levels are located. the patients were -- until power was restored which shouldn't occur until the following late afternoon. so, i want to thank all the hard-working staff who helped us respond to this emergency. and of course, the staff worked very hard around the clock until full power was restored. next item is the six annual detailing institute. the capacity building assistant program of gph for learning innovation hosted the annual public health detailing institute on march 29th through 31st. public health is a based (indiscernible) to encourage clinical practice change through brief education on one-on-one provider incident. the institute this year was on the

interactions between health epidemic -- this was a multi state exercise in this work and really proud of the team for leading this effort and by, all reports was it was a great success. next item is volunteers for san francisco's 40th annual carnival and the dph and indigenous (indiscernible), they have volunteers for the historic carnival event on saturday may 27th in the mission district and the contact for volunteers is listed there. also, wanted to shout-out the recognition on the next item, the chief experience officer was recognized by (indiscernible) hospital review, a leading journal for hospital list and hospital executives much congratulations iana johnson, the chief experience

officer at gfs for being on the decker's hospital review for the 2023 list of 50 plus hospital and health system chief experience officers to know. and then last item is with regard to the covid update. as we are basically in a study state with regard to our covid cases, our 7-day rolling average of new cases per day is 48. and 46 people were hospitalized as of march 29th including four in the icu, just a reminder, this is all patients in the hospital who have tested positive for covid. this does not necessarily mean that the people are in the hospital because of covid. 86% of all san francisco residents have been vaccinated. 65% received booster doze and buy violent boosters of those ticked up to 39% of residents who received that. much higher than the state and considerably higher than the national

average. that's my director's report. i'm happy to take questions from the commissioners, thank you. >> thank you, director colfax. commissioner morewitz, any public comment. >> folks online, if any of you have received accommodations, press star three now. jeanette, can you unmute the first caller of those? caller, please let us know you're there. >> this is gloria jensen. i was on hold for the warm pool comment and i was cleared twice. so, may i make a comment on the water pool program? >> there's no technical issue. >> the public comment at this time is for items on the director's report. the appropriate time would have been during public comment. >> right. which i was on hold.

>> right. janet, please mute the caller and caller, please feel free to submit a written comment. i saw the hand and there was no hand up at that time and the person who is moderating confirmed that with me. go to the next caller, jeanette. >> this is yy aka, patrick. can you hear me? >> yes, sir. please begin. >> you have gone on some sort of feint recording. we can barely hear you over-the-phone. i am wondering why pickens last week and now then director colfax is claiming that during the 90-day, the first 90 days monitoring survey, laguna honda had received 124 deficiencies.

according to the first root cause analysis repor that was raised on the 8 surveys, laguna honda received between october 21st and april of 2022, that report, i'm sorry, not that. the first 90-day monitoring report that's dated january 31, 2023, listed a total of 76 citations, according to shag. the question is whether

sahg is trying to hide duplicate occurrences of the 76 tags and try to hide 48 deficiencies from their published report. which is it, dr. colfax? was it 76 as was reported in the first root cause analysis, i mean, in the second root cause analysis report that covered the first 90-day monitoring survey or was it 124? why are you claiming 124 if shag had only publicly noticed that there had been 76? did somebody there at dph or

shag have an accounting problem? you do not know how to count? do you not know how to report this data accurately? this is ridiculous that you have that large of a discrepancy of 48 additional deficiencies. you guys really need to explain this. and let the public know who is presenting what numbers and what numbers are trying to be creatively hidden. i've read all of those reports. the total of 696 pages and i'm flabbergasted at this variance. thank you. >> all right. please go to the next caller. let's see. there's no caller, so folks who do not

have accommodation, this is your time to raise your hand. if you haven't gotten accommodation and like to make comment on the director's report, press star three now. we're on the director's report. no more callers, commissioners. >> all right. thank you, commissioners. comments or questions? vice-president green. >> yes, thank you for the report and i just have a question about how we're going to really track covid because at least where i work, the hospital is only requiring covid test now for people who you highly suspect have the disease and yet we know there's quite a few asymptomatic individuals who may be hospitalized and even for something like a delivery. do we have a sense of how we'll get a reliable set of the prevalence of the disease in the community going forward? the important thing is covid driven hospitalizations, but i'm wondering if we have a sense or

if it's worth or manpower to direct this data. >> that's a good question, commissioner. it's a work in progress and i do not believe we have an adequately system statewide or nationwide to track covid cases and as you point out, as policies change in certain institutions in the city, less covid may be detected because of different testing policies, so today, while i wouldn't say that the numbers that we're getting are exact, they do track fairly well with going up before hospitalizations go up. but going forward, the most likely thing is we still will have a good record of covid cases in hospitalization. that's what we really need doing tracking going forward. there is ongoing work with looking at things like sewage, wastewater that, there's a lot of variation in that and that's in the process of being defined and how sensitive that is and how

reliable it is because you get situations, as i understand it, for instance, when you get massive amounts of rain and so forth, you have delusion events and so, that is an issue with that monitoring as well. i think the bottom line is going forward, we need to be monitoring the hospitalizations and we also need to be watching what i call the state and at the national level for the emergent of variants that may cause more hospitalizations. >> great, thank you very much. >> commissioner guillermo. >> it's a comment much and i want to speak to johnson's recommendation. it's no small feet to be on one of their list, given the permanence of that period journal has in the field and in particular, for a hospital like gfg. we think

about the patient population we have there. for her to be recognized as providing a stellar, excellent patient experience to be recognized as one of the top 50, i think, really deserves another mention and then sort of related to that, the epic welcome that we're going to be launching and it will be a part of the overall patient -- outpatient care experience, so it's good to know that san francisco stands above many others in terms of really trying to make sure that our -- the patients that come to our facilities are treated with respect and dignity and great care. >> thank you. if i can mention with regard to johnson, her leadership and skills have gone beyond sffg. we deployed her at laguna honda to improve that

work. >> even better. >> commissioner chow. >> yes. thank you. thank you to director for your report. sad to hear about our financial projection and at 50 million, i'm reminded in the past when we've had to look at-large sums like this, although we have a huge budget, 5% is still 5% of a general budget, so in the past, i'm just reminded that we did work with our community partners when we were looking at changes, but i'm hoping that since you're going to be bringing this in two weeks, that we'll have an opportunity to have worked with them already through this process, so that we would have an understanding that people are onboard if they are going to be changes on contracts and secondly, we also have to understand, often, the department takes the hit first

and i think we should hear then, what that's going to mean in terms of differences in certain programs we have and so forth so we're all aware of the consequences of this potential and of course, it's possible the mayor doesn't want to put all of that into the budget so you can help us understand -- the mayor has until june 1st. this will be quite a move over those past several years so if you can keep us updated as to how we're going to accommodate all the programs we have been talking about and which ones have to be changed and how well we're working with our community partners, so, the second one was actually less of an issue. i'm happy to hear (indiscernible) has six

languages and which languages are they? >> i would have to turn -- we can get you the information on the languages unless somebody has that. i don't know if mitch, who is our epic lead is on the line, so we'll get that to you. >> sure. because i think one of the questions in the past has been trying to be able to have people make use of this. >> yes. >> and that the language issue has been there for the last several years, so really is a wonderful accomplishment if we're able to have access for all the people who are using a different language as a primarily language and it would be really, i think, a great help. i guess, lastly on the laguna honda, i had a question in terms of where we are standing with the pause on discharges, which is actually again eminent, which the state and the federal government doesn't seem to want to give

patients sort of a comfort level, since i believe the data is still in mid-may or soon after that in terms of what we're supposed to be a resumption, so it's impacting patients. what are we going to do? do we go through this process? and i thought that the second question in that regard and not in that regard, but in regard to our progress, which has been really tremendous coming down from a federal review of 100-sum odd areas down to 23, but those, as i understand, are different than the tags, right, in terms of -- so there could be a difference that these citations actually could wrap into several numbers

of tags and therefore the tags may, in fact, be less than the -- a number of citations and so, i think the public needs to understand that there's really a difference in the types of reporting and the definitions of those. but if you could just respond to the issue on the pause. >> sure. so, if i could just say one thing about the budget because i do think it's important. >> sure. >> just to emphasize, we are -- we presented to the health commission as a five percent reduction in the budget. thanks to the budget team and across dph, you were able to do that without making service cuts or having any layoffs and i can't sugarcoat another five percent, is we were at the bone with the five percent, right. the first five percent, so this is going to be a tough period and quite

frankly, it's going to be a period we haven't gone through for a while in terms of figuring out how to squeeze out another five percent cut. we will do it and as you know, our commission have excellent superb people on the financial side and super people on the operations side and obviously, ensuring that we're working across our system and with partners in the spread. it's going to be a really challenging time and that's why i wanted to emphasize the april 17th date because it's a short time for coming to the table with the proposed cuts. in terms of the pause, we have -- the pause in transfers and the earliest transfers would resume is may 19th. we had not received any further update from cms with regard to that date changing. i will say that you will recall that -- that we were required to

submit a closure plan and that plan was submitted to cms and the state the last, the draft that was requested was submitted in february to cms and the state and we have yet to receive an approval of that closure plan. i believe mr. pickens has made clear, we also wanted to support the laguna honda residents and their families with regard to understanding how traumatic it is to be transferred to another (indiscernible). we saw what happened when we had to go through that before. there's patients, residents at laguna honda who do not need a skilled nursing facility care. for most of the populations without a closure plan being approved, we're not able to transfer anybody from laguna honda at this time. my may update, we don't have a closure plan

approved. may 19th is still the date that the earliest that people would be transferred at this time and again, we've asked for more clarity around when that closure plan will be approved. we're optimistic that plan will be approved some time soon but i don't have a specific date for you. and then one last thing, the 6 languages, i have an update on the 6 languages. let me get that for you, so i don't, so the 6 languages are english, spanish, chinese, russian, that galli and vietnamese for the welcome (indiscernible). >> thank you very much. >> thank you, director colfax. i would like to under score the points made by commissioner chow, not only is the stress of the transfer but the uncertainty that the families experiences leading up to this and the sooner we can let folks know this threat of transfer doesn't

exist, the better. we're in support of receiving a response from cms and the state on that one, and also, i would like -- wagner and jenny, thank you for the hard work they are putting into the budget and the adjustments that have been requested by the mayor's office which is an advanced of the mayor submitted her budget to the -- other comments. next item, which is for discussion, ordinance 077-22 healthcare code skilled nursing care transfer -- and we have claire atlman from the senior program planner and office of policy planning. welcome.

>> good afternoon. all right. great. all right. good afternoon, commissioners much my name is claire altman and senior program planner of office of policy and plan and i'm here joined by kelly hiramoto who is a special project planner. we'll present the 22-23 transfer reports as required by local ordinance. so for today's presentation, you have received the 22-23 data report which provides information and data in greater detail. so, and then i would like to say before i begin that i'm joined both in person and remotely by representatives of zfg, kaiser and dignity hospital and chinese hospital. if you have specific questions about the facilities data, they

will be able to answer. unfortunately, umpc and cms wasn't able to join us remotely. i did not invite laguna honda or jewish home to be here for their data because the report really focuses and intent of the ordinance is state about the general acute care hospitals transfers. the last thing i will note, i hope we can save questions for the end of the presentation. next slide, please. all right. so, for today's presentation, i want to briefly note the background and context for this local ordinance. as you're aware, upon the closure of saint luke's hospital, cmpc transferred patients from the saint luke's acute unit to the davies campus and there's 7 subacute patients. and the subacute beds will be closed when the last patient

leaves. so, san francisco does not have any admitted subacute facilities in this city and this leads patients and san francisco residents who require subacute care to be transferred out of county. in may of 2022, the board of supervisors passed an ordinance to have a better understanding of the whole scope of need for subacute care and it was expanded to include subacute care. briefly, i'm going to describe levels of care. skilled nursing care is nursing or therapy care for patients who are medically stable but require health needs performed by skilled professionals daily. and subacute care is a level of care that is needed for patients who require ongoing specialized care like trek only meet care and acute care after hospitalization. it's a level of care that requires medical technology to compensate for loss of bodily function. next slide, please. so the ordinance

passed by the board of supervisors, requires acute hospitals and hospital based nursing facilities in the city to annually report to dph information about skilled nursing transfers. and specifically, per the legislation in the ordinance, it requires facilities to collect data on the number of san francisco residents and non-residents who qualify for skilled nursing care while admitted and they are transferred outside of the county for that care or remain in the city in an acute bed or hospital skilled nursing facility which i'm calling this patients not transferred. and i do want to note that this does not include in-county transfers. so, for each patient category, facilities are required to report demographic information, including age, race, ethnicity, gender, gender identity and sexual identity if it's collected by the information and patient insurance provider and

housing status. i want to note at the top of this presentation that that information is not all accessible for reporting health facilities. and i'll be discussing the challenges collecting that data today during the presentation. and lastly, the ordinance defines skilled nursing care as including general skilled nursing care and subacute care, but given the interest in subacute care specifically, we, dph chose to request that data separately. next slide, please. so, this slide shows the san francisco facilities that are required to report through the ordinance. facility was required to report that our license at acute care are skilled facilities and chinese hospital and cmpc and kaiser, dignity hospital, and zfg are the general acute care hospitals reporting. the hospital, san francisco is a critical care

hospital. also known as long-term acute hospital and it's a specialty hospital that addresses extended hospitalization stays for those with complex medical needs. laguna honda hospital and rehabilitation center jewish home and rehab center are required to report because their license includes general acute care beds. however, because these facilities both primarily serve long-term care and provide skilled nursing care, instead we provide or the department provided special instructions for their reporting, asking instead for patient, their resident ask and census. and dph was responsible for issuing the guidelines regarding the data for the reports and the first reports were due october 1st to the department. the 2022 data is due january 31st of this year and moving forward, data reports will be due to the department every january 31st and then we'll have a report to the

health commission annually as well. and i want to take a moment to recognize the work that each health reporting did. the department did put the data together. they found a meth doll to collect and report this data to our department so i want to appreciate their work. next slide, please. all right. so, the image on the right of the slide shows one of the pages of the data collection tool and the data collection tool is provided in appendix a and b in your report. all reporting health facilities utilized our data workbook to report the data, but they utilize the the variety of tools to collect the data that's required in the ordinance. and so, these methods utilized by each data or each reporting health facility is detailed in the report and some of the common methods are on the slide as well. all reporting health facilities utilized discharge data codes to determine the

number of patients who were transferred to a skilled nursing facility because skilled nursing facilities or skilled nursing discharges is a defined patient discharge status code in the electronic health records which i'll say e hr for now on. subacute is not a standardly defined patient status code built in the d hr. to design subacute transfers, hospitals to rely on manual reviews of medical charts to find those patients. two reporting health facilities, kaiser and dignity hospitals have access to referral management systems and this referral data was used to capture patients that met the subacute or medical -- if they had a referral that offers that level of care. and zfg captures lower-level of care days and the days indicate when a patient's acute medical condition resolves or if they were admitted without an acute medical condition and

the patient should be discharged to a different level of care. so in summary, all of these reporting health facilities had unique tools to report the data. and because of the variety of methodologies that were used, our report for this year was limited and hospitals there couldn't be compared or not aggregated. so for the next few slides, i'm going to present each hospitals present data and their method for collecting that data and i want to note that in accordance with privacy rules, instances where there was patient population or less than ten, they are suppressed in the report and the slides. next slide, please. i'm going to begin with chinese hospital. they utilized discharge disposition data and accepting facility address to determine which patients went to a skilled nursing facility out of county. looking at the skilled nursing transfers between 2021 and 2022,

chinese thopt believes the increase has to do with facilities generally being more open to accepting patients due to changes in covid protocols. and while chinese hospitals is not able to provide an estimate for the number of patients who qualified for skill nursing, but are not transferred to that level of care, they did provide dph with the number of in county transfers and so i'll briefly talk about that even though it's not present on the slide. but in 2021, chinese hospital discharged 121 patients to in county skilled nursing facility and 2022, they transferred 134 patients to in county skilled nursing facilities. by having that detailed information about in county transfers, we're able to see most patients that were discharged to chinese hospital goes in county. to define subacute discharges, chinese hospitals reviewed the charts of those discharged to a