i hesitate to ask this question because i no one here is from the dmv. i would net this the response this has been posted by twitter by cruise is that you know sort of describe the action that the dmv taken motivated by a single incidentful and very much focussed on this. and i don't finish as benchers, of and people looking at the data awe are in the seeing everything it is dmv is

lookingament. that is in the when we might be concern body cruise and i don't know if anyonements to address that come out of cruise today. okay. good. >> can i address that? sure. >> they had drintss like the fire truck crash and other things and when you would see in other places like aviation is after have you an even due to something you did not anticipate, you would do a safety stand down. and you would cease what operations might place people in danger until you had a review of the facts and circumstances and made prescriptional changes avoiding place there is are traffic or whatever until you

can correct it. i have to think that this reasoning is in the back of dmv's mind for them to make this decision. why thank you. bh then american supervisor peskin tried to take down the path of of look at potential

discrepancies with -- what way mow exist in the crash data we are not seeing with cruise than way no i don't know if anyone this being be explainable if has men few are cars on the roads that is not true. we don't will under lying number

of events and we don't know the volume of miles traveled and this is why we think this regulators need to be making information available to us. that make its possible. there is more -- cruise stuff going on. . we are seeing more complaints from involve cruise. when this means is difficult to understand. >> right >> all right. >> thank you. i'm not sure who to address this to it was set out in the information and the graph. a third are way mow dp 2 thirds are cruise.

one technology is better than the other? that invites peck ligz we don't know the answer and cannot answer that with the information available. let's open to public comment. let's open check on remote comment. i appreciate the discussion. i'm calling in support of the responsible prescription in the city we know av's can provide a

safe and equal transportation option. and they are subject to requirements discussed today and beyond the federal regulations. companyings are working with san francisco. if first respondeders ensure the vehicles are operating in the city we believe that the av's improve how we move around san francisco and must activate them it intgrit them to the transportation net w to real iesz the safety and mobility and equity goals look forward to w with to you achieve that and thank you very much. >> thank you, caller. hi. your 2 minutes begins now. good morning.

chair mandelman and commissioners. the san francisco transportation authority. i'm with the chamber of commerce. offers support of the prescription of the, v in san freshman. you in we need [inaudible] revilingize our city to puttous a path to meet our climate action plan goal than i bring benefits to the businesses and war and communities. av's create excitement for visitors encouraging them to explore the city bringing energy to the economy. more we appreciate the collaboration. thank you.

so hard it try it address the challenges around av on the road and thanks again commissioner supervisor peskin for continuing it follow this. and help lead us on it and i think with this, we will and thanks to the dmv for putting safety first. -- madam clerk. call item 12. >> introduction of new items an informational item. >> i don't see anyone in the queue. item 13. why general public comment. >> is there anyone had would like to come forward to talk under item then, please, do. remote public ment on then? checking for remote public comment.

hi. call are your 2 minutes begins now. good morning supervisors and [inaudible] on the av i was not told mii make an r now? sure. thank you, chair. go ahead. >> thank you. thank you i appreciate this . i irrelevant appreciate the presentations. they were rable the level of extraordinary [inaudible] struck mow when you saw the color charter showing the problems. and [inaudible] the thing this struck me you listen to the entire conversation. there was not a single mention of [inaudible]. in the one. that describes remarkable

because tesla dropped the prop that cruise and way mow and others [inaudible] a few years ago. and artificial intelligence. the e eliminated, the other people have than i using [inaudible]. i have tried now is essential low the 16 year old [inaudible] the testing 30 seconds. 116 [inaudible]. thank you. within felony million miles, trained 200 million miles. i saw the data avp [inaudible] and 39 when they have to say if you consider them. thank you. >> thank you, caller.

there is no more public comment. opinion comment on item then is closed. madam let the record reflect. item 14 adjourn am. >> we are adjourned.

>> san francisco health commission secret call the role. >> commissioner chung present. >> commissioner christian

present. >> commissioner giraudo present. >> commissioner green. >> president bernal before we start the agenda i have an announcement to make our i want president bernal led this commission though 2020 has been appoint to the chancellor at ucf f we're thrilled for dan the most wonderful person but that position will post and as held president he resigned october 16th and we'll not be able to fill his shoes but leading the commission the elections are usually in march we thank dan and have more to say about that so i'll start

with the land acknowledgement commissioner christian will commissioner christian will read it. >> thank you >> thank you are on the unceded ancestral homeland of the ramaytush (rah-my-toosh) ohlone (o-lon-ee) who are the original inhabitants of the san francisco peninsula. irresponsibilities as the caretakers of this place, as well as for all peoples who reside in their traditional territory. elders, and relatives of the ramaytush ohlone community and by affirming their sovereign rights as first peoples. >> thank you very much. next item is the. >> 2. approval of the minutes of the health commission meeting of october 3, 2023. >> you have before you and upon review my

amendments or corrections? >> okay. hearing no one is there a motion to approve? >> motion to approve. >> do i have a second? he what about public comment. >> yes. i see a hand anyone in the room? please that unmute the caller before you unmute and start speaking i have a scripture for the scripture for the scripture for the respect to agenda items, your opportunity to address the commission will be afforded when the item is reached in the meeting. meeting. the commission from taking action or discussing any item not appearing on the posted agenda, including those items raised at public comment. individuals may no return to

speak again remote dot d dog paul h as you may also watch live at www.sfgovtv.org special your name without taking a lot of time federal, state, and local law prohibit the - first take public comment from individuals and take public comment from the individuals who receive an. >> moments for disabilities. >> caller please let us know you're there. >> limited to 3 minutes per speaker mr. shaw. >> thank you. >> dr. terry palmer and repeating raised long-term plans recurrence of the miss

management of laguna honda and - september 5th combhirltz commissioner guillermo asked in the contract needs to be spent when it expires at the end of august next year and quote laguna honda will likely (unintelligible) for monitoring and evaluation and preference for ongoing regulatory unquote and laguna honda has care for servants (unintelligible) have an spent contract. they stated (unintelligible) likely will change to orderly check ins

after (unintelligible) current contract end quote expires in august of 24 the health commission is considering the contract in an additional period of time. (unintelligible) the vehicle for oversight of laguna honda well additional contracts annually into the foreseeable future only mechanism to insure greater oversight time to present future mismanagement. and at laguna honda. thank you. >> that's the only public

comment commissioners. >> right during is there a vote to approve. >> all in favor, say "aye." >> aye. >> that passes wonderful. next item is. >> 3. resolution honoring michelle fouts, pharmd (david smith, pharmd, dph chief pharmacy officer) >> we want to read the resolution illustration. >> there is an twoogs and then i'll read the revolution. >> i'm the dr. michelle fouts, pharmd. my joy and sorrow are to read this resolution been with dph for 25 years and colleagues no one could have earned more respect and dedication not just their health and wellness but

thank you for taking the time to honor her in the resolution. >> thank you. >> whereas, dr. michelle fouts, pharmd. has served the on and off as a exceptional leader for over that 25 years and during her tenure was a pharmacist and offsets and has inspired a generation of enter professional training by sergio with compassion and collaborative disciplinary teamwork and exceptional chintion and all roles and her intelligence been a model for excellence and doing so while bringing a smile to those around

here and thorough dr. michelle fouts, pharmd. leading innovation technology and supporting residents wellness and other projects and whereas dr. michelle fouts, pharmd. partnered with nursing and technology and faculties and other disciplines in the information system and to improve the patients care. and whereas, dr. michelle fouts, pharmd. inclusive environment throughout san francisco and enthusiasm and grace and innovation optimize mentioned for all patient and the whereas, dr. michelle fouts, pharmd. been a model driven clinician and the staff has benefited for her commitment and revolve health

commission honored dr. michelle fouts, pharmd. for her leadership and contributions to the health and well-being. >> entertain motion to approve the resolution. >> so moved. >> everybody is to enthusiastic so any public comment? >> let's see - i see a hand. please unmute the caller. caller you have three minutes. >> thank you patrick good morning dr. michelle fouts, pharmd. certainly deserves this resolution honoring her years of service. to san franciscans. when i worked with her closely at laguna honda she was wild respected by auto laguna honda staff for generally by

clinicians working at rehabilitation and assisting with those medications adjustment to the free applications (unintelligible) and false related injuries and rehab staff certainly appreciated her skills and experience helping those patients. i also commend her for years of dedication serving laguna honda residents congratulations to her - her assumed are apparent retirement thank you, michelle. thank you.

>> i'd like to note that that mr. shaw threw out positive comments and commissioner chow needs space to speak i'll remind you of that. >> i see mr. p wants to say a few words and then comment. >> thank you very much. commissioners. i also want to add my thanks to michelle when she started her career no out insurance and packaging was done by hand and also and led to a

much higher adequacy and safety for the resolution she'll tell you improve the healthcare and one of the department leaders in the implementation of the system wide d hr and couldn't have done it without without her contributions wanted to add that. >> thank you. >> i apologize to. >> thank you for the opportunity also to join in thanking michelle for all her work and i've watched you and the gentleman described again, the amount of work she put in the transformation for its pharmacy and presentation and was certainly within compliance to all of the different surveys

we've had and all the different surveys has always been a very positive experience so thank you, michelle and congratulations and enjoy you're next activities. >> thank you. >> other commissioners? >> commissioner commissioner guillermo. >> you want to add my thanks and congratulations as a member of laguna honda jc c and throughout my tenure, you know. i know we relied on you not just for the time when the agency has asked for your input and clarification on matters before us but generally knowing you were email: commentac@beverlyhills.org and in front of the scenes taking of the business of laguna honda and

over has spoken about i wish you well and hope we can continue to find leaders like yourself dedicated clinicians not just laguna honda but all of san francisco.. thank you, again. >> well, i guess - may i say some things? >> yeah. >> so i'm the last member of jc c laguna honda to speak sea i think, you know. i do remember back in the day everything was done by hand as said. you can't imagine how the pharmacy has been changed and they get stuck with what we know with the evolution and how each step you

have left hand and become an expert that is valued through this vast array of changes that are have happened and it is remarkable and seen the reports from individuals so clear every time you were involved out of respect that you earned where people look to you as leader and so apparent in a way the pharmacy is the hub and the culture of an institution and never mind the come complete like 5 or 10 percent of drugs and become much more xhiblthd but the plethora of mentioned is like an invisible amount of work a person has to educate and teach others and find the

pitfalls involved in all of that you have been remarkable i hope you can teach the leadership and pharmacy and teach compassion we're really miss you and grateful for all you contributed so i - been a pleasure to get to know you and the colfax. >> michelle i want to express any gratitude to you on behalf of the department your work is very through covid and throw the laguna honda medication recertification process so too important. and um, i believe - able to (unintelligible) several

times in the last in the late year or so and one of the things that so impressed me, you walked through the pharmacy doors how supported your team as residents and enthusiasm and the can do attitude and the quality improvements which very much part of that culture there and want to thank you. i meant - mentioned to people when this transition to other things a true mark you leave behind with the wonderful work thank you, very much for that. >> thank you. >> so dr. do you want to step up and say a few words we would like to hear from you and your plans. >> sure first thank you. you

know. i came to dpw for 25 plus years and has been a great honor and privilege so many opportunities throttle ic staff - and it's been a great joy and pleasure and tried to enjoy the last couple of weeks as i walked through the hassle when i first started. beckett was under was

under investigation and i hope at one point but i think we're well own our way so thank you for the honor and recognizes and so proud of department of public health a no the vote needs to occur and i'll give you a copy of the thing and will be a photo opt. >> so we'll now take a vote on the resolution honoring dr. michelle fouts, pharmd. please say i. >> i and commissioner chow, aye. >> and commissioners would you step forward so we can get a

picture? >> all righty say cheese or laguna honda. >> all right. >> so the next item on the

agenda is general public respect to agenda items, your opportunity to address the commission will be afforded when the item is reached in the meeting. meeting. the commission from taking action or discussing any item not appearing on the posted agenda, including those items raised at public comment. and then all the information about the other agenda items pertain anyone in the room and one hand so, please caller. >> yeah. >> hi richard again. >> you limited to 3 minutes per speaker. >> thank you. >> i also want to congratulate on this new job at uscf, however, as congresswoman nancy

pelosi staff seemed to have an thinking stated conflict of interest serving on this commission. so did sort of good hearing he's finally resigned. thank you. >> all right. that's the only comment on this item. >> next item it >> 5. director's report (grant colfax md, dph, director of health) grant colfax md, dph, director of health. >> good afternoon commissioner green and commissioners i'll highlight a few of the items and answer any questions. you have. >> first was to host a conversation with with dr. fiona where dr. provided his and spent

a lot of time with the staff in answering questions and take one of two photos with people and to make sure that we had a wide range of people who worked hard on covid in the health department at present and able to live stream the event with 750 people watched this and honored to have dr. facuci and in other news. mid-year budget update the economic rally of san francisco is such that the mayor has determined we can't wait until next year for the budget process to begin and therefore instructed the department to have reductions of three percent of the general fund to support the courage fiscal year for

identifying approximately $26 million in addition revenues or saving by october 26th so we will be following those instructions and to the mayor's office and dph will work in the next session and update the commission on this response to the budget process for this year. item three pleased to say a laguna honda had a certified of extension with the department of health associated infections program and services group. long title and recognition as dph laguna honda he's is successfully completing the intervention trainer workshops and over 27 hundred individuals attended the workshops and nursing home and the laguna

honda was in the top 7 percent and completed all four sessions we are pleased to have that information it is very important training program and then we as part of the our environmental health branch participated in many communities event and training throughout the year and most recently san francisco housing development corporation sponsored work shop so this was on tuesday and people wanting to manage services for the public and the san francisco housing department corporation reached out out to partner with the health department to make sure that people understood how to be code k34r50i7b9 in the work so nice collaboration there. we

continue to partner with opportunities for all faces to provide job interim for san francisco youth we know are a core part of our talent and continue to invest because interested in public health we want to encourage that and as a covid update our 7 days testing for post is three point plus percent and 38 people with covid adopt from just a few weeks ago we were in a bit of a solid increase and the new covid vaccination is here and we're delayed in public we have that and asking the state for more

supplies because we - the demand is quite high and not enough supplies so continuing to ask for more with the community partners in that regard. he and i'll be happy to answer any questions you may have. >>. thank you. >> thank you. for the report. >> public comment on the director's report. >> ? >> i don't see any hands oh, we are on item 5 if you want to make public comment star three no public comment. >> please turn on our microphone. >> any questions or comments from the commissioners? >> i see the commissioner chow. >> thank you. >> and i really appreciate the opportunity to participants virtually and want to thank dr. colfax for sending the presentation really outstanding

and had the opportunity to view it and found him very inspiring we were very fortunate during that time to have outstanding leaders thank you, dr. colfax for resigning a wonderful seminar. if note those comments or questions we can move pickens, director and ceo, sf health network & executive sponsor lhh recertification incident command)) >> good afternoon, again expirations thank you for the opportunity to provide you an update on the status of laguna honda as it relates to the cms recertification. >> can i ask you about the

power point? >> director and ceo, sf health network & executive sponsor lhh recertification incident command. >> okay. again, thank you for the opportunity we'll start like to share an update on some of the key components leadership hires on board the two new directors of nursing and have stacey and mr. michael collins and each will be the director for nursing for one of the two respective towers you recall the dual director of nurses structure as part of early

recommendations from improving all the nursing status of operations and made the permanent structure with the improvement of those two individuals and both of them come with tremendous amount of experience and skill in nursing and proud worked her way up to a nurse to registered nurse and certified wound care that is important at laguna honda for the prevalence of nursing facilities and also served previously as a surveyor for the department of health so speaks in the regulatory nursing operation and michael collins a long term care nurse motorist in the career with the united states army and been in skilled

nursing leadership. so they and continue they're learning what we call hit the floor next week to immerse he themselves and tony the officer will transition to a support role similar to myself over the next few months to be there to help with a hand off for the two nursing leaders. i'd like to update you on the status of laguna honda chief medical officer that has been underway for almost a year now. we have gone through a

competitive process with the final stages of offering a position and hope to be able to solidify that in the next several days want to give you an update of this this status of this position and. next slide, please. in terms of our recertification journey as you recall we received the recertification back at the end of july. and accordingly do to that pros we were directed to submit a change of application that allows us to pursue your medicare recertification and that office on the 23. we received clarifying direction from the c s f for a brand new application

that is done on september 15th. and we are now in the window awaiting the survey to ensue therefore we're expecting news from c m f and department of health for medicare. procedure certification survey. and when we do receive that notice we'll make sure the commission is aware of their presence. next slide, please. we reported to the laguna honda jc c we in preparation for the medicare survey took a thirty day pause for the superstition of our relation to the surveys in december of last year. and so

that staff will be freed up to focus on the medicare survey recertification with priorities. and since that survey did not come yet we should have resolved this survey again on the milestone as we are required to dot milestones as part of the our work and also one hundred and 19 milestones that remain from progress that have between today and the last one final date of november 3rd those are expected to be completed by november 3rd and upon doing that people have completed over nine hundred and 60 milestones since january of this year. all related from the initial

analysis and the medicaid surveys a lot of work over the last 18 months but, but since the last seven months. next slide, please. we previously report as you recall in march of this year directed by cms and the department of health services to move forward with discharging resident no longer have skilled level of skilled nursing as laguna honda we started that process in april ease individuals when they first came to laguna honda had nursing level needs but by virtue of the care they have improved no longer need the department to reimburse their care and since

april 15th residents no longer have that care and the majority of residents have transitioned to the nursing care homes or supportive housing and a few have gone back home currently 10 residents no longer have skilled needs on the priority meaning close to a potential discharge in the next month so we'll keep you updated on the process and many of the additional as those come through in the process. >> and as i said i'll close by saying we have surveyors to walk you through we have taken a number of steps to ensure our readiness and survey we'll

continue that process so i'll be happy to answer any questions you may have. >> and i'm joined remotely by simon our motorist and ceo with the leadership staff and hoping 80 can address any questions or comments you have. thank you. >> thank you for the report and we're delighted you have a great team any public comment. >> i see two hands please unmute caller two and three caller are you there? >> i am. that is patrick again. >> limited to 3 minutes per speaker mr. shaw. >> thank you it was concurring about residents no longer need skilled nursing and the level of care and didn't indicate how many residents still remain as

laguna honda and roland pickens, director and ceo, sf health network & executive sponsor lhh recertification incident command. said they discharged 16 that is on adding up to 26 and initially identified something like 38 resident and (unintelligible) then i identified several more so the numbers add up and all of the people identified as no longer needed skilled care and been counted. >> 8 months ago it is appointing but quote have to

(unintelligible) certification end quote can't chart the timeline so in the group chart readiness since july 11th executive team reported and jc c. on july 11th this chart import anticipated by mid september haven't had the initial recertification for - seems reasonable that that 90 for monitoring be conducted and more concerning laguna honda has to be able stopped producing the reports when additional fees are

identified during cd ph complaint and (unintelligible) stopped providing the mom reports due by "each month did that mean the entire laguna honda formally ended if it has need to be honest with the public and let us know we're still under the threat of that each time or whenever it is completely revolved. thank you. >> hi this is dr. palmer i may be repeating previous

questions but 45 people waiting for placement outside of laguna honda no longer than needing care but many are discharged so what happens to the other 20? and all why aren't there enough services to safely place them in san francisco? my other question is, has dph caught up with the complaints were investigated or important to that they were not sustainable and not current? i'd like to this gray area where dph never showed up it is disturbing. and the third thing is that i would like to hear

more about how the admonition criteria and the chief medical officer and staff will be supported not identifying appropriate people in san francisco general. to either jeopardizeism at laguna honda. and there will be huge economic (background noise) >> someone needs to mute there's a lot of background noise (background noise) please hold my time someone needs to mute. okay. it seems like will be a huge amount of economic and political pressure (background noise) to take in people from to

general who can't really handle safely at the laguna honda. because they should not be put on the street or places like medical resolution piece with inadequate health services this needs to be fixed in the city not laguna honda. thank you very much. >> that's the last comment. >> thank you for your comments and any questions or comments from the commissioners? >> commissioner giraudo. >> yeah. >> one question on the discharge finding it challenging? >> sure has the radius that your able to send those folks to? within state the bay area? >> that's a great question. so it varies we the san franciscans

resident will keep them within san francisco and for example, one of the individuals will be relocating to another state and waiting arrangements at the home for medical - ability to be at home but the rest of san francisco we are doing everything we can to keep them in san francisco and have been successful thus far to my knowledge wanted to stay in 0 san francisco had to go oversimplifiers somewhere else but it is challenging one has

disappeared in the san francisco landscape but continue to have success because we're competing with every other town. and we are fortunate to have the charter we have and given the unique care of individuals at laguna honda they may not have 34 have needs just don't rise to the level it cms requires. be reinsured we make sure we do safe discharges and no one is discharged in an appropriate manner. so that's why it takes a while and not as easy and all the individual have to be gone next week because the doctor throws people out. and

(clearing throat) i applaud you for your continued effort. thank you very much. >> and i guess i have one question. >> help me clarify the number kind of more individuals. >> 15 have been discharged thus far and 10 on the priority and in total 75 so continuing minus 10 the reason we are making this a priority i can't imagine it is impossible to focus on all 75 that has been done previously so the chart flow the complications in california public health it is made focus on the protecting and identify 10 or so everybody

including them they're trying to find places for individuals so there are a total of 75. who are priority currently that meets the nursing level of care and it can change for example, in an intervention and transferred from the care and no longer - so is this a fluid have some numbers they often change weekly but right now as of october 16th the last report total 75. thank you.. thank you very much. that clarification is really helpful and can you comment about the collaboration between the dph and laguna honda places i went when we were forced to discharge individuals and that certainly

was a stressful period. and more collaborative effort and understanding the barriers because certainly was not necessarily an understanding of the availability in that situation a year ago. >> absolutely that is a much more collaborative process this time around than in that friendly time of last summer with several discharges and the collaboration biosimilar in san francisco we work working closely from my own dph behavorial health and you recall we had a transition network (unintelligible) and we've called on one of the increasing leaders that actually maintain many of the beds that dph pays for for the care homes and that transfers to the redistricting

of the network and for the behavorial health services, however, this is a stressful situation at laguna honda and we have city departments and homelessness and supportive housing paid for by the department with the human services and the department of aging and working collaboratively by community-based organization opts and partner with dph and public health care services for individuals for homes we can't find places in san francisco we rely on them to help identify places outside so this area. >> thank you so much. it is clearly complex i think we

appreciate the staff at laguna honda is doing a governing board so we're going to expect positive results in the next survey that is (unintelligible) thank you, thank you commissioners for the presentation. >> you're welcome and the next item on the agenda is. >> 7. joint conference committee and other committee reports (commissioner tessie guillermo lhh jcc chair) >> thank you commissioner green and october 10th hogs team meeting reviewed the update and that update similar to what you just witnessed. the city discussed the presentation from sdtd behavorial health from the laguna honda behavorial health improvement project. all this given with the laguna honda for the behavorial health issues. something we've been hearing about over the last two years

and includes the housing to adjust to situations and identifying staff training needs and working with the molds with the units for residents with complex behavorial health feeds. laguna honda will determine the next steps. the hospital is increasing the button projects for residents with dementia and remind the laguna honda admissions policy include of behavorial health are not appropriate for unskilled nursing levels of care and resources and regulatory affairs report and recommended the policies which will come before this commission in the consent agenda in a closed session

approve the committee report. >> thank you for that. report. any public comment. >> yes. i see a hand. >> please unmute the caller. >> thank you are you there. >> yes. limited to 3 minutes per speaker mr. shaw. >> thank you see that commissioner giraudo didn't mention on the third, i testified the commission to laguna honda is being delayed because of a therapist and laguna honda patients is two hundred and 26 fewer patients than in december of 2022 before

laguna honda decertified so reports by the f pe so laguna honda has fewer working (unintelligible) because the clarification codes no october of this year and in december of 2021 have fewer vacancies now. (unintelligible) in december of 2021 and now only (unintelligible) for the working vacancies. so 2.5 fewer. laguna honda is now only 6 more vacancies in activities therapist and 25887 and 86 and

in december 2, '00 and 26 fewer residents. and from 2021 vacancies only 17 now. with 200 and 26 fewer patients and however that laguna honda new medical director will be hired in on board soon and it has been paving delayed to over due. thank you. >> and another caller with a hand and give the caller a chance to raise their hand again. >> thank you. >> commissioner questions or comments on the report. >> hearing examiner go to the

next item. >> 8. consent calendar. and commissioner guillermo said we received three 4 applications and recommend all policies to be approved by the commissioner at large any public comment on this consent calendar. >> we're on item 8 for consent calendar if you want to make a comment stair three no hands. >> a motion to approve the items for the consent agenda. >> second. >> i guess i asked for public comment i'd like to thank the members of the staff at laguna honda for answering a lot of the detailed questions and our role to review everything as commissioners and we try to do our share review them and approve. so been i think very thoughtfully looked at an

excellent policy with that nickel and dimed. >> all in favor, say "aye." >> aye. >>. thank you. >> the next item on the agenda is the creekside at cabin branch welcome noticing and i want to let you know that in addition to the work i've been doing i've been doing a lot of work with laguna honda helping with the recertification effort doing that and any questions on the reporter i'm not able to answer i'll be sure to answer. >> please pull up the power point for this item.

>> (microphone distorted). >> . thank you. >> hey this is manual report informing fiscal year fy2022-23 from july one 2020 to june 30th, 2023. so those are the areas of responsibility for oc pa in

compliance data sharing and investigation. next slide, please. and this is just a sort of summon of some of the highlights that um, were conducted in the fiscal year. and. next slide, please. and this is the organizational chart to give you an idea of the work for wagner in operations indeed and this is an organization cp a organization idea of departments. next slide, please. and oracle so, now on to the compliance program and the compliance program that dph concludes themselves and all the operations and activities to highlight the level of integrity and we do a tremendous amount of auditing to make sure that we are billing correctly so in when

we noticed an olney noticed and billing that was incorrect we'll have an allowance for feedback we're to - (microphone distorted) so allowing that fiscal year fy2022-23 dph returned $1.2 million in as a result of external audit that was from the department of health services the public program that um, we assume the covid public health department emergency and all in that fiscal year. they did da c h suspend their audit and not

$1.2 million in one year but a catch up and those were for non-qualifying stages so not meeting the program insufficient documentation we have this dislowering this we work closely to make sure that it is correct so don't have further disallowances. and we really take this seriously but do, you know. very audit to make sure that whatever we're billing the government is correct. um, on a good note dph has no penalties from the regulators in that fiscal year. next slide, please. and so is this just a year to year comparison. so and

emigrates define of a fiscal year if you look at 19 and 20 and 21 were for the doing my audits we've been doing it remotely but no audits and (microphone distorted) 21 and 22 it is tapering off we'll continue and on to the inducting hoping we'll see that goal move down. next slide, please. each year and a year assessment from the laguna honda and mostly for the laguna honda a population a new program we

actually have started that as a compliance and privacy program so we'll have a risk assessment for the year we're no so laguna honda those are the areas we really looked at and (unintelligible) review it was just quoting that was medicare cms rather were really being focusing on the (inaudible) with the cat rack surgery so two midnights for the observation so we were paying attention that's another thing we spotted and then drug and cod define to laguna honda had a notice of

non-coverage and making sure this is all in place and having that own the next report. and. next slide, please. and so for behavorial health behavorial health we um, this is for the mental health plan the behavorial health is a compliance program with mental health and documentation and integrity provided by our contracts providers. and we audit kwubt if we have over a 5 percent audit rate the procedure to do a corrective action plan and monitoring we also witness that because they - documents and they need to make sure the

documents is correct and everything is all set. and that as a motion as you can see we need the a total of 27 clinics, 27 of our clinics had over 5 percent and like i said a monitoring plan and just note that in odor for no audits completed for two reasons. one, needed to insure we revise our audits to the new remits and also had retirement and promotional activities actually several audits at one time indeed and this is just a comparison um, of your - we're slowly getting it down we're going to continue to work on

that and okay. next slide, please. and some of our complains mitigation we do a privacy matter every other month and take a topic one topic that is - we really want to make sure a reminder for staff like november we'll have that an - a big topic for the holidays and send out the responsibility under this is one of our education things we eye for staff. okay.. next slide, please. the private school program i'm pleased to say that fy2022-23 no privacy related fines for breaches and okay.

next slide, please. . okay. so on this slide we have our privacy incidents and um, our total incidents and we have um, our non-reportable incidents. a responsible breach is an incident it criteria - will be something as somebody posted a video on social media. that is the one control of that d h if someone lose paperwork with information on that and not reterrified that is a reportable breach a non-reportable breach and very quickly able to have

that double deleted and not gone out anywhere. and so our incident we have d s p has 74 with 11 reportable breaches and laguna honda has 75 and behavorial health had three 1 with 6 reportable and the clinics a lot of the clinics had 17, 7 reportable and cb o have - and when we have those especially with the reportables we do a lot of onsite training with the staff and make sure they understand how they can handle d h i. okay. next slide, please. and this is just a comparison for the fiscal years as you can see the reportable the number of

breaches really has not changed pretty constant one thing we need to work on and. next slide, please. and this is our privacy policy one of our that is a privacy we um, issued this ever two months and this started in 2012 with san francisco general and issuing it ever since then a really popular and so we take this topic and look at what are some of the breaches and incidents for that time period and highlight a reminder for staff. and okay. next slide, please. and so data sharing we manage and oversee the data sharing with dph as heart of privacy program and we make sure we have data sharing agreements in place

any data that is shared correctly and things in place as working closely with it and the city attorney's office and other comboibts to make sure the contract and have everything in place a data sharing agreement in place and so that we got our contractors or anyone that is making sure they know their responsibilities and whether the dph data. next slide, please. and this is our privacy and compliance we do annual training. this is a mandatory training two parts was a modular and have the training slides and part two is we do an electronic in which the code of conduct and

our confidentiality stated with part one and two with a privacy and compliance training completed. one thing we need the last year, we - when a privacy compliance incident and we surveyor comes in and provide information with dph and or office of civil right they ask about the training and compliance how has this person been trained and our compliance was not very good so what we need the, you know. if if staff wanted to have access to a system needs training and need to look at the code of conduct and sign the code of conduct and looking look at that that and sign the confidentiality

statement and sign they read that confidentiality statement so we are going to cut you off the system and sustain your access if you don't. next slide, please. it worked we had a - 99 - the 98 or 99. >> 98. >> 98 percent compliance and that worked. it was, you know. and we're doing it again this year and with the training because it is not hard training in piece 0 that worked and we're confident it staff at the system - . next slide, please. our whistle blowers program we working closely with the comptroller's office they get

complaints and the majority are investigated we do a theory investigation. we will investigate and then we'll write a report that we submit to the kr0er78dz either substantiated in the allegations are substantiated we'll take action but unsubstantiated we across the case and had 72 cases from july 22nd and dph has the highest number of cases but we work with the reporting when we see something wrong and, you know. really work with staff and if you see something, say something and error on the side of caution we'll investigate and we file with oc pa have a

hotline and to let you know this is the information we or allowed to share the comptroller's office is very, very tight with the information that can be shared on the whistle blower program without a quarterly report and the information that is on this slide as on the quarterly report and that is the result. >> okay.. next slide, please. and our hot like that we maintain a hotline for various reasons people can call and a lot of proclamation people are calling is that confidential, etc. we have people calling to be reported and perceive wrongdoing and many calls many

of them are had to do with the training from the other fiscal years. a lot of people were, you know. (unintelligible) getting our access, you know. suspended the hotline was very useful. next slide, please. and so is the end of my report and if you have any questions i'm available for any questions that you may have. >> thank you for that report and complicated and critical function of our department and thank you and our staff for you're fine work. any public comment on this item. >> i don't see a hand if you're watching we're on item 9 if you want to make a comment star three. >> what about commissioners questions or comments. >> thank you i was wondering as

you were going though the areas for compliance whether there was a need to then also have audits on the primary care or the billing processes or did not have a problem. >> we did that part of compliance program for auditing on we currently dot climate and started on a positive recommendation health and ambulatory care programs that is in place right now that is new. we need the hire a privacy compliance officer that started to do audits so we'll have a next available report on the status of those audits. that is adding. >> so it was not reported here in this chart that's why i was

wondering. >> yes. >> and thank you, it is good to add that on. >> that will be added to the program. >> okay. great. thanks. >> commissioner christian. >> with the slide on behavorial health services and the trend and it talks about fiscal year fy2022-23 and for the clinic audits and 27 of the clinics had an error rate of over 5 percent talk about the surge the documentation is not for the billing so it was documentation. >> we have some work working closely with them on documentation. >> (unintelligible). >> that documentation did not

support and not a question but any relationship any relationship between the fair coding and over billing or anything else like that. >> we catch it before the billing and auditing when we find of error or so we don't want to miss bill we find an error and if we bill and do on audit and find that was um, that is disallowed so they need - have to pay the staff. we get the pay back from the contract our. >> so looking at the numbers with the offer 5 percent error rate from our experience is that

high or low? >> there are slightly going down they're still high and need to be lower but they are slightly going down and we find those errors we work with the providers and they have to do a collective action plan and monitor and when they have errors they go to the monitoring we recommend that. >> thank you. >> (clearing throat) looking at the last slide and report thank you, regarding the hotline and oh, yes. >> do you need to be an employee to call. >> anybody. >> anybody we have sometimes, people will call and report some maybe wrongs they want to look for i saw and the looked at it

extensively and, yes calls from the public that, you know. say - this happened to me or, you know. whatever. a variety of things people from all over call not just employees. >> thank you for answering the questions. >> commissioners. >> thank you and thank you for your report and the auditing and compliance a thankless job we barely understand how important that is with the functioning and ongoing integrity of services we provide into our ability to bring revenue - to the department and to other cities so. thank you very much for all the be work how is that not

related to the survey. survey report that or the survey that happened in the different facilities by the event if a privacy issue unanimously came from the state is that something- >> (multiple voices). >> it will be captured a privacy issue that something contact for example, similar we have this amend privacy at laguna honda so the city the privacy program has a privacy officer at laguna honda and the hospital for the clinic would have been (unintelligible) would be captured. and then if it was substantiated than that is

reportable not substantiated then an incident. and have you noticed in the efforts at particularly at laguna honda with the network around much more diligent. >> i think all the way around i think that we do a tremendous amount of round competitive staff for example, i, you know. ask questions if i see a computer monitor has a chart open and no one is around i'll focus on all the executive staff. why is that? we also have noticed that staff is more diligent i think when i started rounding i used to

(unintelligible) see paper with information that kind of is sitting though location now has a cover on it staff are much more aware and we also do - well the general laguna honda but in addition to our modular we do training and the food service staff. and environmental health staff that (unintelligible) where english is not first language we have training and for privacy and compliance. >> good to hear. >> and the last thing i want to thank you for all the work you've done at the laguna honda both in our current position and in the past interim role we're

lucky i guess to have had you in those roles thank you, again, for your work and. thank you very much. and the compliance training and percent is remarkable we really thank you for that. and other than that we'll go back to the chief integrity officers to talk about the training. >> you would be doing this first but will be very quick. i think if you saw in my annual report the context is all sown in so. next slide, please. and this is i'm going to very briefly touch on those topics. next slide, please. um, you know. our commission of our compliance with the dignity for the twenty-four hours

operation and the finding of the compliance and for regulars. next slide, please. we operate in kwoerns our program follows the 7 elements of compliance program. next slide, please. and those are the elements we have followed and incorporated into our compliance program. next slide, please. and just um, this is one thing for combinations really paying attention to fell and monitor for fraud and tax pair dollars and services we not only dph but and and i and make sure they

bill correctly and follow on all regulations next slide, please. >> just san francisco policies involving the government we had a robust audit and fraud enforcement and that increased fuven for the federal agencies - . next slide, please. and deficit to provide detailed information and written policies - we do very robust policies on

compliance. next slide, please. and so the dph we have a vaurnl dph constrict around 20 pages but as much pages this is standard and really our commitment to this compliance of all the regulations. and it addresses side behaviors we like our staff to follow. next slide, please. and so those are the topics that are relate to the compliance. better in the code of conduct like i said with the privacy training complete code of conduct is given to the employees and they need to sign they read it and understand it a signature. next slide, please. um, this is important an for policy to be aware of conflict of interest involves any

circumstances where has a personal financial interest and properly influence. and the city (unintelligible) and arises from different scenarios like using your position at work for benefits and accepting a gift in november that notice of gifts and authorized outside of employment for the depth and oc pa will make sure no conflict of interest. and. next slide, please. um, our statement of credibility is compatible the s i a citywide and all city departments - and this, you know. listed the activity compatible with the city officer

or employee. dph goes one step further only attributed to train open that we have a training modular that is very short and sign they received the cable activities. next slide, please. and so kind of what are your responsibility with the provision of care and services, you know. that monitor fiduciaries duty and with the oversight of dph i look at what the duties of this commissioners are falling into all of this, you know. your responsibilities and the different committees we have and understanding of dph

operations. next slide, please. and um, you know. this is recognizing in compliance concerns with the employees and officials to comply with the laws and regulations and the code of conduct making sure that their licenses they're working within their scope of a conflict of interest and if so and actively participating in the training and other compliance activities. next slide, please. and duties to report all employees need to report from they see something they need to report it and anyone what call the hotline if they notice something we tell people and the staff error own the side of caution if you do something that

is not right report that and we'll look at it. and consequences of violations. you know. all potential violations will be investigated by oc pa and once the investigation is completed we'll resolve that and then close the case and if needed we work with h.r. and labor for progressive or correctness of this and. next slide, please. so this is the the report in in a in a nut shell. >> sorry for going fast. >> thank you for covering that information in a sufficient way and thank you. >> any public comment on this item. >> i don't see any hands and remind the public we're on item

10 and star three to provide comment going once, going twice. >> what about commissioners questions or comments. >> thank you for the presentation and the training was very effective and also very interesting. >> thank you we're all saying the same thing and not recycled. thank you very much. >> thank you maggie for your service and routine so team members she has and on the entire presentation a large number of vacancies and also in34e7b8 she humbly mentioned in the laguna honda recertification where compliance will continue to do so that is important and one thing burglary compliance

working when you don't hear about it so that's the job that we make sure that leadership is highlighted and analyzed so incredibly important for the department in protecting the health and health of all san franciscans. >> thank you very much for that pointing that out much appreciated and next item is. >> 11. community and public health committee update. >> two interesting presentations this afternoon the first was the public health and looter first presentation to our committee we want more. it was approved in 195 three and the total is

adequate example timely and low cost prevention and it is part of national lab network and will influence the federal and state outreach within what they do they're what they do the diagnostic testing and monitoring for emergency erroneous for research and workforce development training. in 2022 had one hundred and 63 thousand plus that they monitored. they have been recognized as a center of excellence and we are all most fascinated by they're new

testing equipment and they will be moving to building 5. with the brand new lab and promise we'll all be invited to see the new lab and to hear more about the facilitating machine so we thought that was an excellent presentation. the section presentation was learning innovation in population health and again, it was very informative and we had i been a good exchange with the commission as well learning innovation is both as the internal workforce development and external assistance. what the workforce priority for 2022,

27 are the wind programs which is the equity and when i really appreciated the session part of what they their priorities as well as coordination with h.r. and one of our concerns have 27 percent vacancy rate for employees. and they have had a substantial hiring issue with burn out and retention and torn is 7.2 percent that is all down a little bit their goals with the capacity and strength and promote equity and we had more

substantial and i ran for the summer research program with the population program that is relatively new for a 10 month training program. the cd c with the hiv testing they have been disseminated what i was leaning the sf program have put together one hundred and 21 learning courses for both internal and some to external and they have their part in the year 5 hundred plus attendees. and they've done a remarkable job with the

workforce this is down it was very interesting and had very good information exchange as well. so my fellow commissioners want to add to either um. >> i like to - one point. there were like one related i don't think they presented it it included the first one about the department and, you know. used for. >> no, no the first one the first thing was invasion of body snatchers. >> the second one with the um, they had a film that accepted to

the apa festival and called the heart of access and we were trying to ask if we could get a sneak preview of the film. >> i also want to add my voice to the what a great presentation what great presentations and first, the labs the public health looter i'm struck at the quality of people and the

expertise and potentially reference to the film from the lab people with the body sfachers no idea the drift if space and replicating the residence one body at that time the four floor the population of health so they - something i'll be watching. so also thinking i wish i would have thought of that when they were here. >> last year with the testing for covid and i noticed that from the beginning testing was available and toward the end getting the test results was not

able and from the presentation from the folks that are responsible for so many things like that was interesting. so really much appreciation to them in that distinction. >> that was a wonderful report and a testament to their quality we have a dph and discuss the presentations sounds like you heard any public comment. >> no one own the line but note the 234ri78 with steve mcqueen was filmed in the 70s that was filmed on dph property. >> i don't know if we have a film. >> no public comment. >> all right. make that public meeting then then we have - and any other commissioners questions or comments all right. groundwater next motion to go into closed session. is there.

>> (multiple voices). >> i forgot at the bottom of page any other business? >> hearing no one any public comment on this. >> hearing no one. >> no public comment. >> now go to the emergency closed session. >> so moved. >> and second. >> a new public comment on this. >> no one on line and take a vote shall we go into closed session. >> all in favor, say "aye." >> aye. >> great if i can note anyone watching not seen or heard in closed session but the commission will be back (in closed session). >> consider a there is a motion and a second to disclose are not disclose. >> not to disclose. >> all in favor, say "aye." >> aye. >> and xhorpg thank you, now consideration for jouchlt. >> move to adjourn the meeting. >> second.

>> and commissioner chow, aye. >> thank you, thank you everyone have a lovely. >> thank you board member strong. >> okay. thank you. >> [meeting adjourned]

>> item 50 is resolution calling on department of public health to provide medically necessary transition related care for transgender related people and remove restrictions. >> in 2012 gender health sf was born out of advocacy from community stakeholders and local leaders. really as response to providing quality, accessible jnder aaffirming care for the most under-served. (indiscernible) the way i see it, there is two ways of folks we serve at our program. the first wave of folks who never imagined surgery access was accessible to them. many folks who had to save money or par ticipate in underground economy to access the surgery outside

the country. (indiscernible) really to make something real in terms of being able to connect with the gender identity and external (indiscernible) and so transform so many lives of many of trans folks who never imagined it was accessible to them. now we are in the different era and time where transrights is in the social political and general (indiscernible) and now we are serving young folks to support them and making sure their gender identity is connected to who they are, so providing a space to support transfolks to live authentically and that is the goal to provide the level of care trans folks deserve. >> when it comes to access to healthcare, while we all believe in cost control and make sure we deliver healthcare in a cost effective manner, i dont think that cost is a

reason or legitinate rational to exclude people from healthcare (indiscernible) colleagues i ask for your support. >> thank you supervisor wiener. colleagues on this item can we do this without role call? same house same call, without objection the resolution is adopted. [applause]