in terms of growth and impact. ♪ [ music ] ♪♪ >> meeting of tuesday june 20, 2023. thank you to vice president lori green for chairing the meeting in my absence as was traveling. please call the roll. [roll call] alright. it is my privilege to read the ramaytush

oholone land acknowledgment. we acknowledge that we are on the unceded ancestral homeland of the ramaytush ohlone who are the original inhabitants of the san francisco peninsula. as the indigenous stewards of this land and in accordance with their traditions, the ramaytush ohlone have never ceded, lost nor forgotten their responsibilities as the caretakers of this place, as well as for all peoples who reside in their traditional territory. as guests, we recognize that we benefit from living and working on their traditional homeland. we wish to pay our respects by acknowledging the ancestors and relatives of the ramaytush community and by affirming their sovereign rights as first peoples. our next item is approval of the minutes from the health commission meeting of tuesday june 6, 2023. commissioners, you have the minutes before you and reviewed them. if there no moments do we have a motion to approve? >> so moved. >> second. >> any public comment. >> folks oen the line,

item 2, the minutes. please let us know if you like to make comment by pressing star 3. we'll give it a second. alright, there are no hands. >> alright. all those in favor? opposed? the minutes are approved. our next item is one that i bring with mixed feelings. it is a resolution honoring dr. iona bennett who served as director of health equity as well as a number of other positions within the department over many years. i would ask secretary morewitz to please read the resolution before we have a motion and second. >> director colfax (indiscernible) >> thank you president bernal and health commissioners. i share your feelings as well commissioner bernal

and this is a time to celebrate dr. bennett's leadership in the department and to congratulate her on moving across the country to become director of health of washington dc and just so incredibly excited for her, and for the district of columbia and to celebrate dr. bennett's work and leadership at the department, and there is a resolution so i'll be brief. i think the three things that really-the words that jumped out in terms of her leadership is bringing a structure, and intentionality and rigor to the work we do in health equity as director of the office of health equity and holding us and in particularly leadership and executives accountable for actions in order to move equity forward. really want to thank her for that. want to

thank her for building a team that will insure that her work will continue at the department, and looking forward to seeing what comes next. excited that she will join directors of public health department across the country. with that, i will turn it over to the resolution with dr. bennett. congratulations and thank you for all you have done. [applause] >> alright. i will read the draft before me. honoring iona bennett. whereas served the city and county of isf as department of public health since 2004 and making tremendous contributions. and whereas, dr. bennett held several dph positions including southeast health center medical

director of community health program for youth, director interdivisional initiative and most recently as the chief health equity officer. oversaw the task of developing a racial equity action plan monitoring mechanisms and coordinating the imp lmation of the plan throughout the multibillion department and through her work developing and overseeing the office of health equitaecreated infrastructure that makes equity part of each dph employee daily work. every employees is oriented to equity as part of the work and throughout there department. there are equity staff and health equity plans of action. whereas, dr. bennett convened the dph executive staff every other month for many years as the council to discuss approaches to improve equity. dr. bennett is the longest serving covid-19 incident commander shepherd response in the pandemic. inhabited this important leadership

balancing the needs of her family and whereas dr. bennett is known for invasion, creativity and always willing to volunteer to address the many complex elth weck ataerelated issue. leaves a legacy of service and leadership to support and improve the lives of all san franciscans. she will (indiscernible) at the dph and greater san francisco public health communities. resolved, the san francisco health commission honoring drr bennett for outstanding service and leadership i wishes well in the new position as the washington dc director of health. [applause] >> do we have a motion to approve? >> so moved. >> second. >> okay. do we have any public comment within the chamber or on the phone line? >> any in the chamber? folks son the line if you like to comment, press star 3. we are on item 3. after the vote you will be called up dr.

bennett. there are no raised hands for public comment. >> alright. commissioners, any comments or questions? commissioner christian. >> thank you president bernal. dr. bennett i'm so sorry to see you go. i didn't have a chance to really benefit from you know, all of your leadership and knowledge in the way that i would have if i had been here a little longer, but i thank you so much for what you have done for all of us on the commission, but also for what you've done for those who live in the city as well as people who come in day in and day out to work here. it is leadership is your leader hp is stunning. your effectiveness, the grace with which you have created this racial equity plan and the office of health equity is just admirable so i want to thank you for that and wish you the

best of luck in dc. i know that you will succeed there, probably lifting yourself higher then you were able to do here because it seems you are that type of person who just kind of really moves on and creates amazing things and raises her level everywhere she goes so thank you so much. look forward to seeing what you do in dc. [applause] >> thank you commissioner christian. commissioner guillermo. >> i too want to add congratulations to dr. bennett, as well as my gratitude for all that you've done for san francisco. your leadership throughout the years, but especially in the last 5 years that i have been fortunate enough to witness building infrastructure, commanding a team during the

epidemic with diplomacy, with elegance and dedication unmarched that helps build the reputation of san francisco, such that it is in public health leadership, so thank you and i look forward hearing more about you and your leadership and all the great things you are going to be doing for that city that really needs your type of leadership. looking forward to hearing-i have a lot of friends in the dc area and within dc itself and looking forward being able to tout all your accomplishments here and the fact i know you when-congratulations again and thank you so much. your legacy will not be forgotten here in san francisco. commissioner green. well, i would echo everything everyone has said. we are going to miss you so much. i just love to hear you present and you know, as i thought about it, you've been our north star in so many ways, especially in the health equity. and of course, during your covid work, because you know, in the health equity

area, it's one thing to orient and train and it's another thing to transform culture, to make the insights and understanding that we need to have to function better. really. really actualize . and you've been so collegial, you are so approachable. and i think you've taken areas that sometimes are hard to understand and really inspired. and i know you'll continue to do that in washington. and like commissioner guillermo just said , we'd love to say we knew you when because your future impact in the career i'm sure you're going to have will will be stellar and we'll be very proud to hope that you will say that you cut your teeth here in san francisco. you're so. yes i joined my fellow commissioners in congratulating dr. bennet for her work that she has done in an

i only wanted to emphasize this in addition to everything that they have all said, that i believe that you've laid for us a amazing foundation for health equity that not only were we then looking for help for equity within our our employee population, but that you were willing to then expand that to be really a health equity for this city and i think that is going to be a lasting legacy that whoever follows in your tremendously large footsteps will have to carry out. you've laid a tremendous foundation for this and i would look forward to also the work that you're going to be doing in dc. dc is extremely lucky. i think the type of expertise that you bring to any city certainly would be

one that the district will appreciate and will benefit from. so congratulations and don't forget us. let us know what you're doing and we look forward to even greater things as we read what you are going to be doing. dr. bennett, thank you so much. thank you. commissioner chao, i'd like to associate myself with the words of all of my fellow commissioners. director colfax had talked about your leadership and bringing structure and integrity and rigor to our work. but just touching on something that vice president greene said, one of, i think the most critical and challenging parts of our health equity work is culture change. and you have done so much to change the culture both within the department and for us here on the commission to ensure equity in our work, both inside the department and also in protecting and enhancing the health for all of the san franciscans that we serve. you've really helped. i think,

all of us normalize conversations or around race and other equity issues. and it's really been a privilege to both have you here at the commission to present to us and also to learn from you over the course of i'll speak for myself, my time here. so thank you, dr. bennett, so much for your leadership. we're going to miss you a lot. and we're going to expect to hear from you as well . and i guess we will remove the suspense and go to a vote before we invite dr. bennett to come up and speak. all those in favor of the resolution honoring dr. ayanna bennett, please say i. i have no opposed. dr. bennett, would you like to come up to the podium. i have many san francisco things that are going to have to go up on the wall. and this is one of them. i i really appreciated all of the time i've spent with you . i actually like those presentations. that's why you

can you can tell because i kind of like them. i like being tested. i like it when we get to the point and say, did anything happen? i am really looking forward and i trust in you to keep people going that that it's not okay to just to talk about it. we should have something to say about what's happened and there should be something that happened between one point and the next. i am i have deep faith that the department can do that. i have been telling people i've started to see things that i had nothing to do with in the last year or so. i'm like, i didn't talk to them. i didn't tell them to do that. i don't know anything about it. and that is that is really a joy, actually, to see that people are they've just started to own it, that it's not a project, it's not a site thing, that it's not everybody, but there are people who are really demonstrating in this department that this is how you do the work. and i think your questions and the way in which you've held this as a priority helps to keep them

doing that, and it helps to spread that to the people who quite aren't quite on board because culture change happens in phases, right? so we have to get those middle folks. i want to thank you, dr. colfax, for giving me this position and elevating it to a level that it is not everywhere. i have many colleagues that i know who are doing the same work, and some of them are in the hr department. some of them are there all over the place. they're not necessarily at the level that i'm at, and they're not necessarily given the wide breadth of influence that i've been given. i'm in everybody's business. i try i try to write down who do i work with and i'm like, am i on that? i decided, yeah, i decided i was in a lot of things, but i think that's how you have to do it because we are doing things we shouldn't or not doing things we should everywhere. and so that idea that we are not just running the bus, but we're actually supposed to be improving things, i think is a real ethos of this

commission. and i want it to be the ethos of the department. i think. i think we're getting there. so i want to thank all these folks who came out here, even though they could just be on television and watching. not all were here for me, but i really appreciate how much i've learned here, how much i've grown. and i think i did that growth because i was allowed to take risks and was in fact invited to. so thank you very much. thank you. dr. bennett. hello oh, okay. our next item on the agenda is general public comment, secretary morris will read a statement and then invite comment from the public. sure at this time, members of the public may address the commission on items of interest to the public that are within the subject matter jurisdiction of the commission. but are not on this meeting agenda. each member of the public may address the commission for up to three minutes. the brown act forbids the commission from taking

action or discussing any item not appearing on the posted agenda, including those raised during public comment. please note that each individual is allowed one opportunity to speak for agenda item. individuals may not return more than once to read statements from other individuals unable to attend the meeting. written public comment may be sent to the health commission at the following email address. the word health dot the word commission dot org at write if you wish to spell your name in the minutes you may do so during the verbal comments without taking you a lot of time. please note that the city policies, along with federal, state and local law, prohibit discriminatory or harassing conduct against city employees and others during public meetings and will not be tolerated. we will first take public comment from individuals attending the meeting in person. we will then take would you hold on for one second and go? go ahead. oh, i'm sorry. well, no. and i'm sorry for the interruption. secretary moritz, as you are assessing the number of people who are on the line to give public comment, i'd like to invite the commissioners to stand up and do a photo with doctor bennett before she leaves. oh, yeah, that's great.

sure. would you like to finish the instructions? and then as you're well, why don't y'all go ahead while i continue reading the discussion and apologies to members of the public for public comment. come on. what we're going to do. a quick photo, everybody. all right. we will first take public comment from individuals attending the meeting in person. we will then take remote public comment from individuals who have received an accommodation for disability. i've given each of these individuals a code to speak when they begin their comments to prevent others from speaking during this time, i've given two people a code for today's meeting. finally we will hear remote public comment from all other individuals. there will be a time limit of 20 minutes on the total amount of remote public comment that can be heard on each time. each item from individuals who have not received an accommodation or disability. so we'll take a pause while the commissioners are doing their photo op. but please raise your hand if you'd like to make general public comment on yes. is there any moment? okay okay.

so okay. oh, no, no, no. thank you. i think you. that was lovely. oh, sure, of course. i didn't do anything. i'm sorry. ran over. oh, no, it's okay. it's fine. that's it's fine. i know. don't worry, dr. charles. okay um, so there are no raised hands for general public comment. y'all back when you get back to your seat, we're ready for the next item, which will be all right. so today, all right, our next item on the agenda then is the director's report for this, we have director of health, dr. grant colfax. dr.

director colfax. good afternoon . thank you. president bernal. a few items on the director's report. i'll just quickly do an overview, but i think the first item important to highlight that the department of public health celebrates san francisco pride. this year's san francisco pride celebrations celebrate our quote looking back and moving forward and a df. we have a proud history serving the lgbtqia plus community. as you know, our department has been a leader in providing equitable, accessible , comprehensive and if i may say, groundbreaking health care to underserved and marginalized outcue aia plus people. and you will see some details in the written item just excited that we will df will have a parade contingent at the trans march on friday june 23rd and at the

pride parade on sunday, june 25th. and we are encouraged all staff to participate. and another item i'd like to call the commission's attention to in the written report is under the item. second item sf ems award is recognized for excellence in emergency medical services. you will see in the awards that were presented to ems, one of the recipients was our df hs own curtis gear, who is at zuckerberg san francisco general hospital and was commended for ensuring that dr. gill was commended for ensuring ems initiated protocols and medications are accurate and evidence based and for developing protocol changes related to medical medication shortages and formulary formulary changes. and you can see under that list there are a number of other key supporters of ems that were honored as

well. and i think that will conclude my brief summary of the treasurer's report and happy to answer any questions that the commissioners may have. thank you. thank you. dr. colfax, do you have any public comment? uh, so, commissioners, i just got an email from a member of the public saying that he. mr. mitchell that he raised his hand and is not showing up. so i'm going to manually just i don't see any hands, but i'm going to i will go through them one by one just to make sure that there's no one there. and then if you after this item, if you wouldn't mind going back and we'll do public comment that we miss since something's going on with the system. okay caller do your public comment on this item . caller are you there. okay. i know there's a little awkward, but rather double check than not. have it. hi. caller i've just done media. you please let us know that you're there. okay. and we'll try again another

caller. caller are you there. i'm not sure why it's not coming through. and then finally, last one, mr. urban, do you have public comment on this item. okay. i will work on this while you all you all can ask questions of the director. thank you, secretary moretz. any questions for director kovacs? i do have one. perhaps this might be a question for dr. philip. we received an update on to about a month or so ago about the plans for outreach around pride month festivities, including what we might advise folks in the community in of parks, vaccinations and other things. i wonder if we can get a quick recap of the activities and what's planned for the actual events of this weekend. yes, absolutely. president bernal and good afternoon, commissioners. i'm happy to give that update. so over the past month there has been have been communication

signs that have gone out. there's been partnerships with some of our community partners as well to amplify the message and the message is really, if you haven't received of a person hasn't received two doses of their vaccine, it's a great time now to get it. and we had a community event with soma in may . we had another one on june 10th, and we know that there are events throughout the summer. so even if people haven't gotten their second dose yet or a first dose, we encourage them to do that. now so it's not too late, but we've been doing some outreach and some events and we will continue that throughout the season. the fun season of the summer and all the festivities that will be happening if people have gotten both of their vaccines last year, there's no indication or recommendation now from cdc or from us to get additional doses. so two doses is sufficient. great. thank you, dr. philip, any other questions or comments from commissioners? oh, commissioner cho. yes. i

actually wanted to follow up on dr. phillip's comment in terms of a report from this morning's paper that in chicago there was an outbreak in cluding people who had had the vaccine. so what are we expecting the vaccine to be doing or do they does it ameliorate the disorder or so that people don't get frightened or think they should get a booster or anything? yes, absolutely. so that's a that's a great question. and what you said is exactly right. commissioner chow, the vaccine is not 100% effective. and preventing all transmission of impacts, but it does decrease the risk. and on a population level, that's really what we want to prevent out outbreaks. and in fact, there has been a recent cdc, mmr, r journal evaluation that has said that along with new york city, san francisco, in their modeling is the least likely jurisdiction to see another large outbreak this

summer. we hope that's correct. but that is based on the percentage of people who have received vaccine so far who might be at increased risk for. so that's that's good news. but we are continuing to encourage people as we just talked about, to get both doses of vaccine. well, we have seen people who are vaccinated. if they do develop pox lesions, they are much less severe. as you said, they are not the really debilitating, very severe symptoms that we were very worried about. and that prompted our public health emergency last summer. so it is it is good news that the receipt of the vaccine does decrease the severity of the symptoms, which is great. well thank you very much. thank you. thank you. and just one last comment. i was among the many people who waited in line very early in the morning last year when our state of emergency was declared. and i know that there are a lot of challenges around supply from the federal government, but i just wanted to commend, again, the population

health in san francisco general staff who were so kind and professional and supportive of people who are showing up to get their shots to help, really help people understand what the needs were and all the outreach was done. it was really an excellent and needed operation. so thank you very much. dr. phillip. thank you very much. president bernal and i am going to have the privilege of talking a little bit about that in my presentation a little bit later this meeting. so i'll have the chance to talk about it. thank you. great. thank you. all right . we can move on to our next item then, which is the laguna honda hospital and rebuild center closure plan. and cms recertification update. welcome. roland pickens who is the acting hhc ceo. mr. pickens. good afternoon, commissioner. thank you for having me this afternoon and it's my pleasure to provide you with this update on laguna honda and our recertification process. next slide. so i am

very pleased to share with the full commission information we shared with the joint conference committee last week that we are announcing the selection of miss sandra simon as the nursing home administrator and chief executive officer for laguna honda. she will start officially as the city hire on this coming monday, june 26. and she brings a wealth of experience in long term care, care and skilled nursing facility leadership. she is not a stranger to san francisco. she was previously the chief administrative officer at the jewish home for several years here in san francisco, which is, as you know, the second largest skilled nursing facility in the city. so she will bring with her her vast knowledge and expertise and to really augment that all of the

work that's being done at laguna honda, she will hit the ground running. she'll spend that first month doing a lot of meet and greets and also a lot of onboarding all of the various required education and training specific to laguna honda, several hours of both in person and online educational modules. and she and i will be doing a very methodical and planned handoff and onboarding as i begin to transition out of that role. and then turn over the reins to her. but again, we're excited and just know she's going to do a great job at laguna the way that she's done every every other place that she's worked. next slide. additional updates in terms of key positions at laguna, we are

also recruiting for the director of nursing medical director to assistant nursing home administrators and an executive director of facilities and engineering and in emergency management and preparedness director. we're pleased to announce that the director of facilities and engineering life safety has been filled by mr. gregg chase. gregg actually has been in that position a similar position on an interim basis for the last several months at laguna. he was previously a the chief engineer at zuckerberg san francisco general. and you'll recall in one of the earlier surveys, there were issues with fire, life safety at laguna. and so gregg came over then and has been there on site since he went through a very competitive process with that. had several qualified applicants, but he was selected as the most qualified

for the job and has started for the roles of assistant nursing home administrator. you remember we have two of those roles. one is the assistant nursing home administrator for care experience in terms of the grievance process, yes, the chaplain, the program, our equity work, all of those were softer skills that are really needed to particularly work on the organizational change management that needs to occur at laguna honda. that position. and then also the second one is the assistant nursing home administrator for support services. so environmental services, food services, clinical nutrition and. industrial hygiene. so offer have been extended and accepted by the top ranked candidates for

those jobs. and as soon as those were conditional offers, as soon as the final offer is accepted, final offers require completion of background checks, fingerprinting and all of that. once that happens, then we'll be able to announce who those individuals are. and we expect that to happen any day now. so we should be able to share with you who those individuals are in short order. and then finally, for the roles of emergency management and disaster preparedness, this director of nursing and medical director director will continue with the search and recruitment process, utilizing the search firm. in fact, we have round two director of nursing interviews tomorrow and thursday. so we are confident we'll be able to select an individual appropriate and will then put that person through a final round and vetting process through the city

. so again, we're making progress in terms of filling the long term leadership team at laguna. and as i shared with the joint conference last joint conference committee last week, even as these new leaders are coming on board, the recertification team that's been on the ground for the last year , which actually i was a part of prior to stepping in as the interim ceo, we will all still remain at laguna for the for the foreseeable future to support the new leadership team and to help get the institution through recertification. next slide. okay. next slide. okay. so you recall we're here because last april, cms terminated laguna honda's participation in the cms

program. as you are very well aware, we have continued to work hard both with our staff and many expert consultants that we brought in to make all of the required regulatory improvements to prepare us for recertification between our own staff and the expert consultants were confident we have the right team in place to be successful in our recertification efforts, and particularly as these new leaders are coming on board. next slide. you recall that in november of last year, the city signed a settlement agreement with cms. that agreement, as you recall, put a pause on any transfers of laguna residents to other skilled nursing facilities and also allowed for the continued payment of reimbursement. even while laguna

is in this state of disarray ification, you you will also recall that on. march 19th of this year, cms extended that pause in transfers and also actually in may of this year, cms extended that pause through to at least september 19th. and also extended the payments through at least march 24th in the event that laguna were not recertified before that date relating to that pause in transfer offers to other facilities, you should remember that as i previously reported back in march of this year, cms directed us to proceed with discharge of residents who no longer had skilled nursing needs. and so that's different

from transferring residents who have skilled nursing needs to other facilities, which is what happened last year and then was paused. so to that end, at the beginning of april, we re initiated that process. there were about 40 there were 42 laguna honda residents at the time. in early april who met the criteria as no longer needing skilled nursing level of care. since early april through last week, there have been a total of six discharges of laguna honda residents who no longer need skilled nursing care of those six residents, one resident was able to be discharged back to their home and five residents were discharged to board and care facilities. also known as rcs. residents to care for the residential care facility or receive a residential care facility for the elderly. anyone

who's 65 or older. in addition, and an additional three laguna honda residents who, upon having their assessments done of their level of care, who had previously been identified as skilled nursing, have now reached a level of no longer needing skilled nursing care. so that brings our current total to 39 residents who no longer require skilled nursing care as of to date. and so, as a reminder, you recall that we are constantly reassessing residents level of care where required to under the terms of the settlement agreement do that a reassessment at a minimum of once every 90 days. so this is a number that will probably tend to flex up and down not severely, but as an individual's care needs change. that's why we saw three additional people move into this cohort right over over the last month. next slide. so

consist consists and care at the bedside. so despite much of the progress, this and improvement work that's been done at laguna over the last year, it became obvious to us, particularly early during at the end of our last 90 day monitoring survey that we needed to have additional focus to really try and make movement on some improvements that had still yet to be realized. and so to that extent, extent, we developed an initiative called consistent care. the bedside monitors, ccs, bms. so these are expert consultants that are coming on board through our health

services advisory group contract. those are our are the consultants who've been with us for the last year. you recall they are one of the approved quality improvement experts that cms contracts with around the country. so essentially they are bringing on a cbm, a consistent care at the bedside and monitor for each of our 13 nursing units. so you can think of it as each nursing unit, essentially having like a director of nursing level individual who's embedded within that unit working at the elbow with the nurse manager of that unit. and then all of the staff assign sign across all three shifts and then we're then working with the nursing directors who typically have 2 or 3 of those units assigned to them. so the purpose is to bring in these highly seasoned and skilled. director of nursing individuals. and in

fact, i got to meet them shortly before coming over today. so they are on site. they are a group of and they were able to share their expertise in history . most of them have been directors of nursing and skilled nursing facilities for ten, 20 years, steeped in staff, education, training and particularly regulatory compliance. we pilot it this program about three weeks ago and have seen tremendous improvement and. payoff from having this level of expertise at the bedside. we working with our staff to better implement the training and education they've received and to also work with our leadership to help model for them how to ensure accountability for staff at the

bedside. this initiative will last at least through december of this year and as we continue to try and make sure we're making lasting changes in the culture at laguna honda next slide. so you recall that the settlement agreement calls. for 90 day monitor surveys by cms every 90 days. we had our most recent and third cms, 90 day monitoring survey the week of june 5th through the ninth. as i reported to the joint conference last week, the preliminary findings from that survey were that there were 44 zero regulatory findings. and when you compare that with the first monitoring survey, which is the

one we should be comparing it to because this third survey was what they call a full scope survey. this is looking at all the cms regulations, the first survey we had in december was a full survey. you recall we had, i believe, 120 to 140 findings during that survey. so when you can contrast that to the most recent survey going from 120 to 40 down to 40, we see that as additional validation that improvements are being made at laguna and we're on the on the right track and you recall we have the second survey back in march. that was not a full survey. that's what they call an abbreviated survey where they did not look at all the cms regs. they only looked at a certain portion. and during that one there were 20 some odd findings. so again, we see this in addition to all of the work we've done on the root cause analysis that again, we are

providing definitive proof and documenting to cms of laguna honda's efforts toward recertification and progress, meeting regulatory compliance next slide. so happy to report the root cause analysis, the action plan that was developed by the she ended up having a total of 520 milestones. if you recall the original root cause analysis action plan actually had 320 milestone ones. but as we had each of those successive 90 day monitoring surveys, whenever there were findings, there would be subsequent additional root cause analyzes and subsequent milestones that were then added. so we went from 320 up to four, up to 500, all of which needed to be completed by may and as you recall, we

were 100% successful every month, completing successively completing and then having the cms quality improvement expert validate that we made those changes and completed all of those milestones and remember, those milestones were developed to address each of the 11 categories that were identified in the root cause analysis as being areas that control suited to the state of affairs that led to the original laguna honda certification. and so, as we've been saying for the last several months now that we have the third monitoring survey under our belts, we feel that we are in a much stronger position to determine when we'll be able to submit for recertification. having said that, we are still waiting on the formal findings from that third survey. remember

we only got the preliminary verbal findings. we must receive a written document. cms rules state that they are supposed to give us that document within ten business days and we are hoping we will get it. that was not the experience with the first survey nor the second survey. we did not receive that report within ten days. and then upon receipt, we then must work with the cms quality improvement expert to review those findings. the quality improvement expert would do an amended root cause analysis and work with us to develop milestones related to the deficiencies. those 40 or so deficiencies or whatever ends up in the formal written report from this last survey. so once that process happens, we think we will then be able to know are we on track and in what date do

we think can we hone in on when we are ready to submit for recertification? we have said the last several months our goal is to submit this summer. we are confident that it's still going to be the case. the actual date this summer. again, we still we've got to get the results from this last survey in order to really pin that down, because it's going to depend upon how the state for those findings, how did they score those findings? how many are a, b, c, d, e levels? so that detail we won't have until we get the hard copy. but i wanted to share with you some of the thinking about how we're going to be getting closer making that decision on resubmission, on submission of our application for the final survey. next slide. and again, this is a pictorial of our time line that talks about all the survey readiness activities we've done over the last year of

the action plan that came into play in january with the root cause analysis and our recertification process, which you see at the bottom again shows our time frame of this summer for actually submitting the application for the recertification survey. next slide and so that concludes my presentation. and we'll be happy to take any questions or comments at the appropriate time . thank you. mr. pickens, do you have any public comment? sure and i just want to note that some folks had trouble getting in and raising their hands. but as i've gov tv and i both called using several phones and it worked fine. so if you're having trouble raising your hand, please hang up and call back because this system is working. i see two hands i gave two folks accommodation. so if you haven't received an accommodation personally from me, please lower

your hand because we'll start with those folks first. and i may please unmute the first person. hi you're unmuted. please us. now that you're there . yes commissioners, my name is francisco acosta. and i have real and i hear and i've the presentations from day one. it's like a like a swat. you have in my heart to have patients who have died. and had no time in your so called needs assessment . do are mansion why did i. do i mention why drug addicts were

transferred to laguna honda. and we the people of san francisco and some of our attorneys work with a lot of pressure the fat government to have san francisco . we didn't consulted who gave the devastation. $5 million. but i'm asking you, patients that died, give it up. eyes on the line. how are we going to come and say that. and i understand that. and given that there's

some acute care, why don't we get that same thing in place? we are the only one in the entire nation that have this certification. so your commission do our research. dr. kovacs. do your research without side has gone yellow and blue. the eyes we cannot be bullet the matter has to be taken to the highest level. and some people have to be exposed for doing. and my name is francisco acosta. i serve this nation, so i know how to deal with rascals. thank you very much. okay can. and there was another hand up, so

please press star three, if you'd like to make comment. and you haven't received accommodation. i'm going to give it a second. since folks have had trouble. okay now another hand has popped up. all right. thank you. i'd like to just begin by maybe a few clarifying questions and just emphasizing a few things that i think should be emphasized. number one, you had spoken about the residents who had an assessment and we found that they no longer require skilled nursing care, where i believe it was 39 residents who left laguna honda for that reason. could you just confirm again, it sounded like everybody who was discharged was either placed in an appropriate lower level of care or to their homes, correct? correct. so 39

is the number that remain as of last week. okay no longer need skilled nursing care. okay. there were originally 42 of those 42 six had been discharged . one went home and the other four went to lower levels or basically boarding care homes, organized living facilities in the community. and that is the intention for everyone who no longer require skilled nursing care, who is a current resident at laguna, that is that is correct. and so, you know, we have a massive team that works on that process because remember , these are some of the most difficult individuals to place. you know, i would even venture to say sometimes it's easier to find a skilled nursing bed than it is a spot for some of these individuals, as they often have challenging life circumstances as some may have behavior health issues, either mental health or substance use issues. many of them may not have housing, which

is why many of them actually ended up either going to a board and care facility. some of the individuals on that list are waiting for scattered site housing, which is run through the city and are just waiting on their units to become available . and then they will move at the appropriate time and then secondly, i want to thank you for the hiring updates. and i really want to underscore that in looking at these hiring updates. and it's really great the pace at which these critical positions have been filled with it appears to be a very talented candidates. these hires both align with the priorities that cms set forth. they really placed a priority on laguna honda hiring these key leadership roles. and they also address some of the past deficiencies that were identified or cited during some of the previous surveys, particularly particularly the facilities, engineering and fire life safety and the emergency

preparedness positions. so just i think it bears repeating an emphasis that not only are these higher, some of these were our new positions. they were created as the structure of laguna honda was changed in order to align more with high performing, skilled nursing facilities. and then the hiring of these filling of these positions was something that was really very important to cms in our path towards recertification. is that? that is correct. if you look at that root cause analysis and those 11 areas of finding, you will see one on facilities, infrastructure, you will see one on emergency preparedness and planning. so as you point out, these recruitments very much are in line with all of the expert consultants observations and recommendations of what laguna honda needs to in order to perform like a high performing skilled nursing facility. and again, this is all part of a restructuring that began not when we got the first feedback

from cms, but immediately at the point of decertification, realizing that there needed to be restructuring to align with high performing skilled nursing facilities. and that work has been going on for a very long time. that is correct. that started the day after decertification and in april of last year. and finally, i just wanted to thank you for including this photo at the end of the staff at laguna honda on behalf of the commission, really wanted to acknowledge the hard work of the staff and our union leaders, our union partners at laguna honda to really embrace the change that's needed to really fully engage in the training modules and be a big and important part of our path towards recertification. so just again, on behalf of the commission, i want to acknowledge all of the staff, our union partners for, for their hard work and commitment to this process as well. thank you. great commissioner guillermo. thank you. and i again, thanks for your presentation. mr. pickens. i just wanted to say an additional

word or have a little have you comment a little bit more on the consistent care at the bedside initiative, something we talked about a little bit more in detail at the jc this is another program that is intended to really not only get us to the point of sort of confidence with our recertification, but really indicating a sort of a structural change in how problems can get resolved. policies can be reinforced and monitoring, i think at the local and the unit level, which is really, really important. and i know that the initiative will last only until december 2023, but i would hope that based on whatever the results are of this, hopefully the success of this initiative, that will find a way to incorporate the best parts of it going forward. and

again, looking forward to hearing more about that as we continue to monitor the impact of the cc. cc b m, yes initiative. thank you. sure. i can talk a little bit more about it. so again, the cbmm initiative was born out of some of our more recent survey activity, particularly the one that led to an immediate jeopardy finding a few months ago. and what that showed us and also cns was again, despite all of the improvement work that has been done at laguna over the last year, obviously there were still some areas that needed improvement and correction quickly because the clock is running out. we're getting close to the time for recertification and so we needed to then evaluate where we were and what

fix we might be able to offer to cms in order to convince them. because remember, the settlement agreement is very clear. at any point if cms feels laguna is not making progress in regulatory compliance or towards recertification, they have the discretion to end the agreement and request that we begin to transfer residents and moving forward. so we had it. we needed to show that we were serious about making that final push towards regulatory compliance. so these coordinated care at the bedside monitors are again director of nursing level individuals who will be assigned to each of our 13 units. they each will have a unit, they will split their time across all three shifts of the nursing unit. so some days they will work day shift of the days they will work night shift. other

days they will work evening shift. they are required to meet and get to know each and every staff person assigned to that nursing unit. so that's usually somewhere between 30 to 50 staff who are assigned to a particular unit. their job is to make sure that each staff member who takes care of a resident knows the care plan can use an adult learning technique of teaching back, that they can teach that care plan back to the cbm to show that they understand it and know how to implement it. and that's particularly important in terms of our focus on resident safety, making sure staff are aware. if you have residents who have particular issues that have because that may have been addressed in the care plan, but unless staff are able unless staff have read that care plan and understand it, that may not be sufficient. but the role of these individuals then is to work with individual staff

members and also with the charge nurses and the nurse manager of that unit to help them to bring in their. 10 to 20 years of expertise as a director of nursing, to say in order to run a highly reliable nursing unit that delivers consistent and safe regulatory compliant care. this is how you set up your operation. this is how you huddle with your staff. this is how you give direction. this is how you then hold people accountable to what they've been trained to. because one of the things we saw more over the last year, as much as we were churning out improvement effort after improvement effort and putting out directives and mandates, what we saw is there wasn't there in many cases, you could put the expectation out there. but unless you also then build in a check and balance and a validate and an accountability

, then the improvements either don't happen or they don't stick , they they may be temporary in nature. so the goal of this program is to number one, more quickly identify ongoing areas of noncompliance or or safety risk and to remedy remedy those and then to do it in a way that is lasting. so the way the process works is every morning there is a huddle with the cbm leads with myself, the chief nursing officer, the laguna honda recertification incident commanders and the medical director. we hear directly from the cms. what were their findings from the previous day? what are issues on each and every unit that if they left, if they were to go unchecked, could either be a patient, a resident safety issue or regulatory

compliance issue. we have a very methodical we have methodical standard work that says we have a hierarchy. what are things that have to be resolved between four hours? what has to be resolved between 24 hours? but that's the standard we've given ourselves. anything that gets reported, that gets escalated that to that group has to be resolved timely. and so again, that was one of the things that was missing before we would identify things. you would say, okay, this person go off there and fix it, and then we go into this black hole and just disappear here. so we removed all of that ambiguity, put structure to the process. yes. and we and we repeat that process every day for these cbm escalation huddles and huddle resolutions and we keep keep track of each and everything we find. and it's a lot of work, but it's really i'm really excited because now we're finding out about problems in

real time as opposed to letting something that may fester for weeks or months or that we at leadership may have never heard about because it never got elevated to us. well, that doesn't happen anymore. we have people on site who are seeing it and letting us know and then we fix it. thank you. thank you for all of that detail. and it sounds as if this is the makings of a deep cultural change also. and so i don't know what the structure will look like in the future, but hopefully the cultural behavior will stick with regard to that because that's really what's going to make the difference in the future. thank you, mr. cho. yes, thank you. and thank you again for the explanation on your cctv . m. each time i hear it, it makes more sense. so i, i think it was great. i'm curious about

two things. one, as we add these new positions and as we bring on our new ceo that we are going to have to understand the relationships of all these people. so i would imagine i would hope that our next meeting at the commission level, we could at least see where all these people were in some sort of org chart. certainly yes. and i don't know where the kbm people are, but but in any case, i'll leave that to you and your new ceo coming on, which i guess is about six days or so. yes. for you, if you're counting down . the september 19th date, really continues to be problematic from what we understand, even if we were to file for recertification, we know that it takes a longer period of time to have a survey

and then have, if any corrective action plans that they then come back and say yes or no or i mean, we've >> they come back and say yes or no. we're never going through it. a certification survey, so i'm not sure but that's what happens, right in other surveys. so september 19th, it looks like 90 days from here and a routine certification, recertification, we would only have 90 days so how do we get around the 19th date or what is our understanding, what is your understanding that it's -- the progress that's being made would then lead to another change in our need to, because we're going to have to file apparently,

still, a discharge plan or have we already filed >> yes, our discharge closure plan was already approved. i think the one you're referencing is what cms is requiring the state put together. >> oh, okay. the state is putting one together but we're applying for recertification some point during the summer and here's the 19th date of september. so, what is our thinking that we're going to be either asking for or that it's an understanding that if we apply by that point in time, this would not happen or what? >> i think it is a good question. obviously, i can't speak on behalf of cms. i can only go by what they've given us in writing, which does give that september 19th date. it says it's a part of the settlement agreement and the settlement

agreement also says that at any point, cms has the discretion to extend deadlines, if they feel that there's sufficient progress, so i would hope, again, our desire is to submit this summer as we have said, our desire is for cms to give back the 2567 so we can turn it sxarnd better inform of what date it will be, so there's moving parts and we're just trying to do the best we can to take all of that into consideration with the september 19th date, also with the uncertainty of not having the final statement of deficiencies so we can actually do the retired improvement work to inform that decision of when the application will go in. the good thing is, the application itself has been ready for months to go in, which is no easy feet. it took months to put it

together with city attorney's office and consultant. it's several hundred pages long, so that work has been done, so you know, we've front loaded this process, so that we wouldn't have any bureaucratic impediment that would hinder us from the actual submission. >> oh! thank you for that explanation. and i'm sure we'll be getting updates as we go along. >> commissioner green. >> yes, thank you for the encouraging news and thank you for that information that we are really ready to send in the application as soon as possible. i had a few, a few questions and where are we in terms of this ten days? aren't we coming close, if not slightly over that timeframe? >> yeah. i believe they included june 9th, so we're right there. >> okay. do you have any concerns that the final report will have any surprises or, you know, what is the industry where

we have gotten some preliminary information and it's reflected in the final report, are you worried that any -- are you worried about surprises in the final report? >> at this point i don't anticipate this happening. we've had a good past survey that went well with the survey team. they were very open, transparent, upfront with us as issues arose during the week of the survey, as they often do. they engaged us quickly and we responded quickly and they were good at the verbal exit they gave us. they read a script that says this is pending supervisor review. the team that was out there came from the cms region nine, san francisco, seattle, and their leadership was on the phone during the exit interview, so the same leadership that

we'll be reviewing and validating their onsite field team findings, we're part of that exit, so i would be very surprised if something appeared in the written document that we're not aware of. >> that's really good to hear. most of what you're anticipating, your refinements on elements you've been working on and i guess the other question with the ccbm and i really agree with dr. chow, it would be wonderful to see how the moving parts move just like cbm will interface because one is the higher level, finding random items and the other will be in the neighborhood itself. i'm curious particularly about sustainability because i know we've had some moments where we had nurse managers and i would be curious to know what an and paid turnover and key staff would be especially when you got

your very stable administrative staff on how we're planning on sustaining this because we all know that reinforcement is so critical and they will be back and we have phase to deal with as well, so how will that all come together? >> so great question. in fact, we've coordinated with mark. we do want to come to the next lagoon fla honda jcc and present our best thinking in terms of a sustainability plan. it will address many questions you just raised in terms of how do these initiatives all fit together and how do we make sure that this hasn't been a wasted effort and so all the work that can go into a more long lasting organizational improvement process that sets laguna up for long-term success and so that we're not going to find

ourselves on this position again. >> thank you for the hard work of everyone, as commissioner bernal said. it has been a that blend does heavy lift -- it has been a tremendous heavy lift for anyone and we're appreciative. we do see the progress and we're pleased whether we see reports compared to months ago when we were starting this journey, so thank you. >> thank you. >> all right. commissioner christian. >> thank you. thank you, mr. pickens. it's good to see you. i appreciated your comments regarding the need for and the active change of culture at laguna honda and i mean, at every circa cross the board -- every circumstance across the board, policy eats -- is there anything you can tell us about the plans to sustain the cultural changes that you are creating right now? >> yes. great question! a couple of things. one of those

assistant nursing home administrator has care experience and under care experience, that's care experience both for residents but also for a staff and part of that individual's work is to make sure we are addressing staff, satisfaction with the workplace and at the same time, staff accountability for doing their jobs appropriately. in addition to having that position at laguna, as we know, many of the residents at laguna are patients throughout the health network and dph so we're establishing a network level care experience position that will then help bridge the transitions as residents move,

say, from san francisco general or from primary care, for our residents who actually come directly from referral from their primary care physician into la la lagoon fla, that we have a way of addressing staff concerns but also our resident concerns. so, that assisted nursing home administrator will be responsible for the work we started on the recertification organizational change management. that includes things, like, the fact that typically, one of the findings in the root cause analysis was that laguna had an over reliant on computerized training and education, just the people sitting in front of a computer doing module training. well, the expansion shows that didn't

serve us well. staff were not retaining information, so we're now going to much more adult learning technics. more onsite, hands on training for our staff. we did that initially last summer where we had all 1500 staff go through a whole week long didactic process and so we will be continuing that moving forward, so that was something that showed us that needed to be part of the new culture at laguna. no longer, it's easy to get compliant by staff to say, okay, go watch this video and you can check off, you've read -- you've been trained on abuse, but that doesn't really work well in terms of staff's ability to ask questions, to say, "this

is what you just heard. tell me what you just heard or give me an example on your nursing unit of what you might see or how you'll deal with it." that's an example of the more long-term organizational change that we see happening at laguna and facilitated by the nursing administrator as within example. >> thank you. >> do you have something? >> i do understand that we had two hands that are, perhaps, a few hands that came up later. apologies for technical glitches happening on our end or those calling in but we would like to make time for the comments to be heard. >> yes, thanks. please unmute the first caller, jaime. >> hi. >> please comment on this item and we'll go to the other items.

>> okay. for item 6, what secret (indiscernible) presentation today. on slide six, it's related [hard to understand speaker] we learned of it and you have put a letter to dhf and he said laguna honda that will hire additional consultants that will cost $1 million a more -- [hard to understand speaker] and it involves a new contract and new consultant. it does neither and additional consultant hasn't been hired. the same consultant you've had since may 2022, [hard

to understand speaker] and they ordered that -- it didn't mention a tbi program from the past. [hard to understand speaker] it was filed laguna honda recertification end quote and it listed no initiative. the fund isn't allowed to extend on -- not initially in the contract. it's designed to receive cms, so i share the scope -- that ran for an administrator program provided by hvv staff and a total of $1 million in available consultant staffing hours and consultant

staff for senior improvement specialist and actually prevention and transferring coaching staff of $3.3 million in available consultant staffing. mr. pickens just stated that those cpdi staff will not be [hard to understand speaker] they will randomly appear from the night shift and it doesn't sound like they are going to be there for the sheriff, so i don't know how you're going to train frontline staff if they are only there before 1:00 of the 3 shifts. thank you. >> all right. thank you. i will unmute you again after we take the other caller on this item and we'll go to your other item. jaime, mute him and unmute the next caller. hi caller, please

state your name. >> hi. it is dr. palmer w.w. i'm comforted by the fact that you're looking at getting your ducks in a row to prevent evictions on september 19thth but i'm not comforted by the focus on san francisco general and the public health system is being the main and only source of residents for laguna honda. there's a citywide shortage of medicare nursing home beds and many elderly and disabled patients who need them and if coordination of care only occurs for people within the public health system and not for people outside of it, we're going to have elder abuse and elder neglect because people can't take care of themselves outside of a nursing home. i, myself,

applied to get my mother into laguna honda in 2017 and as someone who, she had run out of money and spent down to medi-cal, she needed 24 hours supervision and i could not faithfully take care of her at home. she had, she was eligible for a nursing home. i did not, i told a doctor that used to work for laguna honda, i went through the regular thing and i was treated actually with growth and sensitivity and so was my mother. i think laguna honda is a resource for all san franciscans and needs to behave in that fashion and also the department of public health needs to work with the other providers of housing and treatment for elderly and

disabled people to move people out of laguna honda so bed can safely and locally, so beds can open up to those of us who are elderly who need the bed and want to stay in our community. my other question is, cms in its may 18thth letter includes all governments and the unions about how to proceed at laguna honda to make sure all hands were onboard, i gather. has that meeting occurred? if not, is it planned? thank you. >> all right. >> now we're going back to take a call that was intended for general public comment. >> jaime, please unmute caller ten and mr. menashaw, let's hear your public comment. >> my comment was for the

meeting minutes, item two. not public comment, so i'm going to start. >> thank you. >> it was good seeing in the minutes, june 10th, that dr. palmer, (indiscernible) and michael testified on that dch behavioral health services agenda item presentation, the recertification at laguna honda is jeopardized by using laguna honda as a destination for missions of quote, behavioral complex people whose care can't be optimized in a nursing home setting or who jeopardize themselves of folks in the nursing home and end quote. that's an acceptable risk.

dr. palmer noted, quote, if this is not corrected, we can look forward to more immediate jeopardy citations and ultimately, to a loss to our public nursing home and end quote. she was referring to laguna honda. i disagree with mr. persico, however, that housing behavioral house and nursing patients in the same authority should be done at laguna honda. you can't safely, quote on quote, cohort them in laguna honda two different patient towers because they are connected by the link building. you should have all plans, build alternative facilities and keep these two populations separated

to prevent the run-ins you had back in 2004, where people with behavioral problems are setting fires in the building and endangering elderly and mental patients who don't have much in the way of ambulatory independence, thank you. >> item no. seven is a population health division updates. we would like to welcome back susan philip, director of population health and san francisco health operator director. welcome, dr. philip. >> thank you very much, commissioners and so happy to be here presenting on behalf of the really wonderful team that i work with, as the population health division. so good afternoon, again, commissioners. secretary morewitz, director colfax and thank you very much kenya for the assistance with the slides. next slide, please.

so this slide is really orient the population to where health sits in the department and the next slide is really to talk about, we've just talked about where we are in relation to the rest of the department and this slide really sets a focus for what it is that we do. if i draw your attention, i think i've presented this before, the wheel on the right with the multiple, really nice colors for pride month as a coincidence is the tenant functions of public health and this is a -- this is a nationally recognized framework. really laying out, what should a highly integrated and successful health department be able to do within its community and for its community and i won't read out all of the ten functions, but you see that

they are grouped in three areas of assessment, policy development and assurance and at the center of it, in this iteration, in this revised iteration of functions is equity. and we completely endorse that framework, previously in the first iteration of this national framework, it was research at the center, but i think we can all agree in the very nice remarks for dr. bennett transition that equity does have to be the center of everything we do. many of these ten functions occur within ph.d. there are some that occur in other divisions and areas of the department as well. and so, if we look at what the key features and the key functions of ph.d. and we certainly do more than this, but if we wanted to group them into four large categories, on the left, we see that we deliver core public health functions and expertise

citywide. we advise on citywide public health policies. the division advances public health research and innovation as a core part of what we do and the division on behalf of the entire department leads the effort for public health accreditation for the department of public health and i'll speak about that a little bit more in just a moment. next slide, please. so, with this slide, i'm going to talk a little bit about the four large groupings of what our division is currently focused in an ongoing way. how are we supporting work we just talked about and how are we thinking about making improvement in the division to carry out the ten functions of public health, to keep equity at the center to support our staff? these four areas are all interconnected so i think you'll see the relationships between them. i'm going to give a broad overview

of how we are working in these areas and how we're thinking about them and then i will go into a little bit more detail about each one in subsequent slides, so for organizational capacity building, we're going to share in just a moment a relatively new organizational structure for ph.d. that was initially announced and released last fall. it really is intended to increase our capacity to support the current work, to develop new areas of work. it's necessary for example, climate change and it climate health is an area we anticipate becoming increasingly important to san francisco in our work. and also reinforce and build on our ability to learn from the lessons of covid and incorporate some of those best learnings into our new work. we also want to be able to better bring in and administer grants and other resources to support the innovation in the work we want

to do here in the department from cdc, the california department of public health and other funders, so we're strengthening our team here and that work is being very capably led by eduardo ceda who is here today and the risers in ph.d. so we're happy to have him. we also know, as has been discussed nationally that we have to develop and support our most valuable assets which is our team and our staff and so we want to really double down on professional development with an equity focus and have a culture that supports excellence and making ph.d. a great place to work and we'll use tools like the recent employee engagement survey to accomplish this. we had a relevantly excellent response rate for phd of 78% so we'll dive in and use the responses to really fuel this work. for leadership equipment, we have leadership opportunities, post-covid, that

you will discuss. we also have some key vacancies of very experienced leaders who stayed to serve the city during the pandemic but are now retiring or moving on to other opportunities. this is a national and a statewide trend. and we know that this is a great loss in terms of collective years of experience, but we're working hard to hire into these positions and as i've mentioned, we really promising up and coming leaders that we're excited to be working with in phd. overall, this hiring effort has been led by really amazing group. we have a phd hiring task force that includes not only our phd team but dph-hr staff as well. they have been working collaboratively and set a goal of 120 hires for phd between november and the end of this month and they are on track to hire 128. they are doing an amazing, amazing job. when we think about covid task force

transition, it fits into capacity building and leadership recruitment and many, many things to dr. lisa golden and charles fan who has been a task force leader and has been really working with us in phd to adjust and incorporate the covid-19 response work, to major undertaking this group knows and the funding and the functions have been shifting and we have had to adjust and think about really what are the core pieces that we want to retain and incorporate so we're aiming on those -- centralizing central partnerships and allowing the community to lead about how we go about accomplishing making san francisco the healthest place on earth and compelling data and thinking about having nimble response teams. for example, if there's outbreaks of preventable diseases, how can we

respond quickly. public health reaccreditation and i mentioned this earlier. we submitted our april police for reconsideration in march and led by priscilla chew and we have until end of september to submit the documentation which is extensive. we'll start with the next slide and i'll walk through a few aspects of the areas we have just talked about. so, this is the revised organizational chart for the population health division. rather than each of the 14 to 15 branches reporting directly to the director of the division, as we previously had, it creates what we're calling "groups" led by a deputy director for the division. as of now, there are two physician positions and two non-physician positions that will be in leadership, and these division executive leaders will then support the work of the branches

underneath them. so, we have leader who's will be leading research and learning and development, operations, people and infrastructure or grants, public health, core services, and community health. and could you click to the next slide, please. so, currently, i am so pleased that we are fortunate enough to have deputy director daisy aguia who is serving as deputy director of operations and infrastructure and daisy is here with us and i know she's well-known to this group and has served the department for many years and we're just thrilled to have her, in her leadership position in phd. really being such a key partner to me and everyone in the division to accomplish the big goals that we are setting out. we have been working very hard. our next step is going to be completing the selection process for the deputy director of community health. raleigh exciting position -- a really exciting position and in

this new structure elevates community to make it in many ways, a center of what we do so the other leaders and groups will be wrapping around the community input and the community partnerships to deliver the core services and deliver the data and have the innovation to reflect the community and its needs and the department has done this for a while. we're making it explicit in this organizational chart. so, then after that, the next task will be turn to hiring the physician deputy director. there are two of those. they will also serve as deputy health officers and so, very excited about the potential for this and the potential for this organizational structure, again, allowing us to add in additional capability as we need to around climate clay, around other areas that are opportunities for us to grow and to additional serve this city and this structure will better allow us to do that.

next slide, please. so, in this slide, i'm thinking about some of those benefits. i've mentioned a few of them and we have artificially divided it that benefits the community and the division of population health but they are interconnected, so again, it's so important that we're visibly elevating community this structure and aligning our work with phd. irk quit is a huge focus for this community group and areas of work. following the amazing example that has been set and established for us by dr. bennett and her team. and then in the division, creating leadership level support is incredibly important and included in that is succession planning and having people have an opportunity to step forward and to lead in those ways that serves the department and the city so well. expanding our capability for emergency

response is really going to be important, having these additional leaders that can serve on key roles whenever we might have a public health emergency and being able to support the work of the branches and the teams below them to enable them to be freed up to do the expert work that they excel in. and then, again, applying equity with everything we do. i'm saying it twice because it's so important. we're thinking about it all the time as we're doing this work. next slide, please. i'm going to shift into another quadrant which is the task force and moving in the work. this is, of course, a really huge task and our division was so involved as you all know, in the response. we had 241 of our staff activated and that's about 58, a little less than 50%. this partnership between leaders and the covid task force and the phd

branches have been really integral and we're going to be moving the functions and the staff over and incourt rating them into our -- incorporating them into our work into p.l.d. you'll use covid to bring in new functions and new ways of sharing our work so we're grateful for our collaborators and other dph leaders and external partners and the task force staff who continue to help us with this period of integrating and learning and you know, balancing all of the, all of the changes and somewhat, the unknown of what the staffing is going to look like, what the funding is going to look like and they've been so committed to this work and we're really very pleased to be able to encourage many of them to apply for permanent positions within phd or elsewhere within the department so we can really keep the talent that was developed and the leadership that emerged during covid. next slide,

please. so, again, just a little bit on public health accreditation because again, i feel like we hold this in the division, but we do it on behalf of the entire department and on behalf of the commission. and again, many thanks to priscilla chew who leads these efforts. the timeline, we initially became accredited in 2017. we were approved in spring in march for -- for a consideration and the body that accomplishes the public health accreditation board will follow up on the materials and do a virtual site visit. so, often or sometimes, i get questions from staff or from others about why go through this process? it's labor intensive. it's challenging to do this.

well, in some ways it really is, it really is putting into words and into a symbol, the work that we already value, the board really values community involvement. it involves equity. it values improvement. all of these things that we're already doing as a department and we should get credit for it and we should make it part of our standard work to be documenting and doing all of these things, including workforce development. i think the other practical thing is that this, like, accreditation that we're familiar with for hospitals and other institutions is becoming a standard, a mark of quality for a health department and we're also seeing this is getting incorporating into grant and funding opportunity to you get more points if you're an accredited health department. it's a lot of work and hard work but it shows the staff that phd stands for or should stand for

so we're happy to participate and help lead this work with collaboration from other people, although it's led within phd, there are, there are many people that are involved with this including secretary morewitz, thank you for your involvement in it as well. okay. so, next slide, please. >> kenya, next slide. there we go. >> okay. thank you. so, i'm going to shift a little bit where we've been talking about all of the work that we have done and will continue to do to really think about rebuilding phd after covid and rebuilding after the transition of so many of our senior leaders, but as we know, public health and emergencies and infectious diseases don't operate on the timeline that's most convenient so i know that you all are very

aware because we talked so much about it and really appreciate your support last summer when we were faced with this m-pox and primarily around lgbtq and gay men. it was limited vaccine. i'm saying word for word what president bernal said a little while ago. we know that it really was the collective work of the city and of the department that enabled us to respond so quickly and enable to get to the point, again, as i've mentioned that cdc modeling shows that san francisco is estimated to have the lowest risk of large reoccurrence of any major city, like new york and san francisco have the two best outlooks for that and we hope that's right and we're going to prepare as if it might not be and reminding people to get vaccine if they haven't, but

that's good news. and i want to talk a little bit about the amazing work of all the teams that came together. i'm going to speak a little bit about phd but show you how its collaboration and partnership across the department and across the city. while we were really trying to -- let's see here. is there a slide before this, kenya >> can you check if there's a slide that got skipped. are you able to go back one, kenya. >> i'll go back. there was a slide i skipped. >> thank you, thank you! i'll go ahead and read and while we're going back and i think that's just fine. and then you all remember that we, in san francisco, became the first u.s. jurisdiction to announce we would declare a public health emergency and have that signify

how intensely we were going to respond and how we wanted to do everything we could to help keep people safe. there are many, many challenges for the public and for our team it's, we built on lessons and partnerships from covid-19 and really leveraged that, creating a public dashboard. within that, we saw a disproportionate cases along latinx and dr. bennett was instrumental in saying we don't need to wait. we need to anticipate there will be disparities and we need to look at the data and respond quickly. we had so many community partner expertise with lgbtq and sexual health that had it in a right space approach. we were able to incorporate m-pox work into community based infrastructure including into our organizations that hadn't worked in sexual health but knew how to reach latinx populations and others

who could benefit and who really joined very quickly, understanding the data and doing everything that we could to reach out. next slide, please. so, oh. one back, please. great! thank you! the san francisco city clinic team, which is within the population health is our expert sexual health clinic here at dph and in the city. they responded so quickly to be able to test and vaccinate and treat people with m-pox. 14% of total cases in m-pox were diagnosed. they were -- in this city and it was quite complex to give treatment. it required extensive paperwork, it was very time-consuming. it seemed to be out of the reach of many providers because it was so out of the ordinary for what the usual patient flow would be and city clinic really stepped up and was able to see people

regardless of what their usual source of healthcare was and we need to plan for that, into the future. we need to plan for ways to respond quickly. speaking of responding quickly, the det clinic, as we have talked about at zuckerberg san francisco general and president bernal spoke about, they were the large clinic that was a walk-in site throughout the pandemic, enabling anyone to walk in and get vaccinate and they administered over 20,000 vaccines. there were challenges and people were frustrated but that team did an amazing job. very quickly we came together and were able to do that. i also really want to shout-out something that happened with us that didn't happen in many other counties where i have colleagues which is our health system partners, again, just as they did in covid, stepped forward and particularly ucf and kaiser were willing to not only have

vaccination clinics but to see people that were not their patients within those clinics, with the goal of stopping the outbreak as quickly as possible. and it's extraordinarily to have those partners and again, it's an outgrowth of what we were able to do together in covid-19 with our mass vaccination clinics and we want that to be our culture in san francisco and we want that to continue. so, we, as a city, have been able to celebrate 50,000 doses of vaccines given which is remarkable. we want to make sure anyone who hasn't gotten their vaccine is available. it's much more available now than it was last summer, of course, and so there are multiple routes that people can get vaccinated including through their usual source of sexual healthcare and it was raleigh wonderful to -- it was wonderful to given an opportunity by president bernal that it's not too late. we have a long summer ahead of us and we want those available to get the

vaccines if they haven't gotten their two doses. next slide. this is my final slide. this amazing team i work with, they are so committed to making san francisco the healthiest place on earth. they are always looking for opportunities to innovate and collaborate and you have just one example here on this flyer. incredibly important and very timely example of our partnership with our colleagues in behavior health a.25 van ness, for us phd staff are located, it's the first phd to stock niloxine in the restroom. it can be used by visitors and staff as needed. it was leaders from we livor health, from our -- from behavior health and branch operations and others that made this committee to make this happen and so proud, again, to be associated with a team that thinks this way, big

picture that thinks innovation and did what they could to make this life saving innovation as it could be in our building. and we just had a staff training this morning which is what the flyer was. again, it's really remarkable. it's a privilege to serve alongside this team at phd. i think you're going to hear amazing things that the team is doing and we gave you? examples, i think, in a handout that touches the surface and we'll keep bringing things to your attention. i think it will be of great interest to the commission and i really appreciate your work and your support today. so thank you! >> thank you, dr. philip. we're proud of the work of public health division. thank you for the updates. secretary morewitz, do we have public comment. >> let's start with those i've given accommodation. lower your hand if you haven't gotten accommodation from me and given two-letter code. jaime, let's start with caller ten because

that person received accommodation. >> okay. mr. morewitz, it's patrick, can you hear me? >> yes, please begin. >> okay. this comment was the second one that i missed and president bernal -- >> mr. meshal, this comment period is for the phd update. >> what about -- >> do you have a comment for this item, mr. meshah. >> i do and my comment is, why aren't you taking both the two comments that i have called in and you didn't take. you said you would take both of them and then commissioner bernal only let me give one of them. i want three minutes to give my other other comments. >> you had the laguna comment and -- we can move on. >> no, no, no.

>> you've got two minutes, mr. manetshaw, keep going. >> this goes on the director's report. did i did not comment on public comment. >> please mute him, jaime. okay. let's go to the other comment, please. you're unmuted. are you there? >> hi. it is dr. palmer. can you hear me >> yes, please begin. >> yeah. there was a forum about houses with senior and the lack of medical services for houseless seniors who are fragile in navigation centers and shelters and on the street and the other thing that came up is there's a lack of data about what happens to houseless seniors and also that houseless seniors are disproportionately,

african american or black. so, i see, you know, a lot of different things in the population health division highlights but are refocusing on medical services to this population and, you know, decent wraparound services to keep them from getting worse. thank you. >> those are the only hands, commissioners. >> commissioners, comments or questions for dr. philip? commissioner guillermo. >> thank you and thank you dr. philip for your presentation. i know we haven't had a sense of the whole, what has been going on with the public health division, given all the other things that have occupied our time, although we

know that it is because of the division that you head up that we were successful beth in the pandemic and -- both in the pandemic and the emergency with mpox along with the other issues that this division is responsible for and i'm glad to see the response, the structural response to the information and the data and the experience that you've had over the last several years incorporating into the new ideas about how to respond better to the community. i had a question about the reaccreditation process and i'm glad to know we're in the throws of it and we think it's just as important as it truly is. are there any components within the accreditation sphere of documentation and in the application that you are particularly concerned about or

particularly happy about and confident about that we should be aware of because otherwise it becomes this, you know, process we're informed about but don't know whether, you know, and as important as it is, but flavor in detail would be appreciated. >> yes. that likely would be worth giving you a little bit more detail as we get further into digging with this. part of what we're aiming to do is have a consultant help, who has served on the board and knows this work and to be able to highlight where our challenges would be. one thing is our challenges may be different than they were in 2017, again, because we've had a lot of transition and we're trying to put into place, new practices. i will say in most areas, we are developed. we have developed, at least beyond a route men tree phase. we need to dig into the

improvement work, which is a key component across all of our areas of work, having a core performance improvement team that will be in daisy group to help us do that because we haven't been able to do that with all the scrambles we have been doing, so i think we have to go back to basics and i'm happy to come back or send a message to the commissioners if there's areas that particularly seem to be doing well or areas we're having challenges but so far, it seems like we're largely on track. we just know we need to up our game and continue to improve things. i'm very, i'm feeling very positive about all the work of that workforce development and supporting staff, and again, daisy and her team have been really instructional in that and jonathan and bare hernandez at their team at the center of innovation and look at how we utilize our ability to engage

our staff and decrease turnover and really try to develop our staff with an equity mindset of allowing really promising people to have opportunities for leadership, so we're thinking about all of that and we certainly could always improve, but those are also areas that are reflected in rea consideration. i'm happy to come back. >> i'm glad to hear about all the hiring that's going on at the pace at which it is going because i did express a concern last meeting about making sure that, because san francisco is such a difficult place to reside for a number of reasons that we are not going to be shortchanged with regard to the type of resources, particularly, human resources that we need in order to be able to realize all the ambition we have with these great programs that we're both continuing re-imagining as well as reestablishing, so.... thank

you. >> commissioner chow. >> yes. and thank you for the update on the public health -- health reaccreditation. that happened as one of the earlier city departments, i believe, that have it. and so, i think if you are having challenges in the accreditation process and i remember when we first went through it, then i would think anything that we can help do would be, and i think -- i think board members at one time were interviewed or had to be part of, at this time, onsite visit, so it sounds like it's virtual now, is that right? >> i believe so. i have to say honestly, i don't flow if that's because of a change post pandemic or because it's -- it's

reaccreditation. >> i'm sure as commissioner guillermo said, we're interested in saying, as you were pointing out, that shows we're at a level of activity that is like in hospital accreditation, the best that we can do, so.... i appreciate that. i'm looking in and wondering and understanding how large the phd is and with the extra functions that you're having as a health officer, also, that you're asking for two physician deputy health officers. each of these areas have had position leadership, at least from the research side and so, how is it then or do these

people lose a certain amount of authority or is this added support for them or how does this enhance what everyone has been doing, which has been really phenomenal? >> yes, thank you, commissioner chow, for the opportunity to state very clearly that we're not going to be able to replace or substitute the work of our experts at these levels, at the branch level and they are the best in their field, so these leaderships are not going to be necessarily guiding their work or really even, you know, determining their work, but they are there to support. you said it correctly. they are thb to remove obstacles to look for connections within the division, within the department, outside of the department and help facilitate that, so it really is meant to allow the branch leaders and subject matter experts to work at the top of their game and so that's the

goal is to try and provide a level of support for that work and to also, i'm saying, i think it's so important to make sure there are deputy health officers in place and we have always had those before. i was one of them, so again, we want to make sure there's great succession planning that people have opportunities to come in and learn from the commission, to learn from each other, and that we also have a pathway for people who are interested in being a public health director, being a population health director, a health officer, to have pathways to really learn what that is like, so i think there's multiple benefits in n- having leadership structure. again, if we said we want to realign, we want to think about a new way of making a new branch, it was difficult in the old structure to think about how to add something else, but here, we have more flexibility because the span of control for each of our leaders is going to be much

more reasonable. >> do you have an idea of timeframe in terms of filling these positions? >> we are very glad that daisy is there. we have one down out of those four. we are very close to finalizing and being able to announce our community health director position which is exciting and then next, i turn my attention to the physician leaders, the deputy directors and deputy health officers. i'm the rate limiting help because i'm hiring all positions. >> with your all your functions, i'm hoping you'll find time. >> it's a priority. i'm looking forward to that. i've been grateful to have daisy's help so i can't imagine having three more people as -- maybe that's too much to ask. >> oh, thank you. >> dr. philip, before i call on director colfax, i think it's worth repeating that san francisco went from having one of the most concerning mpox outbreaks last year to being

designated by the cdc as being the lowest risk of a large occurrence and that's a testament to the work of the department and to your division as well and the people at the general and our community partner so thank you again for that. now that we are not in a declared health emergency, we have the opportunity to go back to an issue that has been great concern to the commission and myself as well. even looking at the progress that you're making in hiring within the division, there's a 30% vacancy of positions and i know we've talked about the progress in getting these positions filled and that's great, but what's the impact of those empty positions, particularly, on the work of the division and what might be left on the table and also on the staff that's there and how far they are being stretched or how thin they are being stretched in their work? >> it's very challenging. it's challenging to do more than sort of keep the lights on, but i will say that our team, again, is very committed and are

looking for ways to innovate as they can. as you saw from her noxolone intervention. we want to enable them by being enough team members to help them do that. we have, again, team vacancies as well as the deputy -- we want to support the team to enable them to do the work they are able to do and primed to do in terms ever innovating and health. it's promising in that, again, with this task force that's led by daisy and the team that daisy works with, they really have made progress, so we are at, the form three or higher level on all of those positions that are listed there, so things are moving. it's just everything, of course, takes time and we would love to be able to fill them instantly, but i'm very heartened by the progress. i think we are turning

a corner. i will knock wood and say that and i think that's very hopeful and again, retaining people by working on experience and development and all of that, it's just as important because again, it takes a long time to hire people. people can decide to get another opportunity very quickly as we know and we want to stop that. we want phd to be the best place for people to work in public health. >> of course we want to ensure your team has the support and the colleagues they need to do the excellent work. thank you for letting us know about the progress and we'll want to know more as time goes on to make sure they continue to pace. director colfax. >> thank you, president bernal. i want to add my thanks and gratitude to dr. philip for her work and susan. she directs people, she's the city's health officer which has been a very active roll-over the past several years and also serving on the commission that dr. philip has been in this position for a relatively short time and done so much in terms of this restructuring and phd

has always been a fantastic division. you know from the research, the innovation, the community work that is done there. it's always done so well and it has been a leader and looked to across the nation for models of care and prevention. dr. philip, just to highlight, bringing a focus on developing structure and systems and providing clarity through the systems and clarity in holding the work accountable and working on those that have a shared commitment to those teams so i want to thank her and her team for bringing this work forward in the context of, doing the all work that continues and also building up and fortify that phd leadership across at every level of the division, thank you.

>> thanks, dr. colfax for your support in doing that work. >> thank you, dr. philip. next item is community and public health committee update. >> are you providing that. >> i am with dr. chow. >> of course. >> i hope. >> so, we had a really wonderful presentation today. the tuberculosis update. we received this last year and we are hoping, a long with the presenters that this will become an annual presentation because it's so useful and interesting and necessary. so, first of all, san francisco has the comparatively and relatively high incident of active cases. it is three to four times the national rate. it's also much higher than in the rest of california. understanding the reasons for this is complicated

by the fact we're a city and county. other people gets counted as a city verses county. i'm not sure how that all plays out, but we are an urban core and we are higher than los angeles as well as new york. again, and higher than imperial county as well, so it's interesting and concerning but there may be reasons for that that's not concerning, so you received the slides and if you later refer back to slide 2, it notes that after turn buck low says cases, they had a decrease in 2020. from 2013 to 2019, there were one hundred cases in most years. 2022, the mark

decreased -- the total was, well, so, earlier, it was, the total cases were around 745 and then in '20 to '22, it's about 190. the reasons for this are multi factorial, covid perhaps and the small numbers detected and people weren't seeing medical providers and also the fact that new immigrants have small numbers of cases of tuberculosis. while the immigration has been going up, the cases have not been going up because the immigrants aren't responsible in that sense for the, most of the cases. according to the presenters, most people, perhaps, 90% had

lateen tuberculosis, so when they came to the country, perhaps it was lateen and then became evident later, active later. it's easy to wonder whether the decrease in immigration may have led to a decrease, but again, that's probably not the case because the rate among recent immigrants is low. the rapid molecular testing may lead to greater discovery incidents. here in san francisco, it's incorporating much more widely and it has been around for, since 2010, which makes it easier to use this test which is more sensitive. also, the case complexity and an interesting thing, the case complexity increased, more

medically complex cases. the median age for people who are testing with tuberculosis is greater than 60 and that has been true since 2019. and again, the rapid diagnosis has been an important factor in this coming to light. the presentation also talked about the racial and ethnic disparities in active tb incident cases. and that is on slide number five and with this slide, we again, encountered the question of how we aggregate or disaggregate asians and pacificy landers. people who identify as asian have the highest rate as tb cases, pacific islanders, not so much, much, much lower. we

want to group asian and pacific islander, it might be helpful to once again use our, you know, our strategy of dropping a footnote to say, explain that, while this group, these groups are aggregated, there are few numbers among islanders and dropping a footnote to note that we are tracking, as best we can, statics in the native american community and to, because of the low numbers, the percentages are not statistically significant, apparently but the low number of populations but to let people know we're not ignoring the population and explain why the numbers are what they are. and the next slide knows that the

highest countries of tb cases between 2018 and '22, 2022, china had 37%. people born in the philippines had 13.1% and vietnam had 8.5% and it drops from there, so those are the highest places of origin in asia, again, pacific islanders are not represented here because the numbers are not there. asian people are greater, greater than 11 times -- 11 times greater to likely be testing positive for tuberculosis rather than those who identified as white and 4 to 6 times greater than in the african american, black, and

latin community than it is in the community of people who are identified as white. here in san francisco, the incidents by neighborhood concentrated cline puna town and market, it's -- concentrated in china town and significant where there's a high asian population. 86% of the cases of tuberculosis are due to the reactivation of lateen activation which can live in the body. it's so preventable. the presenters talked about the approach to tb prevention, working with health providers to provide preventive treatment, working with community partners to provide, education and linkage care for people and look nothing the congregate care and

residential settings to promote preventive therapy where lateen tuberculosis is diagnosed and staff and residents working with health systems to increase an optimized workload for testing and treatment for tuberculosis and lateen tuberculosis and focusing on prevention and control to assure a prompted evaluation and therapy for those with ltbi and then we went on to hear more about the newcomers health program, noting that june -- it's an amazing program you know. part of it, part of what it does is provide refuge health assessment program, supporting the health and well-being of refugees, and people seeking or

granted asylum. human tare yum parolees. at this point in time, afghanistan, ukraine and nicaragua and venezuela and -- again, the areas that are providing the changing populations from, which are significant from a tb stand mount, ukraine, grad may la and afghanistan and honduras, from a tb standpoint funded to protect refugees and their health is what they do and what they do well. refuges receive oversees health screening, sighlies, humanitarian, parolees, there is

no oversees screening for tb conducted prior to u.s. arrival so it's important to the efforts that these entities are making to reach the a sighlies and the people who gained humanitarian parole and the partnership between the tb and the new parolee health clinic is significant and amazing and it screens lieu man tare january parolees from various countries for tb and refer to additional health services and the outreach they do is tailored specifically to each of those communities and they are being very, from my perspective, very innovative and diligent about that outreach. talking about ukraine because of the high number of people who are coming, the four highest in europe and highest in drug and tb worldwide. that's likely due

to the fact that the care infrastructure there is based on post soviet and eastern block health systems and the war in 2022 disrupted any recent infrastructure gains that had been made. and so, building on the parolee tb screening program, in november 2022, usci had a parolee for -- cubans and haitians and the sfdph tb clinic is screening these populations with both the igra and the chest x-ray and attestation and the use of the chest x-ray is important and significant way to increase the numbers of people with, as i understand it, perhaps dr. chow, with lateen

tb, so.... that is what i've got and dr. chow had some other thoughts, i believe, during our presentation. >> i just wanted to clarify and also indicate that we are very pleased at for the years 2013 to 2019, there were, there were over 100 cases on each of those years, almost. some of them were as high as 118 and per one hundred thousand here in the city. and in the last three years, granted? of this -- granted some was during the -- is this because less people were coming in but they demonstrated on one of the slides, the number

of cases being found on people of foreign origin was really still quite small and that most of these cases are really, as commissioner noted, lateen tuberculosis. if you follow that trend, it shows in the u.s. and in california, there's not really a difference in that trend. our trend went down. the national trend stayed at about, yeah, 3 to 2 and the other interesting figure for that -- of chinese origin was 37% of the cases as they had counted up from those years and then it was noted that it's interesting because if the u.s. is about two and china, actually about 55, this is just right in the middle but most significantly, these

were latent so i discussed that the big effort is trying to inform providers, particularly, of the importance of screening latent within their medical groups. they subscribed outreaches to our clinics but i thought that it was really important that they still try to reach the private providers because so much of the care for the asian population is still given within private practices, so we had or we'll try to outreach or give them contact to outreach to -- really only three or four large providers groups, i should say, medical groups that are not part of the large systems that they could get outreach to and see if we can bring this down further. but it

really is amazing that in these years, they had done that. one of the issues we had was direct observation, which required everybody to go down to general. now, in fact, and this is really interesting. they don't need to do that. in fact, there are three different ways of really doing the observation. one is actually going to the homes of many of these who are frail and elderly, so that's great. another was an app and a third was a video, similar to what you did for covid-19 to get certified. i, personally, i was impressed there was outreach and ways we have found it more convenient to our residents to be able to do the treatment that was necessary, so it was really a very positive report and i was extremely pleased after all these years to see the improvement in our tuberculosis

rates and we're hoping this will continue. >> the innovation that was evident was amazing just like dr. chow said, so now there's an app, there's the video surveillance that came to light during covid, probably and the home visits also and the work that people are doing, you know, on day-to-day basis to expand the access to treatment is really admirable. >> any public comment? >> yes. there's several hands. those who received accommodation, please leave your hand raised and those who have not, please take your hand down. jaime, let's start with caller 12. caller, you're unmuted. >> in november, word leaders will be coming to san francisco.

and i've listened to the presentation and i'm sure you're aware that we have many people dying from the drug fentanyl and other drugs -- >> this item is about the community public health committee. the topic, your comments have to speak to the topic. >> i am speaking to the topic. so, we have a -- >> the presentation was on the tuberculosis report. >> i heard about it too. so, when the (indiscernible), do we get, the fentanyl cases that go to the morgue, if you ask how many people in the various

categories that go to the morgue, they are not given the information because they say the california, there's a state law that prohibits it. [multiple voices] >> tuberculosis -- >> all right. we'll go to caller ten. mr. manitshaw, this is a community and health committee update. >> i'm going to file a sunshine complaint if i don't get the other three minutes. >> please mute, jaime. >> okay. pleasant public comment today. that's all. >> commissioners, any comments or questions? already. move to go the next item, which is the consent calendar for action. commissioner guillermo, please take it away. >> thank you. you have before you a recommendation by the

laguna honda jcc to approve policies, let's see the number, 20 policies that are presented for your approval and i would request, do i make the motion? >> actually, we would get a motion, yes, you can make the motion. >> motion to approve. >> all right. any public comment on this item >> yes, we do. jaime, please unmute caller ten. >> a reminder, this item is the consent calendar with policy items related to laguna honda. >> mr. bernal, thank you for your kind reminder of what this agenda item is. it's troubling seeing the policy and proceeds

consent calendar and [hard to understand speaker] relies to quote, remove the therapy aides and they will no longer return them to the restorative program, end quote. the traction changes prevent particular policy, since the restorative nursing program is being changed in other detrimental ways. the action plan deliverables from the restorative nursing program should be a quote, on quote gap analysis completed by january 25th and a program document would be completed by february 8thth. here it is june. why is it the restorative

nursing policy being changed again so suddenly? if the restorative aides been returned to laguna honda rehab services department for (indiscernible). as you recall, the restorative aides were moved from rehab to nursing wrongly in 2014 by jennifer carton wade understand her leadership. why hasn't laguna honda updated their health commission on the rehab services department, quote, restorative care level one, end quote, program. is that program still functioning to prevent functional decline of laguna honda's frail residents? i will remind you, commissioner bernal and mr. morewitz, by the time

mr. morewitz comes back from vacation, i will have a sunshine complaint on his desk and have your sunshine (indiscernible) unless you let me speak today on audio tape for the agenda item i had my hand raised for, director's report, agenda item 5, if you give me that three minutes, you can avoid wasting your time handling a sunshine complaint, sir and sir. >> we can move on. mute, please. that was the only caller. >> all right. commissioners, any comments or questions? if not, we can move to a vote. all those in favor. >> aye. [multiple voices] >> any opposed? okay. we'll move to our next item which is a joint conference committee and other committee reports. back to commissioner guillermo, chair of the laguna honda hospital joint conference committee. >> thank you, president bernal

and that will be short because most of the agenda items have been reviewed and presented on here today. the executive team report, which is essentially what mr. pickens provided for us today. we reviewed the regulatory affairs report and you approved the recommended laguna honda hospital policies as recommended and we went into closed session where we reviewed the credentialing and the pick report for the month presented. that's total of the meeting. >> all right. thank you, commissioner guillermo. do we have any public comment? >> oh, we do. please unmute caller ten, please, jaime. okay, have you three minutes mr. meneshaw. >> i get it. community members who observed the jcc meeting on

june 13thth are alarmed. at the rate recertification things are progressing. there isn't enough time for enough improvements to avoid laguna honda closure or discharges of evictions of all residents on september 19th. it was obvious during mr. pickens presentation on the 13th when he painted an overly optimistic picture toward the progress of presenting a recertification application, perhaps, in july. the community [hard to understand speaker] this commission knows san francisco has a shortage of skilled nursing beds and cannot afford

to lose laguna honda whether losing 120 or all 780 beds. the commencement announced on april 4th, that we have prevented an update on the contract. it was presented in may or june and should have been prevented today. the contract -- the march contract is for support of the flow of information within laguna honda recertification, quote on quote, incident command structure and it's shocking. again, you'll be looking at a sunshine complaint because you promised me i could speak on that third item and now mr. bernal is being

(indiscernible). >> okay. that's the only public comment. >> all right. any comments or questions from commissioners? >> none. >> seeing none. we'll move on to other business. is there any other business? seeing none. move to go the next item which is adjournment. >> so moved. >> so moved. >> i see no hands on other business. >> what's that? >> i see no hands for public comment on other business. >> all right. all those in favor of adjournment, say aye. >> aye. >> opposed. we are adjourned. thank you. >> okay. >> our next meeting is not until july 18thth because of the july 4th holiday which falls on a tuesday so we'll see you in just under a month's time. thank you. >> thank you.

[music] digital literacy is something severely lacking in our world today and it takes a lot to understand that. food water and shelter have basic necessities so long we forget about wifi and connection to the interenet and when you go into communities and realize peep ople are not able to load homework and talk to teachers and out of touch with the world. by providing the network and system we are able to allow them to keep up in the modern age. >> folks still were not served by internet throughout the city and tended to be low income people, people in affordable housing. people of color and limited english and seniors, all those are high concentrations in affordable housing, so we thought given that we had a fiber network that stretched throughout the city reaching deep

into neighborhoods that would be a perfect opportunity to address it in san francisco. >> the infrastructure the city and star help us run are dejtle programs. it played a critical role from the time we opened during covid till now so we were able to collaborate with online services that offer tutoring and school support. it also helped us be able to log the kids on for online school during covid, in addition to like, now that everybody has switched most of their curriculum online we can log kids on to the online homework, check grades in addition to helping parent learn how to use the school system portm >> the office of digital equity our goal fiber to housing is insure we have all three legs of the 3 legged stool.

the first leg is high quality internet connection. we liken the high quality internet connection to the highway. the second leg is high quality devices. this is the car. you want to make sure the specks on the car is up to speed and lastly, it is important to get kind of that driver's education to learn how to navigate the road, to know the signs to watch out for in terms of making sure you are school while you are surfing the internet it is private so that is the digital literacy piece. >> my daily life i need the internet just to do pretty much everything. the internet has taken so much control over people's daily lives including myself that i just need it to get certain jobs done, i need it for my life. i need it. >> the program really seeks to where ever possible provide a service that's equivalent or

higher speed and quality as the best commercial service . >> we serve all of san francisco, but we definitely have to be equitable in our distribution of services. that means everybody gets what they need to be successful. >> actually one of the most gratifying part of my work here at department of technology, it is really bringing city resources to address problems faced with our communities with the highest need. >> i think it is important because i grew up in a low income community without internet access and it is hard. i think it is important for everyone to have internet access no matter their income and maybe one day their kid will have internet access for us and help the school and with their skills.

dev mission's goal is aiming to train young adults, youth so we can be a wealth and disparity in underserved communities like where we are today. my name is leo sosa. i'm the founder and executive director for devmission.

we're sitting inside a computer lab where residents come and get support when they give help about how to set up an e-mail account. how to order prescriptions online. create a résumé. we are also now paying attention to provide tech support. we have collaborated with the san francisco mayor's office and the department of technology to implement a broad band network for the residents here so they can have free internet access. we have partnered with community technology networks to provide computer classes to the seniors and the residents. so this computer lab becomes a hub for the community to learn how to use technology, but that's the parents and the adults. we have been able to identify what we call a stem date. the acronym is science technology engineering and math. kids should be exposed no

matter what type of background or ethnicity or income status. that's where we actually create magic. >> something that the kids are really excited about is science and so the way that we execute that is through making slime. and as fun as it is, it's still a chemical reaction and you start to understand that with the materials that you need to make the slime. >> they love adding their little twists to everything. it's just a place for them to experiment and that's really what we want. >> i see. >> really what the excitement behind that is that you're making something. >> logs, legos, sumo box, art, drawing, computers, mine craft, and really it's just awaking opportunity. >> keeping their attention is like one of the biggest challenges that we do have because, you know, they're kids. they always want to be doing something, be helping with

something. so we just let them be themselves. we have our set of rules in place that we have that we want them to follow and live up to. and we also have our set of expectations that we want them to achieve. this is like my first year officially working with kids. and definitely i've had moments where they're not getting something. they don't really understand it and you're trying to just talk to them in a way that they can make it work teaching them in different ways how they can get the light bulb to go off and i've seen it first-hand and it makes me so happy when it does go off because it's like, wow, i helped them understand this concept. >> i love playing games and i love having fun with my friends playing dodge ball and a lot of things that i like. it's really cool. >> they don't give you a lot of cheese to put on there, do

they? you've got like a little bit left. >> we learn programming to make them work. we do computers and programming. at the bottom here, we talk to them and we press these buttons to make it go. and this is to turn it off. and this is to make it control on its own. if you press this twice, it can do any type of tricks. like you can move it like this and it moves. it actually can go like this. >> like, wow, they're just absorbing everything. so it definitely is a wholehearted moment that i love

experiencing. >> the realities right now, 5.3 latinos working in tech and about 6.7 african americans working in tech. and, of course, those tech companies are funders. so i continue to work really hard with them to close that gap and work with the san francisco unified school district so juniors and seniors come to our program, so kids come to our stem hub and be exposed to all those things. it's a big challenge. >> we have a couple of other providers here on site, but we've all just been trying to work together and let the kids move around from each department. some kids are comfortable with their admission, but if they want to jump in with city of dreams or hunter's point, we just try to collaborate to provide the best opportunity in

the community. >> devmission has provided services on westbrook. they teach you how to code. how to build their own mini robot to providing access for the youth to partnerships with adobe and sony and google and twitter. and so devmission has definitely brought access for our families to resources that our residents may or may not have been able to access in the past. >> the san francisco house and development corporation gave us the grant to implement this program. it hasn't been easy, but we have been able to see now some of the success stories of some of those kids that have been able to take the opportunity and continue to grow within their education and eventually become a very successful citizen. >> so the computer lab, they're doing the backpacks. i don't know if you're going to

be able to do the class. you still want to try? . yeah. go for it. >> we have a young man by the name of ivan mello. he came here two and a half years ago to be part of our digital arts music lab. graduating with natural, fruity loops, rhymes. all of our music lyrics are clean. he came as an intern, and now he's running the program. that just tells you, we are only creating opportunities and there's a young man by the name of eduardo ramirez. he tells the barber, what's that flyer? and he says it's a program that teaches you computers and art. and i still remember the day he walked in there with a baseball cap, full of tattoos. nice clean hair cut. i want to learn how to use

computers. graduated from the program and he wanted to work in i.t.. well, eduardo is a dreamer. right. so trying to find him a job in the tech industry was very challenging, but that didn't stop him. through the effort of the office of economic work force and the grant i reached out to a few folks i know. post mates decided to bring him on board regardless of his legal status. he ended his internship at post mates and now is at hudacity. that is the power of what technology does for young people that want to become part of the tech industry. what we've been doing, it's very innovative. helping kids k-12, transitional age youth, families, parents, communities, understand and to be exposed to stem subjects.

imagine if that mission one day can be in every affordable housing community. the opportunities that we would create and that's what i'm trying to do with this >> [music] art withelders exhibiting senior art work across the bay for 30 years as part of our traveling exhibit's program. for this exhibits we partnered with the san francisco art's commission galleries and excited show case the array of artist in historic san francisco city

hall. >> [inaudible]. call me temperature is unique when we get to do we, meaning myself and the 20 other professional instructors we are working with elders we create long-term reps i can't think of another situation academically where we learn about each other. and the art part i believe is a launching pad for the relationship building:see myself well. and if i don't try when my mom

again. she may beat the hell out of mow if i don't try >> seniors, the population encounters the problem of loneliness and isolation even in a residential community there hen a loss of a spouse. leaving their original home. may be not driving anymore and so for us to be ail to bring the classes and art to those people where hay are and we work with people in all walks of life and circumstances but want to finds the people that are isolated and you know bring the warmth there as much as art skill its personal connection. men their family can't be well for them. i can be their fell and feel it. >> i don't have nobody. people say, hi, hi. hello but i don't know who they are. but i come here like on a

wednesday, thursday and friday. and i enjoy. >> we do annual surveys asking students what our program does for them. 90 plus % say they feel less alone, they feel more engaged. they feel more socially connected the things you hope for in general as we age. right? >> and see when i do this. i am very quiet. i don't have anybody here talking to me or telling me something because i'm concentrating on had i'm doing and i'm not talking to them. >> not just one, many students were saying the program had absolutely transformational for them. in said it had saved their

lives. >> i think it is person to support the program. because i think ida elder communities don't get a lot of space in disability. we want to support this program that is doing incredible work and giving disability and making this program what supports the art and health in different way bunkham art as a way of expression. a way of like socializing and giving artists the opportunity also to make art for the first time, sometimes and we are excited that we can support this stories and honor their stories through art. we hope the people will feel inspired by the variety and the quality of the creative expressions here and that viewers come, way with a greater appreciation of the richness what elders have to share with

us. [music] >> i don't want to be involved in the process after it happens. i want to be there at the front

end to help people with something in my mind from a very early age. our community is the important way to look at things, even now. george floyd was huge. it opened up wounds and a discussion on something festering for a long time. before rodney king. you can look at all the instances where there are calls for change. i think we are involved in change right now in this moment that is going to be long lasting. it is very challenging. i was the victim of a crime when i was in middle school. some kids at recess came around at pe class and came to the locker room and tried to steal my watch and physically assaulted me. the officer that helped afterwards went out of his way to check the time to see how i

was. that is the kind of work, the kind of perspective i like to have in our sheriff's office regardless of circumstance. that influenced me a lot. some of the storefronts have changed. what is mys is that i still see some things that trigger memories. the barbershop and the shoe store is another one that i remember buying shoestrings and getting my dad's old army boots fixed. we would see movies after the first run. my brother and i would go there. it is nice. if you keep walking down sacramento. the nice think about the city it takes you to japan town. that is where my grandparents were brought up. that is the traditional foods or movies. they were able to celebrate the

culture in that community. my family also had a dry-cleaning business. very hard work. the family grew up with apartments above the business. we have a built-in work force. 19 had 1 as -- 1941 as soon as that happened the entire community was fixed. >> determined to do the job as democracy should with real consideration for the people involved. >> the decision to take every one of japan niece american o japanese from their homes. my family went to the mountains and experienced winter and summer and springs. they tried to make their home a home. the community came together to

share. they tried to infuse each home are little things. they created things. i remember my grand mother saying they were very scared. they were worried. they also felt the great sense of pride. >> japanese americans. >> my granduncle joined the 442nd. when the opportunity came when the time that was not right. they were in the campaign in italy. they were there every step of the way. >> president truman pays tribute. >> that was the most decorated unit in the history of the united states army. commitment and loyal to to the

country despite that their families were in the camp at that time. they chose to come back to san francisco even after all of that. my father was a civil servant as well and served the state of california workers' compensation attorney and judge and appellate board. my parents influenced me to look at civil service s.i applied to police, and sheriff's department at the same time. the sheriff's department grabbed me first. it was unique. it was not just me in that moment it was everyone. it wasn't me looking at the crowd. it was all of us being together. i was standing there alone. i felt everyone standing next to me. the only way to describe it. it is not about me. it is from my father. my father couldn't be there.

he was sick. the first person i saw was him. i still sometimes am surprised by the fact i see my name as the sheriff. i am happy to be in the position i am in to honor their memory doing what i am doing now to help the larger comment. when i say that we want to be especially focused on marginalized communities that have been wronged. coming from my background and my family experienced what they did. that didn't happen in a vacuum. it was a decision made by the government. nobody raised their voice. now, i think we are in a better place as country and community. when we see something wrong we have change agents step up to help the community affected.

that is a important thing to continue to do. you talk about change and being a leader in change and not knowing whether you have successes or results. the fact of the matter is by choosing to push for change you have already changed things. through inspiration for others, take up the matter or whether it is through actual functional change as a result of your voice being heard. i think you have already started on a path to change by choosing that path. in doing that in april of itself creates change. i continue in that type of service for my family. something i hope to see in my children. i have a pretty good chance with five children one will go into some sort of civil service. i hope that happens to continue that legacy.

>> i am paul, sheriff of san francisco. [ music ]

good afternoon and welcome to the san francisco board of supervisors meeting for today, tuesday, june 27th, 2023. madam clerk, would you please call the roll? thank you, mr. president. supervisor chan chan, president . supervisor dorsey dorsey. present supervisor and guardian and guardian present supervisor. mendelson mandel present supervisor. melgar melgar present supervisor. peskin present. peskin present supervisor. preston preston present supervisor. ronen. ronen present supervisor. safai safai present. stephanie