versus having i eëif there fa primary estion. dr. [indisce >> >> hi. s.you commissioner. th whaki education grated for do outreach klclinics refer patients who to control so they can do the environmentalthe resources are not available to that hopefully in the future we can get it back >> okay, thank you doctor. i hope so, because as you w, in often times a parent doesn't havef intime to really about particularly asthma since there is such a increase in it.if ther education seminars in the clinch as southeast, atare advertised i think it would be a service to of the families. i xñto possible in 2025. thank thank you. >> any on alright. next agenda item, which is the overview the dph program ng

performance etrix and welcome jenny. od jenny chief operating officer here to present thesentation has the finance committee members but thought it would be great to educate the entire commission. in the process i think questions as members of íthe finance budget committee asked to contrac question is hoy do ow rking? how do we know it is re, again in the data driven do we know fwraum a data functioningism i have stripped down all i there have commissioners have seen buebt [indiscernible] but really there is a lot of terms of contracts, approval, ng, fiscal monitoring byththe role of presenta just ocess and the monitoring process so you real unde it st. not intebe a full blown of what program monitoring and comp were questions that have we are happy refresher.

we sent a nsive presentation given to the commission over 18 ago ere is a lot of ntext and trying ng on that metric question, but there is obviously a these metrics that i'm program and financial monitoring co with that said, i will dive for the agenda it has two parts. i will do program monitoring and business--[indiscernible] walk through the process and then i will go how performance metric are the metrics are developed by office contract compliance but for ease t presentation i will present the information, but i'the business office and and hiv health service should yoabout the monitoring process are available to answer questions as well. we'll hopefully do our best to business office does two is program when they look at individual programs

have single agency have multiple contracts for different the program mothe individual that program performance with objective oued is performed by the business office of contracts compliance. in addition the city has fiscal monitoring and this is ing at the fithe organization and not nethe c"actual performance dual is overall healthch is done the agencies with ar threshold have its moni the those based on dph we will and manage that, but those are done in with the hese type there is areas within dph that does compliance with monito and and quality programs throughout he the network and population the area focused on monitoring in terms as i ctment the the fiscal side and then really ing down in terms of the metrics that next slide, pleas so, in terms of the program

monilrvary by section and monitoring take pire completed year. the reports tend to use and sutities to insure compliance which is through the helt insure receivreport and quick spot check, sometimes members the summary, which didn't ha i think we were braps trying to spare page ]1report times 10 contrac think the questions were there and so we will insure you ll as well background on4 being monitored. me [indiscernible] if it is a new program, it will not comp we have somenon-direct are more administrative in cernible] for a few exceptions there is perhaps require specific didn't seem necessary to layer on a monitoring report. e, you can rough timelines at we have different programs. these are aspirationi think there is variation in these are overall goals and

tend to the [indiscernible] shiftethe federal funding. getting into the of there ries, whicram performance, is either standardized or ive performance m there is deliverable's, which is units more outputs un served and client satisfaction sted survey and then the four really client is quite this, more like do comply with ada this presentation will focus on e not going to specific comp the nextmore into a sample and a onal timeframe how the metric are developed and are reported 6. an the report. k if we were looking at a ogm monitored by fiscal year, we wo program managers to the metrics year and they submit the rethat are appropriate and memely and data is available and are then they jectives on our

website and through the over the course the fiscal year, july to e cbo perform submit the data, and submit it on the time they choose, but all the must be submitted for the prior year by septethat year. basically thre program time period. ofat which point, the mpliance comes in. they conduct the monitoring visits.analyze it and objeibleecompliance and distribute reports and based on are being monitored. i had a question from terms of contract programs, have 476 that are cbo and 54 shows the areas that we e through the bocc. the next just drilling down more e monitoring report. the type ed on the website. the right side, a screen and vioral health service adult and if you click on the link and i

got a screen shot on next slide, you'll see a set of these areas.foprograms, they are required a standard secreate exception rules that are noted and you will see that slide, but they ca metrics as think in certain cases depending on the ogram th have but individualized metric depending the service area and regulatory requirements. before, area in claiming and billing where we receive a lot of datas more consnote, during the pandemic we did data, but we held a overall the had and outputs. in fisc a and 21-22particularly around [indiscernible] still heavily deployed time for covid purposes, we provide those sumerary scores, but moving forward we are hoping

focus on that and moving forward. a screen shot of what you find if you clicked on within of so you will see performance indithe outcome as a process.n, thr is where they may exclude or include the type of service just make sure approp@ on i a ilthof th, d 3 is calculated.slide, please. going into e scoring, again there is two components each of th going to statistical by a narrative report here as well. again, developed by the system of care see the data here and see qualitative narrative detail just ure if a program has [indiscernible] that is the narrative section does. =ifficulty

hearing speaker] comments in terms of the data outputs provided there. similarly, with satisfaction, calculation which inclus percentage on submiof and the performance in tryingthey will actually note in the narrative report in this that they had return rate 90.3 percent.ides standardize way looking at it. next overview of the monitoring reports to talk about how the metric staff and we'll dive into two areas. service, which has probably the most contracts that members-the committee see as "& well as service which has significant amount of data. next slide, please. in terms of the drivers of oral health metrics, vast majority and contracts compliance requirements. also have continue quality

through d also again can op for lated to individual programs as well. the type of metric they nature. soch as compliancogram the letion of objction in rehospitalization a lot of interest in the note the process and compliance because it gives more texture and of data quality. if a assessme in a timely manner, in terms of accuraother purposes beyond like general population may e if you got it in a interest in the outcome type of metric help tell metric story.s of justa peak ahead, very very ea know, we did them more time and stabilization, stabilize the system there is more to come a

what is possible catch their breath now.next slide will cus just adolescentdata, required dhcs anthe assessment process and individualized plans. an ex is 90 percent of new clients e a assessment and submitted within 60 days episod of outcome 80 clients prove [indisis a similar t called ansa.and strength assessment. in terms of the drivers t, hiv health service has ize contract deliverables and ar the tric are primarily ral [indiscernible] recommendations and s we have to standardize the metric care and teof our metrics hdthat we started in san francisco were federal as well whcame out. in terms of metrics used, service such as id possible.retention to care

and getting treatment as is service and basic life kusing [indiscernible] beyond just the clinical services.. in terms of examples the metrics used, viral suppression is part of getting to zero program, and coupe cypost and lower sehieve.insuring medical visits alth clients, at least 8 0 percent and is ahead for the ng lasting injectibles require to look at different ways to look at ll at population, whiccontinuing to age and expected to large majority being over 60 in the next expect pev'disability and aging as well. next with that, looking is next, i will note, beyond the work we terms of stabilizing the and is new legislation in the city

for profi it actually expands to regular financial stability to include programmr requireto wide standards focting office is beginnin stakeholder process now to those ovember. with th controller office. we believe we are doing of when did a lo of its city wide monitoring took lot of %@our templates as a way for we'll work and watch insure we are ent process across the entire city and wia with that, that was lot of inform happy to answer any questions and joined by all the experts in that helped me develop the materials fo a lot of le and happy to answer questions u much for the excellent presentation. you have a real unbelievably complicated information into a very understand we really appreciate that. also need teams, because this obviously requires a tremendocollaboration and is the mber of topics, very complicto i want to express to

fellow commsioner chung, commissioner guillermo and sioner in tremendous amounts of the detailed nitty-gritty we understand this better and for wonderful outcomes as you pointed out. these programs remaabsan sco, is there any public comment on the item? >> ere anyone in the room that would like mr. shaw, you three minutes. mr. manette sh try one more time. mr. shaw. there is no ú!public comment. >> we'll mmstart with commissioners not on the subcwho ttee and have the make their comments and questions. any questio few questions and i prsaid this is deep process is.ect if

wrong, but in well as the finance and planninwhat the chromeer and new regulations, help or pldoes not happen correct that will 72 performance as well as things i guess is my there are a few goals of the legithe board of supervisors, we are required approval of contracts over 10 mi dollars so you are seeing most of very contracts across the city experiencing similar sentiments members of the made as. i thnumber of profit and i think this came i think beyond baker place, there are other the departme financial instability i think one of the changes that was made as a that, which is really complex the pandemic and i doto simplify it too but i best to but some ha

that instance, previously wthe fiscal monitori by the sort of we didn't want to year because it was a lot of commission doing a lot of work collecting information and all the information has from the pri thinking was, after a while theyand in the arthe d lighter touch ono8 th lot inthe wi improve the mes monitoring continues and expanding an maross pr what you presented, still .involved )with is in so i know what doing and your department is light years ahead of many other your lu presentation, becaus helped me further understaof appreciate it. thank yo. >> i realized had a questionsioners percentage of the programs monitor considered---vast majority of them. we do it is on of 1-5 with

p average. overall you will see as you them have acceptable or above rating in terms past year performance. >> if you offer ce to help them do whatever to and they do not through ing spis, do not comply with the offer to help them out? you offer assistance and do not cooperate with the se the assistance. in all good faith you tried to with their monitoring and they did what e]d@ >> so, i thin multiple kind of like levels of flags if call them in fiscal monitoring. first, therjust may not trigger sistance, then step up, the findings ated or if there

issue that brings concern, that's when technical assistance is kind of mandatory. are level, the fi them technical assistance.believe if did n't wonot cooperating with technicalstthere another level up red flag status this iskindh'highest red and with that level the departgets th defund a agency if gered flag status. fiscal 6 years seen one agency go up to very rare occur >> is . is it not there is different >> i appreciate that, but to understand the ere's always a few in other city departments as well as that have gone a bit wayward in th >> [indiscernible] >> thank you. commissioner christian.

k you president green.%you so much foonce again, inform prthe ng about and i understand that--i am fit monitoring ational requirements that are man and ese are services to people in the ci risk and and very important that engaging with the residents and just like it is across ard in we city have hr requirements. certain you must do an if you know /+or of also present in a look not it is necessary or useful to have certain for people ices through s

and alsovr information-providing to with the organizations and being vague a lot of organizations provide are referred they are programs and they are individuals th me are those employees required t and the kinds of things organizations require employees to take? have that information.out,terms of the controller's office to ng financial operational performance and developed and in out more information for you on this, november and it dramatically different fro we currently track on the the other i sent very late uld not expect you to but we can look into that. you mentioned office interacting with stders, e of who rs are or ways to

give input on -the categories of stakeholders us consider? monitoring group and a pretty extensive list at this of the cbo's they reach out to up outreach ings is legislation to get input as they deveeir updating policies in november and i expect this a fairly itera process as we get through to november. i specific list ser as the controller's gets the [indiscernible]all the contracti be comprehensive in terms of everyone who be impacted by this legislation that way they wouloutreach and te to r engagements.ank we'll probabbut coming to us to provide a evolving of this extend report back. wthe quirements are and how different or not they are whatdepartment.directed city wide, some departments that perhaps be regulated as we are, and so k a nging everyone up to the to see in terms of what these policies do anw different they will be from our current monitoring policies. >> thank you need to hear when

you other commissioner comments?for presentation. i sit on the finance and program it is always really good to be able to hear as often about the processand the responsiveness that you have had me particularly, for that. appreciate the rs detailed responis question. i do have one specific question. i always have to that san the and county of san francisco, whic from i think what is structured in otso the complexity and pe has ch on the sector that which is--has varying of pqcompetency and

resources in order to fulfill standards are the kind ofbe reminded of. looking at the responsibility the e ller has goals to standardize and monitor. but i think it is incumbt are that complex to really get to iterate can get better, because ultimately we are trying to g for the residents and citizens of franciscto just acknowledge it is and to bring people into time and effort intúj as difficult the acknowledge that. having said that, i do think because is complex, in the bureaucracy a tolook hing that i think i'm the most concerned about is we we do ect real time as quickly as we can.analyzing it is data time data is collected and when itwe are what the tddata is [indiscernible] just ;wondering,

how difficult is it king specifth aspirationally try to collect in and when the report comes outhat the public, the commissispond to fashion to renewals,nesolicitations, or isues something that ofyowithin nes, is co why the thded tinginbj so, to ge soofme n is caare also getting significant number so be ng these monitor reports are but at ways bureaucracy and implement it faster. >> thanyou. something that would i think in terms of et the department ;jand then we have to the funders as well as the ld really try to again, work on lewe have advantage in the controller's office familiar with the kinds of things ally and those hopefully we'll be able to make that the the

right for us to continue or to the bureaucracy as needed to be able to do that. want to acknowledge that that the fact we are ahead xk of the game in terms of most the other departments in doing that twee do is t co >> thank commissioner chung. >> i just all the commissioners in thanking the io i think the evolution of the beenget to th point, and i think are really excited to see what how this make decisions and also like in transparency and like better job in like public to you know, like the nature of the work and how the fung/ --what's the word i'm looking for? not so the bureaucratic it, but last th is everything.rnwe start asking harder questions and hope these harder questions are helpingus in the direction of like where it is to a

like commissioner guillermo said, the fact that we other departments, it great work that you all are sometimes you v([wknow, we might we have one shamong we very interested in hecomes every citizens in this particular city ane.)< thank you. comments or questions, we are so lucky to be associhave done such diligence and work with you i k course, once again, gratitude to the anging this to a new handling ng amount of complexity and appreciate the work and look forward hearinlegislation will effect the an- commissioner chow:i didn't see your hand. please, close the conversation. lf withá the comments that have been made think that what seeing the department is being part process so that it isn't merely looking and seeing whe are dotted are cedthe

that there nitoring both not just outcomes and process, over these years, there been really to be the right mix and i think we ng to the now learning the both onon the side, so helpful and very clear there are so different processes goin really look at the there are times when things seem to rough th think that over ha been too much work--trying to exclude extra work on the part of yet being able those doin? has-been and ly responsible and it so, i think in the or coming months hopefully, we'll continue "9have a opportunity to i don't think we are looking

going 30 some odd ago where we entire contract package and contracts to look through and the attempt to needed for reneat sius has been helpful in the materi i ry been a to look at how present new coolution that amount of data thget areas that we to look thank the at the finance particularly those who are handling all esto really e we saw some of th performance reports detail 6v actually was the uire. it is there we were not looking these but that we worked ouwhich f- a privilege to and the contracts much better and when from the committee to the commission that the was happening with these kcontracttake

the recommendations trhad been i really do wathe enormous work that so ofthe department do in order to insure us th can from our contracts looking best outcomes and >> thank you commissioners.ain, i'm standing up here ing doing the work on the program side as well asi thank them and i helping us vigate. >> direct >> i just want and this. jennthe new coo and challenging budget process to go through with the the presentation that was clear time i wo is concepts, so doing to ryimportant area that sionan ongoing s. >>thank you. we'll go to , which is current research epidemiology of m the use l person. >> i was in person last year. >> thank you for having me. nice to see everybody.

i have ,ithe [indiscernible] an we are di so, we of the population health division. you cago to all most fully derally funded with nihcdc draft with iscernible] all the work we do. our goal is really arou better ñvstaff some grants have ended to the ll spend time slide the left and tell bout few projects we have. topreboot study.behavioral opioid overdose prevention. we just wrapped up adapted to fentanyl and ran both in san francisco and so i study yet. it exciting proj tools to ,rthey toe.used over a decade where we u4

one one ge nal providers that called counter to counter iscernible] this is more evidence efforts utical companies would. we demonstratedhfcoject that [indiscernible] qchanges !.mcnational id recognize how challenging working with people who already on opioids is very very different from not startingon somebody. we played a key shiftpolicy so opwerced off lot deas.n[)ó unw thatatpr ois with managing nastge cax÷ ics ué througthe city ve mana the rb , our study of general population use disorder effects in blacnpeople with d9

substance hadn't re tr has been satisfying.medications work.had many ask for remonies and it has ally and tell us they managed to remain cocaine and i think it's--we haven't had a lot of sn't moving experience to provide this below that is harness. this a study 7 study of medication pe it is know may have benefit in alcohol 0use disorder and should have data get in the m3 trial trial interaction between [i [indiscernible] a medication that or ly started working on about 20years ago to reduce methuse and it did study that showed yes it did and effects dur ability an for for phase 3 trial large ey wante interactions.in collaboration

give up two weeks of their time to go through very small et and not interested in very but we sutato see issues and that larger trials. prime is a study aadherence r daily prep usmong people who use metham >> could you define prep so no prime. r pre-expos[indiscernible] ongoing study. i say while this we had injected prep intervention and listis looking at how injectible who excited movement but around logistics hint is a study of who themphetamine nathat looked we did several studies of opioids and we followed them over time and lost acsess to happids we and many went to street opioid use to stimiants

which seemed stbecause taught increase [indiscernible]most of people using s esta phenomenon that has data neursy at cocaine and rly neuropathic pain. we followed up with a study tee how does it and how are they us not suggesting we'll end upbut it might manage the situation whenare us this mightgood gprescribed [i help them manage paknow, but exciting patients and frankly patits that usually nobody is when you able attends ottor people lasso is a exciting study.trial, this udis a study of who diattributed examiner acute ule toxility. it is work that-been rightl

but a lot of deaths we stimulants result in death. it isn't like breather and your heart stoprobably effect ural disease. next slide. study of acute toxth6 they came to san astranged from midwestern family and the foundrugs, particularly methamphetamine d friends passed or stopped using young people came to congestive heart fail and lung couldn't get down throom to visit them and just stuck in their room and seen ove a week deceased and e was methemphetamine ood stream. this is death we see, particularly with many particularly with stimulants.(!it

sounded much re elder who's didn't have family and friends passed aw these deaths should we tap more into re model in order to preve them or improve the fact of use and homelessness accelelot of people who are 50 years old on 75 or biologically have been through in their life. ings overdose prevention because fentanyl responds more interventions, but not necessarily tapping into about chronic and less about of the stimulant death in the lastwhich en we look at the stulant only not involved opioids evidence of that is profound.dying from s cardiovascekg's had qtc interval which is you

of arrhythata n do a ek meth or cocaine get a sense the baliqtc and talk to them an that risk and escribe them other effect the qtc interval as well.is dr clinicians to help design#c manage stimulant and prevention asprimary issue. staten as for prevention. lot of the deaths stimulant death fundamentally opiate h 9z stimulants raise threshold ])j people on ththis. icians what they sa use more fentanyl safel isone-off, the fentanyl to so overdose tends to be higher.e deaths ;lot more like opioid death. use see and comorbidities instimulants die f) [indiscernible] th look ch more additional moies. another complicated slide. sorry, dove

narratives and got excited about them, to understand what with these deaths. all by handin:1g out naloxone. sure most sqmajority are happening in spaces and 52 percent of the people nobody and haven'tdays to weeks before they that dent frankly. we have to look on to the stimulpant only death are be that makes sense because itis cardio at [indiscernible] naloxone isn't going to do ulanything and out of hospital cardiac arris opercent, so a tough disease to reverse. go to we cailand witnesat opiolook y delayed un e. deat, this wasn't kly chronic disease.lordia only 71 percent had evidence the event.ch overall, this supported these are stimulant deaths are deaths of chronic disease and

next slide. our general epidemiology involves lawewill continue this have the just at acute toxicity death but in greenrelated it is actually pretty flat. it drops s flat.but sometimes i about this the denominator le at it might correspond th middle is th involve stimulants much attention number the blue is acute toxicity you

expected for that i state for sure.next slide. what we e doing is do mostly medications, particular ly for simulates alcohol the ongoing work around geons foilr opioid use diso rderon other agents so we don't have ndiscernib fentanyl does for mortality and saturation tof the city wihas the changes we see. i want to e more increase we saw was all african latinx individuals in the it really for first time among asians so hitd non-white individuals in the city very hard stimulant deaths are not like opioid deaths, similar to alcohol deaths.

the way we manage more managing chronic disease and thank you. >> so much really clear presentation dedication to this work, because thisst challengwefthe city now and people like important critical to try to find some a problem +áthat is n franci >fthere is one person. mr. manree mr. manette e more time, are you there? we don't have public just alfinding or about the non-stimulant deate observing arnd . thstimulant deaths? this everyone focused on obvious x reasons, it is most of but -i ink lumping m[ stimulants there are 1uwhen someone people that traffic drug but which means that der population. understanding that and gate the deaths

is really important. i submit a lot ñ methemphetamine and great to it is feel on disingenuous the fentanyl and i--sofor part of w to best drive public case, if we pt ñ as assume [indiscernible] we'll go down s understanding it is really important to right interventions. >> of the data and i guess lusions, this goes along. >> commissioner christ >> guillermo' work and thnew to me, because we in the profession, medical profession especially, er focused fentanyl and rdl meth anymore so and the work your happy demeanor aning ntinuing enable you to keep it, you so much. commissioner chow. ank you are doing. i lyat your become iscernible] in

you think that be medical secondar type of population to then incidents the medical ca great question commissioner chow, thank yofrom this wo in collaboration with dr. d drwho a.atric emergencpack give small number of [indrndoses of w have mine at psych emergency service they have 30 percent fewer anclinical intervention for next year. that is one thing we around psychiatric toxicity which is ma francisco around developed a hi protoc9z assessment who uses people have functional benefits. some people uson the street and to address their use.áx the package of preventative therapys

that anyogs should have, is i work in ward 86 similar to hiv care in the sense of vaccines and making sure because we found in the research with overdose program we found t of irmed opioid use. from fentanyl are by people using stimulpipe things like that. we found [there is and very heavily african american people who dont and die fromandl they have naloxone are not intending to use soon a of injectible opioid blocker that fo lasts month to see if overdose events starting in the new yeathe cardio a the toxicities of stop personally offer staten at this pointing data who to k father but ft they are risk factase and we don't incorporate inyingthat by threshold to start a staten on somebody. that

they actually prevo we know whusficulty hearing speaker] aef dementia is slowed by animals at least, the methemphetamine meis emphetamine i findsame and usually go i' nge thesabl medications pryo work. th do xeyou think ntwor]iy5yo ar her places in trcothbe alad>> there was a lot of d several years ago but that funding is st 'pso it has harder and the--but it is still do collaborate with people around the country on many different obviously, stimto fentanyl for good horrible national tanyl. you very much. want to reinforce, this is nialong zocdc money and dr. ka subtle. the cut f rates for the extremely competitive.dé this is a casealth department goes in alng universitywe ot the only health

department that draws down h they collaborate nationally, but there national trial neso really important there. is to understand that the research s group his team does translates quickly to be on i talk the commission i'm [indiscernible] bu translatey interventions on the ground and one of more recent examples contingency mathe heal department pioneered sm contiskancy management not drugs or e king hiv meds and that is rsial years "7ago is ndcernible] and ll drugs that is rolled out are coming to me and saying have you hearment and impresse because it is out embraced by ferent communities and really piece started at dph anded to p-8the ry communities that this bein proud of vo the work kaufman and to >> thank you so much for adding that and again, thank you so d for all the the next e ag çpatience we have ogive us security who ñ llthe dph

security update. >> evening commissioner security a update with regards to the progress made on security management plan and well as continual work of [indiscernible] e security staffing tr" and next slide. thank you. in fiscal year have reported that the sheriff fte had reduced a update that a weekly basis th progress on and re however s to filling 21 remaining fte's.22-23 that the program fully turnover and hiring barriers, the vacant positions. of the 11.8 they k( able vacancies egñven remaining fte's, intervention increased by rcent rounding

nearly om 2800 over 3,000. next slide. of the bert bram was 22-23, this was the emergency department bert the provided over 6,000 patient interventions and had nearly 800 the next slide. eriff office cadet e that report in the previous the ning as well b> improved opthat equates to vacant fte's, opposed there whwas at least four to rvic the hospital enin addition, they also received their required tradph required training.tr as the training with crisis prevention fgand interven texpanded their services visibility and personal safety escorts in

of hospitals parking areas. providto [indiscernible] fte ll as crughout at private security officers provide service th include collaboration with clainical staff with regardto eliminating sources of contra band.completed the c training and expanded their services there to on the units standby and resident assistance and prereportedfiscal year those three bert e's pr support for e nursing units.de. we reported that say community clinics was delayed as a result of the rfp of the have the safeto have the at silver avenue staff ber 1. based n÷the perforthe ree where we started have rated the a long time ing, but now wie are that program with success to the cus, use

of force by 52 percesiwith restraining patients continues to be the law year is in all race ethniciti 20-24, use of force the highest at 36 percent. have been monitoring is the first year at use of force ital. contributing factors for that have to do with course, the services, but in additi to and their standard with onding to risk behavioral and what they call code 50 office they have taken e approach as far address the issues using distance and verbde-escalation to id any physical force. each one of the areas su in race ovctof use force in hospitals against nnunder security the bert nearly 800 more-800 more intervention in sherif enforcement.e emergency department bert progover 6500 bert interventions or patient

interventions over 53 percent first started in 22-23. when it oto we office enforcement, monie by race. we ce to prevent from escalating. what we see wk emergency suppethnicity nearly african 31 that support was for percent for next slide. the for q82024. turn it back over to or>> thank you for the those on the me[icernible] su outcomes outcome from teams and you ask your be congratulated. as this is a mode program fectreally ve data we geerand evne that the efficacy. there any for your to ent on th commissi a question when you ask the person their race or do you by

i think this xyz? gather data use of force included in th d some type at the n fally category, so i thnumbers thk you. ck mmthank mr. eaally .ghabrdown the of se refrom ñúbtrained individual as it is wonderful toyou commissioner. > rector colfax. want to also thank mr. price for his work has a very busy of try t groups of connecting different groups to make sure fe as possible and works sheriff d built stwraung relationships talk about the bert ately so and i want to acknowledge the work does across@uoucare, including the specifically, there have safety concerns at in staff was very concerned and also to the clinic because theywere about outside the clinic there &<

3f issues hand mr. price took hold worked very qustem eriff office rectify the situation and things there, so just ana broadross the service livery systems sure that can do r importantly, keep our patients who come to as safe as we can as well, thank you mr. price for your work. wk=thank you. >> coit is so incredible. enwere first coming to us abou to address it and to see 4e all acknowledge that. i wathat dr. colfax said, the context of people many people tare is a ce as a result that thto ple and you are to safe their jobs and enforcement to it is astounding so thank you so much for it and thank you what is what is completely these--never hundred percen fromations these areas in staffing for >> thank you for that mmissioner and your thank you say end to remove law enforcement, but to make

sure that we we ar lawpatient ag because what i doing incidts was called these d i still opptheir success that they without sheriff deputies cent of the time.13, 6sent and what are issues that escalate where bert escalates to law çgneed, other we don't enforcement into pace care situation peit is this is thank you so much, we >> thank you.e next the joreport from zsfgjcc of 23, commissioner chow. >> thank you. thmmittee at the d reports, including the ceo report and we are now the bert talked about this aftern reports and the report. we are very pleased we op of the categories it like a 0 or minus 1 had also commended the th

regulatory i said earlier, being very replate and reduced of all our clinical needs during the medical staff itwed ll commission rules and cernible]on the committee the [indiscernible] >> thank you. omment? >> no public comment. estions or comments? thank you commissinext finance planning committee lermo. >> i thought commissioner chung was i put commissioner guiso, the fi meeting and reviewed the m; report andá%quite ntracts. one, two, three--six--five i ask if they were able u >> yes.d for the monitoring report and updated document and i >> so we move forward? >> yes. something worth mentioning is the so we nderstand the the level

of effort that t and that's the cha in the calculate the units.that worth it is the new cal instead of paying they divide the contract by the amount of standard, now it is the position and different levels on the amount real and that is coming in the next there yet. >> so that concludes my update. y public compublic c mr. manette shaw you like me to share the slide now ess it consent calendar tes. are you speaking on this item too? this is committee report-bacthe consent i guess for ank you, sir.is no public comment. or tosteps and ove we have to seg >> commissioner salgado has something. >> i cuse myself with involving do after we hear vote into

two sections and i'll lead through vote and extract contracts are removed, you will vote on everyone but adon the uc contracts. in the mean time, blic comment., i will the thing now.is there not tation on this? >> alright. $ [difficulty just hire what save million annual expense? ead of issuing the $10 million which is astronomical, experience staff what they are doing running a skilled nursing facility.the commission believe ,3motored for [indisrnible]+ross the two contracts totaling $15.2 million. my chart sho external consultant since may just after and years to

the health coiion is apparently okay to see if help rather then hiring competent staff. it is to me [indiscernible] full board of supervisors are along health comm. this commission is not performing fiduciary restraints needless $53 million as fiduciaries this avoided all alongd whbefore decertified. [indiscernible] just $1 gering the contract must full board approval &tntring a supervpubl is kthe public comment. i believe we to--i'm going to say something, i can't make the if rot what i please make a eryone to vote. pleaa motion for to the nt calendar minus thacts. >> is th? >> second. doruxt is lgado will threh>le +8 >> yes. >> alright. no public comment on other

business? >>th to go into closedession. >> closed session] ] great. you can seconclosed session. plesee oraris going on, or not the contents of closed session. >> second. call vote. oll ca >> l call]

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some sort of civilpens to continue that legacy. >> im sheriff of san fr t the people can just go there and it ir everyone♪] >> i would say i am at. i came out of painting rjoyed tactileties of artwork and tile work. ii really believe that art should be available to people for free,e0g

world. you shouldn't just be something in museums. i love that peop there, and is there fors art with a job to do. it is a place. where the artist takes site, and g we commission it i big sculptures you see we are in the neighborhood.ose are som beloved kinds ofro really give a sense of uniqueness and being specific f= colette test on a those projects for its. of favorites ry, as well as several parks and the steps. >> mosaics areken, and rearrangedo make need to!rsp as they are called, to actually shape the tiles of get thehem to mash, and thenak installed by someone who is not to me, and they putup the mash with the6u tiles attached to and then they groped it

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turned arounif i tell the schoolou come make tiles with is a tile that he made to. it is a little bird. wor ofth develops ovime, and if you have c a=z you come back and you see it again with is an exciting place.&úwm tv i'm san francisco mayor londonan to congratulate sfgovtv on 30ca[íted service asast channe played a criticalnd i our residents in government. thank you for 3nspiring and connect the people oftsco is city filled with diversity culture and progressive ideas. but it way, one ofown on it wouluntil 32 years later that n served in the board of supervisors.éhave continued who are these women?

and th >> to it became as a supervisor. i was working mayor's office and there were some then supervisor and ved that su i it s tion, but /nservuse i really believe that government is a place where you te oppo >> madam clerk, would you to! reand we at was usually certain kinds of people.erbeformed of all the people that in the be lñinvolved in this committee and there were certain we bors to vote so we did at, and i won the seat on that kind of started everything. >> i think having women in called family >> i think san the country here isvery behind and i think thknow, have a ch who are ac women inall of th dialogue around what policy choices actualimpact to peopd lives would be.the board here in the ézcity way. >> su democracy is about representa women are not just taking care of childrparents and working so all of thnow of our

policies of nsr policies nt >> supervisor maxwe >> of san francisco female from the board of supervisors as well. that's erget re and have to influence policy. i think it's important ourselves in that. >> supervisor cohen. >> dorir and small businesses, he will really really special, she she workedfor e a>board operator and then secretary.ed th tz somebody called congress racial equ women, seniors eç!tmore p the three women to supervisor liot. >> when you think about the i think to be coverof our legislatures so many faucets of policies.to it's through your lifeentify and for a young githink ?7having women on the board is important besethat power of decision.udes business for >> thertime, they were arguing and i only tt african-american, and g there, room full of

t the people of business. and of anto do what? they had to one for me, showed the importance of importance of rican-american women. past, present and future, thank you and s gc?