for sfgovtv i'm chris thanks for >> hello fellow commissioners and members toft public welcome to the health commission meeting of tuesday september 5th, 2023. please call the roll. >> commissioner andrado. >> present. >> commissioner christian. >> present. >> dismissinger bern al. >> present. >> commissioner greene. >> present. >> and i'll recognize commissioner christian to offer the ramaytush ohlone.

they have not seeded or lost or forgotten the responsibilities of the place as well as all people who reside in their traditional territory. as guest we recognize that we benefit from their traditional homeland. >> thank you, the next item is the approval of commission meeting. commissioners you have the minutes before you. which you have reviewed. if there are no amendments, do we have a motion to approve? >> so moved. >> sektd.

>> public comment, please. >> hi everybody, let me read a script for each agenda item. members will have an tount make a comment for up to three minutes. however the process does not allow questions to be answered in the meeting or for questions from the public to, i'm sorry for members of the public to engage back and forth conversation with commissioners. making request to the dph. please note that each allowed to speak three minutes on one agenda. written public comment may be sent to the health commission at the following address. if you wish to--please know that policies along with local

law, prohibit conduct against public meetings and will not be tolerated. we will first take public comment from individuals in-person. and then remote comment from individuals who have received accommodations for disability. i have given each of these individuals a code to speak to prevent others from speaking at this time. finally, we will hear from our remote individuals. there will be a total of 20 minutes on remote comment that's can be heard at each time for those who have not received accommodation for disability. is there any public comment from the room, this is regarding the minutes? okay, yes, please come up and i have a, i'll put three minutes on my timer and when i note the time is up, please finish your comments. >> dr. former physician specialist at public health.

i staff central emergency that's what we were called inle and served as word naturer administration. we didn't have an opportunity to talk about some of the issues surrounding the vote to adopt article article 31 and i did want to bring to your attention that there are a few things that you have the power to protect people from violations and propositions 65 enforcement along the entire western since line of the shipyard, people who live on city streets, streets lick griffith, crisp avenue, revere and finch, are being exposed to a toxins from deep soil

excavations that are being conducted along with fence line that does not even have basic humane, that's what you should address from article 31. many of you are probably not aware that there are industrial grade mining dust curtains, the mining industry has a financial incentive to keep the product in. they want to avoid lawsuits and loss of valuable product and they have developed dust curtains that are highly resilient, have tolerated typhoons and can be used to reenforce the western fence line. many are not aware that there is a children's playground

within 500 feet to the shipyard and the campus of the defense laboratories. the land field is also at the boundary of san francisco street and fitch street. it has no dust barriers in contrast the barrier waste entombed in the area in the south pacific that was bombed and where at least 100 ships were brought back to the 100 shipyard, that waste is in tuned and in san francisco, we have a situation where people are living literally within feet of a radiation contaminated land field. and there are people in campers and homeless encampments along that western fence line. so in addition to you know, reinforcement of the fence line

and enforcement of proposition 65 violations, there is the benefit of worker--. >> your time is up. >> speaker: thank you very much. >> thank you so much. and we have one person on the remote. jamie, please unmute that person. >> caller: code a a can you hear me? >> yes, please begin. >> caller: the minutes of this august 15, commission meeting, reports for the dr. chow was to hear laguna honda has applied for medical recertification. report mr. peck ins indicated that obtained medical location, the next step reports from a

second application to obtain medicare recertification. approval first. we learned from a chronicle article the next day on august 16th, medical application was improved by cdth. so when will the medical application be submitted? the minutes also report commissioner chow inquired how soon honda will--they will have to revisit the submission status end quote. that was [indiscernible] since

the location was approved on august 16th, they have the duty to inform the members of the public of the actual date admissions are expected to resolve. i want to publicly thank dr. chi for her great leader ship on 100 shipyard monitoring that, she is a hero in my book and this commission needs more aggressively listen to her testimony and take substantial reneedial actions to protect our more vulnerable citizens in the shipyard area and out there on treasure island. this commission needs to do much more around monitoring

that radioactive toxic dump. thank you. >> thank you, that is last public comment. all those in favor of approving the minutes? >> aye. >> aye. >> opposed? all right, the minutes are approved. the next item is general public comment. my apologies, all right i have a script to read and then we can move on to see who wants to make public comment. subject matter of jurisdiction but not on this meeting agenda. each member may address the commission for up to three minutes. discussing not appearing on the posted agenda. please note that each

individual will be allowed individual--so let's first take anyone in the room, would you all like to make public comment? okay, we will go to remotel public comment. i see money hand. please unmute that person. >> caller: hi, this is dr. palmer, i'm aa, i wanted to follow-up with what dr. sintie said and when are we going to hear from the health commission about dealing with the dangers of bay view hunters point. and the clearly, inadequate protection that residents are having from the toxins there. i would like to know when that

meeting will be. thank you. >> thank you. all right, those are the only hands that i see raised. >> all right, thank you for your comments. our next item is the director's report. dr. colfax director of health. >> good afternoon, health commissioners and members of the public. the director's report for september 5th, is specific and i'll address some questions. so the good news to repeat is long term future of laguna hospital is secure. this was a major step for the city and county of san francisco. in that, the california department of public health and the department of healthcare services, at the state approved laguna honda hospital for recertification meaning and

thankfully the critical dollars will continue to flow to the institution. more than 95% of laguna residents rely on medicaid funding for their care and this will ensure that they serve the residents for generations to come. and i want to recognize the incredible work with the honda team as you know many many leaders were deployed to laguna honda, especially the frontline staff who really pulled together and ensure that our quality improvement happened. the partnership with our unions and of course the incredible support of our policy makers including the health commission, mayor london breed and the board of supervisor sxz hom others that contributed to this as well as our advocates. moving on to our second item which is similar to the first item, but just to say that our

efforts, at laguna honda are continuing, they will be sustained. this announcement represents a new beginning as we ensure that laguna honda maintains this quality improvement and will be the nursing home, the exemplary home for the future for the rest of the state. i also want to let the commission know that we did apply for our medicare funding, our medicare application was submitted to cms on august 23, we are survey ready and expecting a survey at any time at laguna, if you recall those surveys are unannounced. next item, with regards to covid-19, the commissioners are likely that we're seeing an increase in covid-19 cases, locally and state wide and across the country, thankfully

even with these variants, boosters and baxovid are making a difference and due to the ending of the may, of this federal state of emergency and vas reductions in federal funding for covid-19 services, we have had to reduce our covid-19 footprint in the community in terms of providing services to at certain community testing sites and you can see where the sites will be closed. and thankfully we will continue to offer, testing at ella hutch center so i just want to call your attention to that. we do expect the cdc to

announce when the fall covid booster will be available, we made that announcement anytime. right now, we believe that the covid booster would be available at the end of september or october. our healthcare system will be ready to administer those changes as soon as they become available to our network patients and of course we will look to our other partners to ensure that members get their booster as well. next item is to congratulate the grad units, the graduation was held on august 5th at china town health center. it was sponsored by asian resource center. and it's cosponsored by the china town ymca, this is to empower youth as well as faster

leadership skills and the program was started in 2019, and you can read more about how this program promoted healthy living and education in the director's report. wanted to congratulate to dph leaders who are recognized, through the american college of healthcare executives award, that american executive is a professional society of more than 48,000 who lead hospitals and other healthcare organizations. and yearly, the american healthcare of executive also known as ape, each year, the hcag, across central california collects executive in early career to receive the highly

competitive regents awards. i'm happy to say that carina for health at home examine integrate rehabilitation services was recognized with the regent early award which is a great honor and really affects her leadership and without saying, who currently says as san francisco chief operating officer and laguna recertification commander was recognized with the senior level career award. so really, great recognition at a national level of the leaders that we have in healthcare executive, healthcare executives in the department. next items are focused on the great work that is being done at dcsfg, just to call out that the california health and human service and cal hospital can,

and the california and human services and care hospital compare recognize as a hospital that can consistently demonstrate a demos culture of safety in the maternity care honor role. the 2023 maternity honor role recognized aimed the redursing birth to c-section. so another indication of great medical care that people receive. also very timely at cfg, received honor roll. this recognizes for the hospital efforts to increase access to addiction treatment by placing the hospital honor

role and it was one of 100 hospitals that submitted data and was, was recognized for achieving excellence progress in making opioid treatment more available to our patients. and as you know, with the incredible challenges that we have overdose deaths across the country, and across the state and unfortunately here in san francisco, this is such an important thing to continue to expand treatment and make sure that treatment is available when people want it and when they need it, that every door so we know that treatment works. and then with regard to, other wellness activities happy to say that, that wellness, the wellness center has reopened, the team wellness month is a foundation to coordinate a

variety of wellness for staff. so we know that our staff need to stay healthy in order to support people on their support patients and our clients in their journey of health and wellness, so really nice thing that this center has been reopened. and you have our gph updates in the news. you can add that link in the report. and lastly, i did want to call on dr. suess an philip to provide the commissioners with a brief update on further work that she and her team have been doing to at the commissioners request, of structure in a timeline for strengthening our community engagement. so dr. philip, i'll turnover to you and then commissioners i'm happy to answer any questions the report. thank you. sxl dr. philips is joining us remotely. >> thank you, director colfax, i'm happy to join you again

today and give you an update on the work that we have been doing in ph.d since we last met and talked with you and heard from community. and we do completely agree this is a very important area of work as you heard. we are pulling together a multi disciplinary team for the first time to really work with community and to to really press for clear information from the navy, from the regulators including the epa, the department of substance control at the state and the water board as well. and so what we will be doing is coming back to speak with you more formally in january for an update. in the meantime, i'm going to be joining the communications meetings with the av and regulators to really push for clear communication. we are having our internal

meetings on a regular biweekly basis and deputy director for ph.d which you heard on this topic for article 31 will also be helping lead our efforts to reach out to some of the community members that were present at the health committee to speak with them and to start doing that work of ensuring that communication is as clear and as strong as it can be, so that is the work that we'll be doing in the coming weeks and months that we will started and we will continue and accelerate and reporting back to you in january. >> thank you, dr. philip. before we go to commissioner comments or questions, do we have public comment? >> sure, is there any public comment on this item on the director's report? okay, i don't see any in the room. i see one hand raised, i see two.

we will take comment first from those who received accommodations, so i have two folks codes, if you're those two folks, leave them up. may i please start with caller 2, and we'll go from there. >> caller: good afternoon, it's patrick, on the can you hear me? >> yes, please begin. >> caller: on page 2 of the report, update section at laguna honda submitted both the application for medical and medicare recertification in august. however, a budget report posted on the board of supervisors agenda for tomorrow, september 5th, states that laguna honda application was going to be

submitted on september of 17th, presumably to beat l.a., obtained that september 17th date from somebody. if laguna actually submit its medicare application on august 16th, as dr. colfax just asserted or will it be submitted on september 17th? particularly why wasn't the background information provided to the budget and legislative analyst, the board of supes told that they have been submitted in your request in the 4.5 million dollars in the emergency repairs. after all, you claim that you need that 5 million in

emergency repairs to assist with recertification, but you've already obtained it why is the budget and legislative analyst misinformation that the application has not been submitted yet for medicare recertification. this is a glaring error. thank you. >> thank you. jamie, please unmute the next caller. >> caller: hi, this is dr. teresa palmer, can you tell us when the admissions will resume? i imagine it's after any survey that medicare will do. but, we do need to know. have some item of when this will be.

and then, is medicare recertification needed for services to resume or can long term certifications be admitted. once who are still alive, be readmitted? is theres no indication anywhere in writing that they have any proximity, i would like to see that in writing from the health commissioners. and it seems to be that residents who have had to leave the county prepared should have priority at laguna honda. how are the hiring of high ends going? since most of the staff is not even cna home health aid and patient care assistance, you

need adequate to superintendent. you're at-risk of jeopardy again if there is not enough supervising rns. and how are you going to deal with the admission and management of conflicts and acute behavioral patients? is it going to be on going pressure from county hospital to admit patients who can't safely be handled? is general hospital once again to be the well being of everyone else at laguna honda and patients who are admitted that need another setting? and when, are they--[audio breaking up] mr. peckins did verbal eyes that you're committed to that waiver. thank you. >> those are the only two

public comments for this item. >> all right, before we go to commissioners questions and highlights, i want to highlight two things, congratulation to see carina clark as well as the teams for the maternity and opioid care, that's really great news. i just really want to highlight, in the covid-19 testing, they were doing in the community that free kids will will still be available one in the western addition and also in the southeast center for people to pick up, right? >> just want to make sure that we had spoken it today. any questions or comments? commissioner jer ado?

>> in the report, i understand that the test kits need to be free but it needs to be sue --publicized because even here it's not indicated that it's free. that's one concern. >> yes, she can add some more information about what we're doing to help community to increase awareness of those kits. dr. hill? >> thank you, commissioner. that's a very important point, we're emphasizing that those kits are free. and trying to ensure that all others have access to kits. and we will make sure that social media and flyers

emphasize that the kits are available at no cost at the community sites, thank you. >> thank you, i have one other comment about article 31. and i understand from the minutes for our last meeting beinger the timeline of reporting back to the commission is january first, am i correct? of the date and information that you are gathering currently, correct? >> dr. philip, did you hear the question? >> i did, i believe we are scheduled to come back on january 16th but i'll review that date to make sure i'm accurate. >> thank you. i was not specific, it was janl. but my other question is, we had discussed at the meeting and in the, that there would be more than community engagement just with the people that were

here, that were making public comment. but in fact, that we would try again with community meetings that in fact, they people here at the that were discussing the concerns, were going to facilitate with dph for a community meeting or community meetings. in so that's what i wanted to follow-up on. >> thank you, commissioner. yes, we wanted to start with smaller groups of people to be able to understand what we need to convey. because truthfully, we need to have all the agencies involved participate and so our goal with these next immediate steps is to be able to bring some information to these agency partners to navy and epa to the department of substance control to the water board to ask them

to help us, by engaging with these community requests et cetera. there are limited that we can do single handedly but one of our main roles is to try to coordinate and try to make the information as accessible as possible. so it will be a combination of trying to understanding ourselves and but also facilitating so that the agency that's are primarily working right now as the regulators and primarily clean up agencies, are also engaged with this process of understanding what the current gaps are from community communication from the the perspective of residents in san francisco and that's our role to ensure that we're closing the gaps and asking those federal and state partners to join us in exactly what you said, the community meetings to better understand and to better frame information that they are sharing. >> okay, so my understanding, i

just want to make sure i understood. so step one is to engage the partners, the navy et cetera to get the information that then you're able to share with community engagement, to be able to present what you have learned in let's say, the community small community meetings et cetera, am i correct? it's like a two step process that you're recommending. >> there are multiple steps that are happening, and we're trying to figure out the best way to proceed. but we will reach out to community but simultaneously, we are, we are joining meetings that are on going with the agencies, the federal and state agencies, we're joining the communication work groups, we're trying to do other things to close the gaps in communication that we know exist. and that is, that is what i

think our key role will be is to facilitate the communication gaps. so we'll be reaching out to community but also to join the larger process and my goal would be to really make sure that, that's people responsible can join with us as we engage in the community process. i know that they have done that in the framework that they currently have and there might be additional helpful ways that we can expand that current work with guidance in our role at dph. >> okay, thank you very much. i just wanted to be clear on what the process was. so i appreciate it. >> thank you. >> commissioner christian? >> thank you, president bern al and thank you commissioner ger ard o for carrying on these concerns that we articulated on

a prior commission meet ing of our subcommittee but also at the last committee meeting which unfortunately i was not able to attend due to illness. so i want to thank all of my sister and fellow commissioners for carrying that forward and i, i apologize for being not being able to be here to help with that. i'm glad to hear you, thank you dr. philips so much for taking the time to come back with us with information about how, the department will be proceeding, very glad to hear that there will be this such a strong effort to close communication gaps and i, i assume that i'm not the only one and that you share in this concern about there not only being greater communication but greater involvement of the department with the navy in the early

stages when, i understand i think we all understand that the department has no regulatory authority that belongs to the navy with respect to the clean up. but during those clean up processes and even after that shouldn't, the department be reviewing what the navy does and engaging with them about in the areas where, where the department may feel and the community may feel that their efforts are lacking. i understand there is no authority but clearly there is the authority to engage and represent the health commission concerns our physicians concerns and also the community's concerns and to ask for some engagement and movement around addressing the concerns themselves. you know, this is we have, you know, this is a great

institution and we have no higher duty than to protect and preserve the health of the community and that is done by so many department and this is no exception and given what we're addressing here, the con contamination, of our city. and even if it could be contained in one area which of course would not be, okay, it is i think somebody noted, i read the minutes from the last meeting and somebody did note that there is no contamination like this and it will spread through the waters and to the rest of the city and so, there is a strong and on going and unending sadly need to monitor

and to address the issues that are found and so i just wanted to lend my voice to the voice that's were spoken already and to, voice my strong confidence in you and the rest of the leadership of the commission, well of the department and also certainly in the commission to address this to take this on a much stronger way that we have so far. and i don't know whether there is anything else that you can tell me about the ways that you're thinking that the department will engage or may engage with the navy in a back and forth even when there is no authority or no right people for authority for the department to klaep up per se.

>> i do agree with the sentiment, we to have an active role on working with this with the community in mind and being advocates for the community. and that's what we need to do. for the first time, we do have a multi disciplinary team which i'm feeling very positive about. i think you met some of the experts in our environmental health, represented in article 31, they continue to follow along very closely for the technical development that's come out of the work that is happening at the shipyard, in addition to that, we have deputy director of ph.d, asia king whom you also met. but leading our over al engagement work in this area. we also have janet james brown, and dr. a coiy who is trained in governmental medicine and

working as part of health division and with us as well. and i'm closely with this work as well. as you can see, i believe for at this point, we have a very highly qualified team with a breath of expertise. we're all committed to the work of ensuring community health for the residents around the shipyard and we are actively, going to be actively engaging with the navy and talking with community. to really try and make sure that we are doing everything that we can so advocate for clarity and for the highest standards. but again, the main regularers are the epa but we do have a voice and we're going to start using that voice and starting that process now. >> thank you, dr. philip and

yes, advocacy, that we're here to advocate on the maf of the community. and to that point, i'm not a physician or researcher but there is on fwg levels of testing in the community to ascertain the levels of, substances in people's bodies, i know that the community has come forward about with the evidence that they have presented with higher lelz of heavy medals and health, and it would seem to me that assuming that that is documents, that there would be a reason to have set up a testing regimen to people living closest to the sites to understand what may be happening in those sites.

>> we will certainly be talking with federal experts, the experts and academic experts and certainly we'll be advocating for the state-of-the-art in relation to whatever interventions should we put in place by federal state partners or by us as a city. but we do want to make sure that we fully understand the current state as you have said and then we can work on solutions and counter measures based on the state of science by the experts who work in the area. >> thank you, dr. fill partnership, i know i'm not the only one that has a great deal of confidence on you and your team. thank you for your work. >> vice president, green. >> thank you so much and i could not have said this more

eloquently than commissioner christian zen. it's going to take a lot of--and your team, so much of this you don't know until people report to these areas and reports were of great concern of all of us. and more and more activity starts to surface after things have been cleaned up. i hope also that as you report to us, you can give us a flavor for the kind of response you're getting. i think there are some concerns in the part of a lot of people depending on who takes over in 2025, that there could be stripping of the funding as well as the priorities of the epa, i'm not sure about the navy. but if you can give us some guidance and understanding, because when multiple bureaucratic organizations are involved, sometimes as you know, there is significant

gridlock of really moving forward. there have been suggestions and the public of ways that you can imagine, the current idea that was brought up today. and i'm wondering as you learn and interact, that we do have oversight and regulations. so we can add least level set and advocate more strongly if we need to. so we really appreciate hearing about your interactions examine your senses on how things may unfold. and i have another question on covid, people are concerned obviously, the clarity of people undering the testing is free, but i know there is a lot of confusion about the actual cost of vaccines in particular with the emergency over. i know a lot of people are concerned that their health plan may not cover or there would be a problem with peoria

tricks, because the newest vaccine is going to be multi vial by is makes it difficult for some places to purchase extremely costly and if you don't use all the doses, it goes to waste. and i gather the companies are not going to rebate unused doses. i'm wondering if terms of public information but including our healthcare partners how we may provide more information because the people did not get vaccine because they were fearing out-of-pocket cost. >> thank you, thank you for your comments both about the shipyard but also about covid. and really as director colfax said, we're waiting to hear the cdc recommendation and more information and the way that that vaccine will be made

available for those who are uninsured and unable to afford vaccine, there will be programs in place to ensure that, but right now, i don't have unfortunately additional details to share with the commission but we will as soon as we're able to hear more about how that may look. and i agree with you that we want san francisco to maintain the standing one is of the highly vaccinated cities particularly with this new formulation of vaccine. as director colfax said, we know that we have fewer directed resources to do that. we will try to share information and allow our partners to pass that information on to who they serve and work with as well. >> thank you so much, and as the film that has, you have always done a great job in this department. so we have great companies that

this new vaccine will be no different. thank you very much. >> commissioners any other comments or questions? >> no. >> commissioner christian. >> thank you, i just wanted to join president bernal in congratulating the ache awards that is wonderful to see that the rest of the country continues to recognize what an amazing staff we have here in san francisco. i was also very interested in the teen heal internship. and i wonder if that's only at the china town center or if that exist outside. it's such an amazing and important piece of work to be doing with the youth of our community. and it does not exist outside of health center, it would be great if we can try to expand

that to increase the foundation of health for the young people in our community. >> i appreciate that question, commissioner. dr. hammer, i'm not sure if she is on remotely. may have the answer to that. and if not, we will get you an answer about that is specific. i believe within dph it is, i just don't know if there are any other entities that are moan sites for a lack of a better ward but we can get that information to you. >> yes, go ahead. >> dr. horton. >> yes, dr. him is on vacation and i don't know the answer but i will get back. >> thank you, both. and congratulations to the health center for that work, really thankful for it. >> thank you. >> thank you. >> all right, we'll move on to

our next item which is financing and planning committee update which will go into our consent calendar. for today's update, we have commissioner bernal. >> thank you, i had an opportunity to stand in for commissioner chung for the today's finance and planning meeting. at the meeting today we reviewed the september contracts report which listed 6, i believe contracts that were both renewals of the existing program and extensions or contract amendments for others. and we recommend those six for approval on the consent calendar. in addition to the six that were reviewed in the contract report, i think we had 8 new

grant agreements and contract agreements. that again, we recommend to the full commission on the consent calendar just so that, i have a little bit of context for the new ones, i can give a brief description that first was asian and pacific islander which operates as a community center. a new grant agreement to, perform tenderloin navigator program which, is again, it's a new program, where that is going to provide i believe, 7 p.m. to 3 amor, services in the tenderloin to provide trauma informed mental healthcare hiking and referral services on

the nights and weekend. second is the security services which is the process of bringing in security services for our facilities that are, that allows us to have less of a dependence on the sheriff's office or the sheriff services and that contract is new professional services agreement. new professional agreement with the psj, this is an attempt to again, a new and diva tempt to recruit high level of physicians particular difficult to revaout primary a clinician

leaders, i believe and other executives and this is the first time using this particular provider service and its a 12-book contract, next. contract with richmond area services to hire and train peer counselor to unhouse the individuals. it's a program that is in a great with the best neighborhood behavioral health teams. the next is, approval of a contract with luna health. this is an interesting one also that, will provide non categorical support workforce development training programs for the department. the next is a contract with health services advisory group

to provide on going support to the laguna honda hospital, to really help with the sustainability efforts post certification recertification and to transition laguna honda from that recertification focus to release on going level of professional and clinical patient safety and compliance with regulatory framework that laguna is subject to. new contracts and they list it there for your information and recommend all of these for

approval and consent calendar. i think that was the bulk of the agenda the meeting agenda for today. we defer one item to the due to absence of the members of the finance committee. >> thank you, commissioner guillermo it's good to review these items today. do we have any public comment? >> do we have any in the room. and i'm going to make a quick addendum to the contract, mr. sanghaw mentioned it would be sustainable but it may be about quarterly meetings and a tampering overtime, not the day-to-day engagement. so for your information it would be something on going basis.

jamie let's set the timer. >> caller: this is patrick, i take it we're on agenda item 5. and i'm seeking clarification mr. morewits and commissioner val, the process in the actual consent calendar for the next agenda item so it will be taking public on both the specific contract listed in the september contracts report separate from the discussion of policies and procedures for the two separate hospitals, is there going to be two published comment periods? >> you know, we don't answer any questions, i can address

that in the next item. do you have more comments or is that the end? >> caller: i was just asking to you clarify that at the start of the next agenda please. >> thank you. >> any commissioner questions on the finance and planning committee? then we move on to item 6 which is the consent calendar. >> and if i may note. this is one item and there is one opportunity for public could make public comment on all of these items because there is one vote on all the items. i believe there, it is. >> yes, it's one vote on all the items and we'll make a motion to approve after we get a quick summary of those. we just received the summary on the contracts report and the individual contracts and we're chair briefly regarding the csfgs as well as lh and procedures.

vice president greene will be presenting. >> yes, thank you the jcc recommended we approve the in the pediatric service for the family and community care clinic and the department of medicine. >> all right, thank you vice president greene. and commissioner guillermo for that laguna honda. >> yes, for policies and procedure, the jcc for laguna honda met and asked for poll he's presented for recommendation at the jcc meeting, prior to bringing a recommendation to the full commission, those policies were revised and provided the language to to the jcc members

in time for this meeting. in particular, there was concern about the or questions around the admissions policy and prioritization of the admission. one that was particular concern and i'm calling it out just because it was one of the key revisions that was requested had to do with the first, articulating around residents who were transferred out of the facility during the time that laguna honda was decertified and now will be the first priority when, when laguna honda begins to evaluate a new admission request based on the admission criteria. so beyond that, the jcc

recommends the listed policies and procedures for consent. >> all right. >> thank you, to the finance and committee and as well as lag no honda for your hard work on these items. our next is to have a motion to approve the consent calendar. >> so moved. >> second. >> all right, we'll move to public comment, sure. policies were posted on saler morning with time for the public to see as well. so i see one--and do caller three? >> yes. >> hi. >> it's patrick can you hear me? >> yes, please begin. >> this is a sunshine violation that you're taking what is

separate two separate items that should have been separate items and denying the client an opportunity to both actual contracts and the policies, shame on you for violating the sunshine ordinance. it's impeding, the contracts to date for all consulting for lag no honda appear, 40 millions. because the, the commissioners and departments requesting 40 millions in emergency repairs to laguna honda that will occur

long after, recertifications obtained, this is another 50 million dollars expense in costs extensively to obtain recertification. but if recertification also occured and emergency repairs have been put for maintenance, why is it 50 million necessary? i recommend that you reject approving that hsa contract, it's just certification being presented to the board of supervisors, does not indicate a, it does not indicate that it transition work, instead the certification included on the contracts report the

consideration to datetially says will continue doing the same kind of work and not transitions work following obtaining recertification. people are not being honest with the public about how this 50 million dollars inexpensive including the 10 million dollars for afg, ashg contract is even really necessary to obtain recertification. the previous contracts with shhe says that they would be, preparing laguna honda hospital staff for hand off and that's been a--. >> all right, jamie please unmute caller 3.

>> caller: hi, this is [audio breaking up] >> are you there? >> caller: yeah, can you hear me now? >> yes, start now. >> caller: okay, okay, you can hear me? >> yes. >> caller: okay, i don't see how you can vote the 2001 revised section on additional priorities if it has not been proper low discussed. and the subsection is confusing in that it says that people who need a nursing home and are in a medical facilities but are receiving nursing home care have priority, don't they just need nursing care? why do they have to be receiving nursing home?

it's very confusing. and i still, it is good that you're putting us first priority, is admitting residents who are not in a nursing home who need their care, but how they going to get nursing home care, it's very confusing. and then, health network facilities, patients where ever they are have more priority than people who have been neglected from laguna honda who are suffering out of county. it does not make sense to me, this is still weeks of the flow project and running into people from laguna honda to keep this open in terms of code general and not laguna honda being the facility for elderly and

disabled to be. and i urge you to look at the priority again to make sure that the people in the highest need are first in the priority and that is stated clearly, people in the most danger. and people who need to be in laguna honda, people who are not. it should be individualized, elderly and disabled who are at-risk, should not priority no matter what facilities they're in. and especially if they've been dumped out of county. thank you. >> all right, those are the two comments for this item. and just for clarification those who are not laguna jcc, i do interrupt, they did asked for a review in six months to check how it's being implemented. >> all right, we have a motion and a second on the table,

commissioners any questions or comments? all right, seeing none, we'll go to a vote, all those in favor? >> aye. >> aye. >> aye. >> any opposed. all right, the consent calendar is adopted. our next item is dph security services staffing plan update. we have our director of security bevle price to present. welcome mr. price. >> good evening, commissioners, bevle price security for dph. i want to give a brief background before we go into the actual power point. so dph has a security plan that we review on annual bases to look at opportunities for improvement.

so we had a appropriate staff to appropriately staff our goals by reducing law enforcement as to well as to align with cnses guidelines with regard to the use of law enforcement interventions when it came down to a patient and individuals in the hospital. that plan included the using of psychiatric technicians as well as psychiatric nurse to see perform or function in the behavior response team or burt. it also included using non uniform sheriffs cadet to operate as ambassadors both of these as well as laguna honda hospital. you can go to the next slide.

one driven bit fact that the delay in the rfp process, the community ambassadors as well as the challenges with the sheriff's stof with regarding to staffing. so the timeline which was originally set for march 2022, was actually pushed out to october 2023. so this presentation is provided an update. you can go to the next slide, please. so the original proposal was to reduce the number of sheriff's deputy by 11.4 and add 29.4

burt psychiatric nurse sxz technician sxz also to improve program within phases withining in march through may the 22nd. the update is since july the 22th, the sheriff's office was unable to staff at 11.04, so there was not a need to do the reduction because they didn't have the staffing for the physicians anyway. so we officially remove the informations from the work order. the inability for the sheriff's office to staff the positions is primarily driven by this challenges and hiring is not just with the sheriff's office but with the challenges recruiting slault what is driven this all across the city with regards to law enforcement

and had it not be been for those challenges, i believe that the sheriff's office would have been able to staff those positions. next slide. as i mentioned burt was to be implemented in phases, psychiatric staff to provide support in the emergency department as well as the hospital campus. the update is that the bert program is in challenges, the whole objective behind the bert program is to add dedicated 2013 to the emergency department which has been done. in addition to they were to provide support throughout the hospital. so if we were to be able to

fill those additional 11.4, we're doing a lot but we would be able to do more. things as such provide additional support to outline clinics as well as roit now where bert is focused on the emergency waiting room and then the what is is it called, pot a which is where our psychiatric visions are. the original plan was to bert teams to be assigned to each of the treatment pods. so that is still a goal that we're trying to reach. on a monthly basis we received a update from the bert manager. and what i understand, if you 29.4ftds the height reached 19.9ftes. at that point, they began to lose who resigned despite the

fact that they were commuting from sacrament to to san francisco. so that despite the challenges with hr, which the bert manages that more than 7 months would go by before they received an application. in addition to that, there is no side tech schoolsed in the bay area. it was originally one and conquer which is now closed. so that coupled with the other issues and in addition to that also, hospitals are not adopting this motto of psychiatric nurses in bert support. so not only are we trying to get staffing but also competing with other hospitals who are also recruiting in their areas for this particular type of motto.

>> the plan also includes that sheriff deputy will continue to be onsite so it would be overlapping that continues to be the case in the emergency department. however as i mentioned, the fact that they were not able to fill those 11.4 positions, they were not able to accomplish that operating about 30% vacancy rate. let's go to the next slide. the plan proposed that the cadets would go to a non traditional aoun ferm which was accomplished and we would reduce two of the 42 cadets so that those cadets will be assigned and information hospital desk would be provided by health workers. this is the situation where the

sheriff's office was not able to do any affective recaougt for the cadets as well as get buy in with the sheriffs with regard to shrining them as hospital 'em baz doers. --ambassadors. as a result of that, we began to work with ocda, through their contract with security staff to actually provide 46.5ftes to begin functioning training and healthcare security functioning as healthcare ambassadors as well as administrative policies where were revised to clearly define the security officers role authority and jurisdiction functioning at general hospital as well as laguna honda.

we look at the 40ftes for sheriff cadets it comes out to 2.5 million compared to the 46.5 private security, sorry private security is 2.5 and sheriff cadet is 5.7. so the security has been in place accord to go this plan since 2022. let's go to the next slide, the number of changes that have occured since at laguna honda. originally the plan was to reduce the 4.2 deputy and add 8.29 uniform cadets. we did, reduce the deputies,

however here again was a situation that we could not get by and in addition to their staffing in regards to at that time, one of the needs was the cadet to karp in clinical searches which chairs policies, a lot has changed since then. and then we're going to add three psych nurses or burt at laguna honda as well. we went from not hiring the cadets to using that to fund 16 health work inventories perform that role. under the management of hospital nurse anding that's where the plan stands at this particular point. however, there was still a need for security services based on

the plan for laguna honda was that we needed to staff 24-7 to determine any kind of contraband. so once again, we reached out to oca who provided the 34.6 honda contract. so one of the contract was whether this was dph, it's neither it's a contract with o.c. a. contract out with the community base organizations to provide client safety services, the rfp was finalized in january of

2022, approved by the civil service commission and the contract was awarded in 2002-2023 with the plan of implementation of 2023. regarding the ceo hire it will be consistent with the same security training that the private security that we had planned out in addition to that, there will also go through non violent crisis and be certified in that course upon their first day. and they also have to go through the dph training regarding trauma and deescalation as well. next slide. so under the current state, one of the increase use of force against patients.

so we see on the left, it's been over a four-year period. we still have disparity that black african americans are still the highest subject of force use. in addition, sheriff's deputy are primary role of use of force has been assisting nurses with retraining patients. majority of black african

americans occur in the emergency department at 36%. they have been caught for 4,000 more service called activation than the sheriff's office. that's that is our staff was utilizing this resource, and they have been trained as to when to use bert as oppose today useling sheriff's office. so we started to see the increase as as far as they're work withing patients as well as how they're dealing with the issues of escalating behavior. in february 2023, when the sheriffs when burt starting staffing 20-7 in the emergency department, over 3000, about

3000 proactive activation, 83% were with law enforcement. when you look at the chart on the right, the activations black african americans were the highest to receive support from burt. so it shows you the outcome of call-in to the opposed calling a health professional that is trying to determine whether an individual is in distress. so we see that based on these numbers here.

next slide. reaching the fte staff and gos for the security plan. based on everything that i've shared with you currently, our staffing levels have reached that plan, didn't go how we arrangely planned but when you combine the office and private security we are at the plan operating, since 2002 and at this point, it's proven to be successful as you go in each

one of the doors of the hospital, you have been providing greeter services as well as other value added service with clinical staff to address patient safety which is something different in law enforcement. so i'll stop right there and i'll turn it back over to you, mark. >> before we go to commissioner any public comment? >> sure, i see one hand, we're on item 7, if would you like to make public comment, please press star-3. jamie, please unmute that one caller. >> caller: it's patrick, can you hear me? >> yes, please begin. >> caller: apparently the behavioral emergency response staffing at laguna honda that was identified as being

necessary on january 22, included adding pilot security of 34.6ftds for security officers in march of 2022, before the decertification in april and development of an action plan mild stones subsequently began. the prices were report didn't include the costs for the 14ft ehealth workers nor is there a break out of what job applications codes are involved for the 14 health worker positions or job classification codes for the 3 psychiatric nurses conventions.

but it's likely that those additional 7dph employees will probably run another two million on top of the 1.6 million for the outsource, contract for security officers. that totals a total of 51.6 response team members. it's kind of alarming that there is a lot of contraband coming into laguna honda that you would need to try to deal with it.

if there is something else with laguna honda and applications for being admitted, it's unique 52ftes to get a calendar on this problem. thank you. >> that is the only public comment. >> commissioners, comments or questions? commissioner gerardo. >> i appreciate that, great presentation. i guess one of my concerns. >> please turn on your microphone. >> new system. thank you. i hope you heard me. if the challenges you have in hiring, are they salary? hr? commute? just the behavioral health field? i'm assuming it's all of the

above, but i just wanted to check with you and is there a further out reach or recruitment plan? especially for the burt staff? >> thank you, commissioner. most definitely is all of the above. however from my update with the burt director, the plan is to start focusing on hiring lvns and what they're going to do is vet through them the psychiatry department and from there, gave them extensive training and start utilizing them since those resource right side more available but still we still have the barriers that we have with the on boarding process. >> thank you, i appreciate it. >> you're welcome. >> thank you for the presentation, i just wanted to commend you and everyone in the general first of all for developing the concept of the burt team.

secondly for thinking through protocols as well as training. and i remember you had great confidence that this would be a terrific, affective program and it's just so heartening to hear this information to hear it's been successful, beyond what we had hoped. congratulations to everyone, i think it's remarkable what you've been able to do in termds of force and just the way that you've been able to approach some of the more conflicting actions with such thought and dignity. i was wondering, as you see this success evolve, at what point would you change ratios? and we talked about staffing but as we get more data because it's a 24-hour day service, when and how do you think these ratios compared to our team might shift and what will that

imply about recruitment? >> thank you, commissioner. as we originally planned we do not foresee a situation where there will be absolutely no sheriff deputies, just based on the level of violence that occurs. those positions will continue to remain and the same will be the case. but what would like to see is that anything that does not reach to the level of a crime in progress, there is no need to get law enforcement into a patient care situation. that's what our expectation is with burt. >> i know budge receipts made quite in advance, but is there enough that you'll have enough data that you will shift away from other regulatory?

>> i sure hope so. >> thank you. >> sure. >> commissioner christian son. >> thank you, i join in congratulating you in the use the burt system, and its success. i'm wondering if you have any thoughts about the disproportionate number of times that i would imagine that there is a need for assistance for black african-american people who visit the emergency department or the hospital itself versus why wide latinos and latinas and asians.

african-americans are small percentage in the city yet the percentages are so high of black african americans who are in the situation where the staff needs assistance from burt. do you have any thoughts that can help us understand that disparity? >> sure. thank you, commissioner. dph does a lot of training on bias. and i don't think they would do that training if it was not a issue, who gets called burt or law enforcement? so you have that issue and then you have the issue of just, hospital set setting and the history with hospitals concerning black african-american. there is a lack of trust, so as

a result there is a reaction, that again, somebody who sees that at the early stage can provide that support as opposed to getting law enforcement person because, it exacerbates the situation. >> thank you for the presentation. >> thank you. >> thank you for the excellent presentation, you're showing progress and answered the questions that our commissioners have on equity and thank you for security that you provide for dph and the staff and people you serve and for being responsive to the needs as well. >> thank you. >> thank you. >> motion. >> thank you.

>> all right, next we have item 8 for discussion the 2016 public healthy and safety bond update. >> it will pickup it's to no need to bend over. >> start over, good evening commissioners and staff, joining me my name is mark freemo oversight advisor for the department. joining me is terry director of facilities from zuckerberg general and then chief project manager joe chen from public works. this is just our typical flow of information. go to the next slide, this is something that i added, to show

commission some of the activities that we're embarking on and implementing to close the gap from the 2016 bond funds that are available primarily due to a lot of issues to covid and supply chain. so the first is the state grant that addresses, behavioral health services to adolescents, under the age of 25. and also focuses on transitional use between the ages of 18 and 25 where this work will take place in the existing hospital building 5 out of the portion of 7th floor. we list it because there will be infrastructure improvements for this program that could leverage and benefit the program therefore by reducing

the amount of money that we would have to spend, so we're looking at all sorts of ways and buckets to bridge a gap that jerry will talk to right after i get done. we received our perm pits for increasing our psych emergency services which will allow us the greater capacity to treat patients coming in p the space will increase, so the capacity for that unit which is sorely needed in the city. will be inhansed. we received 11.4 million from the 2020 bond to help support pes. so that project is one of our high priorities. when you sell bonds overtime, the treasurer will project the that money. our projection like a year ago,

was half of this. so we're happy that now we can go after 10.3 million and apply to the program. we had an m.o. u approved this fiscal year's budget for over 50 million which will help us in the 2026 program to advance design and early demo as well as urology. so it's also another saying that will help supplement the funds that we have a deficit for. also currently developing a future bond in april 2023, december. which will have other things involving china town and building three seismic renovation and critical infrastructure.

so some will go to zuckerberg general and some to laguna honda. this also provides potential opportunity to bridge smft budget gaps in our earlier program. the other thing that the team is doing, is really looking closely at some bids that we received from the contractor. there'ses a lot of risk that contractors put on. smft risk is not realistic, some of the risk is totally realistic. so the team went and they looked at this particular infrastructure which is a lot of electrical and low voltage and they were able to reduce ten million dollars from that budget. so it's type of activities that we're trying to do that terry will talk after me about,

bridging that gap. next slide. so the next two slides, basically with we've had three slides. you can see the numbers to the far right, we're approaching almost total spending on all the funds that we received in 2016. i call your attention to the second column that says other fund sources. so this is where additional money is coming in, the 11.4 is what we talked about for the tes, next slide is we talked about the community health centers. okay, same thing here. we went after, environmental health grants, energy grants, so all of those reflect in that second column in addition to the

general obligation centers. i'm going to turn it over to terry. >> thank you, mark. congratulations on your new sound system. this slide is a scary slide. it's a draft project budget, it's going to remain a draft throughout the life of this effort, because it's always changing. up in the left hand corner you see the grid that is pointing out the obvious that we're one of the most expensive cities to do construction in. moving to the i would like to draw your attention to the deficit, the numbers in red.

once you've total up the projects we're looking at 11 million deficits. and we're explain to go bring that down. the next time that we're in front of you, you're going to see a dramatic change because we're taking a lot of those items after they come to fruition to abate these costs. so to take the scariness out, while we have 11 million dollars deficit, the current times that we have at hand, dropped that down to abate about 83 million dollars. and if you, if you look at the family health center clinic in the building specialty clinic, the numbers are equivalent to the deficit that we have and those are contracts that we have not gone out to bid for and we will not go out to bid

for. so they are, until we have abated or found alternative funds to support them. so that takes for me it takes the scariness out of that number, because we have a way to immediately address it but we're still working on all the methods to bring project costs down and looking for alternative funds so we can complete package on this bond. and how we're doing that? , if you go to the next slide, we're doing it by reducing the perceived risk. mark put it at reducing risk with the contractors but also not only in the misunderstandings of the bit documents but also to listen to the contractors and hearing their concerns and seeing what we can do to reduce the risks.

run of the risks that we had was a security path for the riser in the building so we were able to consolidate that with another project and remove that risk completely. out reach, drawing in more competitors when we go out to bid, early demolition, removing all the problem that's you find on the site early before you actually go to construction. descope, reducing the scope of the project. and exploiting the alternative funding sources. as far as forecasting there is a forecast of the business environment meeting the inflation rates within in 2024. last you've seen that throughout the city, we're seeing a lot of improvement throughout the city. accept for dph, except for at

zuckerberg. we're still experiencing pandemic hospital and not the choice place to bid on a project. so we're still experiencing that. so we're going to work on the contract to reduce any fears to somehow, to bring our bids to a more realistic site and delivery. with that, that's my presentation on the budget where we're at. and if you take it from here and talk about project updates. >> thank you, terry. good evening, commissioners. public works program manager for the 2016 safety bond program. next two slides i'll be providing project updates on the component project. since the last presentation, many are gaining momentum and

happy to report that we're well into the core of the build back activities, ten ended and reenforcement steel for the completion of the radar, and ex ray scanning of the existing slab, they were able to restain which allow the wall frame activities to move ahead. the overall project is at 30%. main include wall and metal stuff framing with mechanical and in wall plumbing. also on going work on the floor which is includes new plumbing piping and in the over ceiling space that will support on the third floor. targeting to end by 2024.

overall project completion is at 27% demolition of the main space is completed with approval of invex work plan, has completed and started the slab demolition and trenching. has also started in various areas throughout the space. project is target to go complete by the end of 2024. next slide please. on the project, overall 30% as you may recall, the seismic project includes the scope such as call in enlargest, removal of sun shades and metal plate installation as well as seismic

joint between wing 5. we have completed 204, we have 27 locations that are currently in progress with various types of work on the first floor, fourth floor and roof level. project is target to go complete by early 2025. on a clinical laboratory, overall project completion is currently at 40 percent. the medical record to be completed by this month with work on going. the new automated track equipment is scheduled to be delivered by first quarter 2024 with the target of completion. the psychiatric emergency services early demolition project which a stand alone is 98 percent completed. also received approval for the renovation approval. project targeting to target

bidding with construction starting in early 2024. in order to traem line this presentation, we have eliminated the project for the community health center component projects from this slide deck. the community house project are part of the phs program include health center, and south gate center. that concludes my portion of the update and let me turnover to mr. primo to provide updates on the projects. >> thanks, this is just a time line of the new research and academic building of the pride hall. really, 100% completing construction, it looks like they're going to have their total move in by november sometime, so this is gives you a time line. if you have not gone through it, it's an amazing building exterior as well as interior.

so i'll open it up to questions now to the commission. >> before we go to questions, any public comment? folks we're on item 8, if you would like to make comment, press star-3. i city no hands. >> okay, commissioners. commissioner ger ardo. >> thank you, about the mental health in patient outpatient services and its, and the construction, is it part of the infrastructure grantor what the update is on the project? >> i believe it is but i have jason such, service manager. i know he has a migraine but i

asked him to listen in, jason, are you there? or would you, mark? we can get back to you on that. >> the answer is yes. yes. >> the answer is yes, it's under the? >> 7 a a and the adolescent, part of that grant. >> okay, what is the status of, the construction or? >> oh nowhere near that. >> we're just trying to establish the grant at this point. >> so once the grant, then it will be applied or some of it will be used for the adolescent? >> yes, it has a completion date of june 2027. >> that's not soon enough but that's okay. thank you. >> any other questions or comments, commissioners?

mr. primo and your team, thank you for the update. >> thank you. okay. our next item is item 9 for discussion it's fy2023-24 and fy2024-25 patient rates ordinance. welcome executive director. >> greg are you standing in >> >> i'm texting them, they're probably walking up the stairs right now. >> oh okay. >> give me one, sorry for the delay.

just talk regularly. no bar. >> good evening, commissioners through the chair jenny louie financial officer. matt is our director of reimbursement will be going through the actual details of our raise but just introduce to just know that these rates are used. this is an item that has been approved by the board of

supervisors and we were late to getting this to the commission for its approval and i do regret the delay. so that i will turn it over to matt and walk through the presentation. >> good evening, i'm here to present on the patient rate for fiscal year. we can go to the next slide. the patient rates were approved by the board of supervisors affective on july 25th, this annual rate increase, its officially to reinsure that reimbursement from medical and medicare continues to support the services. generally speaking, specifically speaking in the areas of invasion emergency and trauma related services, this

extends the rate authorization through fiscal year 23-24 and fiscal this-at that and new for this year, as i believe that we all know, with tally initiative, health services has gone through payment reform and this ordinance reflects the updated rate structure that has been implemented by the department of healthcare services. so in addition to those high level changes, in terms of uniformity. an additional year, all other physical services are increasing by 5.6 percent in 23-24 and 2.9 percent in fiscal

year 24-25 and these rate increase right side consistent with the controllers office and guidance. another thing that we've done is we've consolidated, the rates for evaluation and management services across the network. what has happened is that, in previous ordinances, we were listing the services in each divisional section to make it easier because we were consistent with the rates across the board to make it easier we've consolidated. and so some technical changes and patient rates relative to our peers whether the rates should be adjusted in the future.

move the administration of the medical benefit behavioral to more convenient system. and then all of the behavioral health rates that changes that we made this year and for 24-25 all reflect the rates that have been established by the department of healthcare services. so i do want to touch on point asked by the commissioners. while when we review our enm rates, most evaluation has been

serviced within our primary clinic which are all qualified centers and so, the payment rates for has been fq qualified health center, are a bit higher than normal fee for service rates. so we have those higher rates than you may find in a private practice. that this ordinance and increase in rates should not affect the amount that patients are liable for. as you know in 2019, we went through a whole host of changes to our patient collection and liability policies including patient cap or patient enter cap changes and broad scale changes to our policies. i think we've over the past couple of years between the no

surprises act, a b1020, we've all come in compliance with those rules, either the 2019 changes to policies or to just in compliance to changes to policy and compliance with the legislative changes or updates. so with that, i think if you have any questions, i'm available to answer. >> thank you, to we have any public comment? >> there is nobody on the line at this time. >> nobody on the line, commissioner guillermo? >> thank you for your presentation, i have one question about the reevaluation of patient rates that you're plan to go dorel tiff to market pierce. can you describe a little bit, well, let us know when that rereevaluation process is going

to start and when you say market peers, are you talking about other public hospital systems or nonprofit systems or for profit systems that have medical and medicare patient population? >> thank you for your question. i think what we i would foresee. since 2019, we have paused on increasing the rates for trauma and that's i think, it's become a point, it's come to a point where we need, it's time to review. so i know that we're working with the controllers office on engaging in a study. so i expect that to happen within the next couple of years.

and thefn to your question who are our market tiers, i think the large healthcare system and especially in california would likely be pierce but when terms of defining who that would be, we would allow that market study whoever we engage with to define who our market peers are. >> thank you. >> vice president greene. >> we have bronze plans or plans with huge deductables, if they show up how are we managing these patients in terms of their costs. i know it's been a conumbbrun, they put them on sliding scales

for reimbursement, $300 is a huge, as you said fee higher than they should be. maybe a small group of people but how would you manage the individuals? >> thank you for your question. i think that i will have to take that as a follow-up item. the one thing that i will say about your question is that the large population of our patients, has medical coverage. so it lives under the medical program. so we would have research for regular care what is our patient schedule or what we expect? i remember especially mr. wagoner and his team when we

noticed when people especially at the trauma general, getting these bills. we were way ahead of that reform, but it may be useful because it may be that the volume increases. to the extent clinic since we don't have strange covered california in primary. we really have mostly now managed medical patients with medical and lv san francisco at least in the primary world, we're not seeing, a very very small number of patience in the state category sometimes as higher bills but for the most part, we can get everything covered. i think it's important one especially for the inpatient services. >> i will be curious with this,

because there may be some individuals who end up with the plans, i don't know how it's going to affect san francisco especially with the extra programs. i know some people are getting through their employers and they still want to go to the places where they've gotten care. thank you so much. >> next report from the joint conference jcc meeting from august 23. i ask that you hold the gavel while i excuse myself. >> thank you very much, president. >> i had the jcc meeting, we discussed robust presentation on achieving safe and equitable care. and it included many metrics that they follow at the hospital most of which they

have met or actually exceeded with very rare exceptions for which they have excellent plans of approach. and there including falls and hospital pressure injuries which were the ones of greatest focus but also bladder infections and hospital acquired infections in general. and the point is to look at this through a general lens to better understand this information through the lens of equity. and in addition to hearing the celebrations that were reviewed in the director's report today, we also celebrated the additional star that the general got from cms which is an accomplishment because it's reflected on data really before the last few years. i think the improvement that

they made are yet to be reflected in the star system. in addition, we heard how involved the leadership the general is in in advocating and of course we heard the commission reports which is the fair's report. and then really privileged every month to get reports from departments at the general and the pediatric department in particular is to impressive, every time we hear about these. it's really, wonderful experience. so we recommended what is on the consent calendar and in the close session, we approved the minutes and got a report that we also approved.

any public comment? >> there is none on the line. >> any questions from commissioners? >> all right, thank you very much. seeing none we'll move to another item of the business. any other business? any public comment in any other business. none. we will entertain a motion to adjourn. >> so moved. >> second. >> all right, nobody is on the public line all those in favor of adjournment? aye. >> opposed. we are adjourned. thank you, everyone. >> thank you, sf gov. tv. sorry before we end, thank you to moorewits to get the audio, much improved thank you for being persistent for this, mark. >> it's the dph folks. >> get that in the minutes,

please. >> the stewardship program is a (indiscernible) based program. we work with student kind r garten through 12 grade and work with scrks fusd and (indiscernible) focus on 5 themes. sense of

place, plant adapation and animal adaptation, water soil or (indiscernible) depending on the grade level and accommodations the class may need the educators work to adapt the programming to be whatever works best for the class, so they can gain activities (indiscernible) some don't, we try to meet students where they are at and get comfortable connecting in the space and feeling a sense of ownership and safety within their (indiscernible) >> the first component of a youth stewardship program trip will be a in clasds visit where we go to the school, we give a presentation on the natural history of san francisco, we talk about the concept of a habitat, so what does a habitat contain, understood, water, shelter, space. >> children at this age, they learn best through

using their senses, having the real life experience and (indiscernible) students also learn about responsibility and it is a great message for student to learn, if you take care of environment, the environment will take care of you. >> so, when we finally get the kids outside, we have two main components to the field trips. one is going to be the restoration component where we are working on the habitat and parks by pulling out (indiscernible) or maybe watering, and then the other side of our trip is going to be the educational component, which can range from a nature walk with a sensory theme where we are talking about what we smell and hear, to a focus on plant adaptation and animal adaptations.

>> (indiscernible) >> just a great opportunity for students to learn more, connect with nature, and hopefully what they learn from the youth stewardship program they can take with them for the rest of their lives, and they will appreciate their environment more. hopefully, when they appreciate it, they take care of it more every day. >> (indiscernible) >> so every year we open the application up in the fall. interested teachers can apply for a classroom visit and up to two field trips to the city park of their choice. field trips are 2 and a half hours long and like i said, they can happen in any city park (indiscernible) .

>> (music). >> the ferry building one of san francisco most famous that as many of 15 thousand commuters

pass through that each gay. >> one of the things that one has to keep in mind regarding san francisco is how young the city we are. and nothing is really happening here before the gold rush. there was a small spanish in the presiding and were couriers and fisherman that will come in to rest and repair their ships but at any given time three hundred people in san francisco. and then the gold rush happened. by 182948 individuals we are here to start a new life. >> by 1850 roughly 16 thousand

ships in the bay and left town in search of gold leaving their ships behind so they scraped and had the ships in the bay and corinne woods. with sand the way that san francisco was and when you look at a map of san francisco have a unique street grid and one of the thing is those streets started off in extremely long piers. but by 1875 they know they needed more so the ferry building was built and it was a long affair and the first cars turned around at the ferry building and picking up people and goods and then last night the street light cars the trams came to that area also.

but by the late 1880s we needed something better than the ferry building. a bond issue was passed for $600,000. to build a new ferry building i would say 800 thousand for a studio apartment in san francisco they thought that was a grand ferry building had a competition to hire an architecture and choose a young aspiring architect and in the long paris and san francisco had grand plans for this transit station. so he proposed the beautiful new building i wanted it wider, there is none tonight. than that actually is but the price of concrete quitclaim two how and was not completed and killed. but it opened a greater

claim and became fully operational before 1898 and first carriages and horses for the primary mode of transportation but market street was built up for serve tram lines and streetcars could go up to the door to embarcadero to hospitals and mission street up to nob hill and the fisherman's area. and then the earthquake hit in 190 six the ferry building collapsed the only thing had to be corrected once the facade of the tower. and 80 percent of the city would not survive the buildings collapsed the streets budges and the trams

were running and buildings had to highland during the fire after the actuate tried to stop the mask fire in the city so think of a dennis herrera devastation of a cable car they were a mess the streets were torn up and really, really wanted to have a popular sense they were on top of that but two weeks after the earthquake kind of rigged a way getting a streetcar to run not on the cable track ran electrical wires to get the streetcars to run and 2 was pretty controversial tram system wanted electrical cars but the earthquake gave them to chance to show how electrical cars and we're going to get on

top this. >> take 10 years for the city to rebuild. side ferry use was increasing for a international exhibition in 1950 and people didn't realize how much of a community center the ferry building was. it was the center for celebration. the upper level of ferry building was a gathering place. also whenever there was a war like the filipino war or world war two had a parade on market street and the ferry building would have banners and to give you an idea how central to the citywide that is what page brown wanted to to be a gathering place in

that ferry building hay day the busiest translation place in the world how people got around transit and the city is dependent on that in 1915 of an important year that was the year of our international exposition 18 million living in san francisco and that was supposedly to celebrate the open of panama differential but back in business after the earthquake and 22 different ferry boats to alamed and one had the and 80 trips a day a way of life and in 1918 san francisco was hit hard by the flu pandemic and city had mask mandates and anyone caught without a doubt a mask had a risk ever being arrested and san

francisco was hit hard by the pandemic like other places and rules about masks wearing and what we're supposed to be more than two people without our masks on i read was that on the ferry those guys wanted to smoke their pipes and taking off their masks and getting from trouble so two would be hauled away. >> the way the ferry building was originally built the lower level with the natural light was used for take it off lunge storage. the second floor was where passengers offloaded and all those people would spill out and central stairway of the building that is interesting point to talk about because such

a large building one major stairway and we're talking about over 40 thousand people one of the cost measures was not building a pedestrian bridge with the ferry building and the embarcadero on market street was actually added in and in 1918 but within 20 years to have san francisco bay the later shipbuilding port in the world and the pacific we need the iron that. as the ferry system was at the peak two bridges to reach san francisco. and automobiles were a popular item that people wanted to drive themselves around instead of the ferry as a result marin and other roots varnished. the dramatic draw in

ferry usage was staggering who was using the ferry that was a novelty rather than a transportation but the ferry line stopped one by one because everyone was getting cars and wanted to drive and cars were a big deal. take the care ferry and to san francisco and spend the day or for a saturday drive but really, really changed having the car ferry. >> when the bay bridge was built had a train that went along the lower level so that was a major stay and end up where our sales force transit center is now another way of getting into the city little by little the ferry stopped having a purpose. >> what happened in the 40 and

50's because of this downturn we were trying to find a purpose a number of proposals for a world trade center and wanted to build it own the philly in a terrible idea objective never gotten down including one that had too tall towers a trade center in new york but a tower in between that was a part of ferry building and completely impractical. after the cars the tower administration wanted to keep americans deployed and have the infrastructure for the united states. so they had an intrastate free plan the plan

for major freeway systems to go throughout san francisco. and so the developers came up with the bay bridge and worked their way along embarcadero. the plans were to be very, very efficient for that through town he once the san francisco saw had human services agency happening 200 though people figure out city hall offender that the embarcadero free was dropped and we had the great free to no where. which cut us off from the ferry building and our store line and created in 1989 and gave us the opportunity to tear down the free. and that was the renaissance of ferry building.

>> that land was developed for a new ferry building and whom new embarcadero how to handle travel and needed a concept for the building didn't want- that was when a plan was developed for the liquor store. >> the san francisco ferry building has many that ups and downs and had a huge hay day dribbled adopt to almost nothing and after the earthquake had a shove of adrenaline to revise the waterfront and it moved around the bay and plans for more so think investment in the future and feel that by making a

reliable ferry system once the ferry building will be there to surface. >>

>> we are providing breakfast, lunch, and supper for the kids. >> say hi. hi. what's your favorite? the carrots. >> the pizza? >> i'm not going to eat the pizza. >> you like the pizza? >> they will eat anything. >> yeah, well, okay. >> sfusd's meal program right now is passing out five days worth of meals for monday through friday. the program came about when the shelter in place order came about for san francisco. we have a lot of students that depend on school lunches to meet their daily nutritional

requirement. we have families that can't take a hit like that because they have to make three meals instead of one meal. >> for the lunch, we have turkey sandwiches. right now, we have spaghetti and meat balls, we have chicken enchiladas, and then, we have cereals and fruits and crackers, and then we have the milk. >> we heard about the school districts, that they didn't know if they were going to be

able to provide it, so we've been successful in going to the stores and providing some things. they've been helpful, pointing out making sure everybody is wearing masks, making sure they're staying distant, and everybody is doing their jobs, so that's a great thing when you're working with many kid does. >> the feedback has been really good. everybody seems really appreciative. they do request a little bit more variety, which has been hard, trying to find different types of food, but for the most part, everyone seems appreciative. growing up, i depended on them, as well, so it reminds me of myself growing up.

>> i have kids at home. i have six kids. i'm a mother first, so i'm just so glad to be here. it's so great to be able to help them in such a way because some families have lost their job, some families don't have access to this food, and we're just really glad to be

12, 20. 23 is now called to order. roll call, please. thank you. commissioner alexander. i am here. thank you. good to see you. commissioner fisher. i am also here. commissioner lamb. commissioner montgomery. here. thank you. commissioner sanchez . vice president wiseman. ward here. and president. bogus here. thank you. okay. at this time, before the board goes into closed session, i call for any speakers for closed session items listed in the agenda. there will be a total of five minutes for speakers. are there any cards? there are none in person. are there any hands is