>> the health commission meeting, tuesday, may 2, 2023. secretary morewitz, will you call the roll. >> sure. commissioner christian. >> present. >> commissioner guillermo. >> commissioner chung. >> present. >> commissioner giraudo. >> present. >> commissioner chou. >> here. >> commissioner green. >> present. >> today's meeting, i offer the ramaytush land acknowledgement. the san francisco health commission acknowledges that we are on the unceded ancestral homeland of the ramaytush ohlone who are the original inhabitants of the san francisco peninsula. as the indigenous stewards of this land, and in accordance with their traditions, the ramaytush ohlone have never ceded, lost, nor forgotten their responsibilities as the caretakers of this place, as well as for all peoples who reside in their traditional territory. as guests, we recognize

that we benefit from living and working on their traditional homeland. we wish to pay our respects by acknowledging the ancestors, elders, and relatives of the ramaytush ohlone community and by affirming their sovereign rights as first peoples. our first item is a discussion item. laguna honda hospital and rehabilitation hospital closure plan and cms recertification update. i would like to welcome roland pick inns to the microphone. >> speak into the microphone but you don't have to get that close. >> thank you, president bernal. good afternoon, commissioners. it's a pleasure to be with you to provide this update on the status of laguna honda hospital in our recertification efforts.

i'm joined by senior leaders of the hospital who are attending remotely and they are here to support me in the event that there may be questions that i may not be able to answer on my own. they were -- they were there to help back me up. we'll start. next slide. as we have shared before, we all remember back in april of 2022, a little over a year ago, the centers for medicare and medicaid services terminated laguna hospital's participation and the medical provider program. since then, we have and continued to work hard to meet all regulatory requirements and make rapid improvements to prepare for recertification. next slide. as we've discussed here previously,

november 10th of last year, the city and county signed a settlement agreement with cms and the california department of public health. under the terms of that agreement, cms agreed to continue paying for care karat laguna hospital to 2023 and pause discharges to the community and in the voluntary transfers to skilled nursing facilities and i emphasize involuntary because it's important to note and remember that under the terms of this settlement agreement, residents have the right to initiate them receives if they wanted to either -- themselves if they want to be discharged to the community or be transferred to another sniff. there's been 16 resident initiated discharges that occurred over the last

year. it's also important to note that while that pause was extended in early may of this year, on both the discharges and the transfers, a little over a week ago, we were directed by cms while the pause and transfers to other skilled nursing facilities will remain at least through may 19th, they directed us to begin the process of doing community-based discharges for laguna hospital residents who no longer meet skilled nursing facility care as defined by cms in the medicaid program. that represents approximately 40 of the current 530 residents at laguna honda. you'll appreciate that this represents individuals who when they first came to laguna

hospital, actually did meet the skilled nursing level of requirements when they were first admitted but due to the great care that they've received at laguna, at some point in time, they recovered and then no longer needed assistance with what is known as adl or activities of daily living so for example, help with feeding, bathing, toileting, personal grooming so those individuals then fallout side of the perimeters for which cms will pay for care and they have instructed us to proceed with identifying community based for those individuals and our team is actively working on that. next slide. that settlement agreement that was reached in november of last year had many, many requirements, mostly on the part of the city of dph and laguna honda. one of the key

components of that settlement agreement was requirement that a cms approved quality improvement expert conduct a root cause analysis on the operations of laguna honda over the past two and a half years, looking at the results of previous surveys and findings, in order to identify where their key themes or trends that may have led to the circumstances, which led to the decertification. that quality improvement expert is a firm called, health services advisory group, as you know, health services advisory group has been onboard at laguna well before the settlement agreement. they actually came to laguna may of last year, so they have been with us for a year, already working with us to improve our

processes and our regulatory compliance. so, to date, after undergoing that root cause analysis in developing an action plan that initially had 330 milestones that had, that have to be met and completed by may 19th of this year, there's also another component to the settlement agreement which is 90-day monitoring surveys, so every 90 days since november of last year, we've been in a survey window process. we've already undergone two of those monitoring surveys and the first occurred november early last year and the second survey, just concluded in march of this year. during that survey process, teams from both cns and california department of public health have come in and reviewed

our operations. we note that there was significant improvement in the second survey compared to the first survey and we anticipate that the next, the third monitoring survey will occur between a window starting the end of this month, may through some time in june. we're expecting that third survey. next slide. so, that action plan that was -- that came out of the root cause analysis has served as our guiding light and our path toward recertification since january of this year. it truly serves as our blueprint for how we'll accomplish cms recertification. remember, this action plan was developed with the cms quality improvement expert along with our leadership team and represents from their

opinion, all of those important improvements that corrective actions that need to be made in order for laguna to be ready to be successful with its cms recertification survey that will occur later this year. one of the components of that settlement agreement is that every month, the cms quality improvement expert submits a report to cms on the tenth of the month. that shows our progress towards meeting the action plan and our overall improvement being ready for recertification. as we have reported previously, we have been 102% successful -- 100% successful every month completing all milestone in january. there were 126 in february and 133 in march. there were 77 and for the month of april and early may, there are

approximately 120 and we're on track for successfully completing all of those. so from our perspective, we feel we are very much complying with the terms of that settlement agreement and are setting the stage to definitively prove to cms that we are making improvements towards our path towards recertification. as i've mentioned that initial action plan had 330 milestones, those are on track to be completed by may 13th, which is the date listed. and it's important to remember that those were from the original root cause analysis and the action plan. with those two additional 90-day monitoring surveys, there have been subsequent follow-uproot cause analysis on those individual

findings and there have been new milestones that had been developed, so while we originally started with 330 milestones, at the end of this last survey that ended in march, we're now up to a total of 500 milestones. so, two weeks from now, we would have completed the 330, but there are approximately another couple of hundred that will be completed after the 13th day in order that the qie has time to validate that we have made the improvements and that those improvements are going to be long lasting and we're not window dressing but it has been baked into our organizational processes. in terms of some of the timing for all of these various moving parts, the action plans and the milestones, once we're successful in completing that third monitoring survey, again, which we think will be some time between the end of

this month, may and june and then there will be another mini root cause analysis on whatever findings there might be, and knock on wood, it would be great if there were zero findings and in an institution as large as laguna honda, that's unlikely, so hopefully, there will few findings but whatever those are, the quality improvement expert is then required to work with our leadership team to develop an action plan and potentially new milestones, have those implemented over a period of time, probably two to four weeks and then probably based upon that timeframe, july/august, we feel we will be in a better position to have the assurance that we really have fixed those items from all of the monitoring surveys and the root cause analysis and then be prepared to submit and apply for our

recertification survey. next slide. so, that settlement agreement, again, had many, many requirements that were put upon the city and dph and laguna. one of them was the production of a closure plan. one would say why would you do a closure plan when, you know, you fully expect to have continued operations? and the answer to that is, it was -- it was and remains to be a requirement for the continued funding from cms. in order for cms to continue funding, while we're not certified, they are required the pro tux of this closure plan and the original closure plan was approved last summer and you will recall, it wasn't the closure plan that we wanted, but it was the one that

cms was willing to approve that had an initial four months for us to do transfers. we know what happened when that was implemented, that led to the pause and the settlement back in november. in terms of the closure plan, because of the settlement agreement, it had to be updated to reflect the new requirements under the settlement agreement. that updated closure plan was recently approved about a month ago and as we've said before, it's our desire that we never to implement that closure plan but that would require us to resume transfers of residence and we feel that we have demonstrated to cms and hopefully others that we truly are making long lasting improvements at laguna and we're meeting every metric that they have asked us to meet in terms

of these monthly milestones and we are anticipating a successful third monitoring survey. so, again, we think we've made the case for why this closure plan should never be implemented, but at the same time, we fulfilled our requirement to have a closure plan to ensure our ongoing funding. next slide. so, throughout this process, we always want to and we always do keep residents at the center of all that we do and part of that resident-centered care is making sure we respect and protect our residents' rights and one of those rights is the right to appeal. it's laid at statutory requirements in the state of california, medicaid operations

manual and gives our residents quite a big role in terms of how their care is delivered in terms of where it's delivered. obviously, as i've said, we're making sure we're doing everything we can not to have to implement the closure plan, but and in fact, we have, in our ongoing communications with cms and also with hhs, we have requested that they continue the pause that is now set to expire on may 19th for transfers to other facilities and we are waiting their response to our request that they continue that pause. dr. colfax and i have regular discussions with c mr. s and hhs. they have indicated they are considering our request. we had discussion that when they extended the pause the last time, we were only given 24

hours' notice and that created a lot of strain, particularly for our residents with their families, other health systems in the city who depend on laguna honda. they have indicated they are appreciative of what happened the last time and that they are confident they can give us a response well in advance of the may 19th date. however, they didn't give us a particular date, but they just said it would be much sooner than the previous notification and i have to say, based upon the discussions that dr. colfax and i have been a part with the senior leadership at cms and hhs, it is, i think, a much better relationship than it was six months ago and they seem to be much more collaborative and responsive to our needs so i'm very hopeful that they will be true to their words and give us some relief on that pause sooner rather than later. next slide.

so, that concludes my brief overview and i'm sure you have questions and comments and i will do my best to try and address them at the appropriate time. >> thank you, mr. pickens to your team for this excellent presentation. secretary morewitz, will you let us know if there's public comment with instructions. >> i want to clarify the number to call for public comment is 415-655-0001. again, 415-655-0001 and access code is 25978442164. pound. i have a script to read about public comment. for each agenda item, members of the public will have an opportunity to make comment for up to three minutes. the public process is designed to invite input and feedback from individuals in the community. however, process doesn't allow questions to be answered in the meeting or for members in the public to engage in pack and forth conversation with the

commissioners. the commissioners do consider comments from members of the public when discussing an item and making request to the ph. please note each individual is allowed one opportunity to speak per agenda item. individuals may not return more than once to read statements from other individuals unable to attend the meeting. written public comment may be sent to the health commission at the following e. dress, health dot commission dot dhp at sfdph dot org. if you wish to spell your name for the minutes, you may do so without taking your allotted time. city policies along with federal state and local law prohibit discriminatory comments against -- we'll take public comment from individuals attending in person and take remote public comment from individuals who have received an accommodation for disability. for the meeting today, i have given accommodation to three people. note, the first folks that we will call will be the three people. others, please do not raise your hand until your category is called. i have given

each individuals a code to speak when they begin their comments to prevent others from speaking during this time. we'll hear remote public comment from all other individuals and there's a time limit of 20 minutes on the total remote comment to be heard on each item. because of the new remote public comment procedures recommended by the office of city administrator and city attorney's office, please do not raise your hand to make remote public comment on item until your category is called. okay. so, please unmute the first person. i have a timer in my hand. everybody gets three minutes and when the buzzer goes off, know your time is off. call you are, you're unmuted. less you know you're there. >> thank you, this is michael, of the san francisco great panthers. this closure plan is something that you should be ashamed of being a part of. let me read a little bit of it. this is called the intent. the intent

of this revised closure plan is ensure the safe ordering and clinically appropriate transfer or discharge of each patient with a minimum amount of stress for patients, families, guard januarys and legal representatives. all medicare and medicaid beneficiary patients will be discharged or transferred to the most appropriate setting possible, in terms of quality, services and location available and determines, and determined to be appropriate for each resident. about expeditions and safe of a matter as possible. people should not ashamed of this, of having signed onto this. i looked to see what was talked about at the, before the daily

transfers took place and there really -- basically, it's the same thing -- was that -- nearly you have a plan that said residents seems completing the patient placement associates for the following, current level of care, risks for transfer trauma, discharge options. it's the same stuff. this is an insult to the 12 people who died on the first goaround and i don't see anything in this that indicates that another one would be any different. there's no -- there's still no places in san francisco that are going to be able to take -- we have yet to have any

proof that the legal discharge notices that's going to be given have any kind of backing and if push comes to shove, residents will rebel. they will not go. thank you! >> thank you. so, there are more hands up that i have given accommodation to so the only folks who have should have hands up -- two more folks received accommodation. please, unmute caller five. >> yeah, mark. this is hh -- aka patrick, can you hear me? >> yes, sir, please begin. >> today is may 2nd. the pause on discharges is may 19th and presumably, you may begin discharging people as early as may 20th. is that what you plan

on doing? as for mr. pickens, he hopes to apply for (indiscernible), end quote, the third 90-day monitoring survey is scheduled for late may or the middle of june. i recall laguna honda may have to pass two consecutive standard and surveys, not 90-day monitoring surveys and regain recertification. those two, quote on quote (indiscernible) have to have 12 or (indiscernible) slated in the scope of (indiscernible). a pattern of no actual harm or lower. even before cms will accept the -- recertification.

but they will serve 20 deficiencies during the second monitoring survey, double the 12 or fewer deficiencies and at least two of the 23 are level f. widespread. level two, no harm deficiencies. they suggest that laguna honda may not be eligible for submitting an application for the recertification until some time well after the end of september at the earliest. it also suggests that laguna honda will likely not resume until september and may not resume by the end of the calendar year, at which point the current census will more than likely shrink from 530 to 450 or fewer residents between now and then.

there will be lots more out of county patient dumping. you need to clean up this process and move it along and get that pause extended rapidly so the patients have plenty of forewarning and you need to keep this process up to resume admissions. if you only have 450 patients or even 530, why do you need to have the same number of staff? thank you. >> all right. thank you. okay. please unmute caller 7. >> >> hi. this is -- yeah. this is dr. palmer, ww. is cms, i mean, there is no place for people to

go and there is no mechanism of -- there was no way of actually reviewing what happened to people after transfer last time and in the closure plan this time, there is no mechanism for keeping track of people once they were transferred to see what harm has been done and so, this is -- resuming evictions by whatever you've in this case you want to call it, it is dangerous and make cms looks like a thug and it's going to lead to even more endless lawsuits against the city than are now being addressed as in the closed session, so i don't see how

evictions and transfers can be resumed without severe consequences, not only to the patients but to the government agencies that are forcing them. and i hope cms is aware of that. i also would like to hear more about the 120-bed cuts and if cms is showing any insight into the danger of lowering beds even more, given the severe shortage of beds? thank you. >> great, thank you. that ends the category of those who received accommodation. we can move onto all others who would like to make remote public comment. press star three to raise your hand. so, please unmute, as you see fit. >> yes, hi. this is joseph urban. i appreciate the intent

of the administration to pressure cms to postpone the relocation program. nonetheless, i'm going to argue the plan is deadly and the following is an editing session by recent called the story of death regulation, restarting laguna list charges and 146 people read this essay and the transfer plan has preliminary assessment of the patient's risk of transfer trauma. this does assess patients hand, there is no prescribed assessment post transfer, which is troubling. what's more concern is the lack of a post mow -- it's a procedure in a project management and been a step to execute before proposing an improvemented process. to date the public hasn't seen the results of the deadly indents of last summer and we're left to

assume there's not a post more come. the trauma incidents transfers to presume. this is wording, that's what the analysis. there's no means to ensure the procedures will address the problems that led to the deadly failures and pre-assessment of patients, post transfer assessment is more critical to ensuring patient survival. by definition, patients are experiencing the transfer trauma at the new facility. the program was not defined, it hasn't defined the metric for measures patient standards of post transfer. if a patient were on a deadly trend in the new facility, there are no prescriptive procedures in place to take immediate action. (indiscernible) of the care providers at the facility. the plan fails to provide continual risk assessment and mitigation which is unacceptable. patients have a right to receive care that's safe and appropriate for their needs and the transfer to

a new location program must be reexamined to ensure that it prioritizes patients safety and well-being. until then, there's no safe program for patients to laguna hospital. restarting relocation program in its current state is a dangerous and irresponsible action by the laguna administration and the department of public health. significant analysis, process define and testing of a new transfer and relocation procedure must be done before any transfer and relocation program proceeds. that effort will take many months. otherwise, we can now assume the mission rate of transferred trauma resulting in daelt death will send 100 residents at laguna honda to their deaths. thank you. >> thank you. please unmute the next caller. >> hello, commissioners. my name is norm and i'm a member of the

great panthers. how will the right to residents addicted to other nursing homes to have a say in what is best for them. we are hearing that people who need a nursing home bed have to go to the central valley in southern california or further to low quality nursing homes. given the death rate from previous discharges, the public has a right to detailed information on how any discharge will be accomplished, which is not seem possible in current circumstances to honor the safety preferences and care needs of evicted nursing home residents. to prevent death in violation of resident right is cms-cdph admitting to the needs of an extension of the may 19th date for evictions. no evictions, no closure, and no (indiscernible). thank you for

listening. >> thank you. that was the last caller. >> thank you, secretary morewitz and thank you to all of the callers for calling to express your comments. we will now move on to commissioner comments and questions and i have a few, mr. pickens and we have heard consistent concerns from the public and these are concerns that are shared by the commission as well and we do acknowledge that at this point, really the authority and the decision-making power rests with the center for medicare and medicaid services as well as the calico department of public health -- california department of public health so they are equipped to answer the questions but a couple of things have have come up. for example, the closure plan is something that was required by cms per regulations in order to, in order to be in the recertification process and if a

closure plan wasn't submitted, we wouldn't be eligible for recertification at laguna hospital, is that correct? >> that's correct. it's a part of a federal regulation and it's a federal requirement when -- in order to be eligible to be recertified, you must be in compliance with federal requirements and one of those would then be that we have an approved closure plan on file. >> it's a plan but it doesn't signal an intent to closure because our closure is recertificate -- recertification? >> absolutely. we hope this will live on the shelf somewhere and not pulled out but again, it was a requirement. number one, for our ability to sit for recertification and more importantly, it was and remains

a requirement for that ongoing finding, which helps us to continue to provide the care for the residents we still have. >> had we not submitted the closure plan, we would not currently be receiving funding from cms for the care that we are currently giving to our residents? >> absolutely! cms made that clear and it's clear in their statutes. >> okay. on the second question and we're concerned about the looming, you know, deadline for reinitiating transfers of residents. and i want to thank you and your team and the leadership at dhp for working closely in a productive way with cms and cdph and i understand that requests to continue the pause on transfers has been submitted to cms and is currently being considered. we're on may 2nd right now, i know the -- the transfers could possibly resume on may 19th. i

think i speak for the entire commission that it's our great hope that we would receive notice of a continued pause sooner rather than later to prevent the kind of anxiety and really anguish that our residents and their families and certainly our staff at laguna honda experienced in not knowing what was going to happen, so i think that we all stand with the leadership of laguna honda and the department in hoping we receive a response soon. >> great, thank you, commissioner. and as i've said, dr. colfax and i had every opportunity to make that same argument with cms. it's in everyone's best interest and most importantly our residents best interest, but it also is in the best interest of the community and everyone who supports laguna who nose residents will not be transferred and -- who knows

that residents will not be transferred and at laguna where they want to be because they voluntaried requested to be transferred elsewhere and there have been non. >> on the request of 120 beds and we're recertified and it's under the new regulations which doesn't allow triple rooms. is my understanding correct, since we're not currently, since laguna is not a cms facility, the sequence of events would achieve recertification so we are a certified facility that is over seen by cms and that would be the time at which we would make a request for a waiver to continue utilizing those 120 beds, so it wouldn't further exacerbate the shortage of beds we have in san francisco and the bay area and even the state. is that correct, is that the

sequence of events that we need to achieve recertification at which point that's when we should be requesting and that's our intent fully, once we achieve recertification at laguna honda to request that waiver to continue utilizing those 120 beds? >> your understanding is absolutely correct. it's important to note that cms has made it very clear in both the settlement agreement and all of their interactions with us since then is that recertification should continue to be our number one priority and it is. recertification means, bringing every aspect of laguna operations into regulatory compliance so our residents can be assured they are in a safe and well-run facility. in addition to that regulatory requirement compliance, in terms

of those 120 beds, in order to be approved for certification, you have to be deemed in compliance with the rules that are in effect at that time. and in order to make ourself eligible when we submit our application, we have to comply with that rule thatty limb nalts the 120 -- that eliminates the 120 beds and we have maintained all of our options to have those beds added back to our life -- they are still in our license but add it back to the full complement of beds once we become recertified and with our discussions with cms, they have made it clear because of our need to get back into compliance through recertification that a request for waiver at this point would not be received well. and when someone tells me that, that

tells me they are telling me it wouldn't be approved at this time. and they want us to focus our efforts on recertification. those 120 beds are extremely important. we've heard the reports of the health commission about the lack and derth of lacks of beds in san francisco, so we're committed to getting those beds back in full operation at laguna. while we have made sure we comply with, no more than two residents per room at this point, we -- we made sure that we did it in a way that once we are recertified and once we do submit for that waiver that would allow the 120 beds to come back, we can simply put those beds back into operation as quickly as possible, so then we can go back to our full complement of 780 beds as we're licensed by the

state of california. >> thank you, mr. pickens for clarifying the important points. commissioners, any questions or comments? commissioner guillermo. >> thank you and thank you, president bernal for asking some of the questions i had in mind so that i can focus on -- just one additional question. we have, first of all, thank you for your report, mr. pickens and again, even though we hear some of the same information each time, it really does bear repeating and so i appreciate that you're able to do that and but at any case, the question i have is around the third -- the third 90 day survey, the second survey didn't last 90 days although we haven't received the full report back on that. so, i'm just, just in terms of the timeline, it's quite possible and if we're anticipating a better positioning of laguna

honda post may for that third survey, we may not have to look to the -- assuming things turn out well, it may be sooner than the fall that we might be ready to apply for the recertification, is that correct? >> based upon what we know how, i think that's the timeline we would apply before the fall. definitely some time after this third monitoring survey, it's required action plan, it's required milestone so i think that puts us in the window of july/august some time. and i also want to take this opportunity to level said, so first monitoring survey was what they call a full comprehensive survey. this is where cms and cdph came in and did basically a mock recertification survey. so they looked at everything, every

cms requirement and so, we have several findings and tags. the second monitoring survey was not a full monitoring survey. it's called an abbreviated survey, so it did not look at each and every cms standard and accordingly, we had fewer findings in the second abbreviated survey. it's our understanding when they come back for the third monitoring survey, it will revert back to a full comprehensive survey, so again, we expect, number one, it's going to be better than the first one. there may be more findings in the second one because the second was just an abbreviated. it was looking at particular areas and the third one will be like a mock full survey, so i want to level set that again, knock on wood. we would like zero -- zero

deficiencies but the chances are not good. i want the understanding so when you get the results, you have as many on the third than the second but they are not apples and oranges and one is everything, the other is a small subset. >> and can you, for my own memory, the amount of time it took to get the final report back on the first 90-day survey verses the second survey? >> gosh. i tell you there have been so many dates. i can tell thank you took several weeks, if not more than a couple of months to get the findings from that first survey. and so, the second survey came back a little quicker and so, we're hoping that the third time will be the charm, that this will come back.

typically, when there's a survey, one expects to receive what they call the 25/67, the state of deficiencies within ten days. well, that didn't happen with the first survey. ten days turned into a couple of months and the second survey, we got it back a little sooner and then the second survey, we got it back piecemeal. we've had two 25/67 and one for fire life safety and the other for emergency management. they still owe us the final 25/67 for that extended survey that they, we went into at the end of the second survey. so, we are in the window to get that within the ten-daytime frame, i think -- i think today. so hopefully we'll get it this week or next week

and they will do a qia and work with us to do milestones and that will complete the second monitoring survey and then the process will repeat all over again for third survey. >> thank you. >> commissioner chow. >> yes. thank you very much for the report today and also for the responses that you had to our commission president, which are many of the questions that all of us have had and have also been receiving from the public. i'm trying to then understand that our obligation by -- is it by -- for the completion, is the completion of the action plan or completion of all of the corrections for the action plan? what is it that that really is

that we have to do that allows us to continue our funding through november -- under our agreement settlement with the cms so that -- i think you have clarified what some of the surveyor and they have found certain milestones that we are required to present a solution to that the qi has assisted our staff to do and you're on track to complete all of those, at least the first block, right, that you said in your presentation, so what has to happen by that first block by this point or once we have completed it, does that allow us to move forward, even on the second block and still have funding? >> so, the answer to that question is yes. in the settlement agreement, it uses the term that the terms are the

settlement for ongoing fund and the pauses are contingent upon laguna honda showing progress towards improvement and recertification. it doesn't define what that progress is. so, that's why those reports every month from the qie are important because that is the, really the basis that cms has to determine is laguna londa making sufficient progress to meet the terms of the settlement agreement? one can say that those milestones are a good definitive measure of progress so we feel confident that we have shown that by meeting all those milestones, again, by may 13th, we would have met the original 133 milestones 100% successful and then we will focus on the subsequent milestones that would need to be completed from may 13th through whatever the process leading up to when we submit for

recertification. >> thank you. let me just focus on the new closure plan. the old closure plan require that we discharge everybody with a certain deadline, which i know that the department have fought and we were unable to obtain a reprieve. they said everybody had to be moved, which not only was pressure but perhaps, you know, not very realistic. does the new closure plan continue to have that type of deadline or is it more that you make your efforts and we recognize the efforts because you've outlined for us a number of appeal processes, right, which a resident really could take and i think you've indicated also that this is generated and the state is appeal, that a resident can

make if the resident disagreed with either the transfer or even the place you're transferring to, so could you help me understand that a little better as to -- is there a deadline that everybody has to be, you know, moved in spite of the fact that we're trying to apply for recertification and then what does that appeal process looks like? you can begin with, how long does it take to evaluate a particular patient again? and then what is the appeal process? >> lots of questions, so let me, i hope i can get them all. in terms of what does it take to evaluate? for the terms of the closure plan, each resident at laguna has to be reassessed as to their level of care and needs every 90 days, so that has happened ever since the closure, original closure plan was approved last summer, so every

90 days, our interdisciplinary team of nurses, therapist, technicians review each resident to determine, number one, do they fooel still meet skilled nursing level -- do they meet skilled nursing level and what is their needs. that's the process. in terms of your question about, does the plan have requirements in terms of a date by which transfers are discharged would have to be met? no, it does not. it does require that we make our every and best effort to identify if we were to, again, implement it. our goal is to not have to implement this, but if we did, it does prescribe the steps we must go through, the state operations manual dictates what is required

in order to go through the discharge process. our plan takes the essential elements of the state operations manual and then customizes it to the laguna population and then puts in an additional steps we feel are necessary, including the transfer -- trauma transfer assessment. it also then preserves the right, as you've said of our residents to file an appeal. you are correct that the appeal process is not something that we adjudicate. the state has a process for adjudicating that through the state department of healthcare services and with the changes in cal aim that took place in january of this year, that responsibility now has shifted from the dhcs to the department of healthcare services to the individual medicaid health plan, so for example, san francisco health plan or anthem blue cross

in san francisco, in the event we were to move forward, they would be actively involved in trying to help find locations and to handle that referral process and also the appeals process. >> i think that, with the questions that my colleagues have asked, that most of my other questions have been answered. thank you very much. >> you're welcome. >> vice-president green. >> yes. first of all, thank you for the excellent presentation and the wonderful clarifications of the questions that i know the commissioners and the public have had concerns about and it's also really heartening to hear that your relationship with cms is becoming increasingly collaborative. that's terrific. the question i have as we look at survey three, when we started this, the correct action plans and the milestones were kind of

brand-new and there were a lot of kind of heavy lift types of corrections needed. but now that we're well on our way to meeting all of the stipulations, should new milestones arise, can you give us a sense for whether you'll simply be building on or refining some of the plans you already have, verses do you think there could possibly be any unidentified issues. would we be starting from scratch. do you feel it's tweaking thins or when you say there's a bradley based survey -- there's a broadly based survey that could come up? >> great question. i would say the second monitoring survey and the action plan and the milestones that came out of that, truly reflects this concept of building upon the previous work from the root cause analysis and the

milestones because in fact, even for those tags and findings from the state on the 25/67, the qie went back and made sure that if there were any findings that had already been addressed by a previous milestone, that that milestone was cited because what we found is, when they came in for the second monitoring survey, we knew about some of those issue that's they identified and -- issues they have identified and tag but there wasn't sufficient time to put those improvements in place and have them stick, so obviously, they found the deficiency but we had already developed milestones to fix it and so, the thought is when they come for the third monitoring survey, there will have been sufficient time to get some of the things that had not been completed by the second survey done and in process, so that we will, again, have fewer findings and then fewer subsequent

milestones, but we take into position that the milestones have to be reinforce and building. we don't want to do runoff. this has to be a system for improvement and as i shared with dr. colfax, once we finished the surveys and the milestones doesn't go away. these will be transitioned into the monthly copy reporting at laguna, so those initiatives will still be followed and monitored to make sure we sustain the improvements and the gains and we don't take our eye off the prize. >> thank you much and i know we have been concerned about sustainability and that's hard to hear. the last question i had, you talked earlier about the frustrations of not getting feedback in a timely manner from governmental organizations but have you been satisfied and confident with the rca's, so

when qie group has to respond, has the turnaround being tasked and the rca has been developed and the corrective action plans as well? i mean, that's something that's a well-oiled machine at this point? >> absolutely. no complaints about the turn around time of the qie. they keep us on our toes and they push us to do better, to be better, to be faster, to be the best we can be, so no complaints there. they are truly collaborative partners in our improvement effort. and so, we are very thankful and grateful for the selection of health services advisory group as our qie. there could have been other companies but i couldn't imagine anyone else who could have come in and understood the culture at laguna and worked with us to address

our unique culture and our situation and to show then the progress and improvements that we have made so far. >> thank you. >> thank you -- >> commissioner christian. >> thank you, president bernal. it's good to see you, mr. pickens and i join the comments and appreciation for your questions that president bernal and other commissioners have given you today. i had a question about your -- you mentioned that the fact that every the 0 days there's -- every 90 days there's an evaluation of residents level of care and needs. does the staff communicate directly with the residents about the outcome of those 90-day assessment regardless if there's a change or the staff findings that everything is fine or, is there communication regarding that process?

>> so, those are done by the rct, the resident care team, so that is the team that actually takes care of the residents and so, part of the process is to, when needed, involve the resident in those assessments. it doesn't happen all the time, but if there is a particular resident who have certain needs above and beyond, they are involved. now, it's important to distinguish between the assessments verses the care plan as a resident, so every resident has an individualized care plan and that, every resident is involved, to the extent their facilities allows them in terms of decision-making capacity or circuit decision maker so that's where we make sure the resident input into their care happens with their care planning process. >> and so, after this assessment

happens, there's communication with them, everything -- everything needs to be where it is or needs to be? >> for example, if a resident has been at skilled nursing level of care for the last five or six years and upon this next, the most recent 90-day survey have been deemed to no longer meet that level of care, meaning that they don't require that assistance with daily living, they are notified, based upon on our assessment, there's a change in your status. you have gone from skilled nursing level to non-skilled nursing level so the residents, then and their decision makers or family or guardians are then made aware of, in that process because particularly if they go from skilled nursing to non-skilled nursing, there's a process where medicaid notifies them of a

change in status. they get to actually then appeal that change of status and say, well, i don't agree with their assessment. i think they got it wrong. so, there's this back and forth process if they are then able to engage in. >> thank you. and the only thing -- i also have to say, i'm thankful for president bernal's questions and for your answers to them at the top of the question period and the way i receive it is that you and your staff and your colleagues are doing everything you can to get to recertification without jeopardizing the positive outcome that we all need. >> thank you very much. and that is definitely the case. recertification is our mantra and that's the path that we're pushing towards. >> thank you for your work. >> you're welcome. >> any other questions or comments? commissioners? all right. seeing none, mr. pickens, thank you so much to and you your team for your hard and

necessary work in getting us to recertification at laguna honda. >> thank you commission for all of your support also. >> thank you. all right. moving to our next item, approval of the minutes of the health commission meeting of april 18, 2023. commissioners, do you have the minutes before you? if there are no amendments, do we have a motion to approve. >> move. >> motion to approve. >> second. >> second. >> any public comment? >> hi folks o the line, this is time three, the minutes much press star three if you have received, excuse me, received accommodations and would like to make public comment. i see one hand. unmute caller five. >> thank you, mr. morewitz and this is hh patrick. again, these minutes still don't document my concern, although my 150-word

public comment was included in the minutes. there's no clarification i can see in the minutes about my concern that dr. colfax and mr. pickens had asserted there are 140 deficiencies in the monitoring survey but the two ie's, root cause analysis report for that december monitoring survey had only looked at 76 deficiencies. again, and unexplained 48. i would so appreciate an explanation of those additional 48 deficiencies and while i hesitate to do this, i'm prepared to submit a public requests record to find out why the rca's report says one thing

and (indiscernible) something else. thank you. >> that's the only caller for that item. >> all right. can we, we have a motion and a second. done with public comment. commissioners, comments or questions. if not, all those in favor say aye. >> aye. >> [multiple voices] >> minutes are approved. next item is general public comment. secretary morewitz, do we have general public comment and please offer any instructions you may need to be offered. >> sure. at this time, members of the public may address the commission on items of interest to the public that are within the subject matter jurisdiction of the commission but not on this meeting agenda. for example, laguna honda, there were an update. this isn't the time to talk about laguna honda because the item passed. each member of the public may address the commission up to three minutes and the brown act

forbids the commission for addressing those items on the agenda. everything else, i've read as part of the earlier public comment statement. so, folks, if you would like to make your public comment, and received an accommodation, press star three. i see one hand. unmute caller five. >> hi again. this is patrick, hh. mr. morewitz and my comments here involve a resolution task by the board of supervisors, so please don't cut me off. this is very short. you can bear with me. i recently published an open letter to governor newsom on the median dot com website that i asked mr. morewitz to distribute to. july 26, 2022, the san

francisco board of supervisors had passed resolution number 365-22 to address to governor newsom and director of the cdph and our state public health auditor and director -- the health and human services agency in california, asking the board of supervisor -- board of supervisors asked for a permanent cause on discharges from laguna honda during the (indiscernible) laguna honda -- my letter asked newsom to work with dr. aragon and dr. galli to

use their authority to intervene and make mandatory discharges to the laguna honda residents, independently of the recertification process. the board's resolution was passed unanimously by our 1 /* -- our 11 supervisors and excuse me, i'm having difficulty speaking because the removal of salivary glands so excuse me. the resolution was passed unanimously by our 11 supervisors but what's inexplicably returned by londa breed and it was -- dr. mayor breed. i still urge this commission to, despite

commissioner bernal's distinct line of processes about where is processes and mr. pickens citation of various federal code of regulations, still request this commission -- >> [timer] >> let me make sure we're clear. anyone else who would like to make remote public comment, press star three. all right. no more hands. >> all right; we'll move to our next item which is the directors report. welcome, dr. colfax, director of health. >> thank you, president bernal and good afternoon, health commissioners. i will be brief in summarizing the report since i know there's other items on our agenda and happy to answer

questions or go into the details at the request. i did want to highlight we hosted the cdc director on her visit to san francisco last week. dr. rochelle, the director of cec. took a tour of our maria martinez health resource center it's our new primary claire clinic in the south of market neighborhood. we are joined by the california state health officer and dph alum, dr. aragon. at a roundtable, we had the opportunity to highlight the success of our covid 9 response -- covid-19 response and retrieve hiv and m pox. we reduced sti's and provided an update on efforts to work in overdose prevention and in supporting people in street care. it was an honor to share our strengths with dr. galinsi

and she was impressed by the maria clinic and was really interactive with the staff and people really excited to meet with the director. another items on the director's report, i encourage you to read about the dph community health program that fosters youth led film projects on sexual health and well-being. our dph, the next item is our gph center for innovation. they were awarded a five-year grant for workforce diversity which is exciting. and just to also point out that the environmental health team is supporting changes to the regulations of hazardous waste storage. there's details there as well. and i did want to just acknowledge a piece of the work

in dph that has done that's important to the health of residents but overlooked and an example, that's national women week. and national (indiscernible) that is critical for patient safety and prevention of infections and we know this to be true at zuckerberg san francisco hospital and laguna honda hospital. and just to give you? examples, zuckerberg, hospital receives $2.4 million pounds -- 2.4 million pounds of lynn nine. we make sure we're compliance 365-days a week and i want to recognize the leaders. with regard to our covid-19 update, our 7-day rolling average of new

covid cases per day is 44. and 56 people were hospitalized including nine in innocencetive unit as of april 26th. 86% of all san francisco residents have vaccinated and 65% received a booster dose. 40% of residents received a buy violent booster and 65% of people, 65 and over received a booster which is higher than national averages in the state average. you will see there's, a link also to dph in your report and i'm happy to take questions, thank you. >> thank you, direct colfax. do we have public comment? >> hi. please unmute caller five. >> thank you again, mr. morewitz. it was disappointing there was no

comment by dr. colfax or mr. pickens about the nationwide search for a licensed nursing home administrator for laguna honda. the last we heard from their pickens -- >> i'm sorry. this item is related to a previous item on the agenda. >> no, it's related to dr. colfax not mentioning that. >> mute the caller. thank you. there's another hand. please unmute this other caller. thanks. >> hello -- >> are you there? >> can you hear me? >> and please begin. >> okay. my name is art, i'm with the sf great panthers and i know dr. colfax can't answer questions and i just wanted to let you know that, you know, there are a lot of cases of covid that i have personally seen and experienced in the last month and i find it remarkable that me, as one person in san

francisco would know so many people who got covid just in the last month. and i'm wondering if there's tracking of such cases, if i'm a kaiser patient or a a sutter patient and those who treat those with covid, do they report statistics to the san francisco health department or is it hospitalizations and deaths that get reported? i know you can't answer, but i would love to find out and maybe, you know, i can get an answer some other way, but i just wanted to make, since we have this opportunity to make a comment, i want to find out and that's my comment. thank you. >> thank you. that's the only public comment. >> all right. thank you caller for your comment. commissioners, comments or questions regarding to the director's report? all right. i don't see any. thank you, direct are colfax. it's no

surprise, we are pleased but no surprise to know that dr. winski was impressed by the work done by the department by infectious disease and covid and sdi prevention and m pox and et cetera. thank you for sharing that with us. all right. our next item is the city option update. this is a discussion item. we have stella, i'm sorry, is it chou. >> chow. >> thank you, ms. chou. director of managed care. thank you. >> good afternoon. you already know my name. i'm joined by my colleague, from san francisco health plan, sumi who is on the line, who is also our third-party administrator of the city option plan. we're here to provide you an update on the program. next slide, please. so,

here's the agenda. i'm not going to read item by item. let's move to our goals on the next slide. so, we have two goals today. one is to give the commissioners an update on the san francisco city option program and shipment policies that you approved in january 2022. secondly, we would like to provide the commissioners a summary of the program fund since its inception 15 years ago. so, next slide, please. to level that, i would like to go over briefly how the program works. so, first, under the healthcare security ordinance, employers would contribute money on the employee's behalf at least on a

quarterly basis by submitting a roster and sending it to the program and they also, the employees will also notify their employees that now, you know, i have put money into your city options account. at that point, the money will go into a fund pool where we fund the pool and assign fund pool of the program. the program would notify the employee at thing them they have funding in the program and the way they can enroll into an sfmi program. san francisco medical reimbursement account where they could use the fund to get reimbursed for medical expenses such as over the counter medicine, prescription, drugs for themselves and their families. and once this fma

account is setup, once the employees contact us, we set up the sfmri account and any future contribution, we go directly into the sfmra account. it bypasses the fund pool. and once the account is setup, then the enrolled employees can file claims and get reimbursed. next slide, please. going back to the policy you approved in january 2022, the city have that process, that is being managed by the office of the treasurer and tax and treasurer, ttx, sorry. i'm favorable with the

acronyms and i'm not going to go word by word on the slide because we're pulling out the (indiscernible), but the key take away, in order to start the enrichment process, fund used to be -- to start the he is cheatment policy, it used to be in local agency and the second piece, once required by law has passed, we will -- the city will do some publication to ensure the money. this takes away from this slide. next slide. why do we have, why do we need this policy, just to refresh our memory. the program was established in 2008 and it did

not really take off in terms of participation and contribution after 2024, so just want to show you the numbers. in 2014, we have received, can you touch the slide, please. in 2014, we have -- the program has received, the program received $60 million in total. the following year, the program grew by 56%. and then, you know, moving forward, right, if you look at five years later, the program actually almost doubled the growth: so this is why you know, over time we have unspent dollars, it have accumulated in the program. as of today, we have about 428,000 employees in the sf city options

program. and 100 of those have less than $1 total balance, so our total is about $60,000, which is about 23% of the total employees and another 35%, which is the 150 employees who have money but haven't enrolled in sfmra, so it means the money is really stuck in the unassigned fund pool. next slide, please. so, since the approval of this policy, we've been working diligently with different departments in the city including city attorney's office, the office of the treasurer and tax collector and then the controller's office also getting guidance from the mayor's office. so, we've broken down our project, this project

implementation of this policy into four phases and as i've highlighted earlier, when we were looking at the state regulation, one of the two things is in order to escheatment of the money, it has to be in the session /* position of the government. we established a bank account under the city treasury in october and moved the entire program fund over. that has been completed. and then phase go, we just completed. it's to notify all the employers and employees that we are kicking off this policy. and before we actually start counting the (indiscernible), we tried to average to everyone. we average to about over 300,000

employees and 4,000 -- employers and we started in early january and we went back in shipment in escheatment so it exceeded our achievement. we were able to move 144 million from the -- in the unassigned pool to the sfmra account where the employees can tap in and get reimbursement. that's the piece and then also, basically, that's where we're at now. before -- we kickoff this policy as of march 1st this year and that will give us three years, right, before we escheat money so including the

notification process mandated by the state law, the earliest we can escheat the money is april 2026, so, to prepare for that, before 2026, we have to complete the planning, right. this list of projects that we need to complete. here's a few examples. for example, we need to establish an online tool so the public can actually look up online to see if they have any fund left. we will also get, we need to get a set of this record -- we will have to figure out how to do it in case someone doesn't access online, right, do not have a computer. they can go to the library or check whether they have funds left and that's one of one. and another one is we have to work with our vendor

who manage our account to set up process and procedures for closing accounts. and the last example is, yes. we need to develop an outreach program, you know, before 2026. of course, we will continue our outreach during these three years but as we get closer, we need to let them know that this is the last time, you know, for you to activate your account and if not, your money will be -- your account will be close and lastly, to prepare for the phase four. we will need to refine our existing reports to make sure that we can continue, we can start to -- evaluate implementation and effectiveness of different outreach efforts. next slide, please. here's just

a visual of phase ii. this is like a recap of the escheatment impact. as you can see, right, we move nine percent of the fund, we increased the nine percent of the fund in sfmra which is close to $144 million, so really to our present surprise. next, please. next slide, yeah. next, we would like to give you a high level summary of the program fund. so again the program has been established since 2008. the employers have contributed on behalf of the employees, $1.66 billion into the program. 36 of that has been

paid out as claims. claims of reimbursement to employees and 27% actually today is sitting in the active mra accounts that's available to pay for future claims. and then 9% has been paid to healthy san francisco program for those who are eligible for the program. and lastly, this is the -- really the (indiscernible) we are trying to work on is the 38% of that total amount is still sitting in an unassigned pool and waiting for the employees to take action, engage with us and open an account. to sum this up before we go to the question, next slide, please, so, for those activated employees, we

will continue our outreach efforts and measure the effectiveness of those. and encourage them to use the program benefits. so, for those that still have inactive funds and still have funds in an unassigned pool in the sfmra fund, we'll need to leverage our outreach through this escheatment policy to further engage them. the program's goal is to make healthcare more affordable for our residents and workers and in sitting money on the fund is the last resort the city will take to address the accumulated funds in the program. so, with that, i would like to invite susi to join me

and we'll try to answer questions you have, and if not, we'll (indiscernible). >> thank you, ms. chow. do we have public comment on this item. >> i don't see any. let me announce it again. we're on item six. if you have public comment related to the city option update and received an accommodation, press star three. no hands and so, if you're a remote public comment person, raise your hand if you would like to, press star three. no hands. >> commissioners, comments or questions? commissioner christian? >> thank you, president bernal. thank you ms. chow for this presentation. i learned something very new today. >> thank you. >> i'm a city employee and i didn't nope about the city option and it's a great option and it sounds very much like the health savings account that i think is a federal thing and in using that, the health savings account, you'll lose your money if you don't use it over a

period of time. once understand the city option, once an employee gets their funds into the mfa, is it possible that if they -- if they let it a drew and save it for when they need it, that they will risk losing it? >> thank you for the question. that policy, what you described, they can accumulate the fund in their account, that was the case before march 1st. so, you know, the program established -- has been established for 15 years. we haven't had any policy really permanently to activate the money and escheat the money much a few years ago, we implemented a policy called the activated fund but when they reached out to us, we activated the account so the money -- because we don't want to pay the monthly fee to

manage the mi accounts, right, so this was the purpose. but now, starting march 1st, the clock is ticking now. so, every -- the money is -- every dollar has a time stamp on it, so back to your question, if an employee does not use that money and to not call us at all, you know, in april 2026, that's the only time they will permanently lost the money and the money will be escheated to the city's general fund for reappropriation. >> if they call you, would something different happen? >> if they call us, we activate the account and they accept new claims so just to give you -- people do respond. i don't know why the average wasn't as effective as the current one because during the six weeks of

outreach, we pay off $51 million of claims so, now people know they can actually lose the money, use it or lose it. they are starting to get into it. of course, there will be unused funds. like us, you know, $2, i don't even bother to use the $2 if it's in the account. >> thank you. >> okay. >> i want to add and stella correct me if i'm wrong, as long as the account is active, you don't have to use the full amount by the end of the three years as long as the account is active and there's at least one claim during that bereavement three-year period, you can keep the rest. it's what we're really looking for is the dormant unclaimed dollars where we actually, you know, at some point, our goal is absolutely to make sure that we want to maximize the dollars in making those flexible as possible and that's why they are rolling over. at some point, as a

practical matter, we know, like, anything, some dollars will go unclaimed similar to other city funds that's managed so we have to have this in process to go through the legal process to do that sort of back-end cleanup but our goal is -- again, they do not have to use all of it within three years. they can -- they have to be active and we need to know they are out there. >> thank you for that. that's great policy, a generous policy but a wise one because we -- i think, people who, speaking for myself, contribute something like that, a fund like this, you're looking for, i'm looking for having funds available for an emergency, really, in many ways and your policy allows for that in a way that the federal policy doesn't, so i commend you on that policy and thank you for the presentation. >> vice-president green. >> yes. thank you for all the

clarifications. one question i had is, as you look at this money that's in the pool right now, do you have any sense for how much is -- you've had a significant increase in contributions in the last five years. i don't know if you have even, you know, whether it's particularly escalated, let's say in the last two but do you have a sense of how much money is in the pool is from people who is employed and active and didn't understand or haven't gotten around to it and how much is money that goes to the general fund because they are retired or they can't reach them and it's interesting to know the amount in the pool but it's hard to understand what the ultimate distribution will be unless we have a better sense for how much is new money and people are just newly enrolled and haven't figured it out verses money that will never be claimed. >> we do our outreach, right, so we measure our responses.

whether they understand they have money in the pool, i think we need to conduct some kind of focus group to understand that further. but i think your question is asking, if we take a snapshot today, right, let's say today is mid-april 2026, how much money will we have to escheat, so as of today, it's $150 million and in january last year when we come to the health commission, the projection was like $104 million, i believe, and we did respond to that question also via e-mail to you but it was a last minute, so i thank you for your question. >> thank you. >> and sumi, she raised her hand. is it okay if she responds? >> absolutely, please. >> you asked a good question, commissioner green. hopefully, you can hear me. we don't have a lot of information about the specific employees themselves because unfortunately, the

employers don't, they aren't required and they don't provide us that type of information. the only thing we actually have about them is some small amount of demographic data like where they live and what the date of their fund was. we did sort of provide you some information. the biggest decider or the biggest insight we have is -- is how old that money is. it's relatively new money. there's $467 million in the pool and all about $150 million of it is less than 3 years and so, think about when you think about just the nature of accounts, we have some accounts that are really, really small. they might have $2 or $3 so nobody is going to use them until more contributions will go in there and some are large as well. our best guesstimate is that we would, you know, we're

going to do a lot more outreach and the reason why you got a big response over the last four months is because we actually spent a lot of time out reaching to everyone telling them about this new policy and that accounts would permanently close. that has never happened before. the medical reimbursement accounts were always different from flexible spending accounts. they would never use it or lose it so now that folks have been informed, we'll have a policy of where we're going to remind them and their employer about this new policy, so that is really driving some of this changes in behavior. it also is because we're -- we have do projects to make the experience easier. debit cards will be in the future. to make it a lower barrier for the employees, so you know, in terms of answering your question about, like, what do we know, you know, it's not that they have -- we don't know

they've changed job and all of these turning that happens in the labor market interferes with people using their accounts much they forget about them. they think i finished my job. i can't use it. and so, it's a constant process of trying to educate them that they can use it and now that there's the new policy of, you must use it, at least once, make a claim or have a deposit within the three-year period or it will be escheated so hopefully that's helpful in giving you more data about this unused dollars that are in the pool. >> thank you for that great explanation. and also, it's quite commendable that you really exceeded your goals in reaching people. it's very heartening to know the outreach has been so successful and be more so as you develop more protocols to approach employees, thank you. >> commissioners, other questions or comments? all right. seeing none, thank you

very much for this update. >> lastly, i would like to thank you san francisco health plan entire team because the rollout has been ten fold during the six weeks and beyond, so their team is just stuck with it and guess through it, so thank you so much from me and the team. >> thanks. moving to next item on the agenda is an action item. it's the mou between the dph and the san francisco public health foundation. we have dph controller drew maler. >> thank you, president bernal. good afternoon commissioners. happy to bring this memorandum of understanding between the san francisco department of public health and the san francisco public health foundation. it's in response to controllers, several recommendations from

their assessment of public integrity in 2020 and in particular, a requirement that the friends of organization so-called comply with the san francisco sunshine ordinance and that particularly in response to one of questions from commissioner chow, thank you for the review, is why there's exhibit b. it's a template version for any donations to go and be reported back so the public health foundation can gather that information. other instances or stipulations in the mou in response to controllers findings include city law, acceptance of gifts, follow the san francisco administrative code for acceptance that extends. (indiscernible) granting controller authority to authorize records and requirement to report donations, including grants on the organization's website. and

clearly identified defined roles regarding expenditures including prohibitions against spending, directed by the controller. so, thank you and i received a couple of questions. i'm happy to talk through them. after me immediately will be jennifer, the cfo for zuckerberg san francisco hospital with a similar mou. there's distinctions between the mou and one, their mou allows for donations in support of employee recognition events not open to the public. that's a distinct embedded because the public health foundation holds contracts with dph. as such, they are an interested party that involves rules so that's why public health foundation doesn't have an exception to allow for employer recognition events. second, there's a fee

schedule. it's a little different for public health foundation, in both cases they adhere to administration fees and public foundation adheres to a sliding scales as the donations gets bigger and admin gets low are because they felt more comfortable and doesn't need as much flexibility to wrap up fundraising effort in particular, but jennifer will speak more to that. lastly, i apologize. i think that was the last thing. but happy to take any other questions. >> all right. thank you. before we go into public comment or commissioners comments, do we have a motion to approve the mou. >> i move to approve the mou. >> is there a second? >> second. >> any public comment. >> i don't see hands. we're on item seven, press star three if you would like to make public comment. no hands, commissioners. >> commissioners, any questions or comments?

>> i wanted a follow up. the san francisco general foundation puts out these letters that ask for donations into their fund. so, your template looks very daunting, you know, normally you would put in $100 and sign your name, do they have to check off boxes they they make their donations? >> i think the template is one way to full on -- one way to fulfill the sunshine ordinance, which is included in this mou acceptance by the friends of organization. it requires that any entity, such as the -- such as the general foundation hospital, that's accepting funding on the purpose, for the purpose of carrying out or assisting any city function disclose the source of the funds on the, as a public record made available on the website. in

order to do that, this exhibit b is the vehicle. now, i think there's still discussion about what exactly, what form they would attach to do those fundraising letters and only requirement in the mou is in the case of restricted funds, exhibit b gets attached. but outside of that, i think the exact format is still being decided upon. >> okay. thank you. >> any other comments or questions, commissioners? seeing none, all those in favor. >> aye. [multiple voices] >> opposed? all right. mou is approved. thank you. >> thank you, mr. morewitz. >> next similar but different item is item 8, mou between the dph and sfgh foundation. we have zia -- jennifer here. >> thank you, president bar necessarily and good afternoon, commissioners. i'm here to talk to you about the mou between the san francisco general hospital and the san francisco general

hospital foundation as noted by my colleague previously, drew, this adhere to administrative code. as well as compliance and city ethics recommendations. there are a few differences in our mou as drew noted and if you have further clarification, i'll answer that for you today. in addition, just some questions commissioner chou, thank you to make sure, all funds from this foundation are subject to admin code so that would include our special programs like hearts grant or innovation and equity grant. the annual report that is made available to the health commission upon request of the director is to enhance and improve compliance and transparency between the foundation and the hospital as well as public and sunshine ordinance. and then exhibit b, as you've talked about is about donor disclosure to disclose interest with the city whether it's a conflict. also noted

that's different, we have the ability to use funds for staff engagement or celebration events. that is because the ethics commission for san francisco reviewed our relationship with the foundation in lieu of the (indiscernible) in the manner in which we operate today. just also want to very much thank city attorney who has reviewed our mou as well and it's in the adherence with other funds of organizations mou's and also to thank the san francisco general hospital foundation who is has been a great partner in terms of supporting the hospital and this will allow that to continue so we can support our patients in the community at-large. >> all right. do we have a motion to approve? >> i so move to approve. >> second. >> all right. any public comment? >> i don't see any hands. folks, we're on item eight. press star three if you would like to make public comment.

>> no public comment. just to clarify, this is the mou with the sfgh foundation. >> the names are similar. >> yes. all right. any comments or questions from commissioners? >> i was wondering, in the annual report and i'd asked the director, for that to appear before the commission just like we get other gift reports? >> i'm sorry, commissioner, i couldn't hear that, could you repeat it? >> sure. because it says the annual report of the foundation is at the, actually at the call of the director that would go to the commission and the commission doesn't have a right to ask it in this mou, the director does. i'm asking if the director then would see that an annual report before the commission would be actually quite useful? >> okay. yes. thanks.

>> thank you. >> all right. any other questions or comments? if not, all those in favor. >> aye. >> [multiple voices] >> opposed. >> mou is approved. thank you. all right. our next item is item no. nine for discussion on the finance and planning committee update. i will hand it over to chair commissioner chung. >> good afternoon, commissioners. the finance and planning committee met before this commission meeting earlier this afternoon and we have recommended adding 6 items to the consent calendar, which includes a may 2023 contract report and five new contracts and in addition to adding the five new contract, we were hoping we can schedule a

presentation somewhere down the line for the voucher for -- for veggie program because i don't think that has been presented at the community and population health committee and so, that would be something that we would be very interested in hearing about and to see the outcomes of that program. and in addition, we also have a preview and discussion of the drafted cherokee care report and it will be presented to the full commission a month from now. >> all right. secretary morewitz, any public comment on this item? >> i see no hands. folks, we're on item nine, the finance and planning committee. no public comment. if i may add to commissioner chung's comments

with your, hopefully respectfully, the contracts report, the horizon's contract was taken off because for administrative reasons so when you consider a vote, that report will not include that item. >> all right. commissioners, any comments or questions for the chair? seeing none. we can move to our next item which is the consent calendar. back to you, chair, commissioner chung. >> i just wanted to point out there's actually an additional item on the consent calendar which is from the recommendations of the cssg-jcc, so -- how do we want to approach that one? >> i can note, the commissioner green can jump in, but that item was reviewed and recommended for approval by the jcc at its meeting last week. >> and it's the radiology

approval's list. i would like to make a formal motion to adopt the consent calendar. >> do we have a second? >> second. >> any public comment? >> i think we -- we already asked for it, did we ask for public comment. folks on the line, if you would like to make public comment on time ten, let us know by pressing star three. no hands. >> commissioners, any comments or questions, if not, we'll go to a vote, all those in favor say aye. >> aye. >> [multiple voices] >> opposed? all right. the consent calendar passes, thank you, commissioner chung. >> commissioner bernal, on the next item, commissioner green will give the jcc update because commissioner chung was absent at the meeting. >> great. thank you. vice-president green, take it away. >> yes. >> conference committee and other zfg-jcc meeting. >> absolutely. we review the the

hiring and ceo and medical staff report, highlights including the successful opioid outpatient treatment survey, the contributions the sfg is making to improve black birthing people's health, the intra introduction of new chief administrative officer angela jernagan and remembering recognition of staff and johnson. we were pleased to hear deversions and rates continue to drop and thanks to the heart and creative work of the hr team, nurse and cant see. it dropped by ten percent. we recommended policies recommended in this meeting and in closed we approved a report and the pits minutes. >> thank you vice-president green. public comment on this item. >> i do not see hands, folks,

we're on item 11. press star three if you would like to make a comment? >> no hands. >> all right. commissioners, any comments or questions? impressed by the drop in vacancies. thank you to our hr team and those involved and those at jft for making that happen. thank you for sharing vice-president green. all right. seeing no other questions or comments, our next item is consideration of a closed session. i will need -- >> sir, i'm sorry. item 12 is other business, just to make sure we're covering everything. >> do we have other business? >> folks on the line, if you would like to make comment on that, press star three, item 12. no hands. >> all right. seeing no other business, we'll move on to our closed session and in order to enter closed session, we'll need to have two separate votes because there are two items for discussion in that closed

session. >> first, we must take public comment. >> we need a motion first? >> yes. >> the first motion we'll entertain to hold closed section related to 13d which is laguna honda and rehabilitation update regarding regular la tore he survey activet. is there a motion to go into closed session on that item? >> i so moved. >> second. >> public comment. >> all right. please unmute caller five and i'm, i need to share my screen to share a slide. >> it's patrick. i want to comment on the litigation settlement on item 8e and not the regulatory survey. >> we'll be coming to that motion in a moment. we can do public comment on that. >> that's one public comment in the entire closed session. i know it's confusing everyone.

please just, mr. minashaw, please begin >> can you put up that chart i e-mailed you. >> yeah. it's up. >> as you enter this closed session, you'll note on this chart that i (indiscernible) involved for $3 million settlement related to the patient sexual abuse scandal in december of 2019 during mike's ceo. the top part of the chart shows it's cms and cdph fines and penalties and the first case and lawsuit by omar an doula, public conservator patient at

laguna honda. it costs a combined cost of $1.89 million. with this proposed settlement of $20 million, we're up to (indiscernible) cost with the class-action lawsuit alleging a quote culture of elder abuse remaining active and outstanding. (indiscernible) neglecting the patient -- in the sexual abuse scandal, dph should terminate carossi. the chronicles (indiscernible) claimed in a recent article that laguna honda quote on quote origin in (indiscernible) it was

sexual abuse scandal under harossi's culture -- her lack of culture patient safety and the cultural elder abuse mismanagement that the public -- you must terminate harossi before these costs reach $10 million or more, and a $10 million problem caused by harossi and that scandal led to decertification which cost laguna honda at least $27 million in consultant contracts and the loss of over $25 million in medicaid revenue. when are

you going to terminate that woman? thank you. >> okay. there's one more caller. please, unmute 12. >> hi. it is dr. palmer ww. the agenda item 13e in closed session concerns a lawsuit about -- that led to managing agentses and employee's acting neglectly but failing to ensure that laguna honda maintained adequate number of staff members or ensure the staff were adequately supervise advised and protect other hospital patients. there was a failure of adequate supervision and monitor shortcomings and care and the

negligence and failure to monitor staff members resulted in poor outcomes as well as multiple deficiencies and citations. this was the original sin and i sincerely hope that the agonizing process and expensive process that laguna honda and sfdph and all the staff and all of the patients are going to now will make absolute certain this will never ever happen again. having management that knows how to run a nursing home is indispensable and you can't treatment laguana honda as a sat light of san francisco general. it's a public nursing home for the people of san francisco and it needs to remain available to them and i

really and i'm sury -- -- and i'm sure the people of san francisco pray this exercise and agony will turn out okay and will never ever happen again. thank you. >> please mute. that's the only public comment, thank you. >> all right. the motion that we have at hand is the closed session related to item 13d, commissioners any comments or questions? seeing none. all those in favor. >> aye. [multiple voices] >> opposed? all right. we'll move to the second vote and this vote is whether to hold a closed session in related to item 13e which is the pending litigation and assert client/attorney privilege in assertion to that discussion. do we have a motion to have those closed session. >> motion. >> second. >> should we go to a vote? >> yes. >> all those in favor. >> aye. >> we're now in closed session

>> sfgovtv, can you raise your hand or let us know when you're ready. okay. they are ready. commissioners consider a motion to disclose or not. >> do not disclose the closed session. >> i move not to disclosed. >> sec. >> all those in favor. >> aye. >> opposed? all right. the motion passes. we'll go to a motion to adjourn. >> motion to adjourn. >> second. >> all those in favor. >> aye >> opposed? we are adjourned. >> thank you, everyone. >> thank you, everybody. >> thank you, mark. >> thank you. [gavel] >> thank you.

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>> this meeting will come to order. good morning and welcome to the may 1, 2023 rules committee. i'm supervisor dorsey chair of the committee and joined by vice chair walton and committee member safai. on behalf of colleagues i want to express gratitude to committee clerk, victor young and thanks to the team at sfgovtv for broadcasting today's