item can we do this without role call? same house same call, without objection the resolution is adopted. [applause] >> members of the public and welcome to the san francisco health san francisco health mission meeting, july 182023. a quick note on the agenda, we'll be moving item 9 the conference committee report to before, item 8 which is the consent calendar to allow for some discussion. to please make a note of that and we will proceed with calling to order, secretary please call the roll. >> commissioner christian. >> present. >> commissioner chung. >> present.

>> commissioner jer ard o. >> present. >> commissioner bern al. >> present. >> commission chow. >> present. >> present. >> just a remind tore please turn off or silence your phones. >> thank you, secretary. now i go to commissioner to acknowledge the ramaytush ohlone indigenous stewards of this land and in accordance with their traditions, the ra ma tuber ohlone have never seeded lands as well as all people who reside in these territories.

as guests, we recognize that we benefit from living and working on homeland. we wish to pay their respect by acknowledging the relatives of the ramaytush ohlone. >> thank you commissioner chung. our next item is approval of health commission meeting on july 20, 2023. if there are no amendments, do we have a motion to approve. >> so moved. >> second. >> any discussion, any public comment. folks on the line, let's see. for each agenda items, each will have an opportunity to make public comment for up to three comments. however, the process does not allow questions to be answered in the meeting or more members nft possible to engage back and forth conversation with the

commissioners. the commissioners do consider items when discussing items. each individuals allow one opportunity to speak per agenda items. individuals may not return more than once. written public comment may be sent to the health commission at the following address, health. commission.dph, if you wish to spell your name, you may but it will be part of your allotted time. against city employees and will not be tolerated. we will first take public comment from individuals attaining the meeting in-person and then from individuals who receive accommodation for disability. i've given these individuals a code to speak. finally we will hear from remote public comment from other other individuals.

there will be a total of 20 minutes that can be heard on each item for individuals who have not received an accommodation, can you please unmute the one person who has their hand up. >> speaker: hi, code a a. >> please begin. >> speaker: thank you, june 28th minutes, noted that chow and green requested an update of the organization chart kind enough to provide a coffee, he never monitored upgraded because the funds are again, too small that's due in part to being prepared again, on at

that lloyd size, by senting, the minutes were is chow is concerned about the research timeline on expect this charges from laguna honda which is now, 60 days from today. will be permitted in the near future. end quote, i think pick ins told him the same thing about a formal sustainability plan.

what is the delay in presenting it. thank you. >> that is the only comment. >> any further comment from commissioners before we go to the votes. those in favor of approving minutes, say aye. >> aye. >> opposed? the minutes are approved. >> thank you. >> next item is general public comment. >> i have a short script to read, members may address the commission on items that within subject matter jurisdiction of the commission. each member of the public may address the commission for up to three minutes. the brown act forbids from taking action including those raised during public comment. so again, this would mean that folks who are making comment now would not be speaking on a topic that is listed on the agenda. i see, is there anyone in the

room that would like to make a comment? i see no one, please unmute mr. minuteshaw. >> speaker: thank you, about the comment on description on the today's agenda has been cleared for a long time. one issue is the deather of

treatment, and facilities, the san francisco is towards the kham approximately and the lack of commissioner involvement in 2016 study had said san francisco would be 700, facility bed sort. he's wrong, that sort of order of 1700 beds or worse, that this commission has taken no action proactively, explore building out additional skilled nursing capacity in our city

and instead, san franciscans are being dumped in the skilled nursing facilities. this commission should conduct another study since the 2016 of 7 years old and sadly out of date, before, another committee exploring whether to convert laguna honda's patient towers into behavioral out beds is undertaken or released in august of september or october, so the commissioner fully en formed of just how severe the bed shortage is and whether laguna honda beds for some of the population will only worsen

the skilled nursing bed shortage in the city. thank you. >> all right, that was the only public comment, the only hand raised. >> all right action the next item is laguna, closure plan and cms recertification update. >> can you please bring up the presentation. >> good afternoon, commissioners it's my pleasure to provide you on the recertification process. next slide. so i'm very pleased to share with you some of our most resent hires and we have hired a new, nursing home administrator and chief executive officer, sandrau simon, she is with us remotely on the, on the computer and, was actually able to meet with

the joint conference committee of health commission at our last meeting, and similar would pause and give an opportunity if the chair so chooses for ms. simon to say a few words, if that's your pleasure. >> yes, please. welcome ms. simon. >> hello, can you hear me. >> yes, hello. >> hello. i'm happy to be here, filling my fourth week and learning a lot and doing all of my orientations and really looking forward to helping laguna honda on the path to recertification and working in conjunction with rowland and the team and the folks here for a new path for laguna honda and i don't know if you have any questions, of the nursing home administrator,

i've been i've been administrator for over 20 years and formerly as the jewish home of san francisco for 11 years, the single administer and chief administrative officer. so i do have experience here in san francisco and then, in multi levels of care and multiple type skilled nursing facilities. i'm just happy to be here. >> thank you, ms. simon, welcome to the commission meeting, we're happy to have you on board. we know that filling this commission has been a priority and we're pleased to have somebody in your caliber along with some of the other new members of the team that i know mr. pickens will be telling us about. >> thank you. we also have two assistant home

administrators, we have joining the team, mr. dill sid who also a long time license home add mr or who comes to us from a facility in the east bay. and we've also hired our assistant administrator who will focus on all aspects for our residents and staff, and na is jennifer carton wayed and we're happy to have jennifer in this newly created position. and we are happy to fire the director of facilities, engineering and this is a new position for lag no honda and puts it in par for several years and now laguna, will have the same level of expertise in facilities and engineering. next slide.

so as we bring on these new leaders, we're still opinioning the ache for three additional position that's will make up the team in laguna. we're continuing with that search process, the executive search we're using is outsourcing new, candidates for consideration and we hope to have another round of interviews within the next coming weeks. the same applies for the medical position, there were a series of interviews last week and we're still waiting on the search firm to present additional candidates for interview. and again the desire is to move forward with a hire as soon as we find the right candidate to meet the unique needs at this point in history.

and then finally, we're also recruiting for management and disaster preparedness, you were that in the root cause analysis for decertification, there were several deficiencies in this area so thus, this position was created to address those findings. so the leaders along with these remaining ones, that were recruiting for will align laguna honda and fulfill the recommendation that's were made to us several months ago by both of the consultant firms that have been of consulting on the laguna honda recertification, next slide. for our path of remains the same as it has been since april of last year, when the

decertification, occured, we continued to work hard and to make the rapid improvement to prepare for recertification. this includes, both long term operational institution and more importantly cultural changes within the environment at lag no nard to achieve both our recertification and also long term success for the hospital. we're confident that between our own staff and the expert consultants, we have brought in and continue to bring in as circumstances require, that we will have the team in place to ensure a success recertification survey within the coming months. next slide. so you recall the history of where we are in terms of the federal for medicaid and medicare and services in california department of public health. back in november of last year, there was a settlement

agreement reached in order to continue the pause and residents out of laguna and also continued funding. that pause was reinstituted and approved in may of this year. that continues that pause in transferred at least through september 19th and funding through march of 2024 and that also assumes that we are not recertified before that september 19th date, and we'll address that towards the enter of this presentation in terms of our timeline for certification. next slide. a maij yor component settlement are the 90 days survey. you recall we had the first survey of november and december of last yae, second of march of this year and most recently had the third june 5th through the

9th. since then, we received what is called the 25-67 which is the statement outlining regulatory findings that was received about two weeks ago, we had required a ten-day turn around to work with the cms quality improvement expert to for them to do a root cause analysis and for them to develop an action plan to address those deficiencies. that action plan was submitted to cms last week on july 12th and we are waiting their review and approval and hope that they will do to in an expeditious matter so they can stay on track by the end of before the end of this summer. next slide. actually, can we go back to the

previous slide. i want today also mention in terms of a mild stone with this new, action plan, the several mild stone, i think the good news is the mild stones are there for the most part are not a surprise, they basically encompass those areas that have been previously identified. but for where, we have not had enough time to do the full fixes of those areas. we are confident that all the mild stones in this last plan have completion date by september 1, that that aligns with the plan for recertification by the end of the summer and we'll be ready for any recertification sometime after september. next slide. again, this is a pictorial of a

time line of the rewhole recertification going back to april of last year, talks about the readiness activity that we engaged in this makes it look simple but to consulting engagement from two different firms, the 90-monitoring surveys, all the action plans of mild stones that have been developed and submitted and that were all reached 100%. and again our timeline for submission for is he certification bit end of this year as indicated here. and next slide. so that concludes my brief overview of update of where we are and i'm happy to take any questions or comments at the appropriate time. >> thank you, mr. pickens, secretary moore?

>> we're on item 4 and let's take the folks who have received accommodations first, so if you received an accommodation, please raise your hand or hold your hands. okay, jamie, please unmute the first caller. mr. mefpshaw you've got three minutes. >> caller: thanks. this agenda items claims mr. pickens from laguna absence, it should not been on this agenda, it's wrong. [indiscernible] who distributed the report number sets the other day to the lhh stakeholders email list.

a 126 survey report, for inception from between march 14th and 17th and on april 4th and april 19th, uncovered another deficiencies including two citations, where it's represent isolated harm, quote unquote substandard tear, belongs to harm patients of fact, being able to application and become recertified. report number 6 also reported that the root cause analysis

reports number 5 and number 6 along with the additional action plan mild stones were submitted as indicated on when this will release, both the robert number, the chants are on page 7, should start indicating at the bottom third of the page what the projected date certain date, on when application per certification will be submitted, obviously not going to be submitted before september 15th, if it moves to pickens, there are new mild stones with due dates in september first. you may have to start

discharging patients on september 19th, because they're not going to get recertified between september 1 and september 19th. finally as a asked over and over, the mock adams contact was closer than presented to the health commission, that commissioners asked for it last april and still have no clear idea why. >> finally please mute. thank you. and please unmute the next caller, caller 4. hi caller. please begin. >> caller: hi, this is dr. palmer, can you hear me? >> yes. please begin. >> caller: okay, time is growing short and by july 31, a closure plan which is going to include a crisis response team,

state hire management stalled at the facilities and partnership with other facilities, to temporarily expand so that more than 100 residents can be distributed and disbursed state wide. i would like to know if current recertification will make that closure plan unnecessary or if it will go forward. and the other thing is you're talking about a survey that is going to occur in early september and you keep vaguely saying, i really appreciate all of mr. pickens efforts but there is a vague statement by the end of the summer, we need to know how that will affect december september 19th, eviction closures and disbursal of resident that we know will result in deaths because wlag

no honda at its worse is a better than a lot of nursing homes at their best and people will die if they are forced to leave laguna honda, thank you. >> may mute. those are the only two callers, commissioners. >> all right, thank you callers. commissioners any comments or questions on the laguna honda update? commissioner chow? >> yes, thank you mr. pickens. i was interested in first, a time line of the recertification, now that you've sort of said that by september 1, then the mild stones that we're discussing or under way, so, the second thing would be or maybe it's actually the first, i was caught by the

september 1, do you see, the difference between our very first full survey and then the third survey that was full so then, it came with a, a different set of mild stones so that preassumably some of the first ones were repeated and the volume have come down. i think it will would be nice for the commission to understand what that difference is now and how you then feel that you are able to meet or recertification deadline, if you think that it's close to september because you've been talking about prior to the end of the summer, and the opportunities that also then, there is a closure plan from the state that is coming, how we believe that that closure plan that you believe is

closure plan is or is not one na, you know, going to, be one that you're, you're looking at not having to use. so, does that make some sense? >> yeah. >> we can discuss the, the comparison between the two full surveys, you're recertification time frame again and then this last issue of the where is the closure plan, what does it do with or without us. >> thank you, dr. chow, and keep me honest and make sure i cover all of those terms in my response. in terms of the first two survey, the most resent stur have a, those were full cms certification surveys. you're correct in that the first survey, there were 126 findings of non compliance to

federal regulations. the second survey yielded 33 findings so a significant decrease. in terms of findings that were repeated from either the first or the second survey and the third survey, and example could be individualized health plans. you know that will be a finding in laguna even before. so there were findings in the first survey, in the first state. back in december, we had about 600 residents at laguna honda. during that time, we had moved with staff to move forward. at the time only 25 percent of

those plans had been vetted. contrast that to the most resent report that koim outlast week. now we're at 440 of the care plans of residents at laguna that have been certified by external consultants. so the is he vert fickation, which where we'll be, the third survey did continue to have some findings of care plans but again that's something that has been worked on and almost fixed but there was a finding in the third. that's an example. in terms of the timeline for certification, as i shared in the presentation, we submitted the new route cause analysis and action plan to see a message on july 12th. we need for them to review that

plan, give us feedback for our last action plan, it took them two months, back and forth before the actually approved our action plan. in order for us to meet our end of september, end of august, deadline goal for smition, we need them to turn that around. so in terms of not having a definitive date, i cannot give one so that we can fix the things that they've approved for us to fix in the manner that we have proposed. in terms of the state, closure plan, you recall that is the new development that occured in may of this year. that is a closure plan that was directed by cms to the state not to us. it's a plan that the state has developed without any of our

input or consultation, they my understanding is they submitted their state closure plan to cms and cms is reviewing and kind of going into a back and forth process with them, those are the reports that we hear but again, that is not a plan that we have preview to. prevaoe. >> so, can you remind again the third survey had about 40? >> 33. >> okay, i'm sorry, so it went from about 126 into a full sur swrai to 33 which will repeat because we're continuing to have just like you pointed out, the individual care plans which now are good 80% complete which is, which is a great improvement. the so, so the state plan then,

you're saying, we're not even involved in that and the state and the federal government can send say that the state would mandate and use their plan which might include or does not include, any work that we would have to do? how can they be writing a plan that might involve staffing from here, doing things without the staff from here, being involved in writing this? >> that's a great question and i don't have an answer to that. i would hope that the state would be refrntion the closure plan that we submitted and approved so that there would be some congruent and alignment in order to make sure that the state played an active role in the closure plan was ever needed. again, it was our desire,

something that will never have to be implemented. but my take is cms waunlted the state to be more involved in this process and thus that request was made directly to them. >> oh, so it's a sort of a stayed, review of what they think would work for a closure plan and you're saying, the federal government really wanted to get involved and the preve to this. >> that's correct. >> and what conversations have you been having with the cms people being that september 19th is not that far away and even i guess you can apply for

recertification, prior or do they really record recertification to be able to extend this deadline if in fact the survey is showing such improvement going on? >> that's a great question. so the cms has the extension to extend the pause. it's not a requirement to%backer for them to expand the pause, even if we were not to admit, per the terms of the settlement agreement, as long as laguna is able to show progress, that is sufficient to provide an opportunity for cms to extend any transfers and/or reimbursement. >> thank you. i think that concludes my questions.

>> lhhc, commissioner girando. >> thank you. i know we had an opportunity to meet the new nursing administrator, ms. simon and congratulate jennifer on her appointment. the other key positions of the director of nursing services, medical director and emergency management, how close are we to those positions being filled? and do foresee any circumstances that going to make that that much difficult in terms of having a whole team on board? >> for, for the direct of emergency management, i don't foresee any things that are out of our control. i think it's just a manner of getting a, a quality applicant pool and similarly to the medical director.

it's clear that we're at a point where, where, we cannot accept meacrate, they also have to have the unique skills required in that culture change. so while they may have a technical skills, we're looking for more so we don't find ourselves in this position again. sol that's why we're continuing with the search for quality conditions, myself two weeks back in terms of sourcing new candidates so we're expecting those in august so we can move on to additional interviews. >> do you see in your estimation that there are

issues that are going, that make it difficult for recruitment of those top quality candidates that, that maybe under your control as opposed to the issues of the quality of the candidates? >> i would say, that we're partnering with all parts of the organization to remove any barriers that exist particularly when it comes to medical director position and then skilled nursing facilities, while it's been a position that has been at laguna for a while, different nursing homes structure that position differently. one has a individual who is the

lead, others will divide up task for the director among several individuals. and that is a typical structure, that division 6 task then means that sometimes individuals are not working full-time. so for the city, we have rules related to unemployment. that may be an issue who may have volunteered obligation,s or other work obligations. but we are working to make sure we're not excluding top notch

applicant from our pool. >> thank you. >> do we have any concerns that they will not corroborate what they have. i recall that we were desperately searching for beds and i remember there were 1,000 in the state and i two were taking medicaid, do they suspect the state is going to come up with beds, make new beds or do we have confidence of corroborate what we know that are simply no beds that are better than laguna beds.

>> in my opinion, it should be the latter, i'm not aware that there is a building boom of skilled nursing boom in the last year. so i cannot fanthom that they would be able to identify vacancies again if a closure were needed where lag no residents can go. i would, i would extrapolate in the worse case scenario that if if were to come to pass, they would then go back to our closure plan which says if you get into position, it would take 18 months or more again. those are hypothetical, ones that we hope we don't reach and again that every closure plan that's plan put together, surrounding laguna honda is one

that will never see the light of day, but it's just an exercise in cms direction and requirement. >> thank you. >> thank you, and if i recall correctly. and there was the requirement that they began transferring the residents, there was a parent of time when we had staff make ing thousands of walls every week in order to number 1 identify available beds within california and/or as close to san francisco bay in the area can and then start initialing transfers if beds were found. and very few were found through that process. and many things long after a resident had left the care of

laguna, we saw some of them pass away. >> correct. >> in closing the topic, i want to acknowledge mr. pickens, your long time term, we know that you'll continue play active role through recertification and just to acknowledge the dedication of and hard work at laguna honda for everybody that they've done and in order to show the improvement and meet. mild stones to really do everything that is necessary for laguna honda to be prepared and continue to provide excellent care as mentioned throughout this presentation and through the comments.

thank to everybody, we see and appreciate you. >> thank you, and as i tell the team, recertification is a team effort. >> yes. >> thank you. >> we will move on to our next item which is the director's report and we have director nababa, welcome. >> thank you, thank you, president. so my name is sa bina i'm the deputy director here at public health. we have a fairly meaty report because of july 4th holiday. so we're counting for a missed session. one of the things there is a few things that i want to highlight one of is extended access to our behavioral center. so serves individuals who need

connection to see substance treatment is located at 1380, howard people can get referred or walk in. which is the opposite space clinic has expanded its hours as well as pharmacy. so to match that and provide extra access to residents that need care in substance and mental health. they have made themselves available on saturdays and sundays. this is an important mild stone especially since they serve substance use and mental health system from areas such as the criminal health system.

dph was awarded a grant program, so this grant will allow those that are experiencing serious behavioral health needs to have access to housing and services and will provide funding for that. it will help support consistent and transitional and supportive living, programs with a gold individuals to long term housing stability. and that's a multi year grant. and it amounts to 32 million dollars. another exciting announcement dph and fire department getting prereleased medical for persons in jail. this is one of the important initiatives happening at the state level. we donough that people fallout of healthcare when they go into jail. so this is a critical part of

their release that we can get them back on medical and they can have a warm hand off into our healthcare system. >> and another two, as our overdose numbers continue within the city, the behavioral health department has released a new rfp to address disparities and this is specifically it will allow for funding provide overdose presensing out reach engagement and education to the plaque african community. it is critical because african americans are over represented in the od numbers and we're hoping that the people applying will have the connections and culture congruentcy to turn

that tied. there are three programs, one is substance and over use presentations to the community. one is out reach to impact the communities and then the final is additional programs services. and it's my pleasure, the way street dedication that occured last week. this was a wonderful ceremony that honored long time commissioner dr. sanchez who made an incredible contribution to see san francisco and did honor a street. and then finally i want to end with bay view children's day with dph, and this was a community base event and staff from dph were able to go out and talk about their services

including child lead poisoning. so attorney house initiative. i'll end there and happy to answer any questions. >> thank you, doctor. any public comment? >> folks on the line, we are on item 5, the director's report, i see one hand, jamie, i see two, we'll take the first, jamie please unmute caller 2 and then we'll go to the next caller. >> can you hear me? >> yes, please begin. >> thank you. disappointing, not hearing the directer's report, anything about dph's plan to add beds and capacity.

they have not addressed shortage to provide various health services to areas vulnerable san franciscans. for instance, the health commission extreme data, doing part in to the 2017 closure of st. luc unit. doctor colfax is bimonthly report to add bed capacity clearly, the city has asserted the in patient acute mental health and care beds, we can't

raid laguna honda sniff beds hoping torah pidly scale mental health or behavioral health beds. this commission needs to schedule a presentation and discussion about about the progress of examining converting one of laguna hondas two patient hours in the behavioral health beds. from mr. pickens previous comment, that study is being prepared now for submission in september or october but it should be presented to this commission now in open session before any decision is made

about borrowing laguna honda beds which is in critical short supplies to use for other types of populations, you need to expand the expand the capacity and not put one constituentcy against another. thank you. >> thank you, and jamie please unmute the next caller. caller please are you there? >> caller: doctor janice cohen and i wanted to kind of, follow-up on the previous speakers comment in terms of

the appropriate distributions of service sxz strategies for how we match patients in terms of their need with the appropriate services. andis going to ask a question to the director to the behavioral access increase in services. i was wondering if the program that the department paid about 350,000 for maybe ten years to ken and his program to integrate our substance use disorder and our mental health services at every level how that has been achieved and whether we have appropriate staff who can do the a lot of triaaging as opposed to a lot of social workers who are for the most part driven by the plan as oppose today something

like the association placement strategy. so i guess my question is, what are we doing to make sure that people are getting screened and diagnosed and sent to appropriate places and not to laguna honda or residential service? so my question is, are we going to have specific psychiatrist who are at the appropriate level of care doing the screening at these access levels to make sure that we're not sending people to inappropriate sites and that the hospital is preserved for the population for which it it is designed and which it was built in which we desperately need to continue.

thank you, that's both the question and a comment. >> thank you very much. just a reminder, the public of course value all input and the question is not answered. everybody heard it, that's the only two callers that we have on this item. >> commissioner any comments or questions? commissioner chow? >> yes, thank you, dr. ba ba, this was a thorough report, i have two or three questions or requests. on the multi grant, this was a grant now as you say for additional housing bridge housing sounds it's not bridge housing. how will this be able to increase?

and while we're at that, it reminds me, i know we have thousands of other supporting and perhaps you can have bridge housing, what does the department do? it's been amazing at the number of support services that we do have more mental health and substance abuse now. i think. the second is more of a q the work over the last six months about the open air drug markets were a very good and you commented as we're getting, oer as more data is available it will be put in the public website, i'm wondering if we can get that in the commission so we can follow through with the work and the success that the mayor's initiatives can

having in regards to this disruption? and on the covid update, we see that hospitalizations are still base. our own data does not carry that. i'm not quite sure where our mismanagement may be in the city. and i think we should get back into if we can't do it here, to unjust indicate the state for example, last week indicated that we had 28 hospitalized patients, i'm not sure where

they get the data, if we're saying we have not been getting it, with 57icu beds available. >> sure, thank you for this question. so for the first one on bridge housing, i don't know if anybody from behavioral health is on the line. but i will say, in terms of the housing portions, we would have to talk to chs, our goal is because these folks have mental illness is to ensure that they're able to stay around the housing. so we can get back to, and as you said all the different types of housing was planned, i'm assuming because the full spectrum is needed for those people to get through until they get to permanent support housing.

and in terms of open air market, i want to confirm that it's an initiative that being lead by sfpd and dm so the website will be the city website. and then finally for the hospitalizations, i would invite our health officer to come up and speak a little bit about that. thank you and good afternoon, thank you dr. chow for your question about hospitalizations. so we along with the other counties in california are being told by our state colleagues that they don't have the they have an issue with the data processing. you bring the point up that

there are some data on the state website, i don't have an answer and we'll have to reconcile and see what the issue is. i will say that the data is to move away from hard numbers because it's becoming harder to track this generally. and we saw good news from covid are decreasing. so covid is not gone, and other potential illness is shifting and continuing to evolve. i thought it was a different way of counting, i just wanted you to look into it.

>> yes, we'll absolutely look into it, thank you. >> any other comments or comments. >> good afternoon, i have a question regarding the 32 million dollars grant where the participant in the care act program will be prioritized, am i correct that that is the relationship with the care court that is being established? and what does that mean that they will be prioritized? it does not sound exclusive but how will that be determined? >> as you know, thank you for the question. and as you know, the care is still in the process of being implemented. i think most will be on the flow, one of the things that we can offer people is service sxz potentially housing.

so i think that's part of this, we're not sure what the flow and the volume will be, it will probably start small just because of the need to start up the systems. this is one of the things that we'll have access to. what we can do as care courts become implemented, we can talk about how that is functioning and how it intersects with this but a lot is tbd. >> so for now, we're going to have a pot of money where we're not sure how we're going to distribute it? because they're not coming in through the care program? >> so i think initially, i'll have to check on this. we will get some money and if the core system has not been

fully stood up, i'm assuming na others can access these resources but we can get back to you with more information. >> thank you, i look forward to getting that information. if there are some beds that's going to be a tricky dance, i think. >> i have a few questions as well. you mentioned dedication, it was my privilege to represent the commission at that sur moan', vice president green was there as well.

and also to express our condolences for sharing him with us and the people of san francisco and his service. i did have a few questions about the access health center, it's great news that hours have been expanded and now on weekends, if people come in and seeking treatment or if they've been referred to treatment, have we had a situation where somebody has needed to be turned away? >> in general no. one of the things it really tries to figure out what your need is and what resources we have and obviously, that may be another kind of where we have to refer to other systems of care. there is plenty of substance

and even with health beds, so i have not heard of. i'm sure there are times when somebody may have been turned away but generally we're able to accommodate the needs. >> thank you. and another question is with the initiative to disrupt open air drug markets. you had mentioned, thank you for mentioning this, this is operation being lead by the police department and office of management. just to clarify my understanding is the role of dph is to offer especially when somebody that has been detained because of open drug use is to offer services when they're detained and when they're released. is that correct? >> that's correct. >> thank you. and last thing i wanted to mention, i don't think this has been mentioned, there was a

wonderful study that was put out with regard to san francisco covid response. and how affective it was particularly, it's compared to other major cities throughout the country. again i say affective not successful. but the work that was done to keep, transmission rates low, while severely limit the number of people who died of covid and also the community partnership who successful in deploying resources, is there anything that we can share about that report? either your health officer, about that report? and any take away. >> we can send the link to make sure that people have access.

and railt' nicely describes all the different way that's we worked to mitigate the covid and some of the places that were successful and some of the challenges as we respond to these threats in the future. >> of course, of course it's a learning process so thank you to you, dr. philip and many others who contributed to that report. any other questions or comments? if not we can move on. which is the san francisco ems update, andrew who is the ems director and dr. john brown who is the fed med cal director of ems as well. >> thank you, gentlemen, feel free to adjust the microphone

as needed. >> thank you, commissioners for having us. reflecting on the last time that i was in this room, i think i've been in. again my name is ems director and john. >> john brown. next slide please. i would like to introduce director, deputy, our quality improvement, elena and caylee that are here with us today. and just wanted to you know, acknowledge their support and putting this together. next slide.

>> so on this slide, i just wanted clarify the role of ems agency and its relationship to department of health and ems system of regulations in california. i know some of the commissioners are new and thank you commissioners for having us and for the opportunity to present our work to you. i think it's critical personally as dr. chow knows, that the health commission and director of health have the oversight care in the community. so the state of california has a shared governorance model has designated 34 local agencies we are one of them. they correspondent to the counties in the state. and we report on some issues. much of the care that is going

on is specific and taylors to our community. so we now report this to you. i'm an employee of the employee of public health and to the health officer. and to in the health commission. there are two hole owes that have finished their resident sxz working for us in medicine for you're and they report to myself as well as to ucsf hospital. and in this diagram and there are two branches one is more operation and conduct all of our operational efforts the other for quality improvement and that's the section that i'll be talking about more in

the presentation. we most definitely prioritize that. we filled our two deputy positions of improvement and operations. i recognize this slide, says that the ems specialist is starting soon, we actually hired last week so keep on looking for those vacant positions. on things like climate change and disaster so we're excited to have that go live this summer. we anticipate some hiring in august of this year.

it's been a challenging but we plan to work with that individual to address some of the challenges. we do not anticipate any additional informations. however, we do anticipate additional revenue to support the growing breath of our programs and portfolio of projects. next slide. so tragedies, our number one priority is triaage and destination act of 2020, this is a b1544 that was passed sometime ago. created statue, so we're on a one-time timeline to meet those requirements.

they wept into affect in october so we have until the end of this year to get our requirement. so what this means is that for the fire department ems medical program which is a pilot is moving to a full program implementation under a b1844. we have two sites in san francisco that are moving to full program implementation as well. and also the v.a.. is considered for 1444. so in ems regulations, paramedics may only transfer to ems departments. they provide the opportunity to go to sobering centers and then v.a.. to we're looking to move all of that program over,

training, accreditation, the list goes on and on and we're full steam ahead to meet that deadline by the end of october. we're also working on our ambulance ability in order to response in events and service, and other priorities is another patient off load time and diversions. we're continuing our efforts, data sharing and collaboration with all of our different partners and talk about that in a few minutes. trying to get all of our data consolidated into one place that is timely and informative and also some of our specialty plans which includes our stroke plan and our cardiac plan as well. next slide, if i'm going to

speak to the operations, dr. braun will take over for some of our quality improvement. the two bullet points and our pilot program will go into a wlilt more detail in a moment. but i do want to highlight that we're working on a new federal platform. so if a promoter wants to host, part that of that event. zoo wooer recognizing how. so we're working on that space. as we ran with covid, we had a details so we continue to be focused on that.

you can see that moving forward. i want to talk about ambulance diversion. the last time that we visited the health commission in july of 2022, san francisco general on 68%. we have worked exhaustively with san francisco general. and want to acknowledge dr. team last month and in the month of may, we had 37% diversion which is a tremendous effort to be able to do that. we've also seen a diversion. our goal is 30%, so we're not quite there yet but we're well in our way to progress towards that goal. i know there is a question about our catty distributions. in january of 2022, catty was a

very manual, you know intensive process. now that it's automatic under a program called ems alert which automatically routes ambulances through existing symptoms. that and provides distribution across the city to help level load the ambulances into the healthcare system and the hospitals. our next slide. in tandem, you may hear the term a pod reflecting these metrics, so we did see a increase over the flu season over the winter months which is not uncommon for that to go during the time of years. we have taken dramatic steps, we have a buy weekly work group with hospitals leaders, executives, data folks, trying to get everyone together to

address this issue. we've had several policy changes, and we're working as hard as we can to you know, make those changes and make those improvements, to reduce ambulance patient off load times. we have a number of hospitals that are doing their own analysis and review to help address patient off load. and the other sort of big piece, we have engaged with the san francisco controllers office. we expect the report to come out this summer, it's going to be a document in terms of item within the ems system within the global to ideas to work on, to help reduce some of the these, you know, these issues wnt ems.

so we're looking forward to that report. with we look forward to next slide. the other is transport is sole' 100% als. and throughout covid we added life support blansz which is two emts and no paramedic to help augment the system for search and to assist with ambulance off load time. we saw that it was affective, so we approached the state about a pilot program for adding a tier within the 9-1-1 system. so our 3 9-1-1 providers are

everiable to provide up to three to four ambulances. this is some of the data, initial data that we've directed and it's been very great on a number of funds. it helps when our paramedic staffing and recruitment is challenging. and the ems, it's been a successful pilot we continue to review the data and had helps with the ambulance off load delay to we max size and ability to respond to those immediate need life threatening calls where life interventions are most appropriate. so we're working on that program.

on a day-to-day basis. so with that, i'll turn it over to dr. about quality improvement. >> if you can have the next slide please. thank you, i would like to highlight some improvement and community out reach. we have a research advisory committee as well as improvement committee that are meeting on a quarterly devices and research the quality from our provider including our hospitals to help inform us as we go through the process. we have two i plan elements from systemy and stroke and now developing one for this

paramedic and triaage destination program. because we like to take advantage of all treatment capabilities in our not just being restricted to the emergency department which has been the case in the past. i want to acknowledge also our in terms of helping attract some interns from the program and undergrad aout definitely, so we had quite a bit of help. again to bring them up-to-date and up to speed with what is happening in our community needs. i know there is a lot of

information and i'm happy to share with you the report that is the report. since before actually 2015, we have participated in the cares registry which is the cardiac arrest. this is a nationwide initiative driven out of cdc and emery school and now 30 to 40% of the united states population. it's a way to survival what you can see here is different types that we follow and try to improve. the criteria listed in the first and second is a way of saying, it's a shorthand of saying, this is a very standard way of reporting our success. i'm pleased to say that we're doing letter than the national average, we have 39% survival

which is witness to standard and found in a shockable rhythm. we are approximately 10 and 5% above the national average in those categories. so we're making progress. i can remember when we had the 50th anniversary big celebration in city hall. so we made good progress, we're above the national average but we still have a lot to go. where it talks about ade which is a defibrillator and cpr bye-bye standards. we're at 13% and 28 percent. nationwide it's about that,

about 11 to 12 percent by the cpr is a lower than it is in nationwide. so we want to improve both categories, and it's rail' reaching into the community and trying to partner with community partners to do this. one of the ways that we've done this is through an innovative program partnering and this is called the pulse point app and i'm going to high lied that for the next two slides. if i can get the next slide, please. quha it does is informs for those that have the ability and interested in helping their neighbors where there is a cpr situation within a short distance from them and it's in a public place that they are

notified that they can go to provide cpr and also helps them to identify the nearest defibrillator are in place. we have we're in the process of purchasing more ourselves and distributing to community partners. at the end of sum of the response elements for the pandemic where we had some sites that were closed down we had a base, to distribute these automatic to places where they're communities were gathered. they will individuals where it is. if i can have the next slide please. one thing before this slide, in the lower right hand corner, we were fortunate to partner with city e nt and we'll talk about

it, and this was filming that was done in the bay view to emphasize this is an area where cardiac frequency is high and distribution is relatively low and we want to try and i am fraof that. so we're trying to out reach in the community. can i have the next slide please. we're now to the level of 11,000 active users, not just registered but have checked their app with the last 30 days and then people that are registering new as well. we don't have a increase for our app and national average of 40%. the reason this is so critical as you saw earlier slide, if administrator cpr, and that's across the board.

however along it takes from the moment that the bystander recognizes the situation to the point they start it, but the quicker they start and the quicker edd is available, the higher survival, and it increases 10%. so if we can get somebody there in 2 minutes instead of ten minutes that's an increase in survival. and this is in continuer and train he's, once a month that we're at community events, providing cpr and providing the app so that people can be interested in developing some cpr ability.

we did not only information on trauma but also with our cpr and aed and also participated in stroke situation. and we're focused at the agency and it's because two departments, each has goals and stand and for including inclusion. with also some differences with cpr and we're trying to promote ems careers. we've been involved with each of the cadres of cities going to through city mt, it's a great program and combination between the fire department and economic development for

drawing from communities of klar for students to enter into the pathway to get a job in the fire department and it's my personal pleasure that in these classes, they want to go further in the healthcare. so i've been helping to secure partnerships and medicine, it's an important out reach for us to get into our ems workforce. so this is a picture of our staff, and you're all invited. we had over 80 nominations, we had a lot of good work going on but i want today use this slide to say what it is that i'm asking for your support. i would say, one of the important things is to continue to support this effort to

decrease the rates of diversion and delays in offloading patients in the emergency department. this is critical as you're aware, we only have a single trauma center. it's a wonderful facility, i buy, i was just there working yesterday, watching all the staff as i was helping to stay off by lots of innovative ways of treating patients and utmost respect for nursing colleagues and staff colleagues of all levels but it's a single facilities so we have all of our eggs in one basket and we need have a back up. came out with an article journal about why this is important and what the possible solutions r.we're going to need resources to move forward but i

do think that we need to have increase capacity. we want to improve survival in more participation bye-bye standards and decreases the responsible. and the last element is we have strong element, is and just recently we had a pride presentation where the medical group had all of their equipment stolen and we had to replace within four hours and get them up and runing, and they took care of 50 patients and only one patient was transported. in future, we're going to look

for some support for that program to improve and enhance our medical oversight. with that, we could not concluded our presentation, happy to take any questions. >> do you have any comments, i see one hand. jamie please unmute the first commenter. >> caller:thank you, so much. i want to comment mr. holcome and dr. braun, when i supported robert's schmuts and the department of emergency communication sxz rob the

director of gem division of emergency services, i had the limited contact with with doctor brown. occasionally have to use ambulance serving, to have been, emergency,

>> i just want to make a comment, since is had so many questions and you i had questions. helpful to further understand, the excellent work that you do. >> thank you very much for this clear presentation,. so i had and when it comes to the bystander, so interesting barriers. to learn cpr is it obvious where it can go. i'm wondering if we have any sense for what the up take is, and if we've done out reach to

our hospital staff and nursing units just to raise awareness? because i suspect a lot of people would be willing to participate if they had the knowledge that this is a possibility? >> i can take that question, the pliers and everything that we have people signed up, we've been doing that, i would also recommend, if you know, folks visit our website, we overhaul the website next year, and how to sign up to give cpr train anding information, so we want to draw community members in. it gets emailed straight to our office and then we participate in some of these events, as much as possible. so i completely encourage the use of that and trying to get it out as many folks as possible.

medical groups, community groups so that we can get as much up take as much as possible, it's a life saving app. >> i suspect that's a lot of our partners who love direct feed and delighted to hear it's posted on the website. the other question is the range of times is quite diverse here. i was looking this up over the weekend and healthcare foundation had done a best practices a few years ago for diversion. and i know that the california hospital has done the same for off load time when i read the answer to one of your questions, that one of the other commissioners submitted, it sounds like it was doing some thing and yet, it sounds, one of the articles is from 2018, we've been thinking through this probably for so long, and i'm wondering, we did such a good job with regard to

covid among the hospitals and the hospital council. i wonder if you're going elaborate, i know it's different climate climb and this is a nationwide and working there is not a day that goes by that there is two ambulances in the driveway that they're sitting. visually it's a big problem and that's a waste of resource. i wonder if you have any thoughts about that. >> i think both patients about the same. and ideal woerlgd they would be a zero and what, meaning zero diversion and what our target ambulance time which is 20 times. the problem is it reality is that we have various congestion to the flow and our hospital

system post acute care hospital as well. we do have a responsibility and that's outside of purview, what is within our purview is decrease the demand. how can we safely meet patients needs without put ing in the back of the ambulance. that's why we put so much effort and triaage destinations. i've been involved with the all the paramedic train to go get this, utilize this resource. it's a wonderful providers, my hats off to them, they work 24/7 in very difficult circumstances. but they bring a lot to the scene. the system where ever possible where we call level load and get the right patient at the right time to the right place. so i think that those things help but we're dependent on other factors. and i'm placed to see in

progress and areas and that is going to help in make a difference in the ambulance day as well. >> you know, we very much collaborate and speak to hospitals and leaders and provide data to some of these folks and some of the ems data that is key to making improvements, with off load times. and speaking with leaders, each has a bit of a different flavor when it comes to some of the rational for off-road delays. in some cases, cruiser importing to certain locations.

so where we can find the deficiencies and implement the policies to do that and then in looking bigger across the system, we're thrilled with the controllers office review. that is going to give us framework for healthcare system to help reduce this issue. >> i hope that in the system, you can see in our list that the ambulance diversion rates of low times are different. so ideally as the system changes, they're copying the best practices so that more and more patients will benefit. >> thank you, these are most challenging issues in healthcare delivery. so it's really great to hear

that you're so thoughtful and working so well to try to solve this big ca none brum. >> thank you for your presentations, it's very informative. i have couple of questions, for one each. the bls program that you can you describe the problematic elements of that a little bit more just for those who are not familiar with it because it seemed that you're pleased with the pilot so far and supporting its expansion. and so, describes a little bit and then its impact. >> absolutely, thank you for the question. the bls program, traditionally, als ambulance respond to 9-1-1 calls in times of high demand in the system. so for instance, new year's

eve, heat wave we willed bls ambulances into the system because a lot of calls can be managed and so that provides greater ambulance availability while still maining safe and proper care for patients that need that care. that was very much on a temporary ad hoc base, when disaster strikes, looking at the effectiveness of that, as we had the opportunity where we had the continuous approval to add into the ems system not knowing what could happen with covid at the time, we found that there were very, instances where it was nice to have those extra ambulances, when we have the vair ability of 9-1-1 call throughout the system. that provides ambulance to see respond to those calls, while

keeping the critical lives advance care available to one into that call. we would rather have a--as we see the a pod times go up, the bls provides a temporary solution to help manage the issues and resounding response times as a result of that. so problematickly, we saw that through covid, we asked the state for, you know, approval within our ems plan and then in november of 2022, we have our three 9-1-1 a ls providers, you know, have them a maximum of four ambulances in the system on a day-to-day basis to have that regular scheduling so that it's more consistent, crews

can get out of their measures. >> one measure that shows the safety of the system, you should have it in the data, there is a break down of the responses by code 2, code 3 that they go. code 2 is regular driving rules. so, what i draw your attention to and if you don't have t i apologize. we'll make sure that you do have it. it's tt return, after they have interfaced, do they come to the hospital with the patient or regular driving and it's about 6%. in other words, 94% is accurate, they're doing a great job taking care of the patients and the patient can be transported. that's about what it is for our paramedics, it has to do with the success and the difficulty and the challenges of doing

dispatch and determining from a caller what the actual patient is going to be like when they're assessing the patient. so my point is variation between emt and paramedics, getting the correct type of calls is pretty good, so that's something that we're going to continue to watch. we don't want to have emts find a patient that now they're having to transport them to the hospital if that makes sense. >> i was just thinking about all the, the events that are held in san francisco that are drawing big clouds. that the b la response is something that aside from the

pandemic related ininsurances that there may be data on how this program is going to work with the with the inning numbers of people coming to san francisco or if they live in san francisco, xaoerntion that and on the other hand, there is the day-to-day sort of insurances in san francisco of of those homeless or experiences mental health and substance abuse and what is the relation, with that so it will be interesting to have some analysis overtime on the effectiveness. so you know, at some point maybe in the next report or maybe, i know it takes time to

take the day to do the analysis and it may not be collecting data in that way. my other question for dr. brown around the trauma, the greater need. how will that happen? it's not a trauma, by it's not something that is going to bring income, it's not reimbursable so i'm wondering what are the kinds of things that need support from the commission or from, in order to the ability of very needed trauma services, in san francisco. >> that's a great question one of the reasons that it's not solved because it's been under consideration for sometimes. there are three basic potential routes one is a that a facility

in the city become a level three, trauma center capable of taking care of all kinds of level of patients but focusing on the lower or mundane trauma patients. the second would be the development of pediatric facility which we only have two centers in the city, that, and the mission bay campus of ucsf, that they would be doing regular care can in case of a surge, the thing to be perfectly honest and most concerned is a large scale shooting event, where we have a rapid cute patients into our system. so in system, a paoed attrition center would be positioned to move into an adult trauma center for that period of surge or disaster.

and the third facilities is a facility that will be facilitated and they could have augment trauma center that we have. none of the three option right side immediately clear and apparent and something that would be easily doable, that's why we engage this process in getting consultant interest because there are other xhaountsz where it takes an analysis of the community, the income, the injury' mix and all of those things that is a lot of data to analyze and a lot of out reach to do whatever the proposed solutions and eventually to solve the problem. so, it is a big process but it's one that i think we're bound to engage and continue, even if everything goes well, if anybody was to happen for any reason, it could not take

trauma patients, a disaster like an earthquake or something where the facility will be badly damaged, we'll have to rely on the trauma. that may be the fourth option that the lower becomes a lower level of trauma capable center. but we need preparation, and exercising et cetera and we need to do it as quickly as possible. >> thank you and to the extent that the solutions, they don't just rest within the county and the prief al sector has to be not just part of it but leading, some of these solutions. >> thank you, and for many years here.

>> in his honor i'm wearing a tie. for both the health and department and the new ems, through the department and of course the partnership with the fire department all of us, many of us, have gone through that transition. and so, i want to also commend you then on a very excellent report in terms of the ambulance, diversion destination and the work that you're all doing as a system for this this. and i think it's important townsed, the department was concerned how well we were going to have the quality and oversight that of course, and

have a smooth operation, and this is what happened, the paramedics are embedded within the fire department. they seem to be collaborative. and i think that your presentation, from the shows how ttsds bringing together all of our departments to have this common goal of how to care for our patients when they are in need. i think it was one of the finer reports and your did i

lienation of reports coming back. you ask what the commission would be able and the departments support and you and of course all of these four items seem to me every one belongs in our role also in support of you for and obviously, with a question resources, those are all going to be in a priority issues as we all understand. i think the health issue on the trauma, as we know, some of us went through where trauma then became exclusive at general because it couldn't be handled well on an individual basis with you know, just so many going here and there and so many coming elsewhere. so the fact that you commissioned a study is one that we're all interested and understanding and i would let

doctor brown and our director figure out exactly how we can help in put and push the conversation regarding how to have ulter mat trauma. it begs the question of air capacity in trauma, i've gone through this. i don't know that any of our hospitals except for uc have air capacity do they? >> i can comment on that for you quickly. we developed in about 2006 an emergency access plan and policy for the city. where we can move helicopters in and outside.

that was successful and doing others, such as hosted the super bowl we had that in play in case there was an event by getting receiving patients by air. but the only helicopter pad at the children and v.a.. also has one. and not traffic but a very good road that we can pull glances in and out of quickly. and the add regularly, so it does not move that level and we do want to design it so we can utilize that. as you know, we had no such facilities but we don't have one at the trauma center. i know there was a noise study about how that would work and

so forth and i know that is still remains as a resource, but there is no interest in pursuing that and i know that is a desaft oar, anybody just as a disaster no other time, i think would be an advantage so i'm ready and willing to help. community may have different sentiments with the changing the world and situation. i don't think you and i want to test that at this point. i only have one question, tremendous ambulance and that's a how well we're responding to 9-1-1 calls?

i can take that question, we're in the process trying to bring in all of those fields into one place and one dashboard for transparency. but in our internal numbers, so for emergency responses code three are sand ard is ten minutes, 90 percentile. for code 2 9-1-1 is 20 minutes. so for the month of june, our response was 10 minutes and 33 seconds. our time for code 2 was 21 minutes for the month of june. so for our response times, they're above where the interval of where we want to be. but i would say that we've had about a minute reduction since some of the higher ipod times over winter, so it's immaterial proofments to try to get the numbers back to where we want to be.

they're and we're work to go work bring those down. >> are we saying that some of the problem is that the ambulance is not not available because there is this lag time and trying to download them into hospitals. and what is the goal, the national goal that or i should say the national form for response time. i think this is high compared to what we talked about nationally. >> i can answer that, we now have a goal for our first

response and that's six and a half minutes. and we have never been able to achieve that, that was designed as a mild stone. and where do i get these numbers from? they performed a study about what is optimal and achievable response intervals for urban areas in the state. urban and rural areas, it's important to separate those out. so we developed our policies and response policies around that, we're originally at 8 and 10 minutes, so we moved to 6 and a half and ten minutes. so we're not achieving those, we're making progress but not achieving those, but in an ideal world, we would be down 6 minutes. we can are focus on cardiac arrest we cannot do that when the dispatcher does that.

there are certain types of complaints that the caller have suches the person is not breathing or moving. that's the only one that science shows clearly minute improvement is ten percent increase in survival. so if we can reach the patient side in as little as one to two minutes we'll have a 70% survival rate. the best systems in the country, the one that we model and their cardiac arrest survival are about ten percent better than ours are. so we've gained one, that's where we would like to be and like to land and their response intervals are geared towards the 8-minute mark. again it's the cpr and time to start that's really the medium improvement and those are the patients that we're targeting. >> thank you very much. i can see the goals are still

the same and/or even better that you're trying to do. really appreciate all the work that you're doing. >> doctor brown thank you very much and also thank you to director carol for being here as well. all in thank you very much. i want to say thank you for this report it's fantastic to see, it's wonderful to thee these improvements being made. and all the work that the

department of health did to establish what would be a robust and i am pleased to say it's being implemented. >> thank you dr. brown. >> all right. moving on to our next item on the agenda, this is where the community and public health community update, please take it away. >> thank you i'll try to be brief, this is focused on the area the clean up area hunters point based on 19 19 86 mandate for oil testing. and in 2004, medical oversight was passed and regulations have been in place since 2005.

article 31, when parcells are turned over from the navy clean up to the city, the it is to articlele 31 to ensure that restriction right side followed and particularly, the soil, we questioned considerably the staff on the continued complaints from the residents of the area, and in the amendment. the amendments that are going to be brought to the commission next meeting, are basically administrative changes organizational changes and and easier to understand regulations, but in our questioning and concerns with

the staff and it seems to us and a bit in disconnect between the, navy saying, or the ep a saying that soil was clean, and then, the city took it over, and there were some issues and that continued have been brought forth by the residents on a rather regular basis from our discussion. so, when this item is brought up at our next commission meeting for the amendments to be approved which we, we are recommending, we have requested a presentation, or a discussion on article 31 but with the

other dph departments that are also involved in this issue since, they are not the only ones that are responsible for the concern with the toxicity of the continued soil contamination in this area. so that is going to be brought hopefully, our wonderful mark is going to be able to way this magic wand to put together, the department's so we can see really as my comment was there is multiple puzzle pieces to this and we only saw the article 31 single puzzle piece versus the other players within this issue and felt that all of us needed to be informed, well-informed or better informed.

of the conditioned issues at, the shipyard, the hunters point area. that was article 31, we went on to article 38 which is the enhanced ventilation system and the rules and regulations update that were ready in january of 2020, but obviously could not be presented. this, the enhancement ventilation system rules and regs were passed in 2014 and this applied to new buildings in sensitive areas that have an increase in or within a map of the city and the affected areas where where there is particular matter, so the enhance systems

are required and this is based again on the zip codes and air pollutant exposure, this did not require any kind of resolution, it was just presentation on enhanced ventilation. the last report which was excellent by wonderful doctor pratt, was on jail health which as a reminder, jail health is combination of responsibilities for physical health, behavioral health and reintegration planning. it is a collaboration with a sheriff's department and their service south side what is defined into the report, such

as individual medication administration and focus on the individual. if needed, there is a seemless transition to csfg and as dr. pratt noted, it is a something to be really proud of, because there are very very few jails in the country, that have such a seemless program today as we do. what the financed goals and increase in behavioral health support and better integration with with behavioral health outside of jail health. 7,000 unique patients that were

served. and 74% of patients incarcerated in jail one and two are released within 7 days and many within, she didn't have the figures within 24 hours. so it was, an excellent update of their true north goals and the challenges going forward but, it was it was great to hear the updates particularly in the focus with behavioral health. and, and what they're trying to do. so i don't know if my fellow commissioners have anything to add to my committee report, okay. okay, i don't know if anybody has any questions but that was

our committee. >> thank you, commissioner endrado. do we have any public comment. >> we're on the community, i don't see any hands, we'll give it a second or two in case you want to raise your hand. no hands commissioners. >> any questions for the chair? >> i was going to ask. >> commissioner chow. >> the article 38 that was just a presentation, when does it go into the affect. >> that's the enhanced ventilation, it's in affect now, yeah it's currently in affect. sxl it has been, it has been since, i mean for since 2014. is when it was passed and so, but the new, and the new >> when dan published it. >> yeah, currently. >> okay, thank you.

>> okay, this is where we're going switching up a the agenda a little bit. the item we'll be taking now is the joint conference committee report from laguna honda, chair commissioner guillermo. >> thank you, very much. we had our jcc meeting on july 11 last week, and what was presented here by the commission by mr. pickens, and in addition there was a report on hr vacancies log na and one of the key things that 45 was inquired was given the lower

census of laguna honda to just over 500 resident, what is the staffing level. that has been maintained and he confirmed that staffing levels have been maintained since prior to, the decertification in the event that certification does occur or when a recertification does occur that we would not have an issue with hiring back the kind of capacity at all the different levels that are required in order to in order to all the changes as they're going to be servicing, laguna honda is able to bring the number of residents to whatever number of beds we're going to be able to maintain certification around and licensing around. in addition to that, we had the

regulatory affairs report which is regular, report and then, again a number of policies that were presented which, required a fairly robust discussion within the committee asking for some clarifications and some changes as needed, on some of the policies which, are reflected in the responses by laguna honda management and staff on some of the clarifications and i invite my fellow committee members to, propose any additional comments or concerns or questions that they may have about the policies. prior to any vote on approval but we did what the changes and with the clarifications agreed to present a, a recommendation

for approval on the consent calendar for those unless again there are additional questions or concerns that are raised. and then in closed session, we reviewed the report and the pips report as we would normally do, thank you. >> before, we go to comments or questions from commissioners, do we have any comments. >> yes we do, jamie please unmute mr. mittkhau. >> thank you. >> caller: our july 11, meeting, did not mention that commissioner chow continues to make excuse cans for laguna honda acting a hospital.

recertification and in its analysis report at glen central management team started in 20 years ago, where ceo john in 2004 and then mie la 2009 and then michael all having been ceo, and closing two care hospital and not following ems regulations. commissioner chow has almost surely know, laguna honda is only 11 acute beds which are mostly acute rehabilitation and

physical medicine that not acute hospital beds. laguna remaining remaining beds are distinct beds that result in hiring reimbursement that commissioner must know that higher reimbursement and requires following after situation not acute situations, commissioner kho*u and this commission needs to stop petition for excuses that log na honda acute beds had the required runing laguna honda as if it was an acute care hospital, it's not. we should ever ever hear this nonsense during a health commission meeting again. thank you.

>> all right, thank you and jamie please unmute caller 5. >> caller: that was me mark. >> i apologize, i the other hand is janice cohen. >> caller: can you hear me. i think i may be on wrong item, this 8 part 2 that he's commenting on. >> we're on item 9 right now, joint committee updates. >> oh i thought we finished 8.2? >> no, thank you sounds like this is not the right item. >> sorry. >> that's okay. and then there is another hand, caller 4. >> caller: this is dr. palmer,

i want to and a dress the discussion that went on against policy 20-01, i urge you not to vote on that today. as far as i can tell you were put ing patients in san francisco general who are not san francisco residents above, other residents of san francisco who need a nursing home bed. and you are having people that need to come in out of san francisco and lowest priority, even though, this management has resulted from them, being sent out of county. i urge you not to vote on 2001 and redesign your priorities for that. and do not approve, a-20o1 the

way it is on the consent please. for all of us who may need a bed at laguna honda who paid taxes, it's, it's just kicking us in the face. thank you. that's the only comment, thank you you can mute everyone. >> commissioners any questions or questions on laguna honda jcc update. vice president green. >> yes, first of all i wanted to thank the staff at laguna, we literally did this the day before you had to commit the corrective action plan. and i know commissioner chow and i had a-line of questions, so i just wanted to thank you for diving into in and helping us better understand. a lot of was a meater of clarifications, i think i was the one that brought up the

issue of prioritization and while we did receive an answer here, it implied that they would clarify or restate that policy and i believe commission per chow had another area of cleansing of data on equipment na is transferred. i'm not sure whether we should await better wordings or whether we received any. >> if i may, so the issue around the data, i did send forward a revised version that is in your packet where the words like i'm make thising up, but it was best try, we'll try the best to remove phi it's now we'll remove phi, that was commission per chow's request. that policy as you asked, the prioritization i encourage you you to ask carmen questions, this is your time to word smith

and make sure that that policy is what you wanted or you can take it off your calendar. >> that would be great if you can read the policy with the clarification that you wrote in and i believe you wrote in the answer. it sounds like it was the wordings than the policy that was confusing. >> carmen if you can jump on and weigh in. this policy does seem to articulate that somebody who is a san francisco resident, who is hospitalized has lower priority than a non resident and both of them are trying to vie for laguna honda bed, and right now the non resident be priority for a long term resident that lives here.

sd and the answers that you have in front of you. can you get online and talk to us a little bit, please. >> i am not 100% sure i'm trying to get from gnaws right now, and i apologize. >> i can read the responsive it in front of me. i'm going to read the question and response. but the commissioners are making sure that the wordings of the policy is adequate. the question was why would somebody receiving adequate care in their presence circumstances and not a medical facility, sorry, that's not, here we go. what about a san francisco resident taken out of county

hospital who is now, why would that person go to the bottom list just because a accident occur in non city. so the response? can you all hear me? is that okay. the response are individuals who are not individuals are not accepted for remission due to their out of county residency. so all are among those who are san francisco residents. we can modify the on the three of the policy to state, san francisco residents are accepted to laguna honda to make that clearer guidelines. refer from the community, primarily from home, raggeder the third priority individuals who qualify for sniff level care and combination of primary/home care that is

providing excellent care for sometime. who are receiving medical rare. if individuals however, and have kaiser insurance kaiser may now authorize laguna honda. i know some may be a little bit, up in the air. i would feel more comfortable if we ex trad that approval. i would like to read the policy

and maybe approve it at the next meeting. >> commissioner chung. >> yes, this thing was pretty clear. the policy was one thing but procedures articulated that it is for san francisco residents in need of skilled nurse anding acute and rehabilitation services. that's the number one and the purpose. and also in terms of the procedure, out of county residents review clearly, so i don't think that there is any conflict at all.

it's just my two cents. >> this was as discussed, discuss caned rather at length and i think that one of the problems in and i would like to agree with the sentiment here, about rehaving this worded care so that, this is not ambiguous and it all it shows in the responses, it does not show it here. those who might need it even though they're getting care at home.

this is a matter that we thought we should have better discussion on. and rather than trying to worth smith here at the commission level, i would suggest that we follow commissioner green's suggestion that this particular area of the policy and this policy therefore removed from the consent calendar just to tell us that we're going to put in the word that does not help us understand the priorities and remainder and this would be a appropriate discussion to try to work out so that the commission would have a have it much clear. so that would be my sentiment, i'm satisfied that there is a change already made.

they removed the best fortunate and in that very clearly, so i don't have a problem with leaving that on the consent calendar. i feel this deserves better discussion it's a policy issue and trying to understand what we would be recommending at the next meeting and that would be my suggestion also. >> so as a procedure matter, removing this item from the consent calendar would be handled during the next yrkts not during this item on the agenda? direct. >> and removing this to see if it's impact any of the efforts, the research efforts so you're all aware. >> that was my certain at the time was that we wanted not to holdup the policies that were

satisfactory. needing clarification so confirm that that is in fact what would happen in terms of the rest of the policies. >> yes, if we can have the rest of the policies move forward that would be wonderful and good morning my apologies for jumping in late. this policy was being reviewed and updated so we can prepare for acute, so the one sentiment of removing the the sentence around ucsf, we were trying to remove that because we don't have a contract with ucsf so this was part of the work for the acute.

after that being sent, we'll quickly turn it around to bring it to you in august, so we'll be ready by september, since the it's for everything to be filed and submitted in september, we want to ensure that it's everything is in line, it's okay. >> and if the clarification that was provided and answer to the questions that were posed, is the guidance with how the policy is going to be rewarded, then that would provide for comfort but we need to see that wordings. >> yeah. so i'll work so by the time you see it in the meeting, and

hopefully it will be like the way you want it. >> as long as we have the opportunity if needed ask for the clarification or different wordings prior to the august meeting. >> of course and please do note, we have a large number of policies in august. i apologize in advance flt >> all right, seeing no other comments and questions, we can move onto the next item previously item 8 and now item 9 the can sent calendar and based on our conversation we would need a motion to remove policy number 20-01 from consent calendar, do we have a motion. >> so moved. >> is there a second. >> second. >> all right, public comment. >> oh, do we need public comment? >> not removing only if you were going to discuss if as a celebrate item. removing, all those in favor. >> aye.

>> opposed? >> the item is removed. >> and i do need to check public comment and there is two public comment. >> correct, now do we have a consent to consider policy 8. >> second. >> is that a motion. >> second. >> second. >> second. >> second. >> okay, great. public comment. >> great so folks we're on the consent calendar it looks like there is three. jamie start with user 5. >> caller: i'm here, can you hear me. >> yes. >> caller: let me start, this is so confusing that you took comment from dr. palmer and had your discussion among the commissioners about the administration policy 20-01 and

i wanted to comment on that before you took it off the consent calendar but my testimony is, that i wanted you to take it off consent calendar and here's why. it's serious concerns about it dealing an example of san francisco resident, how following the accident who had a lower missing priority and than somebody who is not san franciscan. also questions a prior pit of who are in medical food facility in a sniff setting. there are several changes that you need to discard in greater details like how about concerns

san franciscans who are placing from out of county facility and serve san francisco, what about san francisco san franciscans and out of county facilities that or a long time acute care hospital who should be returned to a laguna honda and another medical facility. how about other sniff patients who were placing out of county like patients that were discharged from laguna honda last summer. 12 them died. how about weightless patients

and other potential inequities of racial inequities, people discharged out of county shouldn't they have some sort of route to return and this needs san francisco so they're not so far away from their plans and family from support networks, just policy means a lot of work. you may not be able to get it done by august. >> time. let's go to caller 4. >> yaf, i urge you to consider

the right to turn to the county for people through no fault of their own who end up out of county. the lafk residential facility for the elderly is resulting in out of county transfers. and people should have a right to turn and the people, again discharged unfortunately in september. above the rights of all disabled and elderly to age in their own communities even if they need a nursing home. thank you 689 >> and please unmute the last

caller, dr. couldcohen. >> caller: thank you hear me? >> yes. >> caller:as attending, i resigned from my position there and my employment with the san francisco department of public health because of horrendous conditions and violation that's were strikingly similar of those laguna hospital have been consistently sited over the past ten years problem that both and laguna hospital are both largely the result of the float plan which has been in existence since 1993 but since 2002 has been

institutionallyized as a dph procedure, it's nearly a fiscally directive to discharge psychiatric patients from san francisco psychiatric units. is hon i canly liz gray, the social worker in charge of san francisco general hospital discharges and the dph conservetor. as a mept al researcher that studied for four years. psychiatric matenser and as

somebody who studied all the longitudal, i can say unhe quit cally that there is evidence that implementation of a mental health recovery system and model of care and placement driven by purely directives are futilely exclusive. i have attempted over the last 30 years and it's new evolution in the optimization project. solutions and recommendations in that i would say that in addition to the procedures, listed under priority for

admission, the section under screening. >> dr. cohen, your time is up. >> thank you caller, do we have any discussion to approve the consent calendar as amended. if not we'll go to a vote. all those in favor. >> aye. >> aye. >> o pesed? --opposed? okay, the consent item is approved. okay, we go to the next item, other business. do we have other business? all right, no other business. >> make sure that folks on the line, if you have public comment on otherwise, please press star-3. >> you've got three minutes. >> okay,

>> caller: you guys, you really need to schedule a separate discussion and schedule it sooner than the jcc in the middle of august, you need to rework that entire priority and i invite dr. cohen to return to the jcc meeting to continue her recommendations at how priorities and administration policies should we change as an item under a third business, you guys

screwed around for 20 to 30 years on this slow project definition. and ms. miss an jment and it should be a celebrate other business agenda items as an agenda all by it self and upcoming meeting and upcoming other business commission meetings. you guys really need to have this conversation before, you apply for recertification, you need to get the policy correct before you send them the application. thank you. >> that's our only comment. moving on to our next item, closed session. so do we have a motion to enter closed session. >> so moved. >> second.

>> okay, do we have any public comment. >> let's see any public comment on item 1? 11. i see no hands. >> okay all those in closed session, aye. >> aye. >> aye. >> you have another vote, hold motion a to assert the attorney-client privilege. >> so moved. >> moved by guillermo second by chow and that's the motion, to assert attorney-client privilege, is there any public comment. >> there is one public comment for this whole item. >> all those in favor. >> aye. >> opposed, all right, we are in closed session

>> discussion to disclose or not discuss anything reported in closed session. >> motion to not discuss. >> we the motion to not disclosed is pass asked now we go to the final item, which is adjournment. do we have a motion to adjourn. >> motion to adjourn. >> okay. >> all those in favor of adjournment. >> aye. >> opposed? we are adjourned. thank you, everyone. thank you, doctor.

>> you're watching san francisco rising with chris manors. today's special guest is mary chu. >> hi. i'm chris manors, and you're rising on san francisco rising. the show that's focused on rebuilding, reimagining, and restarting our city. our guest today is mary chu, and she's here to talk with us about art and the san francisco art commission. well come, miss chu. >> thanks for having me. >> it's great to have you. let's talk about art in the city and how art installations

are funded. >> the arts committee was funded in 1932 and support civic review, design investments and art galleries. projects we have are funded by the city's art enrichment ordinance which provides 2% of construction costs for public art. >> so art is tied to construction. there's been a great deal in the southwest of the city. can you talk about some of the projects there? >> sure. our city has some exciting projected in the bayview-hunters point coming

up. one artist created a photo collage. in the picture pavilion, one artist formed a collage of her one-year residency coming together with residents, and anchoring the new center is a landmark bronze sculpture, inspired by traditional ivory coast currency which the artists significantly enlarges to mark that it's a predominantly african american community in bayview hunters

point. >> are there any art installations around town that uses light as a medium? >> yes. the first is on van ness between o'farrell and geary. it's funded with the m.t.a.s van ness geary street project. another project is for the central subway. it is one of ten artworks commissioned for the new line. it's over 650 feet long, consists of 550 l.e.d. panels between the powell street station and the union street station. it's called lucy in the sky, and the lights are patterned with unique sequences so that commuters can experience a unique pattern each time they pass through.

>> perfect. what about the early day sculpture that was removed from the civic center? >> this is a question that cities have been grappling with nationwide. following the removal of early days in 2018, there was a toppling of statues in golden gate park as well as the removal of the christopher columbus statue. we are partnering with the parks department as well as the community to engage with the public to develop guidelines to evaluate the existing monuments and memorials in the civic arts collection and evaluate the removal of a monument or statue but also installing new ones.

>> finally, it seems like the weather might be nice this weekend. if i fancy taking a walk and seeing some outdoor art, where would you suggest i go? >> well, i would suggest the embarcadero. this work was commissioned with funds from the fire station 35. this suggests the bow of a boat and the glass panel surrounding the structure depict the history of fireboats in the bay area. >> and where can i go from there? >> then, i would walk up to the justin herman plaza to check out the work of the art vendors. then check out the monuments like the mechanics monument. also, be sure to check out the

poster series, installed in bus kiosks along market street, which features four artists each year. >> well, thank you. i appreciate you coming on the show, miss chu. thank you for your time today. >> thank you, chris. >> that's it for this episode. we'll be back with another show shortly. for san francisco t.v., i'm chris manors. thanks for watching. >> (indiscernible)

i just know it. excuse me boys, but does anybody have sun block to block this skin from the sun? >> yes. that's right, i need to get my (indiscernible) >> many of us last summer (indiscernible) reapplying sun screen is like getting the second dose of mpox vaccine. >> wait, two doses- (indiscernible) >> isn't it too late to get my second dose? >> girl, it is like sun screen, never too late to put more sun screen on. >> that's right, i need to get my second dose of mpox vaccine before the summer starts. >> let's (indiscernible) 21201 to find the closest location to get the vaccine or go to sf.gov/mpox. >> thank you for the information (indiscernible)

>> excuse me boys, do you mind checking please? >> sure. >> that doesn't look like a sun burn, you might want to getd it checked out. >> what do you mean clecked out? >> checked out. i was told if i got my second m pox vaccine i would have less severe symptoms. (indiscernible) >> maybe i schedule the second dose just to be safe from mpox. >> most vackeens offer you a level of protections, just like sun block. sometimes you need to reapply for more protection. the m pox vaccine is based on two shots several weeks apart to provide the strongest level of protection. visit sf.gov/mpox to get yours. >> thank you boys for that reminder! make sure your are fully vaccinated for m

pox this summer. text summer vibes to 21201, to get [music] >> first start with the amazing ryan nicole. grammy nominator, utilize every gift available to her for liberation of all people. titled the 4a, seeks opportunities to empower and inspire by way of pursuits as award winning artists actrshx ath least and activist. please give it up for ryan nicole. >> there we