>> alright. good afternoon commissioners. sfdph staff and members of the public and welcome to health commission meeting of may 16, 2023. please call the roll. >> yes. allow me one second to do something on here. yes, start with you commissioner bernal. >> present. >> commissioner christian. >> present. commissioner guillermo, present. commissioner chow, present. commissioner giraudo, here. commissioner green, here. >> secretary giraudo will offer the ramaytush oholone land acknowledge. >> the san francisco

health commission acknowledges that we are on the unceded ancestral homeland of the ramaytush (rah-my-toosh) ohlone (o-lon-ee) who are the original inhabitants of the san francisco peninsula. as the indigenous stewards of this land, and in accordance with their traditions, the ramaytush ohlone have never ceded, lost, nor forgotten their responsibilities as the caretakers of this place, as well as for all peoples who reside in their traditional territory. as guests, we recognize that we benefit from living and working on their traditional homeland. we wish to pay our respects by acknowledging the ancestors, elders, and relatives of the ramaytush ohlone community and by affirming their sovereign rights as first peoples. >> thank you commissioner giraudo. our next item is laguna honda hospital and rehabilitation center update closure plan recertification update. for this we, have baljeet sangha and welcome. >> thank you. hello honorable health commission. secretary morewitz, director colfax. thank you for the opportunity to present on behalf

of laguna honda today. also with me is san francisco health network chief quality officer troy williams. moving forward i like to start with slide 3. what i like to share in today's update is the few mile marker updates for a few different topics. starting here with this particular slide, i like to highlight and remind those around the settlement with (indiscernible) as a matter of today on november 10, 2022 the city county of san francisco did sign the settlement agreement with cms and cdph. under that we received payments ongoing till november 13, 2023. february 1, 2023cms agreed to the city continued request on the pause of at least till may 19, 2023, which brings me to

the next slide. on february 1, with that pause until may 19, 2023, we-i like to give a couple items. even though cms continued the pause of involuntary transfers they still require a revised plan. we hope we never have to put the plan into motion and action and implement because of the continued improvement and the future recertification we will be achieving with cms. based on the progress and negative impact to residents that transfers cause we request cms continue the pause on transfers and recertify without having to transfer anyone. (indiscernible) closure plan. there are few points to emphasize. we requested formally cms continue the pause beyond may 19. that request has been made verbally and in writing in

partnership with the city attorney office and as of today still waiting response. we are confident laguna honda is the best place for residents for care. (indiscernible) i want to assure dph does meet with hhs and remind how disruptive and challenging the process was last year. the extension is at the discretion. our job is to request it, make it clear about the improvements taking place, tell the story and narrative what is occurring at laguna honda and their job to review the request and approve it. last time we only had 24 hour notice about the continuation of the extension of the pause. you can imagine the kwress strain it caused the residents and families and here we are gone few days out from the 19. we did not want to be in the position again this time around, but we are hopeful they will act on the request soon

and grant extension, but that is where we are as this point and this presentation. moving to the next slide, i like to talk about the 9 0 monitoring survey. cms will conduct monitoring every 90 days. today we served 2 and the second showed more progress. we continue to work with the survey teams and the items (indiscernible) survey process, many of which were addressed real time. we anticipate another monitoring survey here at the end of may and june. in addition to the monitoring survey, cms has monitors at laguna honda nearly every day and surveyors are in and out every week. they insure compliance and if they see something not in compliance they notify usism we

are under california law if there is unusual occurrence we are required to report it. while cdph came out on one of self-reported incidents, they found a case br a resident care plan was not fallowed appropriately and had the potential to cause harm. no harm was caused but the potential was there so they pointed thought out, we submitted the plan of correction last weeng and the plan was accepted this past friday. next slide, please. so, the action plan is our blue print how we accomplish the recertification and remain compliant and successful long-term. every month reports on progress of cms. the action plan is the output of the root cause analysis the qie performed. the action plan that includes milestones and started off at about 334 or 330 some odd milestones and grew to 500. i'm excited to update you all today on behalf of

the organization that all 500 of the action plan milestones have been submitted and this is a incredible huge facility accomplishment and reflect incredible amount of work, collaboration and improvement just to be done in a few short months. this was a key component and key fixture of the settlement agreement and incredible feat and point on the path to recertification but like to take the opportunity to recognize laguna honda and staff and the residents all who participated getting us to this point. next slide, please. this is visual interpretation of what i just shared with you. the top shares the timeline for (indiscernible) the middle indicates the timeline for the action plan and bottom is just recertification process within each of the components on this slide there is a timeline with months and years and you can track along how this fits togethers in terms of timeline, where are we today in relation to what i described

and related to survey readiness, the action plan and recertification process. the next slide is updates regarding the hiring for key leadership positions, and the top of the slide here indicates really it represents 8 positions. there are 6 bullet points and so-7 positions and 6 bullet points and like to talk about the nursing home administrator and director of nursing. we extended a offer to a candidate and the reason it is conditional is there a series of checks that occur before it is finalized so that is a big exciting element and milestone here. additionally, the role of the director of nursing which is important partner to that nursing home administrator, we are now in the second round of interviews and hopeful we can expand a offer and move down the line

for filling the key leadership positions listed on the slide. with that, that concludes my presentation for on behalf of laguna honda and i will stop there. >> thank you. before we go to questions and comments we'll take public comment. mr. morewitz has a statement to read as well as to conduct the public comment session. >> yes, folks just read a long statement but know the first remote public comment are folks who receive accommodation so only raise your hand if you received accommodation for me for disable. for each item members of the public have a opportunity to make comment up to three minutes. the public comment process is designed to invite input and feedback from individuals thin community, however the prauz does not allow questions to be answered or members of the public to engage in back and forth conversation with commissioners. the commissioners consider comments from members of the public when discussing a item.

please note each individual allowed one opportunity to speak per item. individuals may not return more then once to read statements from other individuals not able to attend. written comment may be sent to the health commission. health.commission.dph@s fdph.org. if you wish to spell your name you may do so without taking your time. city policy along with federal state and local law prohibit discriminatory harassing conduct gaerns employees and other during public meetings will not be tolerated. we'll take comment from those in person. we have none today. we will take remote public comment from individuals who received an accommodation for disability. i have given each individual a code to speak when they begin comments to prevent others speaking. finally we'll hear from remote public comment from all other individuals. there is a time limit of

20minutes of total amount heard on each time from individuals who have not received accommodation for disability. alright. let's begin with the first person who's hand is up. >> patrick shaw. can you hear me? >> yes, sir, please begin. >> slide 3 in mr. (indiscernible) however, without seeing the third form 2567 from that health survey component of the extended second survey, we have no real proof about what progress has been made

and what any additional citation in march had involved. lhh should demand cdph provide the third form, 2567 since the "10 day window" to provide that form after completion of the survey is now three weeks overdue. the california (indiscernible) also concerned about the (indiscernible) because the superior court lawsuit (indiscernible) filed on may 3

alleging wrongful death of three laguna honda patients following their evictions last june and july under the "initial closure plan". multiple other lawsuits (indiscernible) stop patient evictions may 19. after all, (indiscernible) is absolutely right, (indiscernible) revised closure plan (indiscernible) because it doesn't provide for (indiscernible) patient outcomes monitoring. the government must be brought in rapidly to stop more patient discharges at once

during laguna honda attempt to become recertified. you must get newsom, dr. aragon and dr. galley involved in making sure that there are no more evictions starting this friday or saturday. thank you. >> thank you. also thank you to james who is moderating the public comment today. james, please unmute the next caller. >> you are unmuted. >> hi, caller, are you there? >> hi. is that me? >> yes, that is you dr. palmer. >> it is dr. palmer. i submitted written comment. it a violation of rights and form

of abandonment and abuse to evict residents to less safe lower quality or disant facilities. laguna honda manage and city attorney must support direct care staff and residents by refusing to cuclude with unsafe discharges or violate a resident preference for local facility or setting. doctors should have the right to refuse to sign off on discharges as should nurses and social workers. this is part of their hippocratic oath. at this point, there is no place to go, eviction equals abuse, neglect and abandonment. staff, residents, families and communities must stand together and laguna honda management must back up its staff. no federal or state agency has the right to demand evictions that kill, and we have a lot of evidence that we are

risking that. thanks a lot. >> thank you. now it is time for anyone else who would like to make public comment? press star 3 if you like to raise your hand. james, please unmute your caller, if it is-hi, caller, please let us know you there. >> hello. my name is norman daggleman. hello commissioners. norman daggleman, a long time resident of san francisco and a member of the gray panthers, and i feel that eviction would be a certain death sentence, so that's all i have to say. thank you. >> thank you. that is the only public comment we have today on this item commissioners. >> alright. we'll go to commissioner comments and questions. i did have a question to begin. we did see earlier on in the process that there were transfers being required to be

conducted by cms and tragically saw i believe 12 residents after placed in the care of other cms certified facilities had passed away. i know the last time there was a requirement for transfers it was 24 hour notice before we learned from cms that the pause on transfers would continue. at this point, we are 72 hours away from when transfers possibly would need to resume if the pause is not extended by cms. can-i understand there is a very productive working relationship with cms and cdph at this point. could you share with us what is the impact on the laguna honda residents and their families and their staff with this uncertainty about whether or not transfers may have to resume?

>> for the laguna honda residents, their families, the staff, stakeholders, the community at large, this is extremely extremely anxiety inducing and stressful. it is a incredibly frustrating time. it is stressful. it causes a lot of unnecessary physiological issues when you think what has to occur. so, that is why i say is what the short answer in terms of the impacts are. what we are working on doing to insure that our staff morale continues to remain as steadfast and strong as possible to insure the fort itude with our staff and inspire the residents in the work they are seeing and doing the last year and the work we are advocating for now is continue to show them not just tell but show the

improvements we are making. part is 500 milestones we were able to submit. the milestones have a hand in working on contributing to. the other component is also sharing highlighting with them how we are telling our story, how we use venues such as this opportunity to engage with you as the governing body as well as working with union partners anyone in the community to insure they are accurately and appropriately updated around what we are do, so the goal is channel back to the decision makers that are the recipients of request for the extension on the closure plan pause and so our effort is to highlight that to the staff to insure validate what they are feeling. that is the other part that is really important for us to not disregard the true feelings that occur. i think that is-interesting and unique part about feelings,

they are always accurate because they are your own. one can never say you don't feel this way. validate that. remind the work we are doing and remind our focus is the ending destination is recertification and stability and the residency for the residents in laguna honda and to insure our goal is to not just have them stay at laguna honda, but to insure they have the optimal lived experience they can at the organization and so our leadership in dph and state leadership is backing us up with that by sharing the message explicitly with cdph and cms and hhs around that. when we are able to tell that story, it doesn't eliminate the feelings of angst and anxiety, but it certainly gives our residents their families and our staff some level of encouragement that we are not just sitting back and

letting this happen, but that we are trying to take a active step and be in the driver seat of our destiny of what we are doing here. that is more a lengthier response but your question was very spot on and there are so many components so i hope i hit 24 the mark. >> that did. you mentioned that i believe as of last friday all 500 of the milestones contained within the settlement agreement had been reached. those are milestones that have been agreed to by cms, correct? and certified that they have been met? >> correct. >> correct. and lastly, i want to certainly acknowledge the anxiety of all the residents and families and the staff and the potential harm that of course can cause people, and really thank the laguna honda staff for all of your very hard work and dedication working towards a recertification. all

of us i think have been-visited laguna honda and see what wonderful care provided there and dedication of all the staff and hard work going into it and just please know for you and all of your colleagues over at laguna honda that we are in full support of the great work you are doing and working very hard to be a partner in recertification. >> thank you. i get to be the lucky one to relay the work my colleagues and everyone are doing so i'll relay that back to them. >> thank you mr. sangha. commissioner guillermo. >> thank you president bernal and thank you baljeet for your presentation and i want to also acknowledge and congratulate you and everyone at laguna honda for reaching the 500 milestones. you know, even say 500 sounds like a lot, but the work that goes behind it, it is hard to fathom all that that

had to happen just to get to that, so again congratulations on that achievement and hope that that indicates for us and for the public that the work that is put into moving towards recertification is serious, as hard as it is and continues to be the top priority of the department and everybody who is concerned about laguna honda. i'm also glad to hear about the progress on the executive hires going forward. i had a question about the nursing home administrator. really glad to hear we are at the offer stage. do you have a sense of how much longer it might take before we hear something more definitive in terms of the hire and start date and what that process might look

like? >> i don't have a specific number of days. i know this is priority for our human resources colleagues and leadership at dph and colleagues and peers at city level go to go through the appropriate checks and background clearance and everything is done as quickly as possible. our goal here is before summer concludes, we want to do within the next several weeks to make sure that we have this individual to come in and have the opportunity to do what we were looking for in a candidate, which is come out, reinforce, continue to build bonds, continue to build connections with our residents, with their families, with the stakeholders of laguna honda, with the staff and so our goal is to get this individual in as soon as we can so we have excitement of the opportunity to learn and meet everyone and be a part of these future presentations and be a part of

the team that sees through recertification. >> good progress and glad to hear about the nursing home administrator but everybody on that list of points that looks like we are moving forward. >> there is progress on all fronts so that is a good thing. >> right. just to let you know that i'm sure share the frustration that you have expressed with the concern about the pause and we really do hope that in partnership with cms and cdph we are going to end up doing the best for our residents and for all the residents of san francisco with regard to the transfers and anything related to it. thank you again for all your work. >> thank you commissioner. >> commissioner christian. >> thank you president bernal and mr. sangha thank you for coming out today. i

know you have a lengthy list of responsibilities behind your name so know your time is valuable and we appreciate you coming in person to talk to us about this. you've-people in the community have spoken of the real harm that was caused with the last transfers and do you have acknowledge the stress and the harm that is caused by people not knowing and being uncertain and the clock ticking and we are 72 hours away. have you and your staff communicated this anxiety and the harm that it causes to cms, to cdph and hhs and if so can you describe how you have done that? >> absolutely. i think one of the responsibilities when you are have the opportunity and privilege to be in a position of leadership and you represent an organization, department, teams as you all know representing the

department of public health, often times you have to remind one's self-which group and team you are playing for, who you are representing. i think-with that in mind, we have made a focal effort and focal point to end our conversations with our peers at cdph, and cms and hhs to really candidly share the stress and anxiety this caused and as the hours tick away what that actually means for the ratcheting up of these emotions. so, the benefit of the working partnership developed over the last year here in the last several weeks with our leaders, department of public health level is that we-before we were not shy but we are not shy conveying and relaying with accuracy the emotions of the individuals we represent. i think sometimes there might be a

desire to insure that a interaction, a moment isn't awkward or tense, but we are reminding ourselves who we represent, the residents we are advocating for and the center of universe and need to be what this means for them. we have shared this both in writing, we shared it verbally in our meetings, we have shared it in any venue where we have the opportunity to engage whether that is virtually or in person or via telephone. we are leveraging every opportunity to remind individuals that we are certainly not okay with delays, we are not okay with radio silence, we respect the process and organizational decision making and where they have to go, but we continue to remind ourselves and remind them who we represent and how those individuals are feeling. i feel pretty confident that we-they know how we feel and where we stand. >> thank you for that.

someone with the privilege to sit as a commissioner on the health commission, i will just state for the record and anybody else that is listening at cdph and cms or hhs that we hope deeply that they recognize the kind of stress and the damage that stress all these people understand the relationship between stress and physical and mental harm that a delay in communication about people's future is causing and that they will-i'm sure they understand this and that they will at the earliest possible moment when they can do it, communicate with you and with us about people's futures. >> thank you. >> commissioner chow. >> yes. thank you for your previous responses and i think

that it is very clear to me and i hope to the entire public that the department has been striving to respond to our questions also regarding when the pause would be ended or will be continued i should say. since the end date is as commissioner christian pointed out less then 72 hours away. as a clinician i find that it is unfortunate that the state and federal bureaucracies are not recognized the clinical implication of this to our residents and to our families. it is insensitivity that baffles me since they are within the health and human service business, and that their prime concern should also be residents in the case of skilled nursing and obviously patients in our acute

setting. so, i think it should be very clear to everybody in this city that our staff, our department has tried its very best to get a more prompt answer then is occurring and that every day is frustrating to all of you and leadership that we are unable to help allay the fears and the apprehensions of our residents and families. i would like to ask though also, beyond and this in great communication to staff that we have all been able to see that you have been sending to us, we don't see as much in terms of exactly what you are doing for residents and families and maybe even through the resident council or material that is going to the families. could you describe that a little to us? >> absolutely. any material that we are sharing and as you

indicated, there are several letters organizational updates that both go out to-similar content but tailored for residents and families and also tailored for our staff. once we get them translate d to the languages most appropriate, we do get those letters out just to keep folks updated on any matter of development, whether the updated closure plan. we hope to send one out shortly about nursing administrator role and keep updated on things we can celebrate and also things to really appreciate the realty of. we never want to be in the position where some news comes pulled out of no where. some things we do not have control over so can only communicate as soon as we know it. that is always our effort and we continue to work with incredible communication team at the organization who built really incredible partnerships and relationships with our staff and our residents. moving forward, we have

incredible care experience team, and that group really works very hard with specific residents, with their loved ones and family members and guardians to provide updates where they are. so it isn't necessarily a come and get this message, but pushing it through to make sure they have what they need where they are to know what is happening to them in their organization and where they call home. our resident council efforts, one of the milestones we are proud of is we are able to increase attendance at the residence council and insure we have more representation and opening up a larger dialogue. one of the ongoing commitments to this as a matter of fact without sharing too much is this was a component around the philosophy. how does one grow that relationship? how does one build on that and make sure that they are continuing to be present and get to know our residents at laguna honda. not only is it a pillar of what we

are try to do now but what we-we want to keep moving forward and growing up and not regress, but also not stagnant. we are working hard. plus we have representatives who advocate for the residents. the ombudsman office so working with the team to insure that anyone in the ombuds office is able to ask for leadership and that partnership and relationship with the care experience team is pretty strong. happy to say as we walk down the hallway, myself, other leaders-stop in the hallway and what is going on. so building those relationships with you might think a hallway conversation and passing, what does that mean? what does that build into but it speaks volumes. we are building

relationship with individuals we feel comfortable enough to not just say hi in the hall but that means they can ask any questions they may have to fill a gap or that they believe exist or a gap we may have perceived to have filled but communication is never perfect so we may have communicated something and they like clarification. we are working to keep the residents updated and have the written updates insuring we are walking the walk and talking the talk with our representatives and residents and then using all that as a foundation to build into because these are principals and pillars we need our leaders to have and excite td is a philosophy that aligned with the individuals that we believe will be joining our organization here shortly. >> you told us at our last meeting that we were to begin looking at those who no longer

require skill nursing care, so could you briefly tell how that going along and how this process of working with them and trying to keep them as close to home as possible is working out? >> absolutely. so, i'll start-let me know if you like more information. our focus here is to work very closely with the residents with the team we convened to figure the best optimal placement for these individuals and residents who no longer meet skilled nursing level of care. last i talked some may have heard this but will share it again so we

hear at the same time. laguna honda put together a interdisciplinary team called the community option resource engagement team. core team. composed of multiple entities and departments from the city that meets weekly to identify housing and support programs that more quickly facilitate these discharges and transdition residents back to the community. the members include human service agency, they assist with in home support service, ihss as a acronym. there is department of housing and homelessness. they assist with housing community placement. there is a community living fund, which assist with housing program placement and case management with the institute of aging and there is the institute of aging which collaborate with community living fund for case management. the dph leadership is involved to establish primary care service and department of public health behavioral health team is

involved to provide case manager and primary care services. now, the goal then is as we are working with the core team to identify stakeholders and programs appropriate for the resident, we want to make sure those teams work with the residents at the center. for example, john is ready to discharge, the community living fund will do a meet and greet with john, so back to your commissioner chow, they meet with john to do-to engage with him and discharge plan. the meeting will identify needs and preferences and the case manager will present john's interview to the core team along with laguna honda social workers and physicians for any clarifying information and during these meetings the group coordinate services as indicated for john. whatever that may be. identify intensive care case manager, securing other services, identifying barriers we may or may not have anticipated based oen the engagement with the resident the center and any

issues that relate to residents needs or preferences. that is how we are working on insuring the residents is part of the conversation. we are not talking around our residents, we are not talking away from them, we are talking with them as part of the process to insure that we fiend the most optimal setting to transition into so they live their best live and have the most optimal lived experience. >> have we been able to transfer anybody yet? >> we are still working through that. all the stuff i describe-to do them well and insure the residents at the center we are taking every effort to make sure we are working with these agencies so we are at different steps across our 40 some odd residents but everything is moving forward and in different stages of the dialogue. some may be this is great, everything works well, we are

prepared as soon as we have a location or space. others are more back and forth dialogue to help confirm, understand and insure that the care is truly individualized and really are in a place where they can-where the residents all the questions are answered and all the needs are met. >> thank you. if you can give us a update on how it goes after the next report that would be helpful to understand all of the services that are being rendered for those members and where they were able (indiscernible) >> absolutely. thank you. >> thank you for the presentation and update and i certainly can't say more eloquently then my colleagues have how grateful we are to you, to the staff for all the efforts you made. i know you worked through well more then two weekdays in order to really support and protect our residents and i had one question to me quite perplexing. i know

that the surveyors interviewed residents from time to time. in fact there are many interviews as part of the reports we have gotten and i also know the identified transfer trauma in the analysis of the very unfortunate and sad passings that acured after transfer. if they identified this as a key problem, and they spoken to residents, where is there disconnect between what they are doing now with this dead line they haven't give indication and acknowledgment of the incredsable negative impact? have they not asked the residents or are the interviews so targeted to specifics because it would seem if they want to understand what is going on with this community, they have these interviews and talked to the residents. can you tell us anything more about the content of the conversations or where this disconnect might

lie? >> i can give it a shot. i think when cdph or regulatory agency presents itself they are guided by a level of immediate data or fact, whether a self-reported incident or anonymous complaint so from there they will trace the conversation, the experience. they interview the care team involved with the particular residents, certainly if appropriate they communicate and interview the resident and so that certainly is part of the calculus and approach before there is conclusion reached, any substantiated or unsubstantiated and we get conclusions or opportunities or other reports. what you describe is a larger sample of just the experience of the residents as they undergo this

overall experience and so for example, there may be a resident in the room next door to a resident interviewed for a focused concern issue like i just described. i don't believe unless the investigation the topic lends itself to speak with other residents on the unit, but usually grounded in the topic at hand. i don't believe they are engaging how do you feel about the closure plan. how do you feel about this. i think some of the residents are advocates. they are some of our biggest fans if not the biggest fan and supporters and they do share here is what this experience is doing to us and what is happening with us. in terms of a comprehensive conversation that occurs with the organization, i don't believe that is part of the approach of getting assessment of how the delay and

closure plan-update on the closure plan request to extend the pause, how that is impacting. i believe what you describe certainly it does often feel like a unfortunately self-fulfilling prophecy we want to avoid anxiety for the residents and avoid the stress and apprehension and stress plethora of literature over decades what stress can do, and yet by not having a definitive conclusion or definitive answers it only amplifys and creates stress for on the same individuals we are all coming together all organizations working together to insure doesn't happen and think that is the part that is really unfortunate here and we just again like many commissioners have shared and questions posed here today, we continue to do our best to highlight this cycle. this cycle that happens when that first domino

flipped and how this-what impact this has on the residents and we come back to the residents at the center. this is what i share is all our staff from leadership to the front line staff, we know what careers we chose, we know why chose them and have chosen them to insure we can provide the best health wellness and experience to the individuals within our care and so we try to keep coming back to that not just in conversations with leadership at other agencies and other agencies they also have chosen those careers for similar or same reasons so try to resonate and respecting the steps each individual organization and entity has to take for decision making and other things stopping short of understanding how a system works we are on

the same page and same aim and trying to move forward. your question is a spot on one and includes some very pertinent and feedback around the process as well. >> thank you so much for all you accomplished. all of the milestones you met. i know there is a lot of lip service paid to the patient being put in the center of things. my observation in the san francisco department of health is that there is sincerity and realty to it and you are embodyment of that and i'm so ah struck every time i see you in action and see all the sacrifices you made and dedication on the part of some of the most vulnerable people in the county and country, so all very grateful. >> thank you commissioner. >> mr. sangha, and also to mr. williams, thank you for this opportunity to have a meaningful exchange between the

commission and yourself and the staff to learn really all of the great accomplishments that have been made on the path to recertification and great work that has been done. so much information was shared during the session. i like to briefly summarize that laguna honda hospital met all the 500 milestones set forth in the settlement agreement that laguna honda put policies and procedures in place to respond to any concerns that have been raised by the surveyors. we are been a very late process of filling really key positions at laguna honda which we know is a priority for cms and cdph, and really just keeping laguna honda getting and keeping laguna honda on course towards recertification. really want to acknowledge all of the work that you and the leadership are doing to support the very hard

working and dedicated staff, and as a commission we really strongly hope that the fear and anxiety and potential harm it can cause our very soon alleviated for our residents and families and for the staff through continued pause on transfers, so just thank you again for your work and please convey our gratitude to the team at laguna honda. >> thank you. >> thank you. thank you. alright. thank you. our next item is general public comment. again, just reminder to folks who play be offering comment, the general public comment is for topics that do not appear on the agenda so only comments on items not on today's agenda are allowed during general public comment period. >> commissioner you

skipped the minutes. >> let's go back to that then. thank you, i apologize. >> that's okay and sure i apologize to the public too, while we are waiting to get to there, i have one quick edit commissioner chow found a error i made on page 2. the third paragraph, the sentence should read without this analysis there is no way to prevent similar transfer deaths occurring. i have the word now, so crossed off the w in the final minutes. it is 5 line down of the third paragraph. >> thank you secretary morewitz and secretary commissioner chow. you have the minutes before you, is there a motion to approve as amended? >> so moved. >> second. >> all in favor? >> sorry, this is public comment. can we please have that one hand unmuted so we can hear that person? mr.

shaw. >> yes, i'm here. ww. >> i want to make sure that we are clear that this is the minutes and you have three minutes to go. >> i am seeing on the minutes they are defective. you don't include mr. pickens verbatim statement on may 2 that was hoping to receive the third health component cdph form 2567 when the 90 day monitoring survey in march. it isn't recorded in the minutes. hopefully we'll receive it today, or if not, by the end of next week within the 10 day window. dph has only provided to date public records the first two form 2567.

one from the prior life safety component and the second one for the emergency preparedness component of that. been over three weeks since that survey component was completed. the fird 2567 should have been released and provided to laguna honda in that legally required 10 day window. i was told yesterday by dph next request staff, they have no record of it. where is the form since the 90 day monitoring survey-the third one should start in the next 14 days before the end of may? how are you able to correct the deficiencies from the health

survey component if you haven't received that form 2567 yet? you only have 14 days before the end of may when the next third survey may start, and how can you completed all 500 milestones if you dont know what corrective actions may have been identified on that third 2567 health survey component form you claim you haven't received? the public deserves a explanation about this commissioner bernal. thank you. >> that's the only comment on the minutes. >> we do have a motion on the floor. is there-all in favor say aye. opposed? alright. minutes approved. and our next item is general public comment. for items that do not

appear elsewhere on the agenda. secretary morewitz. >> i will read a brief statement. members of the public may address the commission on items of interest to the public within the subject matter jurisdiction of the commission not on the meeting agenda. each member of the may address the commission up to 3 minutes. the brown act forbid taking action or discussing-please know each individual is allowed one opportunity to speak per agenda item. individuals may not return more then once to read statements from other individuals not able to attend the meeting. we have one hand up. please unmute that person. >> it is patrick again. commissioner bernal, mr. morewitz, this testimony is not about the closure plan, so please don't cut me off. (indiscernible) as i testified before,

the 2019 patient sexual abuse scandal at laguna honda resulted in a number of lawsuits against the city, dph and laguna honda. my estimate to this commission at the jcc meeting was the case you heard in closed session would involve a $3 million settlement. i may have over-stated by $1 million, the may be $2.2 million but (indiscernible) probably add another million back in. those sexual abuse lawsuits involving the public guardian from 2019 are far from over and more likely grow to 7 to $8 million, not including the city attorney's (indiscernible) add to that the pending 3 to 5

lawsuits involving the wrongful death of patients discharged under the closure plan. these millions in lawsuit expenses are entirely due to the health commission allowing the mismanagement of laguna honda that is has gone on since 2004 including the " (indiscernible) made by this health commission. we now heard the board of supervisors is considering strengthening oversight of laguna honda hospital following (indiscernible) and my hope is commissioner bernal, that the health commission be stripped of being laguna honda governing body because you have done such a lousy job of it. thank you. >> that is the only comment for

this item. >> alright. our next item on the agenda is the director's report. dr. colfax, director of health. >> good afternoon commissioners. >> good afternoon. >> happy to provide you with-we will start with a item not written here but very important and it is about a amazing leader at dph who is going to be moving on to another role and she is here today. i believe you all know her, but i want to take a few minutes to acknowledge her work, her legacy and the fact that we look forward to partnering with her in her new role in helt care in the city. so, in the 11 years since ana joined the dph nurse manager of the primary care nurse

advice line, she had a tremendous impact on the department and on the health of san franciscans. she announced last week that she would be leaving dph to take the helm at mission neighborhood health sentser as the new chief executive officer. congratulations. with her deparchier we want to recognize for contributions to dph, especially over the past 4 years as director of primary care. what is past 4 years to be a director of primary in any health department, much less san francisco. from her role as primary care lead on the epic roll out to leadership during the covid-19 pan demic, when her ability to quickly mobilize and pivot primary care service to insure (indiscernible) risk of covid-19 to building primary care team lead with invasion population health

excellence to health disparities work, ana approved the health and wellbeing of all san franciscans. that is a person who works in primary and who worked with ana and witnessed her leadership in all these areas i can attest to the fact she truly acceled and never let up and always comes back and addresses the challenges we experience over particularly over the last few years. (indiscernible) which again was most apparent during her early days of covid and she and her team stood up san francisco first alternate test site and reached out to those in community who are highest risk for covid to bring in for testing and later vaccines. the

population health approach to breaking through barriers and serving the community most at risk of health disparities came to surface when we dealt with impacts of 2022. moving that work forward and insuring that the commitment of primary care the perspective of primary care, the culture of primary care was not only brought forward but sustained and strengthened. ana departure will leave a big shoes to fill for the health network primary care program, we are thrill ed to know making the san francisco safety net as she joins mission neighborhood health center one of our closest patners. our deepest gratitude for service to dph and best wishing to you ana as you move into your

exciting new role at mission neighborhood. dr. hammer, did you want to say a few additional words also? >> (indiscernible) just to add, thank you director colfax and good afternoon members of the health commission. it has been one of my greatest honors over these last years to work so closely with dr. anna and i have learned from her, been inspired by her and her incredible ability to use her deep knowledge of clinical operations to deploy or resources to where they are most needed and she does that over and over and over again. the other thing i'll say is ana built an amazing primary care leadership team that has shown resilience through all that we all experience during the last three years of the pandemic and so i have incredible

confidence that they will continue the good work and grateful she has such a strong deputy in (indiscernible) the deputy director primary care who will be taking over as the director of primary care. thank you anna for your service, really huge appreciation to you and to your family for all that they did to allow you to serve us with such dedication. >> the commission would like to invite dr. robear to come up to the podium if you like to say a few words. i want to my gratitude to everything said. your leadership particularly during covid and m pox, in communities disproportionately impacted the redauns r sponse of the apartment to provide testing and vaccination service and other supportss to the latinx community particularly in the mission is-was

extraordinary and we are pleased to know you will be continuing to serve this critical community in san francisco and mission neighborhood health center in partnership with dph so thank you for everything. we know you are not going far and keep seeing, but please the floor is yours. >> thank you commissioners. dr. colfax, thank you for the honor and recognition and dr. hammer my supervisor and mentor over the last 11 years. i learned so much from you. thanks to you our health commissioners for your advocacy and support for primary care during my time here. as a district 10 residents, mother of 3 who are navigating the public school system, my family friends and community feel every day impact and challenges and getting access to comprehensive primary care services, so i want to thank you commissioners for your guidance, vision and support for dph and always

striving to make san francisco a healthier place to live. so glad i will be just around the corner and joining you all and continuing that work. and mostly i feel like there is more to be shared with my husband and my children who have been patient with tolerated and allowed my absence during this time while i was (indiscernible) so thank you. >> we thank your family too so thank you. sure there will be more to say but we need to finish the director's report and go through a few procedures before other commissioners speak so please stick around a few minutes and invite director colfax to continue with the director report. >> thank you. >> thank you. i'll go quickly through the other pieces in the report written down and happy to answer questions. san francisco dph encouraging m pox vaccinations in advance of the summer season and

pride celebration. you will be called m pox known as monkeypox we had substantial outbreak last year and came together and really did an amazing job with community leadership and support in preventing the spread of m pox. the commissioner may be aware, there is a outbreak in the midwest now. we have not seen that happen here, but we insure everybody that we can if they are not vaccinated for m pox get vaccinated. the other component that is related to m pox is also rolling out doxy pep, doxy pep is recall it is dox ycycline taken after sexual exposure. there was a controlled trial, a local principle investigator that showed substantial reduction in syphilis, gonorrhea

and chlamydia so taking the initiative and rolling out and are offering doxy to patients and (indiscernible) i prescribed it myself multiple times already and people are very exseated excited about it. the next item is regard to nursing week at dph, very important to celebrate the incredible work our nurses do every day and every night and everything between in our city system. sometimes it isn't acknowledged how much the nurses work not just 9 to 5 but 24 hours a day from the icu and community and everything between. the theme of this years nursing week is you make a difference. we celebrated and acknowledged more then 1600 nurses at dph, including laguna honda where as you imagine from the prior presentation the importance of nursing is even more highlighted and of course

zuckerberg san francisco hospital and primary care system and in population health where the work around m pox and doxy pep could not be done without the nurses, so incredible work acknowledgment and celebrations and you can read details including celebrations held in other parts of the department. with that, i will just bring up our covid update our 7 day rolling average of new covid cases per day is 33 and 43 people are hospitalized including 5 in the icu as of may 3. 86 percent of all san francisco residents have been vaccinated. 65 percent received booster dose and 40 percent received a bivalent booster and you will see the link around dph in the news. happy to again answer additional questions or comments from the commissioners. thank you. >> secretary morewitz, is there public comment?

>> yes. can you unmute the one person with their hand up? >> it is patrick. can you hear me? >> yes, please begin. >> it is disappointing not hearing dr. colfax's director's report any mention of revised organizational chart for laguna honda once you hire and on'-board a nursing home administrator. commissioner bernal, commissioner chow you should make that a priority and get a new revised organizational chart as quickly as possible. thank you. >> that's the only public comment. >> comments from commissioners. commissioner christian. >> thank you and hello dr. colfax. good to see you. just a quick question that came up in the last meeting and thought it was a good one to

remind us all about. the question was about how we get the numbers about daily covid count. what leads to the count you give us? >> couldn't quite hear, the daily numbers for what? >> the- >> for covid? >> yes. >> okay. the covid count we get, there is the numbers we get from testing sites. those numbers are not representative of the true number of covid because there is so much home testing done so we have to really use those numbers very cautiously. the number hospitalized is more accurate number because it represents the number of people in the hospital with covid. it doesn't necessarily represent the people in the hospital because of covid, but it does gib give a more accurate measure of people in the hospital then compared to the number of tests being

done. we are looking at the hospital number. our main goal which is now right now in good shape with regard not having the hospital system overwhelmed with covid, so the testing number i think you could-we have to be thoughtful what that looks like. our numbers of tests have plummeted compared to where we were, but that number combined with the hospital number combined with what we see in the hidden in the regional trend and state trend, i think and national trnd as a whole it's very indicative of right now covid is at a relatively low level where it is for a number of months right now. >> thank you for that reminder. obviously those who test and test positive at home, the city has no way of knowing about that unless it is reported through work or some way- >> that's right. >> it is good for

people to be reminded when they hear the numbers you present to us at each meeting. >> that's right. thank you. >> commissioner guillermo. >> thank you. i just wanted to direct my remarks to dr. robert and congratulate you on the new gig. having spent the first 8 years of my professional year in the community health center across the bay, i know how important leadership is and how personally i developed myself because i had a fantastic executive director and ceo who groomed me and taught me the importance of primary care and community health, particularly in the appropriate languages, the clinic i worked at had 8 languages so i know how important that is to the residents that take advantage of primary care community based care in the neighborhoods so i thank you for

accepting that position, but i also want to thank you for the 11 years that you spent serving the interest and residents of san francisco and being part of the transformation, being part of the last several years of difficult times at a history of public health and for being part of making san francisco a model for what the nation saw as our response to covid so thank you very much and appreciate it and look for better things and more things in the future. >> (indiscernible) >> i would echo what commissioner guillermo said and you think about primary care and all around us doctors are retiring left and right, we are having a very hard staffing primary care. i get asked 7 days a day for a new primary care provider and yet

the people i know that work at the general, the people that work in primary care, dph are stable. the patients love them and they are so happy to be there and i think that has a lot to do with leadership and everything you do in a very difficult and challenging specialty, nevermind the patients you care for. we had some went to mission neighborhood health center. the cfo was my office manager and she is part time cfo of my non profit so i get a lot of incider information and it is wonderful team. the doctors there are inspiring. the patients are grateful. you are doing wonderful work women health near and dear to my heart so i know you are go toog a organization that will be so happy to have continued great leadership and do wonderful things for the individuals in the mission. you have taken over some of the

clinics that used to be at the old saint lukes hospital and there is a massive need in that particular very vulnerable population to have great care and great leadership and great providers and i know that you will accomplish that and the legacy of what have done within the department will be enhanced and continue at mission neighborhood health, so sure i will get incider information, but so glad you are going there. >> commissioner giraudo. >> i just want to echo everybody's comments, not only of your number of years here at dph, but taking that leadership skills, especially the wonderful primary care model of dph over to mission neighborhood health and i look forward to your leadership there. my staff is in the pediatric clinic. we

have taken the mantra of dph and integrated behavioral health into primary care and we love it, it is continuing and the staff is very very dedicated and wonderful. i also welcome you to mission neighborhood health as i with a different hat on in pediatrics work with the wonderful people and we hope that too the integration of behavioral health and pediatrics again is a model going forward, so i'm grateful for your work here, but also excited about the leadership you are bringing to mission neighborhood health, so thank you. >> commissioner chow. >> yes. i also wanted to thank you for your work over these 11 years and going through all the

transitions that primary care has. primary care has really become a stellar service for our department. many years ago it was rather dispair and everybody had their own thought about what should be in primary care and we had what 11 different clinics with 11 different ideas, and over these years and you have been a very integral part of that, you really built a primary care-a sense of belonging where i think the members of your team all the way from the nurses up to the physicians feel they are part of a system now and not just simply one one or another clinic, but it pulls together and clearly from leadership you exhibited along with others and are dr. hammer that have brought us a premier

primary care network here in the city. i know the importance of mission neighborhood center and these very many years that i worked in the community and they think they are very fortunate to have you going there. we are fortunate we will continue to partner with mission neighborhood, and my very best wishes for a very productive future for you. thank you. >> thank you commissioner chow. i like to associate myself with all the remarks of my fellow commissioners so thank you again. i did have one more question for director colfax. thank you for including the m pox and doxy prep information in the director's report of course there is robust outreach within the department to effected communities, the lgbtq community people living with hiv in advance of the pride and summer celebrations. someone in the target

population living with hiv follow the guidance of the department and stood in line at the general and got my two shots there. could you go over and know some is in the report, what someone like me need to do if i have my two doses or anyone who got a dose or seeking to ges vaccinated? >> i will have dr. phillip who is on the line the health officer overseeing this program provides that additional information. dr. phillip. i thought she was on. sorry. she apparently is not able to join. we can certainly provide that information to you in detail at the next report. >> okay, because my understanding is that someone like me received my two doses last year would not require vaccination and there is a 28 day period at least between doses so if someone

received the dose may 12 they could get their dose-second dose 28 days later around june 10. >> i believe that is correct but i want to make sure dr. phillip and her team are here to clarify. >> thank you, director. alright. that concludes the director report. thank you doctor andiourfamily to support you. good to see you all and we'll see more of you. the next item is an item about public or health commission public comment procedures. we have nicole bonn, mayor office of disability here to present and secretary morewitz has some things to say in introducing this item. >> yes, hi. before nicole speaks she will be remote with us, just to acknowledge the health commission per city attorney guidance and the office of the city administrator guidance

made changes to public comment march this year. it was a effort that was communicated to and encouraged to all city policy bodies, especially those who are charter policy bodies. our commission accepted the recommendations as they were given. it turns out that other city policy bodies had a very disparate decision making process not consistency among all policy bodies. i received as you all have public comment regarding the complexity of the new procedures so this is a opportunity for the public to comment, for you to hear rational behind those changes. nicole, if you could begin to give us a sense of your part in this process and any feedback or input. >> very glad to. i want to do a sound check. i haven't tested webex from this computer for a while. >> you sound great. >> hello

commissioners. i'm nicole bonn, bohn, the mayor office of disability which serves as the overall ada coordinator for city and county of san francisco and so part of our charge is to make sure that we have processing accessible and also usable to folks with disabilities. briefly, i think mark summarized most of where we are, but just to add, part of the reason why we have remote public combecause we knew prior to the pandemic that we needed to do a better job making sure that we could hear from the voicing of people with disabilities and only inperson action. it was arguably not accessible to everyone, so the intent of working with the city

administrator through the mayor to policy and practice guidance on remote public comment was to make sure we could have a more accessible process then we had previously. as mark mentioned, we have guidance that is available for commissions to use, and that was developed in parallel to the board of supervisors legislative process before we knew how their legislative vote would go on public comment, and so now we know that commissions are adopting public comment for the general public with different practices, but everyone just to be clear is required

to have a process specifically for people with disabilities. that is part of what is required in order to have effective access for the meeting. in the recent meeting of the commission secretary for instance, we did an informal poll of how commissions were handling public comment for people with disabilities and then the general public, and everyone confirmed that yes, they have a process for people with disabilities but some mentioned because they opted not to have time limits on the general public comment that the comment for people with disabilities has been included as part of that, which is also allowed. the intent of the guidance was

to help the commissions understand what their options were in terms of providing accessible public comment that would work for most people, if not all people and then we are required to have a reasonable accommodation process generally for any kind of public meeting aside from remote public comment where other kinds of things. for instance, if someone was in person and they needed an in-person assisted listening device, we would provide that. if they needed interpretation from the sign language from the sign language interpreter, we would have done that. something we would have done anyway. one thing that we are finding though, and then i am happy to have discussion hoping we can have today because there has been concern i think and some

criticism that the comment process for some people have experienced feel exclusionary or tiered or really promoting disability access in a way that is perhaps inconsistent, so first of all, i want to clarify that one, as we are providing a process by which people with disabilities can participate, we are meeting at least a minimum obligation and beyond that, commissions can adopt (indiscernible) going back to my earlier example around when we were checking with the commission secretary, some are opting no limit on public comment, some

are opting to put a time limit on it. i heard 20 minutes is what (indiscernible) doing now. there is also commissions that opted 10 minutes, 15 minutes. there are some commissions that opted for no general public comment, but public comment on request by persons with disabilities. all these we encourage these options to be vetted through your general counsel for your departments and any practice like this is allowed again as long as people-there is a process for people with disabilities. but, i think what i also like to mention is that there is talk and concern particularly from some people with disabilities but also members of the general public that has maybe given

the perception that the request to have persons with disabilities participate first or participate through identification is somehow not something we want to be promoting, and so there are a couple things i have to say about that. one is that, for many people that mentioned they are maybe not comfortable identifying as a person with a disability, there are just as many if not more that prefer to be able to identify, to be able to insure they have an accommodation in place and to be able to participate and not only participate remotely, but participate first for a variety of reasons. there are people that have as particular caregiving schedules. there

are people who need to use sign language interpretation and they need to go first or have first access i should say. one of the things also i think that is important to note if it is not clear by the video, i myself and also a wheelchair user, i have been my entire life, and really obviously identify also as a person with a disability and have very keen awareness that people are in different stages of their willingness to adopt disability as part of their identify, or a part of their disability culture, which certainly there is very active and has been for decades a movement around disability community

and disability culture. i recognize and the city recognizes that folks are in different places where their identify around that, but one thing that is very important to us at the mayor's office on disability is when we are talking about disability and having folks with disabilities identify that they would like to provide comment or identify themselves in any circumstance really as a disabled person that we are not only honoring that but understanding that there is for many people with disability, identifying as disabled people deaf and disabled people is a matter of pride and it is a matter of their identity and i think one thing unfortunate, there is a unintended narrative that has come out of what we have been trying so far is i think that

some members feel that we shouldn't be asking people with disabilities to disclose the fact that they have disability status. and so i just wanted to highlight that there are different schools of thought on that and we really as a city want to be promoting the idea i think that it is okay to identify as a person with a disability. all that said and then i'll pause for questions, i do truly recognize that not everybody is in that place, and feels comfortable about that and so one thing that we recommended in the cases where we had questions about that is, people with disabilities who do not want to identify as disabled in order to provide remote public comment

would then just join the general queue, and participate in that way. one of the benefits of identifying as a person with disability needing first access there is a standard limit to the amount of time that you can speak per an item, 2, minutes, 3 minutes depending how the individual commissions set that, there is not a limit to the number of people with disabilities who can identify that they would like to speak as a disabled person or request, first access or disability access or reasonable accommodation or any of that language. so, that is one of the benefits, but if folks prefer not to identify

as a disabled person, then we have been recommending that they join the general public comment queue available through most commissions. so--and we do recognize also that words like reasonable accommodation, reasonable modification, even request sometimes can seem like something that is scary to folks, and so there are other ways that i think we can talk about this access and this is how i have been thinking about it, thinking through it with folks, some people prefer to say, i need first access or priority access. it is the same thing, and i recognize that, but some people prefer to use that kind of language rather then the technical more

legal jargon that we use for those in the field and they are used to reasonable accommodation language in the phrasing that are used in ada and other accessible legislation we have thereat -that guides all these principles. i will pause and hopefully that was helpful. i'm very happy to have discussion or answer questions anyone might have. >> thank you mrs. bohn, very helpful. before we go to commentss or questions, do we have public comment? >> we, do and nicole, before we start just reminder we don't interact with public commenters but the commissioners may ask questions. let's hear the public comment and the commissioners will go. james, please unmute the first person. >> hi, mark. it is

patrick ww again. >> thank you. >> i changed my last name to ww. i'm glad you are having this conversation. i'm glad to hear the explanation of the mayor office of disability. as i testified before, i think it is discriminatory you require people to self-identify if you are disabled in order to gain public accommodation. i prefer not having not to be known as ww (indiscernible) i really encourage the health commission to take a leadership role for every other board and commission in the city to standardize these processes and not have multiple

different processes at different board and commissions. why don't you get rid of the time limit since there are so few regular callers that delay you guys going out for dinner or squeezing in a round of golf after your commission meetings? this was never a problem for years and years and years and you never had a 3 tiered policy before covid. now, that the federal government has declared the federal emergency over, you should go back to the old way you did things years and years and years and years ago and just stop this non sense. thank you. >> okay. the next caller,

please. >> this is dr. palmer. i think the three tiered thing has-is anti-democratic and discouraged public participation. i think if someone needs first access you can if hadcourage them to ask for, put we should not have a three tiered thing. there is much less public participation since this three tiered system began, and it made things unnecessarily complicated. the other thing i want to say is, people who do physically go to testify at the health commission have reported locked bathrooms and elevators that break down or don't work, which leads to pain and misery, so you have done two

things, you made public comment more complicated having to read three paragraphs of directions before you call in, and you made it painful and uncomfortable for anyone with any kind of limited mobility to appear in person. i think you should allow unlimited public comment and you should make sure there is decent signage, the elevators are fixed and bathrooms are available and accessible and there is good signage to them. thank you. >> that's the only public comment. if i may clarify, there was a meeting when the elevators remember both broken and i wasn't notifiedism that is the issue i believe the caller is talking

about. that was a real issue. >> thank you for the clarification. comments or questions for ms. bohn. >> i want to thank you for your excellent presentation. how you gave the rational for the decision making as far as the public comment guidelines, i really appreciated how clear you were, and how you have gone through controversy and sure you will continue to do so, but i do want to thank you for your presentation because it was very helpful. thank you. >> you're welcome. i'm glad it was helpful. that's why we are here. >> thank you commissioner giraudo. commissioner chow. >> yes. ypt i want to thank you for the presentation and

for the fact you are saying while we heard that the tiered system for the remote comment is not necessarily something that some people are agree to, that you have had indication that and within your own decision making in terms of the guidelines that this actually has come from the disability community, is that fair to say? >> i would say yes. it benefited some people with disabilities who benefit from being able to go first or give comment before other people. i think the thing and just listening to how we are talking about it and what i heard, we also received comment on this issue through my mayor

disability council with people with disabilities and think one of the concerns is how we are talking about it. when i think about disability access and we and mayor office of disability are thinking about that, we are not necessarily thinking about it in terms of any kind of tier or hierarchy or any of that language. it is just something that we do and so i think one of the things that might be helpful and will take this under advicement and to work with the commission, think how we talk about this in a way that isn't emphasizing there are tiers, because i'm not sure that that's exactly what we mean. i think we mean access for people with disabilities

requesting access, and then general public comment, but it is not one tier over another if that makes sense. >> yes. the advice we are getting from the city attorney was worked out with you and the disability council and is sort of recommended that for the reasons you said that the disability representatives felt this actually made sense and i guess that you're suggesting people could actually use different wording not to say that they had a disability, but they would like first access and you would sort of accept something like that as being just-i guess you don't need a disability to ask for first access, is that

something that in your experience might have been-i guess abused? >> well, that is a interesting question. i don't have a direct answer to that. i think there is always a fear that people have-in any accommodation process or modification process, there is always concern and i have been doing this work for 25 years and disability access and there is concern that someone is going to abuse it or not (indiscernible) or take away access that might rightfully belong to another disabled person. generally in my experience, people with

disabilities who request and need accommodations will ask for them. i think there is not a good way to be able to say you are not really disabled, so i'm not going to do this for you. generally our advice is also to this process is people are requesting access on the basis of disability or requesting a disability accommodation our advice is to grant that whenever possible, unless you have good reason to understand that there isn't what we call a nexus between their disability and the nature of their request. in the circumstance it is really difficult to determine that so generally we are saying people-if they ask for an accommodation or to participate first, take their word for it. so far in the first

month of this revised practice i'm not hearing directly through mod anyway, significant abuses to this, but it is always something that we want to keep an eye on and i certainly have advised in situations where we have had questions about good ways to approach that if that is a concern. generally so far so good in terms of that. >> thank you. therefore, i guess the other question was the 20 minute limit on non disabled, but if we are talking about people who didn't want to identify and moved into that, there may be a loss of opportunity on their

part if-so, where does the 20 minutes come from? or is that a commission option? >> it is a commission option. it was a general recommendation because we made an assumption that perhaps not every commission would want to move forward with unlimited public comment, and so we had to pick a starting place, and so am some people are using that as a marker, some commissioners are using 30 minutes, some commissioners are using less time and some commissioners are not having any time for remote public comment accept in the case of the disability request. so, it is-that is at your discretion, the amount of time for general public comment. >> thank you very much for your very clear answers.

>> you're welcome. >> i like to thank you. this is a iterative learning process for all of us and the opportunities to make adjustments as needed if there are inequities or concerns identified. would like to thank you for not only your leadership on behalf of san franciscans with disabilities but working with our commission secretary mark morewitz and being a resource to our commission. serving san franciscans with disabilities is core to our work and are mission here at sfdph and not only critical for people with disabilities to have the opportunity to express their viewpoints to us, but also critical that we as a commission have the opportunity to learn about the priorities and concerns of people with disabilities and find how we are doing and serving them. this is such a important issue for us. thank you so much for joining us today and really helping us understand better and hopefully others

listening to the process we adopted and again very gratefulism thank you. >> my pleasure. please invite me back any time. i am really grateful to support your work and to support access for people with disabilities so thank you. >> thank you. >> good night. >> good night. okay. thank you secretary morewitz organizing that session for us. our next item is dph third quarter financial report and we have jen louie the dph chief financial officer. hello. >> good evening. jenny louie, cfo here to present the third quarter financial's. there is a little glare on the screen so will be looking down on my slides so i can follow along. the big picture for the third quarter we are projecting $6.9 million deficit. this

is improvalment compared to the second quarter of $8 million projecting $14.9 million short-fall. this is driven by multiple factors looking at worsening of projected revenue by $2.8 million compared to second quarter and $10.7 million improvalment in expenditure due to additional projected savings by year-end. the revenue side projecting $18 million short-fall due to the reduced (indiscernible) laguna honda hospital as we continue the recertification process and pause admissions. in addition, we are now expecting delay in medi-cal wavers and partially offset by other favorable revenue zucker erberg as fee transition to fee for service model as

zuckerberg. i did get a question about whether or not we are likely to get these revenues. at some point we do expect them and will say this $38 million is a projection modeled out of how we believe fiscal years 10, 11, 12, 13 and 13, 14 will be scheduled and there is a gap between. i think we-this time last year we actually thought these revenues were coming in and did put them in the budget. they still have not-we worked with the california public hospitals and they told counties not to expect the settlement to come in time for the current fiscal year so cannot recognize it. i do not believe they are at risk. i think it is more a matter of time and hopeful they will come in and as mat ter of

practing starting to budget prior year settlement to leverage our management reserve to be able to buffer when we have moments like this, but also when we know it is out there to be able to just not do anything about it but really recognize some of the revenue to help support our budget proposals moving forward. we are hopeful, but currently should the short fall persist of $6.9 million we'll make withdraw from the management reserve to even the year and come balanced. expenditure side, we are expecting to be $11 million better and this is due to zuckerberg san francisco general projected to be $12.3 million over budget due to inflationary cost, registry cost, increased census and i note that these numbers are net of $16.5 million

transfer that is made to off-set the shortfall. this is unusual situation where we have higher then expected census at zuckerberg san francisco general. ordinary these are transfers we make year end but to insure we have sufficient balances to maintain at the general. we startsed to make some of those moves. laguna honda is projected $7.2 million over budget and we have made similar transfer i believe $19 million to off-set that. i want to confirm--19.8 million

moving forward. i will note across the department we are seeing more salary saves as we move past third quarter. we get a better picture of salaries with 9 months of salary and pay roll and expecting improvement in delays of one time hiring as we atdsed 400 new fte in current year position. i note some of the work hr is doing is not for lack of trying. they are-we are seeing a lot of people get processed through the system, but also seeing on the back door people who are sep rating, retiring and the like and it tends to be common particularly as we approach the summer months. with that, these are 9 months worth of actuals but we expect it is possible that these numbers could change by year end. next slide,

please. just big pictures where we are landing. you see $18 million revenue shortfall again driven by primarily laguna honda as well as a loss in the ability to project the settlement. it is offset by $11 million to net out 6.9 overall across the department. next slide, please. get nothing to the details, zuckerberg san francisco general projected 5.6 million dollar favor with patient revenue at 80.4. this is primarily due to transishz to the fee for service model discussed earlier but a part of this transition is not all good news where we are expecting a shortfall of 11.6 and enhance payment plan pool and this is a

pool that's designed for support base rates for desinginatesed hospital systems. with the shift of to fee for service there are two different pools. one capitation and one fee for service. we were previously enthe pool with 2 other counties, la and santa clara and we will be in good company since all the other countsies are parpating. because of is the shift and volume driven and depends on other county volumes and our own as they allocate the pools, it does make the revenue less predictable. this revenue will be trued up probably in about 12 to 18 months from now so will have a better sense of the preliminary estimates we believe there is potentially a short-fall of

11.8 and enhance payment plan pool. on top of it, as mentioned before, the prior settlements of $38 million and global payment program of $30.5 million. this is not a result of the fee for service shift but more as a result of good news in terms of medi-cal eligibility, global payment program is a program that helps hospital system support the cost of uncompensated care and receive points based system for service we provide to uninsured. with the expansion of medi-cal eligibility over the last 2 years we are seeing a lower level of the uninsured which is good news but translates into reduction in the volume of service we provide to uninsured because they now have coverage so

projecting $30 million in the current year. we did notice this trend as part of the budget development in february and we did make a correction to this line item so we shouldn't see a significant variance moving forward into next fiscal year. in addition good news around the graduate medical education program $4.4 million as well as improvement due to rate increase of hethy workers capitation. we are projecting short fall of specialty pharmacy as we await certification for specialty pharmacy plan. on the expenditure side, we are seeing $9.6 million savings in salaries and benefits but this is off-set by 4.5 in contracts, 6.2 materials and supplies as well as 1.4 in work order services for other departments. one thing slightly

unusual in q3 is slight spike in our puc work orders during the winter months where the gas (indiscernible) managing facilities went up and we saw them at san francisco general and laguna honda. next slide. at laguna honda again the reduced census results in about $22 million short fall. i also note this is a slightly better projection then we had in q3 and so while the census remains low, we did also-the state overall provided rate increases for all skill ed nursing facilities effective after the second quarter of this year and we are able to project some improvement so in the last quarter about $26 million and we closed the gap a little to 4. (indiscernible) no adjustment in the volume.

on the expenditure side, we have $11 million short-fall and non personnel service primarily as a result of efforts to recertify laguna honda and slight savings in materials and supplies of $3.5 million and slight improvement in terms of miner work order savings from service to other departments. next slide, please. the behavioral health side, we are about 4 million faivable on revenue and this is a bit of mixed bag. patient revenue we are short $10 million driven by $13 million of short-fall and what we are seeing in the regular behavioral health revenue for (indiscernible) substance use revenues. we did make a correction in the budget upcoming as some of the trends are persistent. there is also a small short-fall as a result of not hitting one milestone in the behavioral health quality

improvement program and we are also short as we have been projecting for the last several quarters on the cal aim revenues due to delayed start. i do not-i believe that we are working to expand the teams and with a change in how we can claim the revenue through the health plan. i believe this short-fall will not persist moving forward next year. off-setting the short fall is $15.8 million driven by state sales tax growth and then we have a miner short fall of $400 thousand in other state revenue. on the expenditure side, 1.8 $1.8 million in salaries savings and $8.4 million in non personnel services and work orders due to prior year incumbrances that could be closed out and no

longer needed. next slide. primary care, we are seeing short-fall of about a million on the patient revenue side. slight adjustment for cal aim revenues off-set by capitation revenue. again, also seeing salary savings within primary care of $5.2 million and miner release of annual projeths related to sugar beverage. this $5.2 million we hope will not be sustained. we want to fill the positions and we are budgeted for them and so with these and all other positions we hope once we catch up with the filling all the new positions we loaded into the budget in the current years, these gaps will actually close. next slide, please. jail health, similar stories.

savings of $1.8 million offset by registry cost. achieve material and supply savings due to lower census within the jails and miner work order savings primary due to worker comp. next slide, please. and then within health network, we are seeing a $3 million unfavorable balance. have a little good news within the health at home billing but most significantly short-fall in the healthy san francisco participant fees. again, this is not related to fee for service transition, but healthy san francisco a program for people who do not have sufficient coverage between all the work that we have been doing, with state covered california as well as the expansion of medi-cal eligibility. we were seeing reduced revenue in healthy san francisco copays,

again a great thing, not great for what we see the financials but a great thing overall moving forward. we see a slight short-fall in our medi-cal county administrative activities to rate change and lower activity there and delay in the cal aim implementation of $700 thousand and then slight short-fall in some healthcare accountability fees of $200 thousand. on the salary side, $2.4 million of salary savings offset by about $3 million as we engage in a contract with chinese hospital to support some of the patient flow this current year. next slide, please. within population health, short-fall about $1.2 million in patient revenues. staff is working looking at the model for how we

move forward with the adult immunization and travel clinic. we are not seeing volumes prepandemic with corporations snding their workers to foreign countries to do work and in addition i think we are still working on public health lab billing but did implement epic within city clinic and we are seeing some improvement in the revenues overall there. and then again, $1.8 million of salary and fringe savings projected this time. and then next slide, please. and within the public health administration which is operation division, slight improvement and vital records fees and also the medi-cal administrative activity short-fall consistent with the network. again salaries fringe savings due to vacant and small savings within the it project

budget of $1.7 million. next slide, please. within the covid response project budget overall projecting $13.6 million of savings compared to the revised budget. projecting about 64.6 of expenditures by year end. in addition we need a inventory adjustment related to ppe that we have done for prior years and this is more of accounting thing where when we performs ppe in the prior year even though we paid for it, it isn't considered paid and used because it is in the inventory like a type of asset so when it gets used the following year it gets recognized and in terms of accounting it looks like a negative expenedture, and then the controller credits the prior year. the prior year purchase. it evens out but it

looks like it results in our reporting of balances of $13.6 million overall, but note it isn't a real expenditure savings that you would ordinarily see. next slide, please. specifically, again the first one is around ppe savings or the recording of ppe used. we also have $1.5 million surplus in shelter in place from the close-out of that program moving forward and then $400 thousand short-fall in covid response unit due to increased contract expenditures. $5 million savings in the community response project from reduction in projected expenditures compared to q2 and then $8 00 thousand in savings in testing based on current testing trends and $3.9 million

savings based oen the vaccination trends. we are not assuming any surges so assuming straight line of the current trends we see then covid project. next slide, please. taking all this into account as mentioned before, should the $6.9 million deficit persist by year end we would take withdraw out of that leaving $116 million in the reserve moving forward in the following year and this would still leave us with about 4.72 percent of what our budgeted revenues are in the current budget year today. i believe this concludes my presentation and happy to answer any questions you may have. >> thank you. before we go to commissioners do we have public comment? >> yes, is the lighting okay for you commissioners? should i turn on-i'll turn on

lights after public comment, is that okay? james, please unmute the caller. >> hi, mr. morewitz, this is patrick. i am a little bit concerned about whether the salary savings may be contributing to the short staffing, particularly at laguna honda hospital, putting additional strain on laguna honda staff and obviously effecting the quality of care being provided to laguna honda patients. today supervisor melgar participated in a zoom call and she mentioned the potential that there may be a

$64 million short-fall (indiscernible) 64 as in $64 million short-fall should be-the closure plan at laguna honda hospital go ahead. (indiscernible) didn't go into detail so don't know what she referring to the current year (indiscernible) or she is talking about the budget that would start july 1 of this year that you guys really really need to expedite getting laguna honda recertified, getting admissions resumed, and putting this whole nightmare behind us and to the extent you can avoid having to extend another sense

into the hma contract that expires the end of june, to avoid exacerbating that $64 million budget problem supervisor melgar is facingism . i urge you to strongly consider whether you need to extend hma's contract. thank you. >> that's the only public comment. >> commissioners, comments or questions for mrs. louie? commissioner chow. >> i just wanted clarification on slide 3. whether we are supposed to read that as a negative $6.9 million surplus, or you really minute to say deficit. >> apologies. this is a $6.9 million deficit and the need to make withdraw. >> once again, you have been

very very clear, so i don't have other questions. it is very easy to read your reports and understand our situation so thank you. >> thank you commissioners. >> commissioner guillermo. >> thank you for your presentation. i had a question on the behavioral health budget on page 6. the 2011 realignment can you explain that a little bit more and whether there is a limit to the realignment revenues coming from the state to the counties at some point? >> so, in terms of 2007 realignment, these were dollars-prior to 2011, county behavioral health service received used to receive funding directly through a program of some kind not unlike medi-cal so these dollars were

realigned so instead of doing all the accounting they said counties will apkale a portion of the expenditures you maintain your services. the 2011 realignment is based off of the state accounting of sales tax, and i do not right now we are not anticipating any changes to cap, but is there something specific around your question? >> just a concern that because revenues are in deficit generally in behavioral health we are relying on the realignment revenues. looks like unexpect edly more so then before and just sort of aware that if there is a change in the formula or whether there is a cap that will put us into more difficult financial situation with revenues or resources available on the behavioral health side, and so that was sort of the intents of

the question. >> great question. overall, we and suspect other counties get projections from the state in terms of the 20s 11 realignment they think they'll get and we load that into the budget and there's more positive news and then expected compared to what the state projected originally and then in terms of the short-fall of medi-cal revenue, we did make an adjustment in our february submission for the budget, which trued up some of the revenues and balanced out actually recognizing using the state projection of realignment moving forward for fiscal year 23-24, we recognize that and then did off-set this so this discrepancy that is flipped between realignment and medi-cal within behavioral health should be corrected in the budget to the best of our knowledge in february. i will

say $23-24, we recognize that and then did off-set this so this discrepancy that is flipped between realignment and medi-cal within behavioral health should be corrected in the budget to the best of our knowledge in february. i will say it is-10 million seems like a lot, but in terms of percentage wise, we are within 5 percent of the revenues, and i think one of theed a vantages we do have is this reserve that enables us to actually ride out some of these fluctuations driven from forces out the city control. driven by state formula, allocations projections as well as rate changes form yula changes we might see. >> they think. i just want to comment and know this isn't the budget time, but i wanted to commend you and all your colleagues on the way you are managing the budget given the challenges and strains that have come upon us unexpectedly and will probably be more difficult in the future, so again, managing this budget, it looks easy on a couple slides, but really want to

congratulate you and thank you for all the work put into having to make sure the resources are available and consistently made available for all the services that we provide in san francisco to our residents. >> thank you for your comments. there was one more question around whether or not we are sufficiently budget for inflationary and as you recall within the february submission we add additional cost related to pharmaceuticals as well as food and other contractual obligations, and so to the best of our knowledge we use either cpi rates directed by the controller's office and i know that our director of pharmacy mr. smith will also do just surveys to just try to get a sense which way the wind is blowing so to the best of our knowledge we believe the materials and supplies budget is sufficient moving forward but again always a

little hard to tell, particularly now as we have supply chain issues and inflation being what it is. we do believe that the budget moving forward is appropriate. >> thank you as always for being so clear and talking about uncertainties. how are we going to incorporate redetermination where we don know how many people are disqualified from medi-cal and what it does to healthy san francisco and then in 2024 the coverage of undocumented individuals through medi-cal and wonder how we balance that because sure there will be a certain amount of effort needed to enroll people to help people find alternatives. is that something we have capacity to really understand or even project? it seems there is so much uncertainty there. >> it is a challenge to determine. we know there will

be some people who have continued their coverage through the public health emergency that did expire. the state will slowly roll out phase in those reapplications over the course of-several months so it is not coverage turn s turns off. it will be a sort of a slower decline, we expect if any to that. there is also effort within the network that is lead by office of managed care and network leaders looking at this issue because there are some real redeterminations where people coverage should lapse and they have passed away and moved out of county and no longer in san francisco and have income levels that exceed the eligibility requirements. we will see some loss in those areas but we also want to make

sure the people entitled and eligible for coverage do maintain and i know there are efforts underway to make sure that we are trying to reach out to as many people as possible. it is a little of a challenge to see but overall between improved coverage, it could even out, but it is very difficult. many counties are puzzling over this issue as well. >> thank you. >> thank you. i have a quick question. this might be a situation where accounting terms themselves are misleading because when you look at the salary and fringe benefits which across the board are favorable to the general fund it means the surplus is means there are unfilled positions across the board in every department. i was particularly concerned when i saw this in the behavioral health area given the large number of hires that we had done in

the past year in behavioral health and perhaps this isn't a question for you but more hr but does that exist across the department because it has significant impact on the work load and strain on our existing team members as well as the services we provide. >> yes. i think that hr will probably be best to answer this question, but working-i work closely with hr and think there is number of positions we fill and process but at the same time we also lose people when they decide to retire go to another city department or go outside of the city for employment and so it is that dynamic that we are seeing and it is not so much--the lack of trying on hr's part and i know we are looking at some of our

performance metric in terms of what we accomplished and i don't have the specific numbers but it is not just a question of all inputs we have in terms of new hires, some of the inputs and people we process may be also internal to our-even though we filled the position it may be because someone competed for internal promotion within it department, which yes we filled the position, but they left a gap behind them. >> thank you for that clarification. it is fair to say that the surpluses that are here are not due to new efficiencies or lower then anticipated cost in providing benefits to our employees that does represent open positions, correct? >> uh-huh. >> thank you. commissioners any other comments or questions? commissioner christian. >> i want to thank you for your clear presentation and guiding us through these numbers and

this report. i appreciate it. >> thank you very much. good to have you here. okay. our next item on the agenda, pardon me for a moment. fy21-22 dph annual report. welcome michelle ko, office of policy and planning. >> good afternoon commissioners. my name is michelle ko a health program planning with office of policy and planning joined today by colleague max guerra senior health program planner with office of policy and planning. i'm here today to- >> keep talking.

>> required by the city administrative code. provides a general summary of dph accomplishments over the past fiscal year. this years report has revised design to help improve the reports readability and incorporated feedback received from commissioners during the community helths and public health committee preezentation. we will make note of where we made those changes in the report throughout the presentation. the annual report opens with a welcoming and message from the director of health dr. grant colfax. this message highlights the three feature articles in the report which includes the covid pandemic response, the mental health sf implementation, and update from the office of health equity and human resources. this message

also discusses dph response to the overdose crisis as well as the laguna honda hospital recertification. next slide, please. the director message is fallowed by a message from commission president bernal, his message includes dph response to covid pandemic, laguna honda hospital recertification and renovation of maxine helths center. those these messages provide leadership introduction to department activities discussed in the report. next slide, please. the next set of sections provide overview of the functions and services across the department. the section starts by introducing the department two divisions and roles and protecting and promoting the health of san franciscans. the next section reviews dph true north and 6 true pillars which is then fallowed by the most recent organizational chart. as part of the racial equity

action plan, this year's report presents demographic information on both the health commission and senior leadership. this data will continue to be collected and presented in the annual report each year. next slide, please. the last introductory section focus oen the health commission. this provides overview of structure and function of the commission along with individual bioes for each commissioner. next slide, please. the next section of the report presents three feature stories that highlight highest profile efforts by the department in the fiscal year. the first feature provides overview of dph covid response in fiscal year 2021-2022. this feature describes how dph entered a new stage of the pandemic response which aimed balancing the anticipated needs of covid with growing needs of the city as it reopened. this feature provides highlights of the one year

anniversary of vaccinations. for example, between december 2021 and when the first doses were administered nearly 1.4 million covid vaccine doses had been given out inoculating 750 thousand san franciscans with best defense against the virus. in addition, by the end of 2021, the city reached a new milestone with 80 percent of the total population fully vaccinated. this includes 70 percent of black african americans and over 80 percent of latinx communities being fully vaccinated. next slide, please. the second feature discussing efforts to expand residential care and treatment. as part of mental health sf, dph opened more then 160 residential care and treatment beds in 2022. dph also opened two facilities, soma live and the meno project. soma rise is

one of the nation's first drug sobering centers and first 4 months of operation, 900 people visited soma rise to rest, eat a meal, take a shower or receive connections to care. the minna project support said people with mental health and substance use disorder transitioning from the justice system to independent living. during the first 6 months of operation, 50 justice involved treatment case management and supportive counseling. next slide, please. the last feature provides update from office of health equity and human resources. dph continue to prioritize racial equity by improving human resources staffing and policies and are hiring employee experience in alignment with the racial equity action plan. may 2022 released the first annual equity report. next

slide, please. fallege the features are 21 highlights showcasing work across the population helths division and san francisco health network. the highlights speak to the work across the department and areas such as healthcare services, overdose prevention, whole person integrated care, hiv services as well as within the population health division and central administration. since our presentation to the community and public health committee, we incorporated feedback to add more data points on patient and client served by each program in order to better showcase the scope and scale of these programs. i want to give a huge thank you to dph staff who help support and drafting these highlights. next slide, please. the next major section of the report focuses on data starting with dph budget. budget

data provides expenditures program and type revenue by source and major investments. for example, $123.6 million was allocated to continue dph covid response in the fiscal year. next slide, please. the next data section highlights san francisco health network data on visits, patient demographics and payer type across the major systems of care. this section highlights how sfhn provides a wide array of services across the continuum of care. unique patients or encounter data is provided for each of the service areas, primary care, behavioral health services whole person integrated care, jail health services,b dental care, home health, emergency, specialty care, urgeants care and diagnautic and ancillary care. patient days and average stay for skilled nursing are

also included for zsfg and laguna honda hospital. thank you for the comments by commissioner chow regarding behavioral health data. we want to note behavioral health encounters historically have not been reported for annual report but future reports will explore inclusion of this data. in addition, we have not historically included average stay days for acute inpatient stays for zsfg and laguna honda hospital, but we will reach out to both hospitals about this data. furthermore, this section introduces-includes patient demographic data by race and ethnicity, age and sex and gender. in addition, payer data that shows payer sources is included as well as within primary care and whole person integrated care.

lastly, each of the health commission resolutions adopted in 2021 and 2022 are included. next slide, please. the report ends with overview of the department service sites and contractors. included in the section are maps of the primary care and behavioral health service sites updated to reflect location changes and list of the community contractors is also provided. lastly, the report includes additional dph resources such as where more information can be found on the health commission, where to get health coverage i of course san francisco covid response. next slide, please. moving forward we will look for ways to streamline the report for future years as well as provide more programmatic data to show the scope and scale of dph programs and services. at this time, max and i are happy to answer any questions or comments, thank you so much for

your time. >> thank you. do we have public comment? >> i don't see a hand. folks we are on item 8 if you like to comment, press star 3. no hands commissioners. >> alright. commissioner giraudo. >> i want to thank you for including our committee feedback and i hope going forward that you will continue to count the number of people that are served. i just think we also need that kind of data to really kind of toot our own horn of how many people we actually serve rather then the not so i appreciate you taking our recommendations. >> thank you. >> any other questions or comments? commissioner christian. >> thank you president bernal. the report is easy to read. i like the layout. i am wondering what will be

printed? what paper because there are some couple slides, especially the organizational chart that i'm sure it isn't printed on this paper and just impossible to read. >> definitely. we will keep that in mind when we print the report. thank you. >> the colors are great and when the smaller things are sharper it will look fabulous. thank you. >> perfect. thank you so much. >> vice president green. >> i think this is terrific report and i love the numbers because i think they speak louder then anything to convey the amount of work and the accomplishments of the department. in reading this makes me feel so proud and looking at the man power we had to work with in everything and every area that is so successful and plus understanding the community we serve in greater detail is so

helpful and i was wondering where people who want to see this can easily find it. is there distribution list or is it it will be on the website or it is so wonderful. >> thank you so much. we appreciate that. disbution we plan to provide hard copies to all the health commissioners and we plan to make it available on the dph website. we'll also work internally within the department to make sure everybody has access and able to point any community stakeholders to the report. >> it is a great resource. >> thank you so much. >> i also deliver a copy to librarian so always on hand to the public. >> commissioner guillermo. >> i want toland congratulations to well done report. it gets better every year and also glad to hear

behavioral health data will be included when you think how much of the budget is spent on behavioral health and the realty of what is happening in san francisco with regard to substance abuse and behavioral health is really important both the demographics as well as the quantity of services and type of services that are provided. that being said, i think what is important about this report and to have distributed as widely as possible is the uniqueness of san francisco's helths department compared to others in the country, most don't have a health network incorporated in the public health department so it important for folks to see what san francisco provides and how it provides because there is so much criticism focused on san francisco and what we are not doing or what we are not responding to, but when you think what this health department has done to

integrate a whole health network and integrate that with population health and public health it is still a model and just pointing to covid is a stellar example of how that has really sort of made a difference as small as the city is but as dense as it is what we are able to accomplish so the fact san francisco has this integration of all the different services is really important i think for the rest of the country and other health departments to be able to see and us to toot our horn. >> thank you so much. >> commissioner chow. >> i also want to thank the staff for accepting some of the input and i think that each year the report becomes much more useful. i think

that with the also your click ing for the website that is nice so people can actually use this and will become useful. a small note, i am appreciative of the colors you are using. people are using reds or greens and some are red, green color blind so becomes a real problem trying to distinguish and this is nice in terms of blues. and only just comment, i think the legend could be a little larger in terms of the blocks the colors represent, but-again, commendable report for us. like commissioner green said, we can all be very proud of the work this entire department is doing for the residents of san francisco. thank you. >> thank you so much. >> thank you. again, it is a excellent report. particularly appreciate the highlights,

because not only is it important for people of san francisco to see the leadership of san francisco and san francisco department of public health, but for our own team members to see the work reflected in the report and know the pride we take in the great work they do and the recognition they receive. i believe this is your first time presenting before the commission, so welcome. >> thank you so much. >> your presentation was excellent and thank you again for your great work on the report. >> thank you so much. i really appreciate that. >> thanks. >> thank you. >> okay. our next item is the consent calendar, all related to laguna honda and approved by laguna honda jcc at the may 9 meeting and recommended for approval to full commission. let's see-who should--commissioner guillermo. >> i wasn't at the meeting last week where the

policies were presented so differ to dr. chow. >> commissioner chow. >> yes, these items on consent were reviewed by the two commissioners present and they represent also to great extent the some of the issues that have been raised and help represent us for our corrections for the milestones and all. recommended that the commission approve these. >> second it. >> alright. do we have any public comment? >> i do not see comments. we are on item 9, press star 3 if you like to make comment. no hands. >> comments or questions from commissioner before we vote? seeing none, all in favor? >> aye. >> opposed? motion-the consent calendar is approved. next back to commissioner chow for the laguna honda jcc committee report. >> thank you. in the

absence of commissioner guillermo pleased to be able to report to you that we received a report from the human resources report which does show a great effort and in fact some improvement on the nursing services this month. we also received a regulatory report, much of which you already heard along with the certification efforts that we saw this afternoon. the committee was pleased to hear about the hiring process and you got a update today and in our closed session we approved the credentials report, the pifs mntss and medical quality report. >> any public comment? >> yes, one comment. james, please unmute. >> it's patrick again.

excuse me--i'm sorry. for the may 9, jcc update, it was disappointing not hearing commissioner chow say anything about the fact that president bernal had gone to great lengths during this meeting to illicit a statement from mr. pickens, laguna honda must be recertified before applying for a waver to retain the 128 beds at laguna honda. the commissions meeting minutes indicated however mr. pickens had clearly stated laguna honda is only received through "verbal interactions"

that we certification must be laguna honda number one priority. the minutes also clearly stated that "pickens had stated ", cms indicated verbally, i repeat, only verbally, that request for the waver would not be well received before recertification is received". so, there is parently nothing in writing commissioner bernal preventing laguna honda from applying to that waver now and should do so. after all, there is strong community support and now over 800 signatures on my petition which remains available online urging you guys to get that

waver submitted. there is nothing in the protocol and regulation number that previously provided to you that says anything about making a waver request is contingent on recertification, so it is time to stop quivling over this and do it. thank you. >> that's it. >> any commissioner comments or questions on the jcc? laguna honda jcc? seeing none, our next item is other business. any other business? seeing none, we'll move- >> check public comments to for due diligence. any other comments on item 11? no hands. >> our next item is closed

session. that closed session-we need to vote on whether to hold a closed session in relation to the laguna honda hospital rehabilitation center quality update regarding recent regulatory survey activity. do we have a motion to hold a closed session on the previously mentioned topic? >> so move. >> second. >> any public comment? >> i don't see a hand. would you like to comment on item 11, consideration for closed session? >> seeing no comments or questions, all in favor. opposed. we are entering closed session. >> give you >> >> i move not to disclose. >> second. >> all in favor?

>> aye. >> opposed? motion carries. we'll not disclosed. the final item is motion to adjourn. >> so move. >> second? >> second. >> all in favor? >> aye. >> opposed? we are adjourned. [meeting adjourned] i

didn't - >> sound familiar do you keep on getting up there's an easier way. >> of course there's easier way get rid of of mosquito they breed whatever

this is water no water no mosquito mosquito feed on good blood the eggs hatch and stay near the waters san francisco to breathe and the adult underlying mosquito waits on the as many until it's sexuality hardens water pools in any areas and creates places you'll not normally think of budget and any container that holds water and hidden in bushes or else were dump the water and do it over soil not into a drain the larva can continue growing in the pooled water is sewage disthe first of its kind the area if the sewage is two extreme have a licensed plumber assist water

pools in rain gutters and snaking and cleaning out the water when keep the water from pooling and keep in mind that mosquito breed in other waters like catch balgsz and construction barriers interest crawl spaces with clmg is an issue you may have is week to cause the water to collect this is an sour of mosquito so for buildings just fix the clean air act drains and catch basins can be mosquito ground it will eliminate it as a possible location keep shrubbery and growths estimated any water to can be seen and eliminated birdbath and fountains and uncovered hot tubs mosquito breed but it is difficult to dump the water out of a hot top

can't dump the water adding mosquito finish rids the source of mosquito there are also traditionally methods to protect you installing screens on windows and doors and using a mosquito net and politically aau planet take the time to do the things we've mentioned to eliminate standing water and make sure that mosquito are not a problem on your property remember no water no mosquito

>> one more statement. we are the one. that is our first single that we made. that is our opinion. >> i can't argue with you. >> you are responsible please do not know his exact.

[♪♪♪] [♪♪♪] [♪♪♪] >> i had a break when i was on a major label for my musical career. i took a seven year break. and then i came back. i worked in the library for a long time. when i started working the san francisco history centre, i noticed they had the hippie collection. i thought, if they have a hippie collection, they really need to have a punk collection as well. so i talked to the city archivist who is my boss. she was very interested.

one of the things that i wanted to get to the library was the avengers collection. this is definitely a valuable poster. because it is petty bone. it has that weird look because it was framed. it had something acid on it and something not acid framing it. we had to bring all of this stuff that had been piling up in my life here and make sure that the important parts of it got archived. it wasn't a big stretch for them to start collecting in the area of punk. we have a lot of great photos and flyers from that area and that. that i could donate myself. from they're, i decided, you know, why not pursue other people and other bands and get them to donate as well? the historic moments in san francisco, punk history, is the sex pistols concert which was at winterland. [♪♪♪] it brought all of the punks on

the web -- west coast to san francisco to see this show. the sex pistols played the east coast and then they play texas and a few places in the south and then they came directly to san francisco. they skipped l.a. and they skipped most of the media centres. san francisco was really the biggest show for them pick it was their biggest show ever. their tour manager was interested in managing the adventures, my band. we were asked to open to support the pistols way to that show. and the nuns were also asked to open the show. it was certainly the biggest crowd that we had ever played to. it was kind of terrifying but it did bring people all the way from vancouver, tee seattle, portland, san diego, all up and down the coast, and l.a., obviously. to san francisco to see this show. there are a lot of people who say that after they saw this show they thought they would start their own band. it was a great jumping off point for a lot of west coast punk. it was also, the pistols' last

show. in a way, it was the end of one era of punk and the beginning of a new one. the city of san francisco didn't necessarily support punk rock. [♪♪♪] >> last, but certainly not least is a jell-o be opera. they are the punk rock candidate of the lead singer called the dead kennedys. >> if we are blaming anybody in san francisco, we will just blame the dead kennedys. >> there you go. >> we had situations where concerts were cancelled due to flyers, obscene flyers that the city was thought -- that he thought was obscene that had been put up. the city of san francisco has come around to embrace it's musicians. when they have the centennial for city hall, they brought in all kinds of local musicians and

i got to perform at that. that was, at -- in a way, and appreciation from the city of san francisco for the musical legends. i feel like a lot of people in san francisco don't realize what resources there are at the library. we had a film series, the s.f. punk film series that i put together. it was nearly sold out every single night. people were so appreciative that someone was bringing this for them. it is free. everything in the library is free. >> it it is also a film producer who has a film coming out. maybe in 2018 about crime. what is the title of it? >> it is called san francisco first and only rock 'n' roll movie. crime, 1978. [laughter] >> when i first went to the art institute before the adventures were formed in 77, i was going to be a painter. i did not know i would turn into a punk singer. i got back into painting and i mostly do portraiture and figurative painting.

one of the things about this job here is i discovered some great resources for images for my painting. i was looking through these mug shot books that we have here that are from the 1920s. i did a whole series of a mug shot paintings from those books. they are in the san francisco history centre's s.f. police department records. there are so many different things that the library provides for san franciscans that i feel like a lot of people are like, oh, i don't have a library card. i've never been there. they need to come down and check it out and find out what we have. the people who are hiding stuff in their sellers and wondering what to do with these old photos or old junk, whether it is hippie stuff or punk stuff, or stuff from their grandparents, if they bring it here to us, we can preserve it and archive it and make it available to the public in the future.

okay? yep. all right. hello. and welcome to the tuesday may 16 2023 hybrid in person and virtual meeting the san francisco entertainment commission. my name is ben blind man and i'm the commission's president. before we start with announcements. we are expecting a voluminous number of public commenters tonight, so we are limiting public comments, two minutes per person. and now we will have announcements. alright. we would like to start the meeting in progress. with the land acknowledgment we, the san francisco entertainment commission acknowledged that we're on the unseated ancestral homeland of the ram official oni, who are the original inhabitants of the san francisco peninsula as the indigenous stewards of this land in accordance with their traditions, damages alani have never seated, lost nor forgotten their responsibilities as the caretakers of this place