>> hi, any name is i'm here representing the great panthers of san francisco and a administrator and i wanted to take opportunity to put before you once again the need to beds at laguna the beds were paid for by the taxpayers and we really nee a loss of nursing beds are g evyday. we would not be able to conjure 20nursing beds in san francisco.

so please let's do everything that we n to protect and preserve them, thank you. >> thank you. >> is there any general public comment from anyone else in the room? >> anyone remote comment? >> we have two people obtain permission today. hi caller, can you let me know who this is? >> speaker: this is dr. teser. >> yes, please begin dr. palmer. >> caller: yes, i want to say worried about losing 120 beds and i think there should be every health commission meeting, discussion of progress on both admissions and getting a waiver the 120 beds. this is very important to the people of francisco laguna honda has a third of the nursing home beds san francisco and, there is a, there is a huge nursing home

shortage in n francisco forcing frail and senior and disabled people to go out of town for nursing home care. and, and we need know, fill up the beds that are availab laguna honda but we also need to not lose the and i would like to hear progress at every health commission meeting. this is this is an an extremely important issue for in population of san francisco. thank you very much. >> this is the only public comment that i see on the committee right now. >> wonderful. sowel move to the next item, which is the director's office, director colfax. >> thank you, we have a lot on the jend so i'm going to have to go through it quickly. there is a lot to share. with regard to in

july unfortunately 39 people died of accidental overdose according to the chief examiner. continues to to be the driver of majority of deaths. is 59 percent fewer than we saw in july last year when there were unfortunately 79. overall this year, e a 15 percent. we have 15 percent fewer deaths this year to date than in 2023. while reduction death is a hopeful sign that we will continue to do on our extreme and to get more people into treatment and save more related to these effortsis, the dph sponsor 2115, during the 2024 legislative mayor london breed sponsored ly

bill 215-5 increases access to methadone by a loin law with resent federal rules. vulnerable populations is essential to addressing the overdose isd this would help expand overdose access to healthcare for the most vulnerable residents. the goal standard for treatmen of opioid reduces the risk of death by 50 percent and i'm pleased to says as of satuay the bill did pass and the bill will go the govern's desk i'm really happy that this continues to make progress. it is so important we get more methadone out there. also a numb overdose awareness events

international awareness day. so i'll let you read about those events, i was able to participate along with other ú h dph staff numbers and you hear about that upngin the upcoming presentation today. on a related noable to visit the call center which receives than 1100 calls a day of patients of thre primary health and this is a very busy call center. and the, the call patients was scheduled with medication s and diagnostic results. more than 60 percent of the team members are buy ling al

and some are even tri ling al. the next centeris ohe engagement team launched practice for promotores, part of a cdc project. promotoras are health workers in spring of mobsinger august 2 they conducted entirely by spanish by dr. bertha hernandez with support of facilitaters. on the final day, 35 percent received certificate ofleti. so really important community base project that we're making

and then you'll see that the staff received award, we're welcoming officer to the executive team to the san francisco hospital. you know, being alameda by her work. we're sad to see her leave ll continue that work and you know how much i like delighted was featured in a health issue in e new england journal and care delivery issue.see our cov update on the of page 5, and i want to say that we're getting the message out that times to get your flu vaccine we start today flu

vaccines in our network and we'll start to give covid vaccines. we're still in communication with the distributor, have no date when we'll receive the vaccines but i n. that's my director's office report. >> thank you for threport and especially on the great on 21 a b-15, fantastic. is there any public comment? >> any ■)comment on director's report? dr. palmer, i saw your hand? dr. palmer, please turn off your computer. >> speaker: my hand wasn't up. >> no publit on the item. >> okay.

was that a public comment? oh she didn't want. back to commissioner questions on the director's report. thank you, and we'll go to our >> i have a comment. >> sorry, i keep missing.for yo yellow hand there, go ahead, please. >> speaker: okay, and ithank the reporter on the centralized call center, 's really encouraging. i remember when it a less than robust call center. but then, i was wondering as you mentioned the the nurse advise line was available 24 hours a day? >> i believe there was something on the health network side?who can answer that, we ca

that very quickly? >> sure and the other question i had was, and i en we get the printed information but, is there a length that we can look at the article that you siteregards to the tv screening? >> i believe that link was included in the report, was it included in the report?we it wa report but we get the written report, so i don' >> okay. so etary march is signaling e article.ll send you a copy and i think dr. yu is on remotely, do you have a answer to commissioner ae

--line? >> no, the hours are not 24-7, at at 8:00 p.m. and weekend i believe it's to 6 or 7 but they are not 24 hours. >> isbecause a lot of commercial plans now have 24-hour nurse advise lines, they've had them for a while. do we have an opportunity to consider that? wehalarge block of patients here under the san etwork? >> yes, that's an excellent esdr. chow, it's cover the call hours. >> if somebody was to call after these i, i realize there but more urgent, is there referral then to either the

county or is it just not anthey're expected to go to the nearest emergency room? >> well the centralized center does t operate 24-7, we have coverage on call. it's always a call 24-7 weekend as llas evening starting, starting from 5:00 p.m. until 7 or 8:00 am in the morning.e hav they're available next take that first triaage call by nuthey need to rout the answers and there is line disclose the, they will go >>okay, no no, that's

excellent explanatiopr our san francisco health network patients 24-hour coverage. thank you very much, dr. yu. >> all right, seeing no other comments or questions. so the next few items are volving approving ftat will go to the board of supervisors. so greg, yeah i didn't see you. he is our dph administrative analyst and the first there is authorize to extend the gift to. >> thank you very much, commission.e proud to present t program for your approval. this is innovative program

na develops skills prevention for professional staff by allowing them to an ex hospital beds control practitioners. hospital infection preconvenience programs are le the public healthcare associated program. thare to be used by hospital staff members to training.fessional co the foreshadow the cility ip and combine total of 80 hours ture goals and objectives. thank you very much for allowing us to present th you for approval. >> thank you, sounds like an exceen is there a motion to approve. >> i make a motion to approve. >> second. cmment? >> is there any public comment

in the room?is no public commen remotely. i'll start with roll call. >> yes. >> commissioner christian. >> yes. >> commissioner greene. >> yes. >> commissioner gi uillermo. >> and commissioner chow. >> yes. >> the ed >> the next of approve to authorize the department of acc $21, 983.13. 282,800. and 166,984.60 from the california department of public health and again mr. wong, do

you have a presentation on that? oh sorry. di for san francisco health network. the ty and of san francisco has received test kits for dph over the last year.since the declaration is no longer in place for emergency, other protocol that require formerly accept this as a gift from cdph. we receive about 50,000 test kits at laguna honda and zuckerberg combined. we redistribute this to cbos, health partners who require test kits due to the minimum, the pop sues throughout the covid event.

so it's our hat we continue to receive these kits that are gifted to the pub and this is the formal acknowledgment for the test kits that were received in th last fiscal year. >> thank you, is there a >> so moved. >> second. >> and is there any public comment on this item?there any in the room on this item?there ? commissioner chow? >> yes. >> commissioner guillermo?ye >> commissioner green. >> yes. >> commissioner christian. >> >> and commissioner gi ran do. >> yes. >> so next is honda fund budget for fiscal year 24-25 and i think leo who is the ing to present to us. particular.

>> good afternoon, commissioners. my name is leo palacio and i'm the program manager for laguna hospital. you should have the gibudget versus fuels for the last year and expenditure budget for this fiscal year. i will be going to* over the document and available to answer questions. for the fiscal 2024 budget, we had about 165,000 in revenue. majority of revenue came cash donations. which were about 8 2000 mostly from the estate of johnny cramer and anthy exemption trust. we also received from interest and about 13,000 from incline donations wiz include a piano, clothisaint frances and blankets from grce

fellowship church. and expenditure summary, me line items got close to the allotted amount thanks to the activities being open again and the mitigation of covid. we're carrying some from last year and we will process them this year. the total amount fofiscal year 2024, was about 125,000.dg all other years, and approved by laguna gift fund committee. review includes analyzing all items for increases in amounts. for fiscal year 25 expect to increase the budget, laguna honda hospital has begun admitting new resident sxz expect new outings for the residents. we coidered the general increase for costs of goods. because of the factors were inc

most items so we can accommodate. we're also adding an outing. increased and we believe the remaining amount will completed by this fiscal year. there is a notable increase for miscellaneous for patient benefits because there ■no initiative for future residents of laguna honda. in summary we're increasing the budget by abt 120,000 for the reason mentioned. we cannot accommodate the amount because of the balance of the gift fund whh million. they're for the general befit and of rehabilitation center. and in accordance with the of the donors. i'll be happy to answer any questions. >> thk you for this information. because it's an item to approve, we to approve initially. so is there a motion to approve■

>> i still move to approve. >> second. ?r. any public comment in the t in the room to repeat what the commission green said, no public comment either remotely or in the room. >> all right, is there any commissioner questions or comments? okay, i'm not seeing any, so guess i'm looking for a show of hand. >> yes, i was commissioner chow no questions before we go to a vote? >> no my question was already answered. and that was to understand the incost on the patient benefit item and presenter already gave us an explanation as to why dthis was raised such a substantial amount.>> thank y call vote. i'll start with commissioner dwraoen. >>--green. >> yes. >> commissioner guillermo. >> yes.>> y. >> and commissioner chow. >> yes. >> the budget is for

this year, thank you so much. >> thank you. >> so the next item on the agenda is hunters point l shipyard updates. and we have asa director in the population health commission.yo forward to hearing from you. >> thank you so much, thank you so back to speak with you. president green susan philip i'm thdirector ined by asa king who is our director deputy, so we're very happy to be representing the disciplinary team that focuses on thclean up on the hunters point shipyard and supporting the surrounding neighborhoods.

as a reminder before we begin the presentation, for the structure of the work at hunters point na val shipyard. the navy is the nuyner clean up and it operates under a tight federal system of regulation and clean up. and the regulators include the u.s. environmentaection agency, the california depantof toxic control, and californicontrol board and california department of public health. the san frcidepartment of public health does not have a regulatory role of the regulators that i just mentioned. do assume a role of regulationcethe land is daemd acceptable and that is done by the the colleagues.

osely to understand the key technical issues involved and also to understand the community and expert input and reaction and ex the work of the shipyard because we know it's a very verylaundertaking for decade and we need to follow along closely, sowe're all providing input as we go. as a key agency that has a stake in the healthof the residents and in the surrounding neighborhoods, but also as an agency that will become a regulater at a point when the land is transferred. so if we can, if we can slide two. outline, that was the correct slide, just the outline.tegy, w that. community partnership and ou

reach activities to date. some updates in the way where we're trying toincrease and approve communication through our website and other en he will speak about the five-year review procesd explain that and then speak increase our inner agency g to engagement, even if we don't have a gular tory role we can speak to the regulators and we've increaacon on that since the last time we were here. and then taing about upcoming events and activities. so for the next n of the presentation, i will turn it over to deputy dirto >>good afternoon rector of community health puty and population health division. if advance to the next slide, please. so enlast gave our update about the department's work, on

the shipyard clean up, we introduced for the first time our inner ipteam and more fundamentally our commitment what we're tr achieve in this work and more broadly in the hunters point community. we know that it's esto work on improvement health this is a part of yoverall departmental commitment to help equity ally supporting communities where they need it most. so as a part of commitment and our overall strategy has been one community partnership, we think this is essential and we'll be giving some updates on some of the thg last several months to se our community partnership, really work on building trust,

better listening and understanding community concerns ly being an advocate to the community where we can to really uplift among, maybe and other regulatory agencies what the community concerns are. and secondly, communication.in of the communication but increasing the clarity, giving additional avenues for communication and i'll speak o well. and the inner agency engagement because there are so regulatory agencies involved in this process, we have avenues to be osin communication with other regulatory agencies to further events, the protections to the the clean up process.e updates

this is really about giving the community the tools and supports that they need to improve health outcome and to spities. if we can go to the next slide, please. so just the highlights of a w of the key activities that have occured since our last update on april 5th, did a community listening session wintat the hunters view phase one housing community and this is neare a s from a communcalled paul bays bay view that has been for very long time involved in environmental justice issues in the bay view. and they invited myself and my

colleague who is also a member of our inner disciplinary team, dr. to come d speak with residents. questions that people had about alsu, they're about 15 residents that joined us at the meeting. and you csehere on the slide that is picture of us at the end of so a to really share resources that we that are existing within e department around more common issues such as morals other indoor air quality related issues. and also this was a key tech point for us to information about how the public provide comment totz

five-year review because at the time erin the public comment review period. and on april 22, we also had the opportunity to directly engage with community members at the climate resilience workshop which was a workshop that was hosted by the navy. so we were along with other stakeholders agencies draft poster, and have it available to the public. and i really stand by it to explain to people what ou clean up role is. as you have seen, there is a t agencies involved that you all struggle to know who is r at. this was a way to not just provide written materials. all the members of our

w÷narymulti disciplinary team were there. and we had that opportunity to our role as dp sxh, what our role isaround the shipyard clean up. so that was a tded event of about 40 participants so we really got to hear and engage with community members another thing that i would like 28th, we we initialed a meeting with dr. shamshy who is a director of hunters point by monitoring foundation and she invited us to her and invited us to the community stakeholders as well. we an opportunity to tour her office.

and we see this as a better opportunity to understand her work and her strong ties as a leader within the community. angot to hear from some of those community members her about some of the concerns were so. that s really the first meeting of its kind that we were able to have withgroup. and later, we were able to come and have that services and they were also joined by some of our colleagues as the department of environment who also joined that meeting as well. and so we continue to stay engad group to talk about opportunities for ship and really understand what the habeen advancing what we can support and way of

resources and way understanding. and continue to provide information as we re next slide, please. you al that one of the key communication channels that we use was our dphsf.gov websue to previeed information on that page and da we've provided even more information on the page which giveoverview of each parcel in the status of the clean up, so that community members can really understand it has a map so we can understand where they are as

far as some of the work being done and also getting quarterly updates on t really u what is the atus, what will be happening at each of these pages. the parcel overview image, are quickable and onal pages. so each parcel has itpage with a wide away of information that we about what is happening at each parcel. additionally what we have learned in our communication as well is the navy's website is a little bit difficult to navigate and to difficult to find information. so we also provide on this page, information thating is publicly available as we receive it from 9 navy

really give another resource for people to find out atn and website is accessible and can be translated into several another benefit of having it as ri resource for community so with that, i will if we can go to the next slide. i will turn over to dr. philip who will walk you through the information on the overview report. >> thank you, so we talked about the five-year review this is the report as the name suggests that comes out every it is required and mandated under the federal law, that determines the navy's responsibility and the regulator's responsibility.

and that is the federal comprehensive environmental response compensation actor rc so every five years, the navy is required to publh this document, this five-year review and this is the 5th one that g is year. and it evaluates the clean up process in the prior five years. meant to do is determine are whether the remedies that have been put in place continue env and of human health. they also take the i to look forward to see if the continued plan recommendly also is protective. know is this process has taken decades to complete and e entirety of the time, they look at the five-year rvals so

they have--on the interventions that they're doing. and the other thing that doing about it in a minute, they have trds climate change might make a remedy that wainitial lea februarying tiff with the modeling no longer affective. are the reasons why the five-year review continue to happen. on let's see, so this first draft was issued in 2023 in november7t and we will go through the process of the steps that were inthe final report was then released in july of 2024. and this procesdoes allow for input both from latory agency that's are a formal role and for public comment. and as i mentioned, sfdph

don't have a formal regulatory role so we included in public comment but it's understand that we're gi technical input at a level that might be different from some of the other document but they're equally important.please. i apologize there the first section, it should 23, so i apologize for my error. so this goes the steps starting with the initial release of the of five-year review in november of last year. thjanuary to april, there was an initial opportunitr the public during three months written comments on the draft five-year report. then in november through july,

november of 2023 through of 2024, dph and regulatory agencies that i mentioned and s five-year report and issued comments. and we, we worked independently the regulatory agencies and did a review, thanks to work of largely ryan casey who is is our engineer and environmental health but our ti discussions around this. and then in jaoushltion the navy then issued its final five-year report taking into th public comment our letters as report.d then through this process, the navy is required to engage the community and told them about the opportunity for input try to clearly explain, what it includes in the five-yeaew. it's a very large document, assessment workshop l, the navy

and, deputy director king alluded to that and we'll show you just a snip it of what that looked like interms of our dph poster and involvemth this is our first five-year review that incorporated a assessment so it's very important for it being the first tis included. and that is going to be incothe remedies moving forward so we'll speak about that. and then june, the navy did talk about e draft five-year review at its shipping yard tingwhich is the avenue by they present to the feel questions in realtime from the public. next slide, please. so throughout this process, dph

five-year review. we submitted three technical letters including april 12th which were preliminary climate on the resiliency assessment which was appendix a and as i mentioned this is the first time since starthof a clean up the cra has been included. in may 14th, we submitted comments on draft five-year review report and then, as the navy put its draft final incorporating some of the initial ionally put out a final letter, july 18th, cot the draft final five-year review report authored by the navy. in addition to putting our comments and technical responses in, we really worked to try and increase public awareness of the open period for comment by publicizing it our communication channels,

website and social media and other formats.then as deputy di king said, we d a poster for the workshop and participated with the public in a dialogue our role and federal agencies did that as well and the change. next slide, please. so this this is a poster that was put together to really talk abwork that dph is start go undertake to assess climate change and we know that that v that is being done to clean the hunter's point shipyard as well. and as much when we can, we're trying to focus on the larger effort that wedepart in population health but more broadly to really work towards

a health equity and good health outcome in the neighborhoods that surround the pot shipyard as well. while it's important and we continue to have a team focusing on the shipyard i'm focus ed ontying it in to the higher effort making sure that it's goodto all residents in san francisco includinin bay hunter's point. next slide please. so within the letters that we for the five-year review, there were some key ththat emerged, things that we really wanted make re that we told the navy this is really important for the health for the residents surrounding the shipyaant to you respond and incorporate responses into your not only ur planning, in the actions that you're taking.

all, improving communication with community. this is important and paramount and we see a lot of opportunity for imprand the community has also pointed out the immense opportunities for improve here. you heard about some of the work that we've done deputy director king. but here's the place where we're advocating with the navy and with the regulators e clear plain language to explain really difficult topics which is quite challenging to do but it is possible and there should be good examples of eta helping advise in ways that that done in other situations and other parts of the country. welldo whatever we're able to do with our website communications and we're pushing the navy to do its part as well. secondly, this was the first incorporated the climate

resiliency assessmeit's imperative that navy amplify and make clear they understand the risk poseclimate. in the five-year review, there were findings thatwater rise and seawater rise co impact the shipyard by 2025 potentially mobilizing some of the contaminants, we ll investigations. the federal and state regulators have ne e same and the navy has said that it's commit today parcel specific more detailed studies of the impacts of climate change ound water and seawater rise. so we'll be looking for e studies and reports coming in 2025 and beyond and really assessing, do they address some of the issues that have been

raised by experts and the community as well. and then related to that and not entirely the same thing, because the navy is very focused on the area of the shipyard and the ithas raised, the important question are we certain that tam have not migrated to the outside of the shipyard. and we agree na this is a really important question and we support communication to address these questions and to use whatever scientific and technical resource right side available in state-of-the-art to answer this question and really provide that information to residents who are surrounding the shipyard now. and there was a question, thank you commissioners about what be

some of the community and questions and concerns. and in some areas it has been to say the regulators approved their plan. stce, they had a plan to excavate certain trenches of soil for radioactive evidence of radioactive activities. and the regulators said that rather excavating, they can stay with their original plan to doa sub set of sampling. that was one area where their response was well we're work r to the regular plan. however, as i just said, the regulators and community have said we need you to be more explicit about climate change and mobilization of te change and the navy did commit to doing these more specific

parcel by parcel reports. they're, there are some areas in which e,inpu from the regulators and the community have changed the that they're plan to go do some of the remedy. next slide, please so i inthe other piece that i really want to make sure that share with you, is that we're engaging with the community as deorpy king laid out. we are talking with the navy giving their inputhrough the letters formerly giving our recommendation and but we are really importantly trying to increase our interaction and our conversation with the other regulators. even if we are not a regulater ourselves, hae a have a strong voice given our position, role and expertise to protect the health s in san francisco. so we ar now initiating

quarterly meetings between our dph and the epa, we have just had a few of those.we are looki continuing that and raising some e questions that we just outlined as one of our key priorities th hearing from communities and also identifying ourselves. we are regular inner agencies calls around communications our communications communications director brown and others participate on those and then, also being part of the community out reach working group. so these are ways where dph hav. whwe can and where we're able, we insert ourselves to able to understand what is happening to be able to voice

what we're in our inactions with communication and to be able to raise upons a own dph experts as well. anc)d that, next slide, please. we'll turn it back over. over deputy director. >> just to conclude, if we can advance to next slide, please. i would khighlight three very important activities and events that we hup that we are happy to engage with. so the first one is event base and it's hosted h-the marie harris community foundation and

dph is cosponsoring this he vept which is a huge environmental summit. and we think this is key to our shipyard to not only with regulatory agencies about what is actively happening right now withe clean up, but we have to support youth in community who are also going to be future leaders tobe supported justice issues and climate justice issues as well. and so, thank you very much our representatives from the marie harrison community foundation. got to be our second year participating in this event and we continue to do so on annual basis anbe a cosponsor and we will be there with the table with myself and some our colleagues from the inner

we support youth development in this area and we're going to be lofor other ways to work with marie harris foundation justice. and secondly, we will also submit written comments to the navy's draft community involvement plan. this is that the navy completes every two years and it really outlines the efforts that it will take to keep the community informed about the clean up process to really engage in communicate with the community so we ten comments to document.be happy to share those withcommission as well.

with, so, on the third thing i would like to share is also on octo in october we are still landing on a date we have been invited to speak with the bay alance which is a coalition of community orgati who want to le about our environmental justice and environmental health work at dph and so myself dr. philip dr. aqoiwe will do that presentation and it as an opportunity to build more partnership with other community organizations in the bay view, not only just on shipyard issuesbut really understanding the full breath we can help support within

hunter's point community. thank you. >> thank you for all the efforts that you're making to collaborate with the communi this is an important issue for the commsiwe'll start with public comment from the room and we're eager ar from you and grateful that you came i have a list of names, so i'll the first i have is tonia randall. >> and i've got a little timer, when the buzzard oeoff, please finish your statement and know that your time is up.> resident of hunters point. i'm also the administrative director r rrison community foundation. i just, ok all my thunder, wate.

we do need underground water study but we need to do the latest technology, chain link fences, it's palling to see that these big tracks are moving this dirt and there a sign that says, do not disturb but they're doing it. the technology is there, and it should be used immediately for hunters point. every seco wait, somebody else can die. thank you. >> thank you. >> it looks like marrian harrison, i may have miss ounce.

>> speaker: i'm executive director we activate science,wdo community base science project, we also teach advocacy and set bridges for people to transition into institutes to do intern ships as work with us. from behind your desk and seeing what we're seeing. we just wanted leyou know that we cannot check the box in the community that you have never been in and actually experienced firsthand. so we encourage you guys tos in to know us because you cannot care about people that yo don't know, right? so and i would like to thank, o. you guys have been a very very

powerful team at the table, of meeting with the community and which community should be first and hing that you guys are reviewing or processing to the city. know that there are people in that equation and that we're human beings we deserve to live life to its fullest and not have such harmful chemical that is making this very hard for us to coexist. it might be too late for me but it's not too late for our kids. so we need everybody with a will and the will to support our the community, you know, urnts, your constituents, however you want to call it, taxpayers, with making sure the communities like this awconcerns do not go unaddressed. we need political will and

portrtitude, m mother, i'm a grandmother, and i'm, you know, and i'm a community parent to otchildren becoming intern with us. one of our kids told me last year, he didn't think he was smart enough to go to college. but his only aspect was one to the military. but i'm sitting here before you to tell you that he five offers of five universities and that's the ki work that we're doing on the ground. we love our community want you to love us too, fight for us and follow us and we'll . thank you very much. only had two papers are there other people in the room? i thought so, wee.@q

>> speaker: did address some specific concerns i had about the five-year review, the fact that the navy excluded in its entirety and did not comment on the aerial bombardment. and i veabout the navy designation of protectiveness status to areas that are historically to contain nuclear waste. what is i want to do dais emphasize the point that dr. philip made that even though the department of public health

has a regular tory role in the leit once did when i was on the rabbit did. the department of public health and has a sibity to ensure the safety and address exposure human exposures to chemicals and radio that we know are present at t in doing so, i want to introduce you to the newest cohort register and i'm going to be mitting some data to you that includes raw data. is the nuclear cluster at hunter's poit's the combined work by monitoring foundationjames medical and con at four mer childhood residents who live within e

one-mile parameter and the pin was placed to the landfill and defense laboratory.among the 11 from t 8 were female, 3 male. among the females one was a non binary and one identified as in african three european including a male that is foign be submitting to you, t effectively we looked concern documents to be present at the ing product that are 100 percent specific for the pnt shipyard. there are a few places in the

world where you can be mroesed to a tonium 239. your time is up, i'm sorry. >> spkethe findings are quite dramatic, they include a four that has po tonium 244 and uranium detectll but this is evidence this clear and convince beyond a reasonable doubt. and i do want you to accept people living within 100 om the. >> thank you very much for your you also brought up, receive quite a bit of public comment thate

but we always review it it will be in our but we will carefully review and we appreciate that do send us public comment. are there any other in this room that want to comment on this item? welcome. speaker: hi, anne gray panthers and i want to, i want to build on arenana's sentiment that there is been great movement since thlast time that we were together and the deputy directer taking so the great panthers are long time for community. i kutly attend the meetings. two individuals about the fact thstarted choking so this is the on going multiple

emergencies in the community. we support the fi report. deciding lack of data, five-year, public comment, reminded the navy that in the year 2,000, safrancisco voters passed proposition b. i will not lot of us voted for right? and we're still waiting. and also we questioned the ness of future residential development and we also asked for a immediate remediation of airborne contaminates using dust curtains, at the fence line.

>> i wonder if they can take a contaminate that was also menonic cment. so i think that's it. thank you. >> thank you. if there is no one else in the >> i'm sorry, we're not able to read somebo oh, i apologize. you've already made comments. but please quaoel free to m. submit anything in writing and we will add he cment. and there is one hand remotely. dr. palmer. >> speaker: it's dr. palmer, we do have evidence that ship yards has been

migrate anding on ingfashion affecting the health of adjacent residents and that is containment of the dust for adjacent residents. and and this isshould have been yesterday. and so, so instead of but what if it's uncertain abouit but not specifying that it's going on. that people's health are affected and there is of evidence to that.putting as dus cuchain link fence. please.

this is crazy, thank you. comment to this item.bl >> okay, we will go to commissioner questions and comments. and commissioner chow, maybe i should call on you first, i don't miss your hand. >> oh, well thank you. i thought the presentation was very helpful bui will actually and now we're speaking also about adjacent see and all. i'm wondering how the how the navy has accepted the comments in of the dph technicaisons? or is there a process where in yoll continue to discuss those? i have not seen oureports so

understand how the reports are being used. so report is one thing. so i don't kne format, if the public comments including us, did then, add comments after that? and then, does that then create some sort of dial the issues that you've been raising? whether they accepted them or not? >> thank you, very much ner cho. it varies based on the issue, you know, we were discussing for the issue of more complete studies and more thorough studies modeling outhe climate risk associated with the remedies, they did agree. because there was nmen with the public, with the regulators at the federal and state level and dp comments as well so. i totality

of the comments did result in a gethe original plan to have more detailed studies risks. there were other instances in i they said they worked with the regulators and were under the regulators ces to stick to what their original plan had been.ampl how much of dirt they were going to test for the radio, strong tm-90.hai had different input from the ity and from regulators determ were going stick to their original plan. and so in the big bucket areas that we talked about,

really going to try to focus on those. in some conversations wi navy but we really want to speak with the regulators d make sure that they can understand our point of view and we're plifng the community's point of view about, about looking at neratin convincing evidence that the actions that are being planned and undertaken are health tive . sol that is the way in which we're approaching now and i feel that will be the most affective way to do because the regulators really have the ear ofthe navy, because legally they have the ability that the clean up is happening. >> i really appreciate that. as u said, you'll be working with the regulators on the issues have been raised and we're not just dropping them but we

continue to go offer to the regulators.■ and work it through that way so they can help fluence the navy's actions which i think is very good. on the adjacent resident imtaken a real position on this? and are there things we are doing as a city because these people are outside of you know, technically outside navy jurisdiction. >> i think that what we will, what we will need as we are, as we are developing capacity or bringi leaders to look at some of the at some thedata and to try to understand how the data and

mapping and epimodology are laid out and we do want to engage further me is building capacity but we are on the verge ofbringing in additional leaders in analytics to be able to do that. we also i would also like to engage with other experts who ucsf at uc berkeley and other entities that are ad entities as well. so i do think that we have more to order to address the questions that you're raising and that's really important one. what are, what are potential health ims as i mentioned before, we also want to understand that we know that there are, health issues and health disparities that we to address throughout bay view, hunters point and other neighborhoods in the south and eastern parts of the city.

those are going to continue to be a focus so this is pa the work. we understand that there are special unique concerns related to the shipyard and that's why the on going disciplinary team is coming together regularly and working to try to understand and address issues. >> so i think that would be a very nice follow-up in your report is to lois understand that and i guess that also wraps in if anything, data shows that something should be done. so i would look forward to continuation of that pe of, of this total issue and assuming we know that the hunters point, bay view health profile is not just related to the shipyard so std

that it's very complex thing but working with the community is very important and i really do appreciate this us showing the closeness na you have now developing with community in terms of the dph input and working with the navy and regulators. those are my questions, thank you. >> thank you. >> ji rar do. >> i just want to comment, since you started presenting, and our increase partneringthth it, and i feel grat ified that you're continue to go do it. great job. and i'm hoping as . chow was

raising, you're trying to partner with the community in trying to keep folks accountable, thal come back to tuesday, a regular basis or when there is more information because i do , you know, top of our list of concerns for the hunters point . and i know i had requested, i haesand i appreciate you answering it throughout the presentation, too. >> thank you so much commissioner and thank you to the entire commission for really the the push and encouragement and the ability to do this work. we're not done, e is no mission accomplished with this. i just want totem per a little expectation.

this is been an on going issue cad. we will not be able to resolve this in a few months. and so, but this does require on going work and on going improvement and all the areas in which we have levers. so epy molg is one of them. i can tell you that we're committed to working on continue to go get closer an that we're doing it with community input at all steps and we're ears of the neighbor, the primary up agency and the regulators is where as we're doing this. okay, all right. we have not placed a three-month requirement. but i destand the complexity and we all understand and those of us who have been here for a number of years, have you know, felt a real important mission

down there to cont to work not just with the navy but with the entire community on the health disparity that we know e unity. so really do appreciate your work. and i at you'll work with the officers and mark too, meaningful update for us but not to forge >> thank you, and thank you for the collaboration, i think these pictures say this all. i had a question and then i'm going to have christian take over with questions. in the past and you've that this has gone on for years. that administration change, if you're showing washington the navy more stable?

we know that epa can rebe eviscerated depending on who is in charge. i'm wondering is there any knowledge on what went on in the past and constants, where there is if there is ange appr know who to turn to. do and we >> i think that is a al concern, commissioner green, and i don't know, i don't know exactly what might happen at the stage and even okat prior administration. as we know the ten or politically has shifted so dramatically at th level. i don't know that we can anticipate. but what i do know, is the dedication of this department n much as we can and to use the levers that we have to do that. i will tell you that the fact that we work with more locally

with the reand others are very committed people, and so, they willthe best that they can to their ability to continue to use their regulatory pow i think it will just depend on what, what happens and at they are able to do. so it's an unknown. but it's an unknown that we're going to be preparing for and o what we can now to do as much as we can try to adplan anding committing to communication improvement, the climate studies all of that in advance. but we willveto see what impact any kind of administration change they may have. >> thank you, commissioner christian. sommissioner seg ada go ahead. >> thank you, thank you for the presentation. i'm new the commission so speaking about bay view-hun■7rs

point, is not new i grew up in the city and it huthat we're still dealing with this. i remember as little kid, friends, had asthma, sick, and missing school, 2024 we're still dealing with this. and it's not acceptable. i know that the city francisco has to wait for the federal government to do their part.■ all i heard today is they're doing this study and thathearin when this is going to get revolved, this is three, four, five generations now. so i would like to hear a deadline, if it's a ten-year deadline. something that is written, something that is peopcan look forward to. esgovernment give us extra money for medical

expenses? do we get any community support from the government, from the so that the people that are dealing with the illnesses don't have to suffer financially? these are the questions that come to mind and the questions that can be answered next time maybe setting this back another two or three generations, no one should have to live like this. ullike to hear a deadline. let's talk to the people in the navy, the squeaky wheel is going to o i think the people in hunters point dedigny, a date when this is going to end. enough oftheye asking for curtains for the ust,how

insane does that sound? so i would love our next presentation if we can hear a deadline this will be done. >> thank you. >> deputy, do you want to say anything at this point? >> it's fine, i just check in. it's wonderful to see you back and impressed by the work that since our last meeting which was not happy, if this is not happy situation and that's not going to change. but i just want to thank you for na --that you have done and ththat you have clearly put into the work and the the structure that you have created for community engagement going community engagement and i know that you will

to add and improve, in the ways that you find that you come upon as you continuehi and i had a couple of questions. you spoke about the quarterly etcured. can you describe a bit about just briefly what that looks like? what that presents look like when you're there in the meetings? asked about the community meetings? were you interested commissioner more in the meetings we have with epa? >> yes, quarterly regulatory meetings first. >> yes, absolutely. so we're meeting in a with a small group with the members

their team some of whom are based here in san francisco and others that ar oer parts of the country, they have laboratories and other parts of the country et ca. so it's a small meeting, it's just our two small of people, talking through. we're asking questions. they are answering our questions. and then what i'm hoping that we do, a question that we want to ask about, about mobilization, not with dp a but and the navy. that may be an example of a question that smaller group, and we here, what some of the■/is been. they obviously are not at liberty to share everything that theyabout in their, in their meetings and process

because it's close to us but they have been forthcoming and they do have a real interest in trying to and promote the health of resident and san francisco is part of this process. it's also evolving and i feel it's in the beginning stage how they have been moving the community engagement. we're also trying to deepen our community to enga with ep a and other regulators to that relationship also. so i believe we're at the beginning stages. but i'm happy that for the first time that i can recall we have that audience and connect and standing ability to have thank you.wz . i'm glad to that you're pleased with it so far. would it be reasonable to

question whether some of the things that might come up in those meetings are actions that have been taken to help the city and navy and regulators to t community public health now? in addition to working wi the longer range time lines and goals? >> yes, we can ask, can ask those questions. is there a particular intervention that you're thinking of? i just want to make sure i fully understand. >> wellven us a report today and we have heard and just recalling some things from the last presentation and

cuwe've gotten, technology for preventing the dust from traveling, simple technology or not so whatever exist and whatever adequate and it's workable something like getting something going. even if that's not the goal. >> that's a goeson and that's an issue that i will try to raise again and have a more would it take to be able to do that, what been the challenge and is it what would it take to be able to

i'm very happy to raise that to standard?how about this issue of physical barriers at the , reasonable question to ask. >> thank you, i think it would that that's a question that we want to know of them in your meeting with them, what they can do now as they move toward the remediation that they're focused on? what can they do now to start decreasing the ■÷u,harm that is being and have it be the best that can be they're identified remediation is in place?

as part of what and advocating with nem or the community. i'll just k for myself, i would like to know as soon as we can when a question like that made appropriately by you is presented to the regulat to the navy to anyone who has any responsibility in the space d they say about about i had a question, technical row. assistance, atu mean by technical assistance that we give to the regulatoand the navy? >> i'm sorry if i ssspoke, i meant technical comments. >> what does that mean. >> it means when the navy says they're plan to go do a remedy

like putting into place the engineer, ryan casey is the inone will review that and with the techniknat he has may ask the question, why are you not x seems to be what predominated other similar situations and then the navy will respond to that. so it's acting a level why they're using the remedies they are and what have reasoning do they have going with this one? that is the level, i'm giving a very simplifi ample, i have expertise in other bunot to this. who is reviewing, reviewing what the navy is proposing and then helping draft the leer which end up being very

technically because they going point by point and each that the navy is planning and asking questions about it, about how we know this is the go and raising questions that the navy ca and many times it's the same questions that the reto are asking but it's important for nem to see 're focused on and vice versa although some of the >> great, last meeting, one of the things that we all ta about was the depth of of technical, the depth of technical acthat we have within the department. and you're standing here before because you're one of those .

did you ever find it inappropriate to weigh in using, your technical comments seareas of expertise and other areas of expertise that we have in the depa >> i'm involved canot only the health director but officer and explaining what that role is. because i'm not an engineer but i'm asking with the questions with the d physician and as deputy a director king said, we fortunate to have director nena as pateam as well. and kiye raises important questions so we'll have an understanding technical understahealth impacts of some of these

exposures and then i'm able to voicmember of the executive team and as a senior department and the people in those meetings, so yes, i do, i do channel the experts on my team and then add my own voice as officer.■ >> that's wonderful to know. and after these quarterly meetings, ere any reporting out to the community about what happened and what what was discussed what the outcomes of some of these meetings? >> there have been for more the informal quarterly meetings. smft larger meetings, i believe there are minutes of some of those meetings that are available but not so far for lemeetings that we've had with epa. >> well i woulask you to consider from based on your participation and your work,

whether it would be appropriate to let the community know that we had a quarterly meeting on monday, this was discussed, these were smft questions we raised.and what you're looking towards the next meeting. and again, i unsues and how muc time this very gowork is i leave it to you to discuss. but as somebody living in the city, knowing that these meetinare taking place, my questions would be what was sc so just record out as you see appropriate.

i think ken i'enough time but i do want to say and i'm echoing comments that have been given, thank you for aring us and it was apparent to us when we were expressing dismay about the level of participation that the department had that, that you are deeply concerned about these su and so, i hope it didn't feel, i imagine thatit didn't feel great but i hope it didn't feel like we that you understood the departments, the city's spsibil responsibilities as the department to the community to sell usly advocate for them, in way that's are consistent with our expertise mission and the things that we can and cannot do,you know as experts in your field. so thank you for this and thank you, the nice report very

helpful. and i looking forward to that y you articulated here and all that we can do to help you, deeply appreciate created. >> thank you so much, commissioner christian and to the entire commission and i'm very thankful to director king and the community for coin with us and willing to partner with us. so i do think that with the resources we have together, we will have a path look forward t and reporting back, even when some steps backwards, we're going to ep pushing for the steps forward. >> it's nice to see this collaboration. y good. >> you too. >> it has to be ■qfrustrating f you because the timeline is set

for the epa so what commissioner christian said about highlighting the counas the efforts you have made and some of these meetings, we would et and it just, highlights all you're within the constraints that you tais i know director wanted to make a final comment. >> thank you, i just wanted to thank the dph team in engaging ways, this is a lot of work and i really want to thank susan philip and asa king for engaging in th's are often uncomfortable, the a bureaucracy does not adapt well. i also wanted to thank people for making public comment and let you know that the department hears your concerns. so thank you being here today. >> thank you.

>> wonderful. >> so, the next item on our agenda s dph overdose response update cunins who is director of mental health sf and crysta d. >> hi commissioners, hillary kunings director of nt i'm very glad to be here along with my colleague crysta geda who will be doing most of the presentation. next slide. i just wanted to situate discussion about the opioid coordinated opioid r we've been calling it within the department of public

health, so a larger department, it's particularly important here crysta and i are among its leaders, really it's playing from across the department in terms of expertise and resources and really want specifically thank dr. colfax and dr. bolba who continue to be anenabling us the metaphor is to nders, advance on this fact. next slide. so we want to share with our key strategic areas around the opioid response. ou20is to reduce fatal overdose, to reduce disparity in fatal overdose among

particular focus on black african americans in san sco, p homelessness and people livi in supportive housing. all of these specific groups populations are at elevated risk of overdose or death.goal response structure that is coordinated, equity driven and advancing policy and doing work na is deeply data driven and ce be. and this is a subsequent adoration, you can see the slas epidemic has evolved. next slide. the slide in front of you is one that i showed last ti

was here, summarizing behavioral health process. this isanpdated version. what you can see on this side is from offer and data. we havethugh july and that's the line you see in orange. soto date, we are seeing about 15 in the first to first 7 months of 2023. and most powe announced i guess last month august, that there have been reported deaths reported for july. this is the lowest number of

overdose deaths we've seen in t since january of 2020. this is given us, i think it's fair to s some sense of optimism and feeling like we're we know that we have much more to go, we know this is still a local and national crisis, so we are by no means done. i want to introduce to g ada who you know and has spoken thcommission on street conditions, street response we have asked and she has been willing to step into really lead us in coordied response, to really amplify, speed up, help all of us and our team to think creatively ggressively about what else we can be doing.

so really a lot of kudos to crysta sh will tell you more. and i'm here. >> thank dr. kunings and good evening, commissioner. i'm directof director initiatives which means i get to on many projects and i've been honored in the last 8 months to be working on the overdose response. so what i want to do today and i'm happy to come back to give you updates, to really talk about where we're at in the response from our more accomplishments and our goals. we're outdated and we've done a lot of things thatout to do, so happy to report but happy to come back. we're operating a■y basis to stay focused.

things forward, let's get things done. i think the structure has ly the next slide, i'm going to give you a big picture overview, we have two strategies. the first being to increase the ability and lityand effectiveness of our use, continuum, that is very large to residential step down core component that we're going be most affective in fight thising opioid cries ris. first opioid methadone, these are affective treatment sxz reduce the risk 6 death 50. need to get the word out and get the folks involved. second is manaprogram, so you probably heard of those as well. also evidence, behavioral treatment that incentivized, behavioral changes in folks

towards goals so. reducing, at other treatment session small incentives like gift cards. this is ll study with stimulant disorder and 89 volve opioid, so we're seeing a lot of sim lant use as wel. to go draw upon those lessons. third is reimproving our post overdose responses over the last sel i've come to talk about re, it includes our street over depose response team, post overdose engagement but really looking at the intervention that don't ha■slot of evidence, we're thinking about how do we learn and howwe strengthen them? so we've given a lot of attention in this response. now i want to go over the next slide and talk abthe resent accomplishment.

so in terms of expansion, and i'm looking for bringing back data soon, i have give to you. so if you did ask all the questions, i have some data to you. i think in the future update, to have data more. we're getting a lot of data up.n data is being inputed but we're starting to see increases and it's really exciting to see and looking forward to share of think in the next quarter, we can come back with that. but first, opioid program. nohow much you've heard, a tele health from 8:00 d i've gone out, it's really phenomenal. just goin the street, letting them know about

methadone, many folks had experience and many not. and able to immediately connect them on the phone. since march, had over 1100 tele health ca some are interested in methadone, some folks, you know, not really ready. as of four months ago, 440 people had picked up their methadone prescription. while it may seem small for an intervention where you're just hitting the streets, this is huge. the second part though that really, that we added to this was a program that we're calling restore. and that is 7-day stay at shelter.of lks that we brought there have been 86.

and over 80 percent who wanted methadone linked toup methadone, so surprising when we couple care treatment with stable housing or shelter and we really wrap it around we outcome. so i'll be talking a little bit more about that program and how we're expanding. second, we have to allow certain describers and we're going to talk more about of the technicalities here but outside of opioid treatment program. so traditionally, you only get methadone in a program, clinic now we ha some exceptions where some folks can actually start describing.

've secured take home approval from the department of healthcare services for san francisco's methadone clinic that are in line with fedguidel know that federal governmentenu guidelines, we have a long way to go in california. dr. colfax wrote a op-ed to talk about thed legislatio we're helping to support. second is management so really getting the word ouere about the programs. i think a lot of folks are not aware of modelality and we have awarded some new contracts will expand and we're starting

to collect standardized metrics on something we didn't have. incentivizing different things. we have ten programs going and we'll be expanding this, very exciting. and second, we've launched a program we call scope at the alcohol soberiking folks who are starting medication. this is folks who are out of the ed, we've already had 18 patien gone there immediately following an overdose.four of those folks ha been able to sueslink some promising first results starting that. we also strengthen our poet , w acny but we're able to engage with

the mayor of ■ñbridge project, we have an outside consulting firm to help map out and see where the opportunities are to increase connecting an getting them the services they need. and then we started to hone in on our post overdose engagement. were trying to follow-up with everybody but now narrowing it in. we had a resent cohort of folks that we're following that had over 3 overdoses in a year. we've had some great success five of them we to m.o. ud.methadone

clinics-last on the policy side our office and along with the mayor and others were able to pass local legislation to require pharmacies to op buprenorphine, so we are seeing prescriptions go away and need to make sure people can get it. it went into effect september 1 and we are working and giving cal systems as needsed to pharmacy. lastly, a v2115 state bill is to help us come into alignment with federal new federal rule e working to get t by the ally hoping that we can get those rules implementee state. next slide. so, for continy manament, we are

expanding our offerings and primary care clinics, wee distributing information about the contingency management programs and hoping to certify all our contingency management contract which we awarded. next slide. we will be expanding our scope pilot making sure ems, the community paramedicine can bring folks there and more training with the paramedics and implementing new data workflows with post engagement teams. next slide. anourategy is to really strengthen our engagement and social sut dying from overdose and so as said, the major disparities are the black african american community, 5 times the city wide average strengthening our housing. strengthening work in the indigenous community, where we don't see

as high disparities but see disparities and eases and increase awareness of substance use programs. next slide. so, go through here, some of the accomplishments. invest in the community to ee,lien to voices and make sure we fund and support clead organizations deeply indpaijed and have relation ships with the bu maybe not done specific substance use treatment work, so we are rkthe san francisco faith based homeless children network and others to g the e technical support to contracts into place. and then, in we have implemented the emergency--over 50 percent of all citfunded permanent supports housing with dpole of

percent by beginning of 2025. and then we are starting to socialize our living proof campaign so this is a campaignlly humanize the issue and tell the stories of people with lived experience who have used treatment service and been successful. x what are we doing now? the community, the black mmunit let us know they want cultural congruent materials for substance use disorder ansowe are putting together a rfp. we are g cacity building plan. we are getting our san francisco faith base coalition contracdo and we are working across many communes pu 2025. next slide. our supportive housing work, we community first responder training, so knowg peop most likely to rever

overdose are also high ringe for overdose and maybe-getting tenas building and knowledgeable and spread the education and respond, we will continuing with our emergency naloxone station and also unchg a peer lead overdose program lead by an orgazcalled delivering invasion in supportive housing, who has done good work. and then really pushing our telehealth program folks are aware. next slide. indigenous community, is is newer work so bringing the voice of the community to the table. we are producing ose prevention videos in 4 languages, a building hour lessens from covid, and the social media videos are a great

of meeting people. and then, building off pity for spanish speaker s to be able to do overdose prevention work, so training across. and then next is increasing public awareness of substance use service and reducing stigma. fimeize the living proof campaign so hoping to get that out in fall. we are updating ou use card to get the word out there. making buttons can i can give later. talk to me about treatment. out is. we just wrapped overdose awareness month so we were lucky enough to participate in a lot events, one with black african american community, the first time e do one. we were with mothers who lost h addiction. on saturday night we had a visual. it has been a good oppoun

to raise awareness, morn lives lost and brg more people into this rk that's all. any questions or or i rushed through some that? >> for your enthusiasm and your optimism and of course ed. it is really heartening for us to hear so mawell developed programs that are really actionable. it is very positive, very encouraging and to top it off, we are going to plus a b2115 and sounds like it is a really good time now for this work and we'll certainly look forward to your future presentatian any public comment? >> any public comment in the room? any public comment. nothing online. >> okay, commissioner giraudo. >> thank you for answering some

of my data questions, i appreciad it. my last question or se what--do you have adequate staff 2in doing this work as you are increasing and paing work, and i am assuming that it is difficult even you have positions to bring in those qualified to be able to do the work and is that kind of an impediment in-as you are trying to kind of make a difference here? >> great question. i think a challenge across public health--[indiscernible] i think one thing i want to say is that, dph ma issuch a priority that w

have been very fortunate to get positions move hiring fast, so for instance with the beam i'm so impressed not only with the number of candidates and the passion of some of the candidates coming into the sothat is exciting. we are facing funding issues on reste pand that program. we are-we don't fund them, some of the ent supportive housing providers struggle to find and maintain staffing so the work getting that going could be difficult. dr. kunins can probably talk about this more, a methadone clinic often--facing quite a bit of challenges bringing in prescribers so this effects intakure and other availability that is another big place we are it. i think generally speaking behavioral clinicians, everyone is looking for them and really difficult to

bring into the wor >> on the up-side agree everything crista just described. on e, mental health service act, which you know about. about a years ago maybe allowed for some funding be directed to substance use for the first time. historically this has always on directed at mental health. ing this artificial divide, anso mental health services act soon to be renamed behavioral health service act, supporting this work and r fortunate source of funding is those two sources have been ars. used to do some of the expansion work that you heard about. the workforce as we all discussed is

indeed chall >> may i also add to that? that is a long answer, but i it is important. i think both have-the answers have been very positive and also think it just a funding issue holding back, it is bureaucracy that has not adapted to the crisis and the behavioral health california is state vizen teen, it is outdated incredibly challenging to address and be flexible around mptd we do it e we are financial stewards and remember, we are also a naged care organization within the health department with oversight as the state and taxpayer money and have to follow the rules. things li beds for treatment, cfr42 which -we can't use epic r--even including in this core effort, we literally cannot look need to look at i our

network because of cfr42, which outdated. you have seen the al wrote the insanity around methadone regulation so there is fug d staffing issues, but also huge amounts of bureaucracy that is getting in the of making progress. i appreciate we-i just felt we needed to make that clear on the record here. the work with dr. kunins and others in e department, dr. [indiscernible] dr. phillip, they are doing everything we can and pushing bureaucracy out of way as much as we can. we can only do so much locally. ne more state and federal partners to help us do this. >> now there is--i know the tr, believe me. just down to little kids. but now, have you been able to

or advertise how many of the psychologists--there is a certification in substance abuse cetera, that i heard of many colleagues who were interested gng through this kind of certification, whether or not we that could focus on recruitment? >> thanks to working with our own hr rtthinking about ve recruitments, exploring what our co-practice pathways, so if you not certified, getting certified while you are in the job. i also will point out, there is not h pele who are addiction certified and we can't just rely on them to do this work. i think reflecting positive change on

the buprenorphine allows anyone with a de a license to prescribe buprenorphine had not been true until the last few years where had to undergo special 8 hours of training. you could a nurse practitioner, p a or physician, but imagine the hurdle of the 8 hours ends up widdling potential prescribers. that has changed for buprenorphine and not chand for methadone as dr. colfax is saying. inmyouview, it needs to be a multi-part strategy people who we can bring up to speed with appropriate supervision around addiction and substance use disorder, as well as working to the people who are already certified or who are interested in it.

>> commissioner guillermo. >> just wanted to comment on the sort of fast and furiousness the solutions and the interventions this department developed and tried to quickly with whether the rea and with the challenges on workforce and all that make available response to the real issues on the street, not just to the republic and others are putting on you, because it is e from what you've described to us, not just today, but kunins, when you come and even to folks that are describing to us in the planng e committee why the contracts look like they do,

this a commitment across, but i have to that, it is difficult to understand from a person standpoint. if there is way somehow that across this muof projects and programs and responses and funding sources and requirements for reporting , that that enthusiasm, that joy when things are showing that can be shared as well, because i think that superseeds confusion why there beso many different programs at such different times in response to sothat seems obvious to uninformed and lay public, because it becomes so clear to us when we are sitting here, and makes me

want to help proclaim to anybody who asks or who is cynical about this. really no, there is a lot of good stuff. i don't know what that is, because there is a much larger community i think that could be supportive. >> i really appreciate feedback, and this is something that has been very important colfax, to myself, crista, we are ng with our teams to do to the lay public, colleagues to simplify messages, to convey what objectives are, how we are doing, why we are doing it, why we think it willwowe are making the choices we are, and we are you , very grateful for that feedback and we'll continue to do that.

anyou- invite you for any feedback where you see us out there to encourage m different-we are very appreciative of it. >> great. again, i'm sure you find ways to do that, but i just appreciate the way that you help us remember the human ity anhumans regardless of the challenges and costs. thank you. >> thank you. >> yes, thank you. it is really impressive and we know as commissioner guillermo said, many of us have seen all contracts that have come through and hable to pull up together and understand all the

differegrs that we have to be able to try to reach that are in need. i'm wondering m a different standpoint, because you are adding--you approached it [indiscernible] buprenorphine tido death in half. how do we select, assuming you are able to have more access to methadone in the future, and understanding that at least ngof the literature, methadone is superior to buprenorphine, which one to actually guide or is it a matter of better accessibility?■ is it a matter of better availability? how do we distinguish which one to put people on?

>> thatthat question. just to say, the irony reflectingon dr. colfax's point, the irony, right now when you are workinwia patient or person who would like the medication methadone or the me buprenorphine, you are not only choosing the medication, but choosing the delivery system. in order to receive you essentially must go to a opioid treatment program. you know those are highly regulated. you have to go every day or nearly every day to receive your medication and be ved taking it. regulations use of federal and state regulations, and there are very prescribed patterns to by which somebody might receive what called a take-home dose, meaning a togo dose.

rt of the editorial dr. colfax and i wrote, which is there has been some recent loosening at the l lel, but it isn't automatic that the sup with those federal loosening and what we did in editorial is very much urge the state to come inalign with the federal loosening of take-home doses, requirements around familiar counseling. needed to be diagnosed with addiction. so, and buprenorphine could be visible substance abuse treatment programs or primary care or in kinds of specialty care, and so while in most clinical studies, there is-i describe in effectiveness of buprenorphine and me it is so outweighed by a person

who might not be willing to go to methadone because of all ents either not willing or can't and therefore bupris more appealing. in my own clinical experience i might offer buprenorphine to somebody who didn't want all the hassle having to show up in a opioid treatment every day. the other point to make is, we don't have a lot science yet about fentanyl addiction per se and the relative effectivene of methadone versus buprenorphine. what we are learning clinically many clinicians and colleagues, the properties of buprenorphine, the properties of methadone may make it better choice for people with fentanyl addiction. but, if somebody

interested--the goal keep the person close, engaged, say we want to offer works, keep talking to the person and switch to the other medicine if needed. line or like there is a first first line and second line that is described in the literature quite yet. it is really a focus on here are two wewill offer or try them both. they come with their pew curearities around the delivery system and we go from there. thank you very much. it is very helpful to understand, from a clinical side understanding the complexities of trying to do methadone to also understand thatthe buprenorphine therefore is much more valuable accessible for people at this point. i really thanswer

e] thank you. >> thank you. commissioner christian. >> how did you xoe i wanted to say something? >> [indiscernible] >> we spent so much time together. so, directors, so good to hear fryou and see you.■ú commissioner guillermo talked about the joy from you today and we see lot. we are fortunate to see this a lot from your to tell us about their work. is infectious so thank you. ain, following up on commissioner guillermo's comments, i think that to the extent you can figure how d this. you are solving problems in real time. there used to there was a one street program and then you are solving these problems in

real time and may say, well, these nt you ed shot approache get it together and figure out what needs to be done. they need to be told this is us getting it together and figuring what needs to be done. eating structures to solve an the problems. work with communication team, i would strongly encourage you to fit talk about ways and perhaps if we can help to tethat story about well, this is figuring it out in real there was this program and then crista anher colleagues experie this and so, brought it back to you and dr. colfax and these things developed, and it a great story and it is a on pp going story and ve story and you are saving lives and mmaniz

people that are every moment dehumanized by us in the way about them, because of the frustrations, whatever it is, or a lack of experience with the problem or experience the problem we don't nt think about. so much with that and what you are doing and presenting the work does help. you probably know from talking an working directly with dr. colfax around these things, but he comes in glowing and like-commissioners if i could-i ell you the story and he tells the story of your work and so know that he's out here and this is how he comes to us and he infects us with that joy and admiration, so you have a incredible champion here with dr. colfax and so thank you so much and get meas you can, take care

of your, thank you. >> i'm going on vacation. [laughter] >> take care of yourself [i >> thank you. >> at this time, there is so much political and explanations for stark and inaccurate and it might be really useful timefor you to really come forward and display all the work or all e done and take crit the programs that are so innovative and making a impact because it seem many people in the public assume nothing is is going on u and it has become a cry for people who don't know and in wa , look at the world. people don't understand, don't know, don't understand transgender health and go through the long list we ha sensitivity and understanding in san francisco, but we need to play some of those skills and communications

outlets to be able tomake sure that our voice is heard and your work is highlighted,usit is so meaningf effective. thank you so much. onerot questions or comments? great. thank you so much. >> thank you so much. >> the next item on the agenda is the planning committee update, which commissioner guillermo will give. >> speaking of lots of projects and programs. so, today i had the pleasure of sitting in commissioner chang's seat to chair the finance and planning committee along with dr. chow. we reviewed e monthly contract's report, which provided usth information on 9 contractors, 8 different vendors. eight of the contracts have been to th health commission previously, so they

were either amendments to because of the amount or the date, or confirmed funding soce and then one not new, but met the threshold coming to commission for the first time. six of the items were amendments to exisng contracts are continuing services with the same vendor under a all eight vendors are subject to fiscal compliance monitoring, and all of them were in conformance wiall the standards accept for three, which have follow up items that will be checked. two of them, it they did not post or blic meetings as required by the contract, and that is going to be addressed. one of them i think heluna health because they are based in san francisco, so thought they didn't have to meet that requirement. and one was late in submitting a financial report, but that is

followed on. that was for contracts report. and then we had request for apo new professional service contract with the san francisco community health center to services to support unhoused trans and gender diverse individuals. and another ntract to request to approve açprofessional service sy there is a existing contract with golden gate something that does the same thing and this is a contractor. and then after that, we got something has come to the commission a coupyeago on the mra funds that have been or going to be-those

are funds that were puinto a fund for employers that had small employers and from city contracts and there about $350 mill the fund and they are going to do a full force effort winewth tool and new communications eligible for the medical exbe reimbursed before 2026 they think of the funds access will go back to general fund for the department. so, that was the tota of the finance and planning committee. >> thank you for pitchg for the report. no public comment. >> there no one-yes, no public comment. >> any commissioner questions or comments on this report? hearing none, we will go to the joint conference committee and commissioner guillermo is going to present

the august 13 laguna honda hospital jcc summary. what was a very common normal jcc meeting for laguna honda viewed the executive team report, the regulatory affairs report and human resources report, and then the policies that will be on consent calendar today. just one thing of note, there was a q & a to again the readmission and admission polic for what is now sort of a opening up of those residents who had prior-who were prior residents a honda, in addition to at some point new folks that are going and then just a update on the 120 bed requt request for the beds that we will be pe

being able to request at some point relatively soon, once there assurance by the state and the feds that we are satisfactory moving right direction with all the policies and procedures you. is there any public comment on that report? >> there is not an commissioner, i might have missed the committee recommended approval of all the policies. y commissioner questions or comments on that report? the next one is commissioner will give us the summary of the zsfg jcc meeting from august 27. >> ank you. the committee met and discussed two very important presentatinsch were quite robust. one had to do with access and that is how the tient

experience would be able to be enhanced ug the hospital flow, and also discussed e issues of hospital flow and why we had so borders so to k in the problem of of se the bottleneck and trying to discharge. and the work being done to try to these areas. the other presentation wa as important and had to do with the revenue [indiscernible] optimization, especially sins much of the billing now isn't just-much of our work isn't in capitated dollars for hospital care, b rcent of our work is actually being done fee for service basis, so this means gearing up the hospital billing services in

to maximize the revenues that we can receive for the work we do the committee also reviewed standard reports ng the regulatory report human resource and ndisrnible] data elements which align with the hospital true metrix which may become part of the routine reports. we will be trying that out to see how this will ou which would be then more then--which would be a monthly tracking of the true north metrix. coittee cal staff report, the is recommending to the full commission to approveneurology rules and regulations we had a very nsiv discussion with the medical

executive committee reviewed the neurology debut the regulation changes are fairly miner. ssi, the committee approved the credentials report and the [indiscernible] report. >> thank you. any public comment? >> no public comment. >> commissioner questions or comment? thank you all. we'll move to consent calendar and you have the septemmonthly contract report that commissionerd polic procedures for both and laguna honda, the jcc recommended come for approval from full commission. is there a motion to approve the items on the consent calendar? >> move to approve. >> second. public comment. >> alright. we'll do callote.

[roll call] >> consent calendar is approved. ank you. >> community public health committee update from commissioner giraudo from the august 28, 2024 meeting. >> thank you i'll try to be brief with the hour. our first was the child adolescent presentations h of our were excellent. to give you the highlights, the community priorities and top needs curry are access to re, for women, housing security, homelessness, mental health, infant economic and family support. child care, social emotional support, learning and nt issues, adolescents, housing security, mental health andic family support. specneeds population of kids is being able to cover some of the

needs, case management, cess to specialty, providers, mental health and care giver re ate next steps is really th guidance and the report should be out tlwhich will also help guide and lo with some of the top need the second part of the report was a update on foster care system and the integration of dp. there's about 600 to 9foster youth in san francisco out of home placement. the healthcare program that is se management focused, the child welfare referrals in 2022, they didn't have anything past that. it is coming out.

there were 49referrals to the hotline. but it was interestingthe majority were from not surprising, but were from educators, so came from the schools, om the teachers, from the school administrators, teachers. and, then also of e needs of this population is consultation and resource guidance. the medical, l and medication needs. challenges is e lack of mental health providers, as well as acissues. for the group that takes care of the ca youth, our public health ey are case managers, but the case load is125 to 150

cases. is rough. it is a super challenge and the objective currently is to hire public health nurses to be able to the challenges and needs of the foster so, it was very interesting. very interactive. our second was a return of the public cy preparedness and response oand we discussed their co which were many. at laguna honda, ally built emergency the operations program. they coordinated with the direct market agey coordinator responding to the overdose. therwalead for

coordination between behavioral health vicej health, hospital and others, which s very interesting. another training and planning and gave examples they were vowith apec when the ec conference was here with eration encore, a full scale exercise to test the--i was a instance with overwhelming hospital search and it was really fascinated what they were telling us, but it wavery very successful. fortunately they had a increase--significant increase in which was also why they were able todo operation encore. there is staffing contingency management planning currently,

on going for ph branch. the highlights too is they moved climate health to their branch, and there a 24/7 duty officer and response team for any disasters. challenges is orienting ne staff to public health emergencies, and continual performance improvement. ardoing a great job and they expanded their services within the ity and within dph. those were two extremely interesting and exciting presentations at r >> great summary. very interesting data you shared. t the foster system. incredible. ic comment.

>> commissioner questions, comments? alright. now the next item is other business. >> no public comment. >> the next item is adjournment. >> i so move to adjourn the meeting. >> i serkd. [roll call] >> thank you everyone. rthday. >> thank you. [meeting adjourned]

>> in the bay area as environme sustainability. wee ■ a leader in the untry acr terms of what you can do and we have a learn that is what allows us to be successful. >> what's woe is you have so many people who come here and they are what call policy innovators and whether it's ban pltic bags, recycling, composting, all the different things that we can do to improve the environment. we really champion

we are at recycle central, a large recycle fail onn francisco pier 96. every day the neighborhood trucks that pick up recycling from the blue bins bring 50 # o tons of bottldes, c paper here to this facility and unload it. and recology, san francisco's yclg company, they sort that cans, glass cans, and different type of plastic. san francisco isaking efforts to send less materials to the landfill and give more materials for c other cities are observing this and are envious of san francisco's robust recycling program. it is good for the environment.

quality plastics and junk plics ad candy wrappers and is difficult to recycle t it is low quality material. ndfill. cities that goes to >> looking at the plastics industry, the oil industry is the main producer ofastics. and as we have been trying to phase outossil fuels and the transfer m, this is the fossil fuels and that plastic isn't recycled and goes into the waste stream and the landfill and unfortunately in the ocean. with the stairry step there will be more plastic in the ocean than fish. >> we can recycle again and again and again. but plastic, maybeo recycle it once, maybe. and that, even that downgrades into a lower quality material. >> its cheaper for the oil industry to create new plastics

and so they have beenung more and more plastics so with our ab793, we have a bill that al a goal of getting our beverage bottles to be made of more content so by the time 2030 rolls around t recycl bottle, water bot will be up to 50% which is higher thatten the percentage in the european union andhe highest percentage in the world. and that way you can actually e drinking will actually become recycled. now, our recommendation is don't to plastic bottle to begin w but if you do, they are ng 50% content. >> the test thing we can d is vote with our consumer dollars when we're shopping. if you can die something with no packaging and find loose fruits and vegetables, that is the

best. find inaging and glass, metal and pap rer all easily d. we don't want plastic. we want less plastic. awe what you we do locally is we have the program to think disposable and work one on one to provide technical assistance service tousables and we have funding available to support businesses to do that so that is ay to get them off there. and i believe now is the time we will see a lot of the solutionsn he market and come on the scene. >> and is really logistics company and what we offer to restaurants is reasonable nes that they can order just like they would so we came from about a pain point that a lot of feel which wills a lot of waste with takeout and deliver, even

transitioning from styrofoam to. and to dream aboutreusing this delivery and food takeout.d we didn't have throwaway culture always. most pe to get delivered to people's homes and then the empty milk containers were put back out whenesh milk came. customers are so exci have this available in our restaurant and came back and asked and were so excited about n rolled it out as customers gain awareness understanding what it is and how it works and how they can integrate it itolife. >> and they have always done it andally that is a way of being sustainable long-term

change to what makes good fiancs there are shipping issues and material issues see that will potentially be a way that we can save money as well. and so making that case to other restaurateurs will e a. >> one restaurant we converted 2,000 packages and the impact and impact they have in the community with one switch. and we have been really encouraged to see more and more reta we are big fans of what

rco terms of adopting new systems and understanding why tentc system is broken. pople come to the facility, they are shocked by how much waste they see and th volume of the operations and how much technology we have dedicated to sort correctly and we l tours and for students to reach about 1100 students. and they wanted to make change and this sorting in the waste stream they do every single day and they trship of and make a difference with. >> an i feel very, very fortuna that i get to represent san franco i the

legislature and allows me to push the envelope and its because of the people the city attracts and is because of the ecoyf policy thinking that goes on in san francisco that we are constantly ssan fra. >> kids know there's a lot o environmental issues that they are facing. and that they will be impacted by the impact of climate change. they will have the opportunity to be in charge and make change anahe decisions in the future. >> we are inventing the way the planet does garbage founded hunger to send less to landfills.thiss so many wonderfs happening in san francisco. i feel very fortunat humble to live here and to be partf t wonderful place. chinato

>> (music). >> welcome tocisco

japantown. >> san francisco japantown iso united states. >> it was founded in the 1800s by japanese immigrants construction over the jars japantown has become a home to a japanese community with aurants popular decision in the heart of san francisco. and sape unique it is one of the three b and how i explain japantown we're a city within a c to taste and experience the japanese culture but really be a community what is all about and one of the best things aboutpane dozens shops in the

neighborhood serving from modern deserts andith friends. >> (speaking foreign language.) >> name is t a leader of the japantown to we to provide something they creates l savory yummy favors we t to provide like japanese flavor well as for the japanese customers. >> if you're foodie or looking for a quick and deliciou to fin >> it is a authentic japanese deter and drink shoppecial

lists in we alsor a roasted green tea and we have flares and other flavors we're known for ice cream and sun disingenuous. >> japantown a variety of counity center the eight h the amendmentssociation of north california. >> (speaking foreign language.) >> this tearoom designed by the tearo art (unintelligible) and then they built everything in jpa that is a a he ship it to the united states. with the carpenter and this is one of the

public only two in the united states and the japantown takes you on journey sdlts neighborhoods and history was a self guided tour you by japantown center west mall and work your way learn about the history what made japantown had today. >> what as young people; right? wh this stays here for the future. speaking o ofugmented reality created we adobe in a phone stand which of the store we call that the tree experience a great opportunity to do completely different that will take you to the with a immersion of an experience?

incredible. in additio to the culture and ar contribution japantown hosted festivities and ts toughout the year some are the cheri blossom festival. and after dark japantown comes life with night clubs and or joy serene moments through theminad francisco is japantowng communie people to experien japanese culture with food and exciting events and japwn is a must see for any visitor to san

>> ♪♪ ♪♪♪♪ ♪♪ ♪♪ ♪♪ ♪♪ it looks at good an tastes good and it is good my mouth >> ♪♪y ♪♪ ♪♪ ♪♪ ♪ ♪♪ i am the executive chef i've been here as at la concina since 2005reas we do th

the reason we start to celebrate the spirit and talent and trivia the hard work of the women in the la nc program if you walk up to my one on the block an owner operated routine i recipient it's a they're going to be doing the cooking from scratch where in the world can you find that >>'m one of the owners we do rollssuburbia that is crisp on the and this is rolled you upe don't this it has chinese sister-in-law and a little bit of entertain sprouts and we love it here. >> there are 6 g cheese grilled to the crisp on the

outside outstanding salsa and a lot of things dip it knocks you out and it's spicecy and delicious i was the first personhat came here and we were not prepared this every year we're prepared everybody thinks our home and so the festivalsut were part of the group we shove what we dond we w we tried to capture the spirit of >> and there from there to

sales and the hard part of thes and creating a opportunity giving limited risks and sales experience to our guys and [music] >> san francisco is known as yerba buena, good herb after a mint that used to grow here. at this time there were 3 settlements one was mission delores. one the presidio and was yerba buena which was ur center. there were 800 people in 1848 it

was small. a lot of historic buildings were here pony express headquarters. wells fargo. hudson bay trading company and famous early stlers one of whom william leaderdorph who lived blocks from here a successful businessperson. african-american decent and the first million airin california. san francisco.as the founders inhe early 1840s.old rush c he spent time stake himsel a merchant seaman and a business person. his father and brother in new orleans. we k him for san francisco's history. himself here arnold 18 twoochl he did one of many

things the first to do yerba buena. was not california yet and was not san francisco yet. >> because he was an american citizen but spoke spanish he was able to during the time when america was taking california from mexico, there was annexations that and conflict emerging and war, of course. of the peek deliberations and am doorship to create the state of california a vice councio mexico. mexico granted him citizenship. he loaned the government of san francisco money. to funds some of the war efforts to establish the state, of cour. he established first hotel here the person people turned to often to receive dignitaries or hold large g established the first public

school here and helped start the public school system. he piloted the first steam ship on the bay. a big event for san francisco and depict instead state seal the ship was the sitk a. there is 4 block long length of, owned much of that runs essentia whell the transamerica building is to it walk today before am a cute side street. ats point t is the center what was all his properthe was be the city's first treasurer. that iseal of itself to have that legacy part of african-american the city's first banker. he was not only a forefather of the establishment of san francisco andifora as a state but a leader in industry.

he had a direct hahn in so many things that we look at in san francisco. dna. you know you don't hear hisor i. representation matters. you need to uplift this so people know him bute him like me. like you. like anyone who looks like him be i can do this, too. and a street in the middle of r financial district. that alone is powerful. [music]

i'm supervisor connie chan. over the lastyears i worked to make district 1 stronger and safeer for all families. first generation chinese e public over two deck ades to give back t city that gave my family new opportunities. it was haneer to be rked to be for district 1 residents. i believe every san franciscan deserve clean and safe streets. and pushed city hall to admore