

for the commission. commissioner green vice president green has shown true dedication to the mission of the commission and to the-her concern and for the residents of san francisco i had the pleasure serving with her on the laguna honda acc. the immense amount of preparation and dedication to the issues that have come up with regard to both laguna honda and all the other responsibilities that she carries as vice president, so it is my again, pleasure and privilege to nominate commissioner green for second term as vice president. >> thank you commissioner guillermo. do we have second? >> second. >> any public comment? >> if you like to

comment on item 2, press star 3. the comments are on the vice president election. again, star 3. i see no hands commissioners. >> commissioners, any comments? vice president green- >> i'm really honored and thank you for those kind words. it will be a privilege to continue to serve with this wonderful wonderful. a collegial group of commissioners and dpa commission and secretary morewitz. >> thank you vice president green. alright. if no- >> we do a vote? >> yes, let's do a vote. >> now that we are in person meetings we go to old school vote for a motion and second motion and you call the vote in favor. >> thank you for the reminder we are returning to

our previous processes. alright. we have nomination on the table been seconded for vice president green to continue as vice president for another term. all in favor say aye. >> aye. >> opposed? alright. motion carries. >> congratulations. >> congratulations vice president green. our next item is nomination for president of the commission. do we have a nomination for president? vice president green. >> i would like to nominate president bernal for another term. this is such a challenging and difficult time in san francisco, and you have brought every skill you have to bear with your incredible political knowledge, your wise sense of reading people and understanding situations and i think we made such progress, especially at laguna honda thanks to your leadership and your judgment, so i cannot think of anyone in the galaxy who is a better person to

continue as president as we work through recertification and many of the challenges and i also hope that as covid is starting to wane that you have a chance to lead at a time that isn't so medically stressful in our community. i can think of few people who have done more for the city and county of san francisco then dan bernal, you are a true treasure and honor to nominate you. >> thank you for the kind words. is there a second? >> second. >> do i need to hands the gavel? >> yes, commissioner green because she is vice president. >> any public comment on this? >> folks on the line, if you like to comment please press star 3. we see one hand, so i'm going to set up-actually let's go back to this. due to change in remote public comment process, there are several categories of remote public comment. one is for those who received accommodation for disabilities. i am

noting that but there is one hand so we'll take the one hand. moderator, please unmute the caller and i'll put 3 minutes on the clock. >> good afternoon. this is patrick shaw. (indiscernible) making public comment on either item is ww. it is seeking to commissioner bernal's nomination. i guess i support it, but it would be nice to see commissioner bernal take more of a lead on getting the department and laguna honda in specific to submit a written waver request to cms

and cdgh around the 120 bed issue. my understanding is cdgh policy allows facilities to submit a written waver request. we don't need any federal legislation to seek grandfathering three person rooms to prevent the 120 bed cut, so commissioner bernal, i expect and pray that you use your leadership as commission president to get that letter submitted to cdgh expeditiously, even while we are still waiting for

the long drawn out recertification process to conclude. assuming recertification happens, that written waver request should be on file quickly so cdgh can move on to approving it so we keep those desperately needed skilled nursing beds at laguna honda and not see even more people displaced out of county because of the lack and the diminishing supply of skilled nursing beds. thank you. >> is there any other public comment? >> that is the only public comment. >> commissioner comments. >> i would just like to speak

to the leadership team of vice president green and president bernal, which has lead san francisco through very very difficult times during their terms, and really want to go on record, make sure we acknowledge as i said for commissioner green, the dedication and the concern that both of these individuals have shown for the residents of california and also their partnership with the department and other parts of government that are lent to a both collegial environment for the commission and the work that we do, but also for showing the public that there is leadership such as theirs, and particularly for president bernal during these times that we can count on.

thank you. >> commissioner chow. >> thank you. i want to express my support of the team and particularly president bernal. over these 35 years i think we have been able to justify the public's trust in having a health commission. prior to this, we were unable-those of us interested in public health to make our needs known unless we spoke to the officialed a min administrator in charge of the health department. if we were to talk about transparency, there were no transparency at that time, and over these years commissioner bernal and vice president green have fallowed in the tradition of

being a-of leading and at the same time being able to be sure that we hear the public and with that we act on behalf of the public, and so, i would like to strongly support the nomination of commissioner bernal as president for another year. thank you. >> commissioner chung. >> commissioner chow took all the words from my mouth, but i also want to just say that i truly support the nomination of the team of president bernal and vice president green. i know that you two have really (indiscernible) and to juggle between that and balance that with your leadership on the health commission at a time where we are experiencing you know, like unprecedented pandemic, it is phenomenal,ic and i just want to express my

gratitude and my appreciation to have the pleasure and honor to serve with you both. >> president bernal. >> thank you to my fellow commissioners for all your kinds words. i'm humbled by them and grateful for your leadership for your community leadership, for the expertise you bring to the body. every day i learn something from you and you make be a better member of this commission. particularly vice president green who has been a hand of steady leadership bringing both her clinical knowledge as well as administrative knowledge to some of the most crucial issues that we have been facing the past few years, whether it is covid or mpox or the recertification of laguna honda where you and commissioner guillermo show great leadership guiding the process as well along with the leadership. i also want to thank mayor london breed for the opportunity to continue to serve to

protect public health of all san franciscans and grateful for this nomination and the possible opportunity to continue in this role for another 4 years so we can now that we are through at least the public health emergency of covid, but still vigilant in the impact of the community. looking forward to recertification of laguna honda and continuing to make progress and getting to zero initiative to get to zero hiv death transmission and stigma and also to address the real crisis of overdoses on the street and implementation of mental health sf among a number of priorities . thank you very much for your kind words, for your faith in me and thank you.

>> we will take a vote. all in favor? >> aye. >> thank you. congratulations to vice president green. as you recall from the last meeting we were starting with a new system based on guidance put forth. we had hiccups because of new technology. we got strong feedback from the public and took that to heart and must acknowledge the leadership of secretary morewitz taking the input and setting up a new system we are using today we expect to go smoothly. ask for patience from folks in case we have adjustment issues but thank you again to variety morewitz being responsive to public concern and doing a excellent job bringing us a new system. >> thank you. >> our next item is general public comment. >> i have a quick script, not

quick, a bit long. 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 that are not on this meeting agenda. with respect to agenda items, your opportunity to address the commission will be afforded when the item is reached in the meeting. each member of the public may address the commission for up to three minutes. the brown act forbids the commission from taking action or discussing any item not appearing on the posted agenda, including those items raised at public comment. i don't see folks outside of government

employees in the room so only do remote public comment and first do that from those who received accom modation for disability. i have given each a code. finally, we will hear remote public comment from all other individuals. there is a time limit of 20minutes on the total amount of public comment that can be heard on each item from individuals who have not received accommodation for disability. because of the new remote public comment procedures recommended by the office of city administrator and city attorney office, please do not raise your hand to make remote public comment on a item until your category is called. we will start with those folks who have received an accommodation for disability. please raise your hand by pressing star 3 for general public comment. i see one hand. moderator, please unmute that caller and see if they have a code to note they

have gotten accommodation. >> yeah, my-this is patrick, my code is ww. i too want to thank mr. morewitz for working out the bugs on this remote webex system. i know the technical difficulties were not his fault. my testimony today is about dgh history, not items on today's agenda. following laguna honda 2019 scandal, which cost the city at least 1 million, 867 thousand dollars to date in fines, penalties, lawsuit settlements and city attorney expenses, and time, dgh (indiscernible) 60 day laguna honda reform plan in august 2019. data

shows the plan was authored by troy williams, the san francisco health network chief quality officer. the reform plan claimed an overarching goal. "there is more to reform then just coming into compliance with regulatory findings". which is ironic now. the goal continued quote "the goal for laguna honda is (indiscernible) long-term care residential facility worthy of (indiscernible) and san franciscans". unfortunately, (indiscernible) kept operating laguna honda as if it were not an acute care hospital, not skilled nursing

facility. the reform plan asserted would reorganize laguna honda quality management department. despite laguna honda quality management reorganization in 2019, laguna honda quality improvement problems persist to this day. thanks to williams and dr. covex leadership failure, laguna honda 2019 reform plan was a complete failure. williams is not a reliable actor. thank you. >> that is the only hand up for general public comment commissioners. >> thank you secretary morewitz. we'll move to the next item, 4 for discussion, laguna honda hospital rehab center recertification update. for this presentation

we have roland pickens the acting ceo of laguna honda hospital. welcome director pickens. >> thank you commissioner bernal. >> a little closer, please. yes, if you can. >> thank you commissioner bernal and good afternoon commissioners. pleasure to be here with you on this rainy soggy day. it is my pleasure in my capacity as acting interim chief executive officer at laguna honda hospital to present this month's update on the laguna honda path towards cms recertification. next slide. you recall

that in april of federal center for medicare medicaid service terminated laguna participation in the medicare medicaid provider programs. despite that termination, we brought on board consultant and working with our own internal consultant from throughout dph and across the city. we continue to work hard to meet all the regulatory requirements to make rapid improvement on our path towards recertification and we are confident we have the resources and skills on-board to make that a successful endeavor. next slide. during this process of decertification, a settlement agreement was reached november, 10, 2022 with federal cms in the form of a

system-settlement system improvement agreement that outlines the current operations at lieu laguna honda. part of that settlement was significant in it allowed for ongoing funding by cms to support care at laguna honda initially through november 13 and was recently extended on february 1 to have those payments extened at least through may 19 of this year 2023. hope we can all agree this was and is still a very humane compassionate path for our residents, their families, our staff and the entire san francisco bay area community. next slide. as part of our journey we had the pleasure hosting u.s.

department of health human service (indiscernible) february 24. director colfax and mayor london breed joined the secretary on a tour of laguna honda and the mayor was quite active in that process and took a active role in leading the tour and i was able to actually participate also. during the tour the secretary had the opportunity to meet residents, staff with union leadership and even some family members. he visited several parts of the hospital including the rehab department and unit neighborhood 4 north to see first hand many improvements and he really did spend time particularly on 4 north looking at many of the service enhancements that have already taken place and actually talking directly with many staff members and hearing from

them first hand what they have seen over the past several months and improvements that have since ensued. as a result of that visit we feel optimistic secretary becerra and federal partners at cms left the visit with deeper and better understanding of our commitment to improvementt a laguna honda and dedication to our residents and indispensable role laguna honda plays in san francisco. next slide. during that visit with secretary becerra, one thing we also discussed was an issue we discussed previously and that is, the 2016 federal requirement that was put into place that required newly

certified facilities to have no more then maximum of 2 residents per room in a skilled nursing facility. we shared with the secretary of our grave concern about this new regulation and the fact of laguna honda might be subject to complying with that. to date that is the best information we have been provided is we must comply. to show our good faith effort to comply, laguna honda temporarily decommissioned the third room in those triplet areas to that total 120bed reduction and say temporarily, because we have left those beds on the hospital license to remain to give ourselves the most options as we pursue recertification with the desire

that accommodation and understanding can be reached that will allow those beds to be reviewed, certified and licensed in the future, and we continue to work with our federal partners primarily through the city attorney office to pursue all avenues to make that a realty that we will be able to restore the 120 beds. we continue that dialogue on a regular baitss and will keep the commission updated as we gain more information, but please know it is our firm commitment that we are doing everything we can to maintain those beds knowing how vital they are to san francisco and the san francisco community. in terms of the settlement agreement that i spoke about a few slides ago, it has many components, and at the heart of it was

the requirement that laguna honda secure the services of a cms approved quality improvement expert to conduct a root cause analysis to identify potential causes that may have lead to the decertification status. the health service advisory group was selected by laguna and approved by cms as that quality improvement expert, and as you know have been on the ground at laguna actually as early as two weeks past that april 22 decertification. so, they have thoroughly emursed themselves into laguna honda and the aspects of the operations they reviewed the previous findings prior to

april 2022 and developed their root cause analysis with key findings and then turned and worked with laguna to develop a corrective action plan that has some 460 milestones that get to the heart of fixing those deficits identified in the root cause analysis. next slide. another component of the settlement agreement is that cms through the california department of public health would conduct what they call, every 90 day monitoring surveys. the purpose of those surveys is to provide cms and california department of public health with a opportunity to assess the progress of laguna towards regaining compliance with all federal

regulations and eventually to recertify in the cms program. you recall the first of those 90 day monitoring surveys occurred late november, december, and i am pleased to report that the second survey occurred on just last week, and i am also happy to share that it was overall a very successful survey. particularly compared to the first survey. in fact, the first survey that was held, there were a total of 124 deficiencies identified in that survey back in november and december. you recall that under the terms of the settlement agreement, those deficiencies required

the quality improvement expert health service advisory group look at those deficiencies, incorporate them into the previously done root cause analysis, update the root cause analysis, and then update with any additional milestones that would be needed to address those issues. happy to report that those milestones were updated and added, and with the result being that the second survey compared to the 124 deficiencies in the first survey, the second survey yielded only a total of 23 preliminary deficiencies and i say preliminary because that is the verbal report we received from the surveyors when they left on friday, and as you know, we will await their official written result where they reserve the right to either add more or

take away some of those deficiencies, but right now it is looking at around 23 so that is a significant reduction from what we saw in the first survey, and hopefully prove to cms and everyone else that indeed true progress and improvement is being made at laguna honda. i think it is also important to say that despite this reduction in deficiencies, we know our work has not concluded. in fact, we are still on a journey towards improving both the operation and regulatory compliance and the culture at laguna that reinforces an ongoing improving learning organization. as i shared with staff, starting friday and over the last few days, let's celebrate that success last week and also know it means it raises the bar for us. it means when they come

for the next 90 day monitoring survey it has to be even better then the one we just experienced. again, to show that there is ongoing improvement in operations at laguna honda. and according to the settlement agreement, we would expect that-the third 90 day monitoring survey, 90 days from last friday within that window or so. next slide. i talked about the action plan. also happy to report that the cms quality improvement expert was able to report give the second report for the month of february to cms. they were able to report that again, laguna honda successfully implemented all of the required milestones for the month. there were about 133

for the month of february. we are now a little over half way through the month of march. there are 77 rca milestones for the month of march and as of now we are on target to be hundred compliant with those and as always we'll continue to monitor those on a daily basis reporting up through the dph and to the laguna honda jcc on our progress. next slide. the slide is catching up to what i just reported we completed the 133 milestones. next slide. again, just for reference for everyone to give a pick torl of our journey towards recertification, the top reflects those survey readiness activities. the 90 day

monitoring surveys and then the bottom reflects the rca and the action plan, the milestones that must be completed. next slide. also wanted to reiterate that what i shared earlier that the cms did extend the terms of the settlement agreement through may 13 in terms of additional payments. you recall that under the settlement agreement, rather the initial decertification, there is a requirement that the facility that is decertified must have a closure plan in place. you'll recall that we submitted our initial revised closure plan in december, cms returned it to us, we made the

requested changes, resubmitted to cms february 2, and we are still waiting on their response as to whether or not those revisions we made are acceptable and are hoping they will provide their approval as soon as possible. the good thing is that we remain on pause and transfers and discharges, so not having that closure plan doesn't effect our ability to particularly transfer residents to ort facilities at this time, and again, it is our firm hope and desire that even once approved we would still never have to implement even the revised closure plan whenever that comes to fruition. that concludes my formal report and at the appropriate time, happy to address any comments or concerns that the commission may have. >> thank you director pickens. secretary morewitz, any public

comment? >> we have a couple hands and a script to read before i get to them. for each item members have opportunity to make comment up to 3 minutes. the public comment process is designed to invite input and feedback from individuals thin community, however the process does not allow questions to be answered in the meeting or members of the public to engage in back and forth conversation with the commissioners. the commissioners do consider comments from members of the public and making request to dph. please note each individual is allowed one opportunity to speak per agenda item, individuals may not return more then one statement for other individuals not able to attend the meeting. public comment may be sent to-city policy along with federal state and local law prohibits discriminatory harassing conduct and will not be tolerated. first we'll take public comment in the room. don't see anyone here so remote

public comment from individuals who received accommodation for disable. i have given these individuals a code to speak to prevent others from speaking during this time. we will hear from remote public comment. there is time limit of 20minutes on the total amount of public comment heard on each item from individuals who have not received an accommodation or disablet. so, let's first start with folks. i see two hands raised. i know caller 3 is someone who received accommodation. moderator, please unmute him first and then go to caller 4 to see if that person is also gotten accommodation. >> this is patrick again. code ww. >> thank you. >> mr. pickens continues asserting that cms and (indiscernible) still haven't accepted the revised closure plan. it is inconceivable 6 weeks after the requested changes were

submitted to cdgh and cms february 2, that 2 it still hasn't approved the closure plan. i submitted a complaint asserting that laguna honda, dph and this commission are potentially violating the settlement agreement paragraph 41 requiring all parties and sig tories to the agreement to release documents under law and our local sunshine ordinance. in past meetings, i noticed mr. pickens is referred to as a doctor. unless mr. pickens holds a ph.d, his salutation should be mr., not doctor. good hearing him say though that you are doing everything he can to save the 120

beds. the city attorney should submit a letter immediately seeking a waver under cfr paragraph 483.90f3iii dated march 3, 2023 that says all you have to do is submit a written waver outlining why (indiscernible) three room suites will not cause residents any harm. commissioner bernal, i expect that you will work with the city attorney's office to get that letter submitted. i will forward to mr. morewitz the

march 3 document i just cited with that paragraph citation, and you guys need to get that letter submitted now and not wait until the outcome of recertify ication. we are all begging you given the severe shortage of beds in the city to make sure that you get that waver request submitted so that we don't keep discharging patients out of county away from their homes like happened during the initial closure plan. please, please, please, get that done! >> your time is up. thank you. let's unmute caller 4 and caller 4, please let us know if you got a code. >> hi. dr. palmer, tt is my code i think. >> thank you, yes. you have 3 minutes dr. palmer.

>> i agree with patrick shaw that the waver is something we are all very concerned with. we need those beds. f it is a matter of the human rights and health of the people of san francisco given the lack of harm that would come from keeping those beds open and the risk to public safety that would occur if the public was denied those beds. given our shortage. i would like more transparency about what can be done and what is being done. i think it is probably more a matter of political will then anything, and i do think that this needs to be further publicized so the public can weigh in on how important it is to have those beds. the other thing i'm concerned about is the next 90 day

monitoring survey is going to coincide with the date of when evictions and closure start up, and we need to know well before that whether there will be an extension. it seems totally unfair to be dealing with both at once, and i would like more transparency around that. i would also like to know what the 23 preliminary deficiencies are and would appreciate if that survey was made easily available to the public as soon as possible. we need to know whether laguna honda is going to need an extension from cms and we need to mobilize the public to support it if laguna honda is going to need an extension. it is big ship to turn around. very pleased to hear the progress being made,

but being transparent with the public will be i think good for laguna honda in the long run in terms of garning the support we need at all levels of government. thank you very much. >> thank you. that's the last public comment request. >> thank you secretary morewitz. commissioners, any comments or questions on the presentation. commissioner chow. >> thank you. i think public comment also was alluding to the issue that i had, which is looking at your timeframe and understanding the strategies that we will have-first of all, it was great and certainly shows enormous progress on the part of your team and on the part of laguna to move those deficiencies down from hundreds to literally dozens, and so i

am understanding that once the federal report has been officially accepted and released that that is public information, and in the meantime, just looking at the calendar that you have given us, it seems to say that on may 13 we are to have completed implementation of all 100 percent of the milestones-of the flags or whatever they are. since you are telling me the milestones are parts of what are really the important survey elements, so that's the 13th. the 19th at the moment is the date that ends the suspension of our need to move

patients. sometime between nay and july is the third survey, so somehow the government and our city needs to have a strategy on not waiting to the last day to tell people we are not going to restart the movement of patients again, and that i think is of some concern to residents. we can say that you are not doing anything until that last day and therefore nobody has to worry about moving at all, but i'm not sure that that will help our residents in a emotional manner and i think that that is-it is really cruel to the residents on the part of the federal government for not giving us more clarity and such a short timeframe, it is like

well, i'll go day by day, because may is just around the corner. >> thank you for your comments commissioner chow, rb and i agree with you. i have the same sentiment and my job is to work through the director to do everything we can that is within our control, which is to continue the advocacy regarding both the status of any potential resumption of transfers or discharges which are governed by the closure plan that is still not responded to, but we are actively requesting that response. and, i think as you point out, there is this confluence of all these things occurring at the same time, and so we will be working to make sure that we do gain

clarity and potentially-definitely not what happened back in february where there was a last minute situation, so thank you for pointing it out. we are aware of it, and in our dialogue and discussions with all the partners, the many partners who are part of this, we are bringing this forward because it is definitely not in the best interest of our residence staff or anyone to have the level of uncertainty and as we gain more knowledge as to how the confluence can be further separated we will bring that back to the jcc and then the full commission. >> thank you. >> thank you commissioner chow. other comments or questions? director pickens, thank you for that excellent presentation and also to you and your team and all the staff at laguna honda

make such tremendous progress in the last survey. a couple things to put in context, i recall the previous survey lasted more then 3 weeks if not mistaken and this was wrapped up just about a week time, which is significant change there. also just the number of milestones that have been reached over the course of this entire process. let's not forget also laguna honda hospital is the largest publicly runed skill nursing facility in the country with upwards of 700 residents and again to highlight the effectiveness of laguna honda, particularly in controlling covid within laguna honda. every death is tragic and one too many, laguna honda stands apart from any other skilled nursing facilities in the country in terms of the efforts and success controlling the spread of covid. i want to make sure everybody remembers all that because we

really are talking about a institution that provides a critical service to the people of san francisco and needs to be preserved and as you know the commission is entirely committed to supporting you and doing that so thank you for your excellent work and leadership again. >> thank you. >> director colfax. >> thank you president bernal and commissioners. i just want to take a moment toic acknowledge the leadership of mr. pickens and his incredible team and the fact that in running laguna honda the day to day operations really integrating the quality improvement work i know the secretary saw and witness and mr. pickens took a active role demonstrating improvements, the teams on the units in the neighborhoods were very actively engaged with the secretary and mayor in terms of sharing not only their perspective and also their commitment to the residents at

laguna honda succeed in recertification. in terms of the quality improvement, the reflection going from 124 to 23 findings, there are 6,000 quality improvement observations happening a week at laguna honda, 6 ,000. if you go to any neighborhoods in laguna honda now you see a quality improvement board, which has all the key milestones laguna honda must meet to meet recertification and how the unit is performing on key indicators. just to emphasize the fact that the work of laguna honda is a big ship to turn but it is turning and are i think going back to the data, we have quantitative proof that things are going in the right direction, so just want to thank again mr. pickens and his team for the

incredible work and of course everyone at laguna honda, every staff person deeply committed to insuring we succeed in recertification. thank you. >> thank you director colfax. thank you director pickens. okay, our next item is the joint conference committee and other committee reports. we have commissioner guillermo the chair of laguna honda hospital joint conference committee. >> thank you president bernal. happy to report that at our jcc meeting of march 14, it was the first time that we had gathered in person since the start of the pandemic so it was actually quite-it was nice to be able to see all of the folks that have been working as hard as they have over the last so

many many many months. and to really have that dialogue in person and to actually see things in action. there was a fire drill while we were meeting and so to be present for that action i think was sort of a good thing for members of the committee to be witness to. at the meeting, the committee discussed a presentation very similar to what mr. pickens shared today, and at the time the surveyors were still on site, so there was less information about how long they would stay and what they would find and as mr. pickens reported, very fortunate and indicative of the hard work that has been put into play that the survey lasted only a week, with only the 23 preliminary deficiencies that have been

mentioned. the jcc reviewed the policies included on the consent calendar today, and recommended that the full health commission approve them and we'll get to that next. but due to the cms survey activities, the jcc meeting was shortened and the regulatory affairs and hiring and vacancy reports were included on the agenda, but not presented by staff as they were with the surveyors throughout the meeting. both items were available for the public to make comments however. and then in closed session the committee approved the credential report and pips minute report and again like to reiterate or associate myself with the comments of president bernal and really commend the effort, the continued effort that endless effort put into the work at getting laguna honda recertified as well as to

really prevent the regard of the closure plan and any other threats to the continuation of laguna honda, the livelihood of all those that work there. thank you. >> commissioner guillermo, any public comment on this item? >> yes, i see one hand. moderator, please unmute the caller. caller, please begin. >> thank you, it is patrick shaw again or call me ww. from commissioner guillermo's summary now of last week's jcc meeting, the closed session update last week on both laguna

honda recertification and the closure plan, which were additional topics in closed session beyond the pips report. mr. pickens announced before last week's closed session that laguna honda's 90 day monitoring survey had just begun, and so it is now good hearing that it only lasted a week and only 23 citations. i had really hoped that there would be no citations. members of the public and laguna honda residents should not have to wait for a probable month or more for the (indiscernible) to write an additional root cause analysis report

and another action plan to detail the results and findings of the 90 day survey we just completed. i support dr. palmer's remark that that survey result should be released expeditiously, and i'm aware of federal regulations and guidance to state agencies that require immediate relief of the findings and the action plan, so i will be requesting those in public records to try to speed up receipt of the (indiscernible)

root cause analysis and action plan. you guys have a ethical duty to san franciscans to disclose the closed session discussions around the status of the revised closure plan, because i still find it inconceivable that cms and (indiscernible) have been sitting on releasing and approving the revised plan that you finally submitted 6 weeks ago on february 2. >> your time is up. thank you. >> thank you caller. any other public comment? >> that was the only caller. >> commissioner, if no comment on this item we can move into the next associated item, which is the consent calendar. we go back to commissioner guillermo. >> thank you president bernal. as stated in my

summation of the march 14 laguna honda jcc meeting we did review and recommend to the full commission the adoption of the policies as listed here on the agenda and in the packet. >> thank you, commissioner guillermo. realize this represents a great deal of work on the part of the jcc and laguna honda staff so thank you for that. do we have a motion to approve? secretary morewitz. can we do a motion first? >> yes, of course. >> motion to approve. >> so moved. >> second. >> do we have any public comment? >> yes, sir, one hand. moderator please unmute. >> gone, it is patrick shaw. i'll try to be brief

regarding approval of the policies listed on the consent calendar. it sill remains shocking the health commission hasn't reviewed an updated laguna honda nursing restorative care policy (indiscernible) to respond to root cause number 8, lack of (indiscernible) nursing program in the resident rights and free from harm section of the first root cause analysis report dated, december 1. even earlier, as far as back as laguna honda's first survey that began june 28, it had identified problems with the restorative nursing program and recommended that nursing take corrective action

to reopen the restorative gym for residents. 9 months later, that entire program remained problematic. laguna honda subsequent action plan claimed "gap analysis" on restorative program would be completed by january 25 and a "scope of service" defining parameters and updating restorative policy would be completed by february 8. today is march 21. were those two documents completed? and if so, shouldn't the restorative policy also then completed and be on this list of consent calendar

items? we need to see the revised laguna honda restorative nursing policy immediately. thank you. >> that is the only caller. >> commissioner, any comments or questions before we move to vote? vice president green. >> i like to (indiscernible) comments about the quality of these policies and procedures because they are well thought out. it was incredible collaborative effort on the part of the team, and it incorporates so many elements of both the corrective action plans, as well as phase 3 regulations, and it was just very heartening and i also appreciate having at the time to review them so thank you for getting them to us and secretary morewitz thank you for making sure we got them plenty of time because looking over the rules and regulations for the general as well as laguna and over the few years i have seen the

specificity and quality and thought process. you can read regulations but it is one thing the read them and another thing to see they are actionable, understandable and structured in a way that really promotes the utility of the regulation so i wanted to say that these were quite impressive and it is a privilege to be able to approve them. >> commissioners, any other comments or questions? seeing none--commissioner chow. >> yes. i would only comment and echo vice president position even though i was not able to go to the jcc. i did review all of the policies and concur with jcc recommendations. >> thank you vice president chow. commissioner chow, excuse me. commissioner guillermo. >> just wanted to state my thanks to both commissioners green and chow for

their detailed analysis of the policies and actually, quite a number of comments and questions that the staff were able to address. again, given the survey had started to really also attend to the comments and questions that are coming forth from the commissioners really speaks to again, the competency and the knowledge that the staff has and the desire to really make sure the policies are reflective of all the changes that are necessary required and hoped for for the future of laguna honda. >> thank you commissioner guillermo. seeing no other comments, we can go to a vote. all in favor please say aye. >> aye. >> opposed? alright. the consent calendar is approved. our next item is

laguna honda hospital and rehabilitation center. for this we have dr. claire horten in the dual role as chief medical officer of the health network as well as acting chief medical officer. >> thank you so much. happy to be in both capacities. i'm also joined by my colleague dr. (indiscernible) who is head of psychiatry and believe will be presenting the policy. >> great. thank you. welcome. >> thank you. good afternoon commissioners. thank you for this opportunity to [difficulty hearing speaker due to audio quality ]. >> please speak up a little bit or get closer to the computer. thank you. >> sorry. this is a-how is this? >> better, thank you. yes, that's better. >> great. great. this is about the laguna honda

treatment and recovery service. the revision of this policy is one of the deliverable's toward the action plan root cause under behavioral health and (indiscernible) related to care plans reflecting (indiscernible) the policy revision is (indiscernible) extensive work by our work group. the main changes include we added documentation for non specialty service for residents with (indiscernible) that they will be entered in ehr and accessible by rct, and we clarified the process of obtaining the residence consent for release of information if they are part of

getting specialty level substance treatment. we added that residents are willing to participate in the substance treatment program they will be referred to and enrolled in the program. we added that they would be asked to find release of information form for provision for our substance treatment providers to share treatment records with the rcp. we added a whole section on the consent for the release of the information spelled out the detailed work flow on that. including patient right to (indiscernible) at any point. we added if a resident wants to participate in the treatment and dont want to sign consent for (indiscernible) we would continue to document

it in the ehr and we would (indiscernible) care plan for resident care needs based on available clinical information, and then last but not least, we also added reference to laguna honda policy 65-05 (indiscernible) for other aspects involving residents substance (indiscernible) the very comprehensive revision of this policy, and i should add that this has been vetted by compliance and city attorney as well as have been accepted by (indiscernible) that's my summary. thank you. >> commissioner bernal, dr. horten has her hand up. >> thank you so much. i wanted to thank dr. chin. it is

pleasure to work with dr. chin and i have a lot of respect for everything the department of psychiatry is doing there. the rct is stands for resident care team and they have rct which are resident care conferences. so that might have been confusing. also a overarching purpose of this is we have very good services for our residents with history of substance use or ongoing addiction challenges, and we have really good mental health services for residents who have mental and behavioral health needs but it is at times hard to coordinate those services because of the-we haven't had a clear process for sharing this information between the two ways that that type of care is documented. these

changes to the policy will allow residents to still always have the option to keep some of their information more private as is their right by state law, but it also goes further in terms of educating them about what that consent implies and allowing those in favor of having practitioners to have full transparency in all treatment modalities be able to better coordinate care through the electronic medical record. those are important changes to both clarify a process, confirm residents rights to their own health information and also enhance care coordination for people who have both substance use and mental health issues. dr. chin you can jump in and keep me honest if i said anything wrong there. >> that is great. thank you. >> okay. >> thank you dr. horten and dr. chin and also dr. horten for

anticipating my question, so appreciate that very much. before wego to commissioner comments or questions, do we have public comment? >> there is one hand. moderator, please unmute the caller. >> this is patrick again, just ad-libbing this. it was good to hear the clarification on the acronym rct but i thought it was part of policy and procedure that there was going to be a new super oversight committee and i'm forgetting the acronym for that right now. i think it is rcc as in charley charley and you guys haven't discussed whether that new oversight body is going to work in conjunction or

replaces the interdisciplinary team process and how often this new committee will be needing to review the work of the rct and the idt team. nice to hear something more about this additional body. thank you. >> thank you caller. i believe the director pickens has something he'd like to add. >> thank you president bernal. again, want to say thank you to dr. chin and dr. horten for working on this. it is very much a significant part of the root cause analysis, and milestones related to improvement of behavioral health services, especially want to thank dr.

horten because she this week is handing off it baton to dr. (indiscernible) who is joining as the interim chief medical officer and so we'll be-dr. (indiscernible) will be assuming much of the work that dr. horten has done on this policy and many others and will be working going forward with dr. chin, dr. horten will be coming back to her network role. she will still have her tentacles, we are not letting her go completely because she emersed herself in the organization and has a wealth of knowledge and we need all hands on deck, so she will still be there in spirit with us. >> thank you director pickens. i was going to congratulate dr. horten having just one job but it sounds that isn't

the case. knowing you, not surprised. commissioners, comments or questions? commissioner chow. >> yes. i also really commend dr. horten for the work she's done and i don't know our new forthcoming interim medical officer. i knew that when you took that role that we were quite comfortable knowing the excellent role that you have played over a general in terms of being able to work with the med ical staff and understanding such issues as regulations and things often we doctors don't. thank you. i did want to try to understand policy is very well written and certainly very protective of patient rights and all that is very clear. i am trying to understand what the difference is between a non

specialty versus a specialty type of service. i can understand perhaps non specialty might be consultation, but when then from the consultation staff carrys out something, is there no follow up or does it require to go into specialty for follow-up or are specialty services perhaps very special programs? just trying to understand that differentiation you are making. you certainly have made clear what the technical aspects and the documentation are. >> thank you dr. chow for your question. so, the main difference between non specialty level of services and specialty that's about the 42 (indiscernible) specialty level of substance treatment services, the treatment, they include whole

spectrum of services assessment, diagnosis, individual group counseling, treatment, so those are specialty level. they require staff with certain licenses and credentials to provide those services, and they are protected under federal law 42cfr and privacy protection. non specialty level of services is really a welcoming informed approach. screening, motivational interviewing, (indiscernible) initial engagement work for anybody referred to our team to assess their needs for substance use services. so, treatment hasn't happened yet. a lot of the work up front for engagement, and also

(indiscernible) patients to come (indiscernible) right away to receive in depth specialty services, so they may receive other services from our department like mental health services or medication management or (indiscernible) the non specialty level of engagement work is embedded in all of the services we provide, we take opportunity at any point to try to engage patients in discussion about their (indiscernible) about their goals and recovery plan, things like that. that is considered non specialty so that is not under the 42cfr restrictions in terms of privacy, so these services are documented in

(indiscernible) the specialty services because of 42cfh they are actually (indiscernible) that's kind of an overview. >> i was going to add, coming from the world of general medicine this term confused we as well because we throw around the term specialty and special care. in the world of [audio cutting in and out] helpful to understand the difference, especially wearing my other hat (indiscernible) big topic there as well in terms of fire walls and care coordination and different regulations around specialty versus non specialty mental health. >> thank you very much. that was a very clear

explanation and i appreciated it. >> seeing no additional comments or questions, we can move to a vote. we have a motion and a second on the table. all of those in favor of approving the laguna honda hospital rehabilitation center policy say aye. >> aye. >> opposed. motion carried. thank you dr. horten and chin. our next item is the approval of the minutes of the health commission meeting of march 7, 2023. i understand we did have amendments offered and would like to hand it over to secretary morewitz to go over those. >> i made a few errors. one i did not note on page 2 approval of the minutes is listed as february 21, 2022 not 2023 so i corrected that. and then commissioner chow noted on page 5 there are two-he asked me to

add a comment under item 5 public health and safety update. it says commissioner chow (indiscernible) rising cost and funding to complete the project and under item 6 first sentence, he asked me to add the word ask, so the sentence now reads, commissioner bernal asked for examples of issues that would trigger a deeper assessment. >> thank you secretary morewitz. after reviewing the minutes and hearing the minutes, is there a motion to approve? >> so move. >> motion and second. any public comment? >> yes, sir. there is one hand. moderator, please unmute. >> it is ww again. i don't know why that reminds me of george bush. anyway. (indiscernible) the testimony i presented noting laguna honda action plan

is shockingly (indiscernible) problems in every department. it was a admission that the (indiscernible) competence care plans and providing (indiscernible) the nbs is mandated by cms (indiscernible) one was to create a charter and establish a new resident care conference, the rcc which i just mentioned in my previous comments about the rct. the resident care conference it seems is part of the new charter and new mbs policy that still needs to be

approved by the commission because it involves new policy. it was ironic hearing commissioner pickens mention it, dr. horten will be keeping her tentacles. that had to have been a freudian slip. many laguna honda problems in the past couple years is because there are too many managers who lacked skilled nursing facility experience have their tentacles acute care mindset wrapped around laguna honda managers. this is one more indication the commission needs to continue searches for senior laguna honda management positions to

have skilled nursing facilities to keep the acute care tentacles out of managing laguna honda. thank you. >> commissioners, questions or comments before we move to vote on the minutes? all in favor of approving the minutes say aye. >> aye. >> opposed? the minutes are passed. our next item is the director's report. for this we we have dr. colfax, director of health. dr. colfax. >> thank you and good afternoon commissioners. the director's report in front of you. i will go through items quickly highlighting of course happy to answer any questions. item 1 is prioritizing women's health at dph. march is women history month and opportunity to highlight the contributions of women to events in history and

society. there is a vast amount of work to protect the health and wellness of women and girls including trans women and non binary people in the hospital and clinics and programs throughout the city and i'll note as examples we have 13 bullets and will not read them, but really bullets that exlempify the depth and breath of the work we do and great to be able to highlight that work during women's history month. item 2 is highlighting world tv day. 2023 events. world tv day is on march 24, and there are a number of events that we held, including and attended. including the tb clinic that will be featured in a world symposium hosted by

ucsf tb centers. hosted by community living room, a collaboration of san francisco community health center tenderloin and city hope to provide education about tb prevention and city resources, and san francisco city hall will be illuminated in red march 24 joining prominent landmarks around the coubtry and the world and it is a testament to the focus on public health including tb in the city, and city hall will be lit in commemoration of this event and we all know tb remains a extraordinary serious disease and the team at dph is deeply committed to preventing tb and when tb cases occur insure people have the very best top notch quality of care. next item is vision

zero sf. the commissioners know vision zero sf is the city road safety policy that builds safety and liveability in the street protecting 1 million people who move around the city every day. vision zero sf is a interdepartmental collaborative committed to building better and safer street, educate the public on traffic safety, enforce traffic laws and adopt policy changes that save lives. the population health division of dph is one of vision zero sf collaborative partners and they recently shared the following 2023 year to date regarding traffic fatalsies in the city and you can see the data presented in the table in the report from 2018 to 2023. next item is recognizing environmental health branch hazardous material team. last

month there was a house explosion in the sunset district. the san francisco fire department and the police department responded to the incident and suspected that the explosion was caused by one or more hazardous materials and requested dph assistance. jonathan (indiscernible) was our on call responder for the incident and was able to use a portable device to analyze and identify a variety of unknown materials at the incident . isthe was critical to allow other emergency responders to understand the potential health risk of the materials and make a decision how to respond. in addition jonathan will be providing expert testimony at the trial for this event. the valuable service that this dph team provides for the city dates back more then 30 years and was created in coordination with the san francisco fire department. and in terms of the last item on the

director's report, the covid-19 update, san francisco 7 day rolling average of new covid cases is 73 and 85 people were hospitalized as of march 15 including 10 in the icu. 86 percent of all san francisco residents have been vaccinated, 65 percent received booster dose and 38 percent of residents have received a bivalent booster. that concludes my director's report. happy to answer any questions. thank you. >> thank you. do we have public comment? >> folks on the line, i dont see hands-we are on item 9 in case you like to comment. press star 3. no public comment. >> commissioners, comments or questions for director colfax? commissioner chow. >> yes. i want to

thank dr. colfax and his office for providing further information about the world health tb day. ironically and by chance, i had come across an article from the-in the year 2000 in which on world health day supervisor tang and supervisor lee actually in china town along with myself spoke about the need for our community to really address the issue of the rising numbers-not the rising numbers, for the very high numbers of tb in the city and compare it also to our other residents and to the nation. while we are still high, at that time supervisor tang had promised we would

eradicate it. speaking as her role of creating more dollars for the programs that would help with this. of course it is necessary to have a continuum of programs that over these years, so i was curious if in the 20 some odd years we have made any difference at this point and happy to say your office gave me information that indicated that we are actually at about a third of the prevalence before that. i think it was saying that the report will show we have about 45 cases out of every hundred thousand, and that today we are at 15, so want to commend the department for the work out there doing in order to try to reach our community.

all boats rise and all boats go down at the same time because it appears there has been a very successful program for the entire city and unfortunately the asian pacific islander remains with that same disproportion within the city but it is great to have the very important absolute numbers being done. really thank you for the extra effort. it happens-i found this article so many years ago and thought gee, did we really make a difference, and it is sort of nice to see that we really are making a difference. thank you very much. >> thank you commissioner chow. vice president green. >> yes. i wanted to applaud the department and all the affiliations for the efforts making in women's health. it was announced this week maternal mortality is higher then 1965 and that's before the travesty and

destruction the dobbs decision is going to cause. we have so many invasion programs. team lily, the (indiscernible) innovative and fantastic. the black infant health program. i think we have the potential to lead the way in health for birthing people and individuals seeking contraception in a way we did for hiv in the past. i fully support these programs. the discrimination in this country is absolutely appalling and if we don't lead and all these programs so many show that we are really on the cutting edge and forefront trying to address inequities in the countsry so supportive of everything the department is doing and the mental health component as well which will only worsen as more and more women across the country who don't want to stay pregnant are forced to give birth. very appreciative of this

work. >> thank you vice president green. any other comments or questions? seeing none, we'll move to the next item, which is other business. commissioners, do we have other business? >> you want me to bring up- (indiscernible) >> commissioner chow. >> yes, commissioners i like to bring to our attention and ask that we consider a adjournment in memory of supervisor tom shay. tom was a member of the board from 1987 approximately 1987 to-for about 11 years, and

is truly a success story in san francisco. a giant who lead our community, the asian pacific islander community to become more active to become more involved in on the city state and national levels so that our community could have a voice. he was first appointed to the board of supervisors by mayor diane feinstein and at that time we had city wide elections, which is really difficult to really as a broad base requires broad base to win. he won his on term and actually served two full terms. he was the budget chair of the board. my family and myself had very close

relations with the shays, and we were able during the time of fiscal crisis at the time he came into office, as the budget chair of the board to help explain the roles and the importance of public health to our residents and the need for adequate funding for the various programs. and through his years there, he often reached out in order to understand the public health needs as he deliberated first as budget chair and of course as a member of the board, the health needs of san francisco. on a national level-well, i should say his story is really amazing on reflection because it is truly the american

story. he was basically a refugee during the chinese civil war moving from china to taiwanism came to the united states and san francisco at the age of 9 years. was educated locally here through our own public schools and the university california. became a architect and as a architect in his work he was able actually to create design and help build 1600 units of low and moderate income housing at that time. he also built the largest building in china town, the mandarin towers, so when you see it and opposite what he had promised the people which of course he could not deliver the subway that came into china town, but of course the subway today faces the

mandarin towers, so--he was always thinking of people. he also realized it was really necessary to get involved in national politics, and actually was the founding and chairman of the asian pacific caucus for the-national democratic party. served many years in that role, and it was always not necessarily just together partisan, but to demonstrate that it was important to be heard that you had to participate. so, i believe that it would be very appropriate for commission here to really pay our respect to tom's passing and i would ask at the time of adjournment that we adjourn in his

memory and let his family know who are still in san francisco that we had that action taken. thank you. >> thank you commissioner chow. i know the commission will be glad to adjourn in memory of tom shay and gratitude for his leadership and with condolences to his family. any public comment? >> no hands for this issue. ; and our next item is closed session. we will take a vote as to whether or not to hold a closed session in relation to item 11d on the agenda, which is laguna honda hospital rehab center quality update regarding recent regulatory survey activity. motion to go into closed session? >> so moved. >> second. >> commissioners, i'll note there are two votes. you vote on item b as you said commissioner bernal and item c

is whether to vote to call-assert attorney client privilege in closed session. you can move forward with the vote but there was another. >> is that one motion? >> separate motion. >> the first motion on the table is whether to go into closed session? >> yes. >> any public comment? >> i see no hands raised. >> all in favor say aye. opposed? and then our next item is whether or not to assert attorney client privilege. >> so moved. >> second. >> seeing no public comment, all in favor say aye. opposed? alright. we are in closed session. members of the public, this is the last item on the agenda unless you choose to stick around after adjournment we thank you for joining the meeting and will see you at the first

meeting in april. >> e content of the open session. close session. >> i move not to disclose. >> second. >> any public comment? all in favor say aye. >> aye. >> opposed? motion carries. we will not disclose the contents of the closed session. that's the only motion we need, right? next, we'll entertain a motion to adjourn and i'll hand it over to commissioner chow. >> i would make a motion to adjourn in the memory of former supervisors tom shay. >> second. >> all in favor? >> aye. >> alright. we are adjourned.

>> i went through a lot of struggles in my life, and i am blessed to be part of this. i am familiar with what people are going through to relate and empathy and compassion to their struggle so they can see i came

out of the struggle, it gives them hope to come up and do something positive. ♪ ♪ i am a community ambassador. we work a lot with homeless, visitors, a lot of people in the

area. >> what i like doing is posting up at hotspots to let people see visibility. they ask you questions, ask you directions, they might have a question about what services are available. checking in, you guys. >> wellness check. we walk by to see any individual, you know may be sitting on the sidewalk, we make sure they are okay, alive. you never know. somebody might walk by and they are laying there for hours. you never know if they are alive. we let them know we are in the area and we are here to promote safety, and if they have somebody that is, you know, hanging around that they don't want to call the police on, they don't have to call the police. they can call us. we can direct them to the services they might need.

>> we do the three one one to keep the city neighborhoods clean. there are people dumping, waste on the ground and needles on the ground. it is unsafe for children and adults to commute through the streets. when we see them we take a picture dispatch to 311. they give us a tracking number and they come later on to pick it up. we take pride. when we come back later in the day and we see the loose trash or debris is picked up it makes you feel good about what you are doing. >> it makes you feel did about escorting kids and having them feel safe walking to the play area and back. the stuff we do as ambassadors makes us feel proud to help keep the city clean, helping the residents. >> you can see the community

ambassadors. i used to be on the streets. i didn't think i could become a community ambassador. it was too far out there for me to grab, you know. doing this job makes me feel good. because i came from where a lot of them are, homeless and on the street, i feel like i can give them hope because i was once there. i am not afraid to tell them i used to be here. i used to be like this, you know. i have compassion for people that are on the streets like the homeless and people that are caught up with their addiction because now, i feel like i can give them hope. it reminds you every day of where i used to be and where i where i used to be and where i

>> i am iris long. we are a family business that started in san francisco chinatown by my parents who started the business in the mid 1980s. today we follow the same footsteps of my parents. we source the teas by the harvest season and style of crafting and the specific

variety. we specialize in premium tea. today i still visit many of the farms we work with multigenerational farms that produce premium teas with its own natural flavors. it is very much like grapes for wine. what we do is more specialized, but it is more natural. growing up in san francisco i used to come and help my parents after school whether in middle school or high school and throughout college. i went to san francisco state university. i did stay home and i helped my parents work throughout the summers to learn what it is that makes our community so special. after graduating i worked for an investment bank in hong kong for a few years before returning

when my dad said he was retiring. he passed away a few years ago. after taking over the business we made this a little more accessible for visitors as well as residents of san francisco to visit. many of our teas were traditionally labeled only in chinese for the older generation. today of our tea drinkkers are quite young. it is easy to look on the website to view all of our products and fun to come in and look at the different varieties. they are able to explore what we source, premium teas from the providence and the delicious flavors. san francisco is a beautiful city to me as well as many of the residents and businesses here in chinatown. it is great for tourists to

visit apsee how our community thrived through the years. this retail location is open daily. we have minimal hours because of our small team during covid. we do welcome visitors to come in and browse through our products. also, visit us online. we have minimal hours. it is nice to set up viewings of

>> claim at change is real and we need to -- climate change is real. environ stewardship plays to change the fuel source from carbon based to re. --ry newable power. >> the city is responsible for developing and procuring electricity that is delivered by pacific gas & electric to end

users. >> i go to the market to try to find appropriate energy product to buy and usually that is renewable so we can ensure that is in the grid and supplied to consumers. >> the contracting workerrin ant they provide keep the lights on in san francisco. >> i started on the team almost four years ago and transitioned in 2017. we are a new team working together with across functional role. >> every contract her team is involved in executing helps san francisco reduce its climate impact by reducing greenhouse gases remitted. >> what i am most proud of is the long-term energy contracts

to get new renewables in california. >> before she was doing this, we probably executed a cunpel contracts a year. it is a huge expansion in our operations and aaron is in the middle. she is centrally involved in entering more than $650 million worth of power contracts, much of that is renewable energy. the lasting impact of her contributions is helping us develop a modern utility power purchasing division. that is why i nominated her for this award. >> this award was surprising. i feeling grateful to be recognized. a lot of people do good work and it is nice to have my accomplishments valued and recognized in the environmental stewardship realm. >> a lasting legacy is creating a modern process to help new employees that come here

understand how we do business. we couldn't have done it without her. >> i am a utility specialist on the power supply team and the power enterprise. >> when i open up the paper every day, i'm just amazed at how many different environmental issues keep popping up. when i think about what planet i want to leave for my children and other generations, i think about what kind of contribution i can make on a personal level to the environment. >> it was really easy to sign up for the program. i just went online to cleanpowersf.org, i signed up and then started getting pieces in the mail letting me know i was going switch over and poof

it happened. now when i want to pay my bill, i go to pg&e and i don't see any difference in paying now. if you're a family on the budget, if you sign up for the regular green program, it's not going to change your bill at all. you can sign up online or call. you'll have the peace of mind knowing you're doing your part in your household to help the environment.

>> i will be remiss if i do not mention persian new year last week and the fact that spring just started, which is exciting. but unfortunately it is great we seat rain but we don't see a lot of spring sprouting now but hopefully soon. with that we will start the meeting. >> president ajami. >> here >> vice president maxwell. >> commissioner paulson. >> commissioner rivera. >> here. >> commissioner stacy. >> here. >> we have a quorum. member who is wish to make 15 minutes of remote comment up to 2 minutes on an item by dialing