>> so we are live whenever you're ready commissioner. >> great. good afternoon, everyone and welcome members of the public and my fellow commissioners, today to the april 18, 2023 commission meeting of the health commission. please call the roll. >> commissioner green. >> present. >> commissioner chong. >> present. >> and commission christian. >> present. >> and we'll -- ~>> yes, i will. the the ramaytush ohlone land,

acknowledgment. they have never seeded or lost or for goent their responsibilities as this place as well as for all people to reside in their traditional territory. we recognize we benefit from living and working on their traditional homeland. we wish to pay our respects by acknowledging the ancestors and relatives of the ramaytush ohlone committee. >> my i'm mark, i'm the health commission secretary and i'll later on will read a long statement about public comment. we have gotten comment during meetings regarding how confusing the new procedure is. this will clarify where we're at.

there are three categories folks that are in the room and attending in-person, are prioritized and go first. and folks who have received an accommodation from me for disability by contacting me at least two hours before the meeting are next. and we go to those participating remotely and there is a maximum of 20 minutes. so there is three categories in order to participate remotely. you can participate remotely by contacting me. hopefully that clarifies for some of you and let's, can you take the slide down and we can move on to the next item. >> general public comment and there is further commentary.

>> yes, here's the long script. at this time the members of the public may address the commission that are within the jurisdiction of the commission but not on this meeting agenda. each may address the commission for three minutes. please note that each individuals is allowed one opportunity to speak per agenda item. individuals may not return more than once to read individuals unable to attend the meeting. written public comment may be sent to the following commission, if you wish to spell your name in the minutes, you may to so during the robo comments without taking time. we will first take public

comment from individuals attending the meeting in-person. we will then take remote public from those who received accommodations for disability. i have given them a code to prevent others from speaking at the same time, and there is only two who received that accommodation. there is a total of 20 minutes per item. because of new remote public comment procedures recommended bit office of the city administrator and the city attorney's office, please do not raise your hand until yush category has been called. all right so folks on the line, let's see if there is any general public comment. there are two hands that i see. we can take them in order, james please unmute the first person. james, are you there?

oh, okay, i guess i'll do that myself. hi caller, you're unmuted please let us know you're there. >> caller: it's--i am. >> please begin. >> caller: as a reminder, dr. palmer and other public commenters express concerns about plans for the warm pool that davis campers was with reduction to the community. requires the health commission to schedule a hearing to determine whether that reduction in service is quote unquote well or will not have

detrimental affect on san francisco's health, is in this commission's per view and body. one of the commissions going to schedule prop 2 hearing, my mother has access to therapy pool program to ease her arthritis before she was admitted for spilled nursing care at the end of her life. these minutes got my concern that dr. coalfax are asserting there were deficiencies in monitoring.

76 deficiency and explained variant through 48. you can comment on the health commission to explain publicly that discrepancy. thank you. >> thank you for your comments and again we're on general public comment right now. so this item is for is for topic that's are not currently on the agenda. next person, please let us know that you're there. caller, are you there? >> yes, i've got three minutes on the clock when i say stop. please finish your statement, you may again. >> good afternoon, health commissioners, i'm january he will, i was a public health worker for public health for many years. i'm union for representing government employees. i have been a resident for more

than 37 years in san francisco. i care about my city. san francisco have been running communism government which we now know san francisco has been controlled by a deep state governorance against the people, the people's within our government that most public elected officials were pay and bought into the office, they purposely impose agenda 21 which is another world for one world government. in 2020 to present time, i deport governor leaders including health leaders in department health lie about the pandemic covid-19 by forcing vaccination for school, business and for jobs. now we see more and more vaccinated people dying and getting sicker. until today, san francisco still have to comment on

policy, novak evenation job. i must be tolerated by reporting the facts and data about government officials lie about the public about forcing vaccination that they never isolated. as of today, april 18, 2023, we have unvaccinated employees still have active lawsuits against the mayors by forcing illegal vaccination violate people's medical choice. religious freedom and constitutional rights. now we more and more people are dying from vaccination. 1168 christians and catholics were terminated from the san

francisco government, health commissioners. none of you elected into your office. how can you make such a decision to support illegal forcing people to accept a medical treatment, covid-19 vaccine. it's time for all of you to defend our public by ending the vaccination mandate for jobs. return all unvaccinated workers back to work. may god end the one-world government in san francisco, in jesus mighty name, amen. and i ask god to bless you, you are educated people but the way that you-- . >> clerk: sorry, that's the end of your kment. >> caller: you are not educated. >> all right, that's the public comment.

>> thank you for the comments and the next agenda item is review and approval of additional budget proposals for fy2023-25 and fy2024-25. >> hello i'm here to update on the city's economic forecast and our proposal with the additional instructions from the mayor's office. if i can get the second slide. great. so tonight we'll update you on the five-year projection and additional budget instructions and talk about next steps with the commission. next slide please. so, as part of the regular budget process, the mayor's controllers office and board of supervisors analyst, do an update to their 5-year projection that they issue in

november with updated revenue projections. and in this march, what they received is the 5-year forecast is worsening by 51.5 million as revenue projections and increase healthcare pension cost. including decisions that have impact. what you see here is updated chart of a two-year budget which includes and at the end i'm not sure if you can see a projected deficit of 778 million over the two-year budget, previously it was about 720 million. so with this worsening news, the mayor's office is issued additional budget instructions. next slide please. so these instructions go to city department for general fund reductions that were

issued on march 30th. we did, they had asked for people, for departments to turn around request. we did receive an extension until after this april 18th health commission meeting for our submission. but the instructions for our five-percent reduction annually for 100 million over the two-year budget, we also have to review older continuing projects for one time savings. given the rapid turn around, i will note that we did a lot but we will need to further refine our proposals just to make sure that we got all the numbers correct. but the proposal before you, is really representatives our best thinking given the short time frame.

proposition c funds to have a shortfall, it's a special revenue funds that funds behavioral health services for people experiencing homelessness. that is also as noted in the november report projected of a shortfall. we believe there are sufficient one-time savings to get us through the budget year. so that may be enough. but it's pending, mayor's office decision. or what to use one-time saving or figure out a different way to balance out the fund. i want to note that it's not a general fund program because it's considered special general fund but still working its way through the mayor's office. next slide please. so our approach for general fund saving is really looking at ways that we can continue to step down our covid-19 operating and response costs.

we try leverage additional revenue opportunities, as well as realign our budget and historical actual spending without any impact to services as well as identifying one time saving that can help us bridge us through the gap to get us through this two-year budget. and there was incredible effort not only to create proposal but to get community input and we were able to get community stakeholders on thursday april 13th to preview the proposals that we have. moving forward and they've seen a similar presentation to what i brought forward to you. next slide please. so this table summarizes our proposals and i'll go into it in more detail but overall of the 100 target over the two years, we're bringing forward 85 million of ideas broken out

into the four categories of covid-19 response, and contracts adjustments leveraging revenue as well as authority and fun close outs for additional savings. so getting into the details, next slide please. one of the things that we're seeing with the covid-19 responses is that emergency declarations are ending as well as federal funding is expiring. so we've rehe vl --reevaluated our tests plans, as they will no longer give out test kits for free and we would, but we do expect continued support for vaccines for the uninsured. we're seeing a testing systems and reduced aoutization in our

testing and vaccine sites. in the first quarter of 22-23, of 2023 this year from january to march, we're seeing about 1100 tests during that 3-month period when we compare that to what we saw a year ago, we were performing at 35,000 tests january through march of 2022 in that same period. so we're seeing a significantly reduces level of activity at our sites. currently, at our sites as well, wesson we're seeing about 3000 in march which is approximately only 10% of our available testing capacity. so this is some of the data that we considered when we move forward with our proposals. most sites are not a averaging the minimum of 40 tests a day

that we would have expected under this plan. and next slide please. so with that we're producing millions and dropping down to 4.8 million in the second year. we had proposed 25 millions on on going covid reductions programming between both network operations as well as community response. so it would go down to 18 million and back up to 20 million in the second year. as well as population health

infrastructure. so we'll annualize those positions, they start in a partial year so the cost is higher but the service level is the same. we're in the process of developing, we believe there is 7.5 million of current year savings of prior year dollars that will remain unspent on year-end. we were originally planning on using these dollars to help offset some of the lost costs in terms of should the vaccine no longer be funded as well as tests kits with some of the vaccine use coming in. related to test kids from the

state but at some point, we'll plan on stepping down the test kits. so overall in terms of impact, for testing and vix we're proposing to produce the sites that by approximately 3. we do need to plan and finalize what this would actually look like, and we have an agile response, so we think additional evaluation will be needed in terms of location. we recognize that there will be an impact because there willr fewer locations which can create access. but the services will continue to be available just at those fewer sites. on the dph operations site, we will reduce the number, we'll eliminate 2.4 million of one time temporary dollars for

staff, that was supporting surge and transition. and in addition, we'll be reducing the request for some useable service staff. this is something that we're going to continue to evaluation over the course. and this represents an initial for your consideration. and last we'll be closing that 7.5 million but we're hoping to retain at least 500,000 to continue the test kit program in the community. next slide. our next strategy to reduce the covid subsidy to reduce the general fund costs that we have and more significantly for us is leveraging that income related to the city option

program. as commissioners know, we made a move to shift about million city option funds on to the city treasury, these are available to people but now in the treasury as well as improved interest rates, we're generating sufficient interest to basically use it to offset the general fund costs that we have for the contracts which is 10 million. so we can achieve 10 million in the budget year and 10 million on going so that's how we get the 10 million in the first year, is mush the two years together. i know commissioner greene had a question on the interest rates remaining quite consistent over the course of

that and any unspent interest dollars will be rolled over should there be a year with a shortfall, we can help cover some of the shortfall moving forward. and of course if the interest is not sufficient, we will work with the mayor and controllers office to determine how best to support the contracts. this will not impact anything in terms of the services that we have available. secondly, with some additional news from the state, we're looking to support about 1.5 shift 1.5 million of general fund saving of general fund contracts to the, to the mental health services act. this is what we call the millionaire's tax and i know there is a request regarding what the difference between mental health service sxz prop c funding, they're both revenue streams. proposition c is a local tax

businesses over 50 million that generates behavior for health services, for people experiencing homelessness. separately mental health services act is a state tax, millionaire tax because it's a 1% on people making over a million dollars and the state dollars are put into the state mental services contact and allocated. there are different categories beinger as prescribed by the state but it's really to expand mental health services for all and it includes prevention and infrastructure dollars. and then we're looking at 4.5 million of potential new revenue that we're hoping we can allocate some of the existing costs to. we have applied to the program

and still awaiting some final approval but we're hopeful that that will come and we'll have to reevaluate our proposal, should those dollars not materialize. next slide please. next we're proposing to realign. some commissioners will remember we've done a similar trip a few years that began realigning the contracts to reflect what we reflect as commissioners have seen in our prior year financial year-end, there is a little bit of unspent dollars at year-end. that will not result in any changes to existing contracts, it's just to where we end start where we end up. we're going to recognize the saving up front to try to get

our budget to be as realistic and accurate as possible. so we have 3.5 on going behavioral health services, one million the first year, dropping to 500,000 in the second year for population health. and then i know that eric and our cio has identified some contracts for that to be eliminated entirely. but again, no impact to any services and not to my community base organizations. next slide please. and then, in addition we're looking to generate some, wee allocated, this is about within the department. and i will have to reiterate that it will not result in

layoffs. in addition we're looking to close out projects 9 million and lastly following controller review process, we're looking to release 7.2 million for the refuse lean program. this is a program that, that our environmental health team manages and we have a report that should somebody may not pay their refuse bill, we would pay the bill on the property owners behalf to ensure that the scavenger services get compensated and then we would put a lien on the property so the property cannot be transferred until the debt is paid. in addition to the cost of the

bill itself, there are dollars that are recovered for dph services as well as access or recorder who has to manage all the liens as they look at the city properties and transfers. so working with the controllers office, they believe that 7.2 million can be realized for general fund savings one time. so next slide please. that concludes the proposal. so with your approval we would like to submit this plan to the mayor's office. we continue to work with the mayor's office as our proposal does not meet the target. it's unclear whether or not we'll need sufficient, whether or not this will be sufficient but we're hopeful that we've gotten pretty close in over two weeks. and again, we will also

continue to refine the proposals and note that there will be some adjustments, i don't think there is any material but if there are adjustments we will bring them back to the commission. so, so, assuming the mayor's office will consider all of these proposals across the city and then she would submit a balance budget on june 1, and then we will go to board and budget hearings in june and july of this summer. sad, this completes my presentations and i'm happy to answer any questions. >> thank you so much for dis stilling this complex prenltation in such a clear presentation. as you always do. are there any people on the lines? >> we're on line 3, if you

wish to make a comment. >> are there any commissioner comments? commissioner gerardo on all the program for the services are prop c, and general fund, general fund was a big chunk of it as well as, as the prop c funds. and in light of all of this is there a concern? how it would affect us is possible rejuggling within within those programs? or are they going to try to make since it is a priority or

public health priority. if you have any incling. >> i cannot speak for the mayor's but one of the services two people experiencing homelessness. as a priority area, i think and i believe it still remains so. from what i can see at this point, there is a way to get through the two-year budget without any impacts. so it will give us some time to give us long term planning. so i'm hopeful but it's, i think it's policy matter for the mayor and the board but at this point, i do not see any indication.

i think it's a more of a bigger question of just looking at the long term impact and understanding what the balancing would like. i'll be sure to bring back any information regarding any changes to prop c and other programs. >> within that, are we going to access any of the opioid funding that is coming, you know, any of the funding that is coming from various lawsuits and would that possibly be part of, that you would be able to distribute within various programs? >> i think our city attorney has been valuable, there is a still a lot in terms of the detail.

it is one-time money that we expect over the years. each has slightly different requirements associated with something that we're aware of and we'll work with the mayor's office and city attorney on in terms of allocation and spending plan. >> thank you. are there any other commissioner questions or comments? in that occasion, we can ask for a motion to approve. >> so moved. >> second. >> all in favor? >> aye. >> aye. >> i want to particularly thank you and your team because how you managed to do this in two weeks is nothing short of remarkable and jenny and louie and louie gibbs and james alexander, i know you worked very hard and many hours to produce this result which is no small feat. and i know you presented to the

community and it's reassuring to try to support us in any way that we can given the city issues that we all face. and no services are being cut and no layoffs are occuring is really a testament to the taught and creativity that you put into this situation. so we're really grateful. thank you so much. >> thank you, commissioner. it's been an exciting two weeks. i cannot be more proud of the finance team but also of the program staff because we didn't do this in a box on our own. i know there is a lot of going on in the department and it was really a collaborative effort. thank you for your comments. >> we really appreciate it. >> i would like to thank you too for your presentation and also for the memo that you write always, that explains your presentation. you would be a wonderful college teacher in how you

present this very very clearly and factually. i really appreciate it and thank you. >> thank you, my mother would have been proud to hear you say that. >> thank you. >> the next item for discussion is laguna honda hospital and rehabilitation center closure plan and cms, recertification update. >> and the microphone is acting strange, try to be as close as you can on the top side. thank you. >> thank you, good afternoon commissioners. i'm roland pickens the interim chief executive hospital at laguna honda hospital and the director of the san francisco health network. it's my pleasure to provide you with an update on the status of laguna hospital and its

recertification efforts. okay. next slide. as we are aware. in april of 2022, the federal medicare and medicaid terminated laguna's honda medicaid participation program for skilled nursing facility care. since that time, we continued to work hard to meet the requirement and make rapid improvement to prepare for recertification. next slide. you will recall on november 10, 2022, the county and city of of

san francisco signed an agreement with cms, because it focused on trying to identify both source of deficiency that may have contributed to the decertification of honda. you may recall cms will continue to pay for care at laguna until november of 2023. and unthat graoerjts cms agreed to pause the transfers and it's important to define the difference between a discharge and a transfer. a discharge is a a relocation away from laguna honda to a community base home. where a transfer is the transfer to the same level of skilled nursing facilities. so those are two separate

categories and distinctions. you'll also recall that on february first of 2023, cms agreed to continue that pause to at least until may 19 of this year. in the initial pause february second pause, both included a pause in both discharges and transfers. however recently we have been instructed to move forward and rezoom discharge of that smaller sub set of laguna honda residents. we're currently at a census of about 530 residents at laguna and there are approximately 40

to 45 residents who fall into that category of no longer meeting the required skilled nursing, cleaning they qualify for discharge to a community destination. next slide. cms a required to require a monitor, you recall that we had a first survey that lasted through december 18th. --16th. we then had our second survey in march. and we are anticipating a third survey sometime at the end of may to early june based upon

the current schedule. next slide. as we previously mentioned that they required that expert conduct a root cause analysis looking at the previous surveys done by regulators over the past two years that root cause analysis resulted in the creation of action plan of quality improvement expert. you'll recall that root call annal identified 11 key areas of deficit and resulted in 456 milestones that had to be met and completed by may 13th of this year and in order to

successfully complete the terms of settlement agreement. we are now using that rca and the action plan and filed stone as our past and road map towards recertification. next slide. as part of this process in the settlement agreement with the root cause and action plan, next month the expert is required to report our progress to cms and they do that by various creation and dis sim nation of a monthly que status report on laguna honda. we're pleased to report that every month they have been able to report the laguna honda has met 100% all the mild stones that were there for that crept

i have action plan. and if you're wondering for the month of april, which is the last month of mild stones there are 120 mild stones that must be met and have to be, and thes only laguna saying, the quality improvement has to validate. so we submit data, interviews and onsite observations all of that goes into the process that the cms quality improvement use to see validate our completion of these mild stones. next slide. this represents a visualization that we've been under. where the top refers to the survey readiness activities, the 90-day monitor surveys and

the processes that go along with that in terms of subsequent many root cause analysis from any of those monitoring surveys. and then updates to the mild stones. so for example, in the first monitoring survey after that initial rca there were additional mild stones that were added. and that will be the same as many are being added. next slide. so again that settlement agreement had many many different requirements mostly in the part of the city dph and laguna honda. one of the on going pauses is that there must be the creation

of a closure plan. as you recall going back almost a year when the city originally proposed its closure plan to cms we estimated that it would take up to 18 months if we were forced to discharge and/or transfer all the almost 700 residents and remember we're down to 530 now. you recall that that plan was reject asked the one accepted was to transfer patients within a four-month rather than a 18-month period. we didn't know what happened after that. there were initial discharges and then the settlement agreement was reached. having said that, the settlement agreement still requires that we have a closure plan. our goal is that that closure plan is an item that sits on a

desk and never has to be implemented, it spells out if there were referrals, and discharges or transfers that that closure plan would governor those. i want to give you an update since i was last before you last month. and i'm going to give you a pretty detailed chronicle event to respond to some questions that came our way before the meeting. as i said today that the pause and referrals to other skilled nursing facilities, that pause continues, while we have just been constructed to rezoom the discharge process for those 40 to 45 patients.

the vas majority are still covered by the pause. in terms of the closure plan, laguna honda recently met with our federal regulators on april 13th to receive the feedback of their feedback from our february second sub rition of our revised closure plan. you recall that we submitted the plan before february 2nd. at that meeting last thursday on the 13th they shared with us which component of our revised plan they were prepared to accept or not and they offered additional feedback and compromised position. then on yesterday, monday april

17th, the regulators sent laguna honda back a revised closure plan incorporating the discussions we had last thursday. and this morning, we have returned them our final set up for their review and approval and they have indicated that we can expect their response as close to business today. so we may have a completed and approved closure plan by the end of the day but again that remains to be in the hands of cdph and cms in terms of their approval but wanted to give you that update. next slide. also wanted give you an update on current operations in lag no.

we're experiencing a surge in covid-19, as of this morning, we have 52 residents covid positive. i can tell you about two weeks ago, we were down to 3 residents that were covid positive. so as you can imagine, we are alarmed. you know that ever since the ging of the pandemic have identified a covid unit so when we have one or more laguna resident, we remove them from their normal unit so they're not able to transmit and move them to the designated unit. that unit is our unit that has the xas ilt for 50 residents. so currently at 52 residents, we had a open a covid overflow. so we're not doing an entire

neighborhood of 50, just one household on one of the other neighborhoods. and each household has capacity for 15. so we have our regular covid unit that is open. so per the unit and the cdc actually worked with us on drafting that plan in the early days of the pandemic, it's continued to be refined by various experts. so we're taking our additional mitigating efforts that include mandatory testing of all staff who work on any neighborhood that has a covid positive resident. that is mandated for staff. in addition, we're requiring

that residents on any unit where there is a case that has been a case of positive, that residents wear a mask to decrease the spread. we are also encouraging that any invitation happen out doors. and for a positive case of covid we're now temporary no communal eating in the residents, residents will have to eat in their rooms until the surge goes away. and we've done enhanced cleaning in areas that have had cohave i cases. next slide.

so that concludes most of my presentation but there are other highlights that i just wanted to share with the commission. so as part of our priority, which has been the last year. one of the one of the mechanisms that we're using is to expedite the staff. i'm the interim but weeks ago, we brought on board a search firm to actually assist with the recruitment of what i call the big 5, it's the top 5 positions. it's the nursing home administrator which is equivalent to the ceo. it's the director of nursing equivalent to the nursing officer.

it's the medical director achieve to federal officer and then two assistant home administrators. and you'll recall in our previous report to the commission, that one of the significant and primary learn that'sing we've had by work withing the cms quality improvement expert, we needed to restructure of laguna to be that of a more skilled nursing facility. that's one of the reasons that we changed the job title. i'm the interim ceo but as we bring in the new one, that will be the home administrator. the use of our terms, ceo chief nursing officer, those are more typically found in acute care hospital settings.

so we're just showing how to better respond to nursing cam mrie ans. an update on the timeline we posted that administration position in february. have had over 30 applicants and happy to say that we'll be conducting the first round of interviews this thursday april 19th. with then a second round that will come quickly on the heels of that and the target depending on the quality of the applicant and the ability to move through the second round. the and for the director the director director of and then

an offer to extend the week or after. we've not had many direct as we've had for the nursing administrator. so the recruiting firm is then the next focus will be on those two assistant nursing home administrator and then the medical director position. and so those are, the highlights i want today bring forward and i'm happy to try and answer any additional questions that you may have at the appropriate time. >> thank you so much for these update. are there any public comments. >> yes, we have two in the room and then we have three hands up.

i want to remind the folks that we have several categories of remote public comment. only those hands, sorry only those folks who received accommodation that have their hand up. i see four raised hands, only two received accommodation. so if you have not received accommodation, put your hand down and you can go after. when my buzzard goes off, i'll say time finish your statement and know that your time is up. >> caller: thank you, i hope you can hear me. it seems like it was going in and out. okay, yes and unfortunately, i didn't hear all of the dr. pick ens comments. so some of my comments today,

might be irrelevant so i apologize for that. can you hear me? >> yes. >> caller: my name is melody and i'm the president of the older women's league. and the older women's league advocate for older women especially those who have no one else to advocate for them and express their concerns and their needs. so as you know there is a good percentage of the patients of laguna honda who are women and we're concerned about their welfare. if there will be transfers, will they have an opportunity to have unpit? will they be transferred to places where it's difficult for

their families to visit them? and you know, there has been some deaths concerning the transfers. so we want to make sure that they're going to a safer place and to a better place, it does not make sense if there are all of these concerns about laguna honda if they should have demerits and who also have problems and nursing homes do have problems. but i think just transferring people on us is not the solution. and one of the other things i want to ask about, i'm not sure

if it's relevant anymore and the issue of waiver and reduction of beds. sometimes i feel that we're out here clammering for information, clammering to hear what is going on. i know that there has been some movement asking for waivers, i would like to see more clammering on your part that you're also working very hard to ensure that women are safe and have a home where they can feel comfortable and valued and treated with dignity. i feel that in san francisco that solutions come slowly and it takes time to solve these problems. >> time.

>> caller: but our deadlines come fast and furious. again, we would like to have more clarification and more information. thank you. >> thank you, the next comment is ken tray. >> and again let me know if you need time with the microphone. caller: i was a teacher for many years. they chose me as a chair. but i returned to an education meeting, we're very concerned about the status of laguna honda, we think it's an

essential city service. we are, we are it's dis heartening to hear the efforts that they're making to meet the threat of closure. but at least from our perspective, that closure threat is still very real. we had a presentation on laguna honda at our last retirement meeting. we need to do everything we can to help keep laguna honda open. that's why i have to say, on a personal note many years ago, when i first started teaching, i had students doing community service project. and one of the locals of the community honda. and what the students

experienced was a high affirming one, they met high quality staff and nursing and reported back that the patients were well cared for. we hope that that institution survives and the retired educators were prepared to do everything that we can to help that happen. so thank you. >> thank you. >> all right, i see two hans up. please speak your code that i've given to. >> caller: yes, patrick. >> would you like me to share that slide? >> caller: if you would, please, go ahead. >> yes, i will not take your time until it's up. >> caller: let me know when i should start. >> your time begins now. >> caller: thank you. it's unfortunate that we're now past one-year anniversary of the hospital being decertified.

and i want to remind mr. prickens is not a doctor. slide ten of this presentation, does not display and he didn't mention that the two ei port on the 10th day noted completion on each of those three months. and the deliverables in the action plan. which is dis heartening because as you can see in the chart, 117 deliverables, 34.8 percent of the first 336 mild stones

required revisions to the deliverables. not known how many were meeting 118 mild stones scheduled for completion in april will also require deliverables relessons. there are reasons that they include one mitigation plan to timelines are not created didn'ted match the implement and action plan. including all program and three end of life care plan are not being corrected. other factors include data analysis, five black clarity

and details in the deliverables, 6, general inattention to detail. 7, information provided for what was requested. for example, his plan was prevented instead of a feasibility study. information provided was not identified in the mild stone. when the audits for january and 9, other influences analogies including the analysis for that program which is that rehabs of the 3-year-old power point presentation. created by an unnamed laguna honda staff member. thank you. >> thank you, please unmute the next caller.

>> caller: hi, can you hear me? >> yes, dr. palmer go ahead. >> caller: hi, it's dr. palmer ww, i want to know in the discussion with the 13th if there was any inside into the need for extension on the moratorium on evictions? because this is certainly going to take time. the stop that we saw from april 109ing, we saw that there is some basic problems at the nursing home. and one of them, you just don't have enough one on one staff to take care of behaviorals residents. and if log na continues to

admit acutely difficult residents and does not have the staff to take care of them, this will continue in jeopardy and jeopardize those patients and the staff the rights of everyone around them. and the is there any sign that san francisco general is being realistic about what laguna honda, who laguna honda can take care of safely without compromising residents rights and the basic mission of a nursing home. the other thing that worries me, are you finding safe and local inappropriate placements for those that don't meet eligibility requirement?

we do have a person that was discharged last time. and are we see more to unstable environment that do not offer the support even if eligible, they hay not very fridge i will. whether it's a transfer or discharge, it's an eviction and it's dangerous. it does have transfer trauma. we need to know as soon as as you know, what the revised closure plan is. and if there will be an extension on the moratorium. this could just, such tragedy is possible, it's very worrisome, thank you. >> thank you. all right, it's time for others

that would like to make remote public comment who have not received accommodation from me. i see two hands, james please unmute the first. >> caller: yes, hello commissioner i'm a long time residents with san francisco. and a member of the great panthers. it was announced at the april 11, 2023lhhjcc that on april 13th, laguna honda chiefs will meet with the state and federal regulators to discuss the lhh revised closure plan which is not accepted by the higher ups. we need an update on this. how will they find safe local and appropriate placements for those who do not meet eligibility requirement for on going long term care at lhh.

how will the residents have a say on what is the best way for them to be honored. given this x-ray, the public has a right for detailed information and how any discharges will be prishd in a a way that honors the safety and cares of the residents. to prevent death and violation of residents rights is cms, ceth admitting to the need of may 19th date for evictions? thank you very much. >> great, thank you. james please unmute the last caller. >> caller: thank you, this is my marshal lion also with the gray panthers. we're suppose to be pulling together in order to move out of the danger.

but lack of transparency. are being negotiated, we don't know what. turns.

they have four lives for a waiver for the 120 beds that are in danger. losing those 120 beds would be a disaster considering how few beds there are in san francisco. so we have good reason to be kept cal about the day that you've been working in secret. your performance has not been stellar concerning transfers. so i demand that there be no closure, no evictions, no budget and no start resuming admissions. thank you.

>> thank you, commissioners that was the last call. >> thank you, we're grateful for those who expressed the same concerns that we have. thank you, you were very eloquent. are there any commissioners questions or comments? commissioner ger ard o. >> i just wanted to ask the community, were you given the timeline for a dischargers? --discharges? >> yes. so we will go through our normal process that includes an assessment a very thorough assessment by the team that includes physician and nurse and social worker and all of that. and we've been, we are also working with community

placement either organizations or programs for those individuals who are not daemd ready to go to home. so be it, most of them are board and care either residents for care who care for the elderly. a couple of may need like a behavioral health program to go to you know, as a license hospital in california we're still governed by all the title 22 requirements for safe discharge and also by the state operations manual for medicaid which has a defined process for discharges and transfers that include the right for residents to appeal any transfers. so we'll be going through all of those required steps. >> as you're going through this, will this it's a long

process. yeah. does it affect the recertification? or the view of the recertification. >> i can share that cm a has made it clear that they expect us to move as quickly as possible. and that's certification all the time that everything we will do should be done both effectively safely and expeditiously. when you think about it, when we are accepting admissions, you don't want to have somebody sitting in the skilled nursing bed who does not meet that level of care. at the same time, you want to make sure that there are places in the community where they can transition to. so, it is, it is the regulators

desire that we move as quickly as possible. however, we're not going to do anything that puts somebody's safety and health at jeopardy. we're going to see the refined learnings incorporating appropriate trauma transfer and discharge assessment to the whole process. >> i hope there is understanding of the process that we are going through, that's all. i guess that's my concern. >> yeah, i understand. >> i know it's yours but i just want to express that concern. >> thank you. >> thank you mr. pickens for being here today and i apologize for not knowing the rules that you're operating under when it comes to these discharges.

you mentioned sending two places in the community. i assume that there is no place in the community. is there a consideration is there an act of consideration of the person who is being transferred, whether they have family or friends close people, close contacts that can be near them? can you tell me how that works? >> absolutely, that's part of the assessment process. so the assessment not only involves the care givers and physician team and therapist and social workers but also involves the resident and/or their family members or surrogate decision makers. so it's not all, on the institution part of this assessment process requires the input of the residents and

their surrogate decision, which is why then, even when we are able to find a potential placement, residents have the option to file a, not grievance, appeal for that discharge. and the state operation manual says the state should adjudicate within 90 days. so already that's a 3-month process. having said that, one of the reasons the individuals are in those 40 to 45 individuals, it's important to understand that when they came to laguna, they met criteria for skilled nursing. so over the course, their the

conditions has approved that they no longer meet the skilled nursing requirements. however laguna was not able to discharge the individuals because there were not places identified. so what we're doing differently is part of this recertification through the efforts of dr. coaltax, the mayor and all the city department heads, the department of housing, house homelessness and supportive housing. they are all at the table at laguna working with us to actively find, spots for the individuals to go to. that's a level of engagement that has not historically been there. so one would that i when all of these resources even though it's still going to be

difficult because there are just, are, you know, not probably enough community base resources but at least we have more members on the team and people with the resources to access some of those programs to help us in that process. >> if i were a person in that circumstance but needed to be transferred to another place and i didn't have any family, i didn't have any identified proxy for healthcare or anything else, but i told the institution, i told whoever i was my case manager that i had a friend sylvia chung that lives at a place, will the hospital be required to contact the person i named? or would it be my responsibility to drag ms. chung into the facility.

>> no the hospital would do that. that's a regular part of the process. if a resident gives permission for that individual to be part of the process, the team would include them. you want to participate in the process that will potentially have a solution. and if we have the state am bus person, they're some that go meet with the residents on a daily basis. : >> i have one more question, and this might put you in a difficult position, but if i were a person or the people in the community who want to do

everything they can to support maintenance of individuals at laguna honda to avoid closure how can people who are not part of this system have an impact that cms makes? >> that's a good que, i would say so far we've seen that local advocacy, i think has been helpful in the process and i encourage people to use whatever mechanism to help support us in our quest to keep laguna honda open so that we can begin to accept new admissions. i would say probably advocacy is probably the best mechanism that individuals can have. >> elected at the national state and local level? >> i think so.

i would give that more thought if i have ideas. >> that would be helpful, thank you. i know you have difficult difficult work and i appreciate and i know i'm not the only one that appreciates your efforts and sincerity to your dedication to resolving the issues that we face. >> thank you. >> any other commissioner questions or comments? i have one or two and i want to associate myself with mr. christerson comments we're so grateful for the work that you've done, from the mayor to the citizens to everyone who works at laguna has worked so hard to come together to make sure that recertification is realized.

you look at the various elements and you may not be able to answer this. the mild stones that you've accomplished where we're all appreciative of. if we do begin appropriate discharges, how will those elements if any affect the recertification. do you think there are parameters, is there anything? we cannot be perfect in any way. but if we meet all the mild stones, does that give you comfort, will they even look at the way that discharges are done. and then the second one, you may not be able to answer this either, as you look at this, were there any lessons learned

that obviously cms is aware of from the last effort? that might public incorporated, for example you said the four months was way too fast and 14 months was far more appropriate. do you have any sensor temperature read on that? >> all right, i'll start with the first question. we're being judged on everything that we do it, be it accomplishments and mild stones and now moving forward with this community base discharges. having said that, we maintained from the beginning that any processes that have our attention are to the destriment. so to that extent, it gives one other one of the challenges to

show us the, and now begin to not begin but to reinvigorate the process for these individuals. what cms is looking for is our ability to number one comply with their rules. and the rule is, if you have something in the skilled facility, you should be doing what you can to place them in a appropriate level. that's one of our requirement. so we see this while it diverts from the resources. it is still part of regulatory compliance. in terms of your second

question which was remind me? >> whether there is anything -- ~>> oh, learnings, there were learnings from the first closure plan. similar to commissioner gerardo question, does not put time lines, x number must be moved by x date. if anything that was a learning the first time around. so there are no guard rails in terms of the guideline. and i think we also learned how we can do an even better job of making sure that we're doubling our efforts on our assessments making sure that we have matched them for discharge destinations.

it takes more involvement on the part particularly of cdph in the process. and if the closure plan that we have presented is approved hopefully by the end of day hopefully that also the disclosure plan. there is progress in that respect. >> thank you. >> well thank you so much for the presentation and it's so clear that everybody is approaching with such compassion and care. and please extend our thanks to those working overtime to get recertification accomplished, we're really impressed by all the efforts being made and encouraged by administrator interview who seem to be moving on a time line than i thought

they would. and also the progress you've made, thank you. >> thank you. >> i just want to reenforce and thank mr. pickens and his team for his work. and also that we remain laser focused in getting laguna honda recertified. and with regard to ensuring that laguna honda not only become recertified but it becomes a exemplar of wla a facility is, not just for san francisco but the rest of the country. as you can see, we met hundreds of our milestones for the last three months, the fact that we have reduced our survey findings from the first to second survey, we expect another 90 day survey in the future. and we are sticking to the

facts that we're showing remarkable improvements. and again the laser focus of the team will remain on recertification and making sure that the honda level at the department level and across the city, that we're all moving in the right direction along with the advocates to ensure that we meet that goal of recertification. >> thank you for adding that important information. so the next item on the agenda is consent calendar. and the item is repressed for approval of series policies that are being recommended to you by laguna honda of april 11, 2023. is there any public comment on this item? >> folks, again we are on item 5 the consent calendar. i see one hand but if you like to make comment and you

received accommodation for disability, you can press star-3 right now. james please unmute the caller with hand up. >> caller: thank you again, commissioners. as you know i've been lying about the power presentation. and my remarks today today include the reminder that still nursing policy. has still not been brought buff for approving. to obtain, excuse me, the name of the organization that awarded laguna honda an award

for its previous nursing program where it was sort of care level roman numeral one. i believe the award was more than likely given to the rehab services department. not the nursing department and i'm trying to obtain records on what year that was awarded and who awarded it and which department at laguna honda. i want to remind you at my remarks that i made earlier today it sounds as if some of the deliverables were required by the action plan. and sloppy gap analysis studies

that two ie had found problematic in the required revisions. i have to wonder if the restore tiff care nursing gap analysis was one of those affective from deliverables based on the fact that it was a rehashed presentation prepared way back in 2018 when they were begging for funding for the restoretive program in the nursing department. you really need to schedule separate agenda item at the james feed about what the delays are in implementing that program and making it sure that is based, after all i retired a

long list of three in the rehab services department to help implement the restorive care level program in response to poj in 1988. >> thank you. that's the only hand for that item. >> all right, in that case if there are no commission ebbser questions or policies is there a motion to approve. >> i so move to approve. >> second? >> second. >> all in favor. >> aye. >> aye. >> okay, the consent calendar passes. and the next item is approval of minutes of health commission meeting of april 4, 2023 and i believe there were a few correction that's were posted online. secretary do you want to review those. >> i'll be requick. a member of the public asked me to correct a few things on her item. so on paimg 2 in red additional

language. and then i also inadvertently left out two written public comment requests so i've included those. other than that, the minutes are the same. >> thank you, are there any corrections of the minutes? okay, baring none, is there a motion to approve the minutes. >> yes. >> and before you vote, there is a public comment. i saw a hand pop up. james unmute the caller. >> caller: sanchez again, i want to offer my apologies at the beginning of the meeting instead of the public comment, i had intended to make, i mistakenly read my written comments for these meeting minutes. so i when i submit my written

testimony in today's meeting it will be straightened out. i had intended to says during public comment that i will believe the health commission needs to revisit the update to 7-year-old flaming san francisco posted report conducted in 2016 which is what mr. pickens had referenced last week at the jcc when he indicated the 700 bed shortage. based on projected demand of skilled nurses. but in fact, the closer to two-care challenge had imitated that there was going to be at

least--not 700 beds. and nursing gap has gone down from what had been reported way back in 2016. had widened that increases. and if the 120 webs at laguna honda are lost, we will have 1058 bed shortage not 700. so i strongly urge the health

commission to have, planning and policy toga back and revisit the 2016 study and update it because we are in more of a hot mess of lack of skilled nursing beds. that we discussed from the department about the severity of the discharges. >> thank you, commissioners that's the only call. >> so we'll transpose the comments in the next minutes. so i believe we have a motion and the second to approve the minutes, all in favor. >> aye. >> aye. >> perfect, thank you. next item is director's report, director:fax.

>> hi, thank you chair green, commissioner green. for giving me time to provide the director's report. the first item is an item that is not written but shortly before the end of this meeting, i was delighted to attend as a full board of supervisors meeting where our behavioral health director, dr. hillary kunings was recognized for her leadership through accommodation that was read by supervisor ronen and verbally also supported by president peskin and i wanted to celebrate that and the fact that her leadership was recognized by the board and it was a great event. and perhaps, we will be able, i think what i would ask the board to do is share a link so

in the next report so that the commission can avail themselves of seeing that recognition. so in other news, they announced the opening of new 70 bed in pressure island. the it helps significant progress to provide new healthcare and substance use challenges. part to ensure treatment. over the past two years, dph has opened 250 residential care and treatment beds.

next item, we laufrmd a hospital to combat the opioid epidemic. as part of the city's effort to reduce opioid overdoses. helps reduce opioid and along with methadone is the most affective treatment for opioid, reducing the risk of overdosing fatalities by up to 50%. under this new initiative will administration prior to taking individuals to a hospital, expanding patients to experiencing opioid withdrawals. the program started on april first. importantly, this effort builds on the dph work through a range of program and services.

this includes hospitals, pharmacy and shelter and navigation centers. also celebrating the earth day, for april 22. by answering calls to environmental action and raising awareness of importance of protecting our natural resources. earth day is a way to keep san francisco safe and there are a lot of details that the environment does in relation ship to keeping our environment safe with operating more than 30 programs covering land, air water and schools and businesses.

next registered nursing career fair at csg hospital for perspective rns to learn about the nursing opportunities through dph. and through three sessions we welcomed 100 team members to meet with leadership team. and by every measure this event was a great success and it points out to the pact that our team in human resources is working hard to build out. including the launching. next is the team launching modules, ensuring that our focus tra taoej i can priorities and investments are

consistently following lean methodology to make sure that we're being as efficient as possible. the office, launched the lean foundation serious. and this is four-50 minute modules. and at the end of the modules, people can go to sf learn to go download their certificate of completion. and i think it's really important that we make lean principles and training accessible to people in 50-minute modules. i serve how would you this is a

big thing to bite off. to implement lean and making it into smaller parts that overtime will continue to lean across the department. 40 people are hospitalized including 8 in the icu. the commissioners may have noted that as of today, the fda approved the booster for people 65 and over. so i, whether booster for those populations to make sure that

we get message out and people know where to go to get this additional booster shot. that is my update, i'm happy to take any questions. >> i think that was one of the most positive director's report we've had in a long time. and i recall how thrilled you were when you recruited dr. crunis to this department and it's great that her work is being recognized. thank you for letting us know that and all of this wonderful news about the mental health beds and the bridge that we have to substance disorder and all the other things that you brought up including the job fair. is there any public comment on these item? >> yes, there are two hands.

and james, can you use yours first that person is received an accommodation. >> caller: thank you, it's hhh aka patrick. the outbreak at laguna honda. 52 cases out of a room 520 residents is just shocking 10% outbreak. sounds like that will have recertification over control at laguna honda which is a major concern to tms.

as far as dr. remarks, unfortunately she did not address waiver or request now to preserve the 120 beds at laguna honda which makes a critical component of the current bed capacity in san francisco, will only worsen if reduce the 120 beds. commissioner green was mistakenly which is totally

unnecessary given the fact that shows that they request in writing that having three patients per room will not adversely affect the residents health and safety. you need to signal now that you fully intend to keep the 120 beds and if it's so bad hearing you saying over and over, you're doing everything you can when in fact, you're not doing everything you can because you have not committed the waiver request yet.

this is getting more and more ridiculous, please. >> next caller please. >> good evening, i'm alan chow, i spoke earlier today. health commissioners, help other susan philip, human resources you're not working for the people. dph and many agency have collected data and many of those data negative because baz of covid-19 that is a lie that creates fear in media forcing mandate to keep jobs.

all those to work for city government will cost a lot of money. shoes an philip, none of you he lektd into the office, who gave the authority to enforce public illegally to work and school. healthy people don't need covid vaccine. now we see more and more people are dying because they're vaccinated. i'm here today to ask you each run of you, susan philip and the health commissioners to

have a heart for unvaccinated workers who are fire by the mayor and the lawless people that i named today to end the unconstitutional vaccination law. work appropriately with many of the departments who fire the workers. we had people to fire bit job in san francisco that is include police and i am public', publicly end your mandate back to work. may god bless each of you and give you a heart to have feelings to help workers who

were fired because they believe in healthcare choose. may god return to san francisco and end the one world parliament. >> your time is up. >> caller: in san francisco. >> that is the only hand for the item. >> okay, there are there any commissioner questions. commissioner g*erardo. >> are we have any information on the omicron variant? do i tell my staff to put their safety glasses back ob?

--on. >> the information that we is is likely to be more contagious than a prior variant because of additional mutation on the spike protein. there is an increase in conjunctivitis, it does not appear, this is all in from what we're learning right now. conjunctivitis, but there is not as much warning of dying from covid relations. there is, the best way to protect against the consequences from the virus are the standards methods that we

have with people including and especially getting up-to-date with your vaccines. dr. philip is on the line and i differ to you if you have any additional comments or updates for the question. >> thank you, dr. coalfax and commissioners. i think dr. whole fax covered it. rell come back to the commission and public if there are any questions to our recommendation regarding this new variant and any others that arrived. >> thank you. so the next is committee reports and i guess i'll start with the committee meeting of

april 11 from laguna honda. commissioner guillermo is out of town so i'll give the update. we received recertification update and of course reviewed and updated the hospital policies that were approved on today's calendar. there was an extensive fiscal year reports that were 18 assessment categories that included resident population, services provided and care needs and most common diagnosis, training and competencies and. we also reviewed the finance report, hiring and vacancy report and regulatory report and in closed session, we approved the report and the minutes report as we always do.

may i get a public comment. >> caller: thank you for your patience today. the report was pretty scary. during the leading, mr. pickens said quote, we're doing everything to prod the process. room capacity filled nursing facility.

others in california have in fact, received favors some allowing for person and 6th person occupancy. whether they can be reinstated if demand is needed. do we have to apply for a saver. the 120 beds are needed during my testimony today. study of course challenge those

never needed commissioner green. pickens didn't answer her. green and pickens if you're looking for a person who is unnecessary given 42cfr program, number of patients per room when authorities requested riding an exception that will not adverse reof residents health and safety. you need to demonstrate that you're serious about wanting to keep those beds and not make

those beds a condition of obtaining recertification. >> your time is up. thank you. all right, james please unmute teresa palmer. >> caller: can you hear me? >> yes, please turn off your computer because it's reburb rating. >> caller: okay, i'm so concerned about the 120 beds.

it may be that there is something that you're not telling us but when dr. asked us about having a state-of-the-art facility he didn't mention keeping the 100 beds. if we're wrong about waiting on you to write the waiver letter, tell us. i wonder if they're showing any inside about the complexity of the acutely behaviorly and substance abusing patients that have been transferred to laguna honda.

making sure nobody comes to harm. thank you. >> those are the only two comments. >> right, any commissioners questions or comments on that report? okay, so the other report we is is from the community that met today. commissioner gerardo. >> thank you, we had two presentations, the first waun the annual report and in 20 2* 1-22, it features the covid response behavioral health residential treatment expansion particularly minna. and office and also the office of health equity and human resources in the the report

also highlights in the 2022 program over the preservice or person integrated care. there are data resource at the end of the report was expense. and we did ask for all the different that the number of people are consistent across the report. the second was a result of senate bill 1,000, and it is unheard of collaboration among many departments in the city.

and what the framework is really looking as many departments come together for environmental justice and to guide the tragedies going forward. it's about policies in the general plan to address health risks. they state the areas of focus which is in the packet but i'll briefly comment. physical activity and public facility, healthy food access, safe and healthy and affordable homes, equitable and green jobs and empowered neighborhoods.

and within that, mental health should be included that in fact, the brain and body connection is there and we don't want just to focus on the body but also the mental health and the group understand the importance of the integration. they also showed us the map of sensitive areas of risk in the in the city, and all in our asked for outcome data, it's one of the phases going forward but it's not in the initial plan. that's the environmental justice framework, i thought it was really good and it was

quite interactive as well. >> that is incredible, this is a incredible work that they've done. >> and we do have a public comment, mr. shaw wants to comment on everything we say. we can give him his three minutes. >> caller: thank you for recognizing i was on the line. a meeting held today because it was not uplifted in the agenda, so mr. morewits should have cut information if the public was not aware of it.

that have been created for behavioral health patients, what it set down and not focused on people with mental rehabilitation needs wla they have long bed for and finally built and part of trying to care for those patients appropriately you decided to cram them into lag no honda giving them the slow projects which is the original deadly sin that they even recognizing and the two ie didn't actually

address in his rca report that the root cause of the problems of laguna honda is because of the slow project programming mental health patients in the laguna honda when you have the appropriate services and the appropriate for the people who deserve newsinger care through a mental health facility. you need to consider a bond measure to before before them since you wantingly closed the mer. what are you guys doing? former commissioners reported social rehabilitation focus

through cara and cramming the patients. no wonder they deserve for mismanagement of laguna honda. the dr. cleared the cookie crumb trail reading to certification is clear that this commission. >> time is up. >> caller: in doing. >> thank you beinger that's the last comment. >> any commissioners comment on the report? very well, nen the next item is other business. is there any other business? >> you want to comment first. >> yes, i just want to bring up one thing about that community framework is that we're hoping

that they focus on youth they mention that they really lean on the community to lead these this effort but we want to make sure that the voice of youth be invited to be part of the environmental framework. >> it was mentioned, you know, commissioner young brought it up but one of my thing, almost with all of our items that are presented whether it's to the commission or to the the community and public health committee the focus is on adults and we really don't hear a component of children,

adolescents and young adults, if it's possible too, i just think we need to look at the whole age spectrum in that particular age spectrum through the presentation through the report is not really there. even in the report there should be some integration so it's something that may be missing on some of the rentations, it would be really helpful for us to be able to see that. >> thank you, for making that point. and sorry if i didn't see the other comments. >> thank you, i want to join

with commissioners young and jer ard o on that request and add a little bit to it, amplify to what they were pointing out, the focus and lens on the young because we're never going to be able to solve the issues that we have until there is a greater level of health and well being and the earliest ages.

that led tlut integrated and the resources that are directed towards the health problems and issues in our city. >> i'm passionate about obstretics and women health. there is something on the line that would like to speak. >> absolutely. >> please unmute the caller. >> caller: okay, it's johnson again, it is for the members of the public to bring up cop i can for discussion, here i am

again although i'm beating a dead horse. but during, let me add that the whole spectrum, the speaker who said the whole spectrum needs to be looked at. of course it does, doing something to en vert back to its purpose, inappropriate sending mental health patients where they don't get the care that they deserve and laguna health cannot provide.

calling but i mean, the department to go back and update that take another look at including preserving all 120 those for cuts in lag no honda and need to consider the long term care in san francisco. so i'm p going to beat a dead horse on a phone right now but i'm going to go back to the drawing board to finish my written public comment to include in the meeting minutes

of today's meeting, there are other areas about the repair that you folks must must revisit and i want to emphasize, the previous action this commission is taken more or less violating your if i ducing airy duty as governoring body to look at the entire spectrum of, you need to work on developing facilities and going back to the drawing board about your budget, there is no reason that there should be a fuel week at. >> thank you, that's the only caller. >> okay. great, so then we can go to the next item which is consideration of a close

session. >> must have public comment on that. >> we do need to take public comment. >> is there any public comment for item 10? going once, twice? i see no hands, all right. >> all right. >> i'm sorry, a hand just went up. please unmute. caller 3. >> caller: it's samsung again, i'm concerned about the number of days public related lawsuits all three of them are probably

lawsuits against the city, although you display the cases, district court not superior court more difficult to for the public to learn the details of the lawsuits. i vent actually made it to the board of supervisors, we'll see again in wrongful termination of employees. thank you. >> all right, there is one more hand, the next caller please. >> good evening, i'm emily, i spoke twice earlier today. help commissioners, help director cal tax, health order susan philips. human resource right side

against lorena kim. to force people a covid-19, filed by unvaccinated. cdc and fda would never mandate to anybody in the first place. california order ended in april 3, 2023 but san francisco continue to have a vaccine. which is discrimination. today item 10, litigation, cost the city more than $300,000 due to lawsuit filed by workers.

health commissioners, health director grant calfax susan philips, luana kim. who gave you the authority to mandate vaccine for work and school. now we see more and more vaccinated people are dying. in another word, you help the globalization. as of today, the unvaccinated employees still have active lawsuit against you the mayor and health official sxz city leaders lying to the public forcing agenda 21 to one world government, so vaccination. killing our very own people and you against discriminate

christians the catholics and this is illegal, it violate people's constitutional right, religious freedom and medical choice. and now we see more and more people sick and dying because you force vaccination and in this order still in place, shame on you people. you should not be able to go home and sleep what you did is murdered people, 168 christians and catholics being terminateds because they believe in jesus christ, they believe in god, the bible, they believe the body is the temple for the holly spirit. >> thank you. all right, commissioners that's the last comment. so you will all can canr a vote. >> is there a motion to go into closed session. >> so moved. >> second.

>> all in favor. aye. >> and you have a second vote to assert the client attorney privilege. >> can we have a motion. >> so moved. >> second. >> all in favor. >> aye. >> aye. >> aye. >> all right, please members of the public thank you for attending, we will be back but while we're in closed session, you will not see or hear us, give me 30 seconds please to take us over and sfgovtv i'm >> close session. >> i move not to disclose. >> second. >> all in favor. >> aye. >> aye. >> and now consideration for adjournment. >> i move. >> second. >> all in favor. >> aye. >> aye. >> thank you, everyone for directing the meeting. >> we're not quite done yet,

>> he is a real leader that listens and knows how to bring people together. brought this department together like never before. i am so excited to be swearing in the next chief of the san francisco fire department,

ladies and gentlemen, let's welcome, jeanine nicholson. (applause). >> i grew up total tomboy, athlete. i loved a good crisis, a good challenge. i grew up across the street from the fire station. my dad used to take me there to vote. i never saw any female firefighters because there weren't any in the 1970s. i didn't know i could be a fire fighter. when i moved to san francisco in 1990, some things opened up. i saw women doing things they hadn't been doing when i was growing up. one thing was firefighting.

a woman recruited me at the gay-pride parade in 1991. it was a perfect fit. i liked using my brain, body, working as a team, figuring things out, troubleshooting and coming up with different ways to solve a problem. in terms of coming in after another female chief, i don't think anybody says that about men. you are coming in after another man, chief, what is that like. i understand why it is asked. it is unusual to have a woman in this position. i think san francisco is a trailblazer in that way in terms of showing the world what can happen and what other people who may not look like what you think the fire chief should look like how they can be successful. be asked me about being the first lbgq i have an understands

because there are little queer kids that see me. i worked my way up. i came in january of 1994. i built relationships over the years, and i spent 24 years in the field, as we call it. working out of firehouses. the fire department is a family. we live together, eat together, sleep in the same dorm together, go to crazy calls together, dangerous calls and we have to look out for one another. when i was burned in a fire years ago and i felt responsible, i felt awful. i didn't want to talk to any of my civilian friends. they couldn't understand what i was going through. the firefighters knew, they understood. they had been there. it is a different relationship. we have to rely on one another. in terms of me being the chief

of the department, i am really trying to maintain an open relationship with all of our members in the field so myself and my deputy chiefs, one of the priorities i had was for each of us to go around to different fire stations to make sure we hit all within the first three or four months to start a conversation. that hasn't been there for a while. part of the reason that i am getting along well with the field now is because i was there. i worked there. people know me and because i know what we need. i know what they need to be successful. >> i have known jeanine nicholson since we worked together at station 15. i have always held her in the highest regard. since she is the chief she has infused the department with

optimism. she is easy to approach and is concerned with the firefighters and paramedics. i appreciate that she is concerned with the issues relevant to the fire department today. >> there is a retired captain who started the cancer prevention foundation 10 years ago because he had cancer and he noticed fellow firefighters were getting cancer. he started looking into it. in 2012 i was diagnosed with breast canner, and some of my fellow firefighters noticed there are a lot of women in the san francisco fire department, premenopausal in their 40s getting breast cancer. it was a higher rate than the general population. we were working with workers comp to make it flow more easily for our members so they didn't have to worry about the paper

work when they go through chemo. the turnout gear was covered with suit. it was a badge to have that all over your coat and face and helmet. the dirtier you were the harder you worked. that is a cancer causeser. it -- casser. it is not -- cancer causer. there islassic everywhere. we had to reduce our exposure. we washed our gear more often, we didn't take gear where we were eating or sleeping. we started decontaminating ourselves at the fire scene after the fire was out. going back to the fire station and then taking a shower. i have taught, worked on the decontamination policy to be

sure that gets through. it is not if or when. it is who is the next person. it is like a cancer sniper out there. who is going to get it next. one of the things i love about the fire department. it is always a team effort. you are my family. i love the city and department and i love being of service. i vow to work hard -- to work hard to carry out the vision of the san francisco fire department and to move us forward in a positive way. if i were to give a little advice to women and queer kids, find people to support you. keep putting one foot in front of the other and keep trying.

you never know what door is going to open next. you really don't. [cheers and >> this is a meeting of recreation and park commission, please call the roll. >> commissioner buell. >> here. >> grif en. >> here. >> jupiter. >> here. >> commissioner louie. >> here. >> commissioner mizola. >> here. >> this is the park and rec commission meeting, of april 20, 2023, we acknowledge that we occupy the homeland of the ramaytush