>> hi, any name is anne i'm here representing the great panthers of san francisco and also myself as a long term care administrator and i wanted to take this opportunity to put before you once again the need to restore the 120 beds at laguna honda hospital. the beds were paid for by the taxpayers and we really need them. a loss of nursing beds are happening everyday. we would not be able to conjure up 120 nursing beds in san francisco. so please let's do everything that we can 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. teresa palmer. >> yes, please begin dr. palmer. >> caller: yes, i want to say that i'm worried about losing 120 beds and i think there should be at every health commission meeting, discussion of progress on both admissions and getting a waiver for the 120 beds. this is very important to the people of san francisco laguna honda has a third of the nursing home beds in san francisco and, there is a, there is a huge nursing home shortage in san francisco forcing frail and senior and disabled people to go out of town for nursing home care. and, and we need to, you know, fill up the beds that are available at laguna honda but we also need to not lose the 120 beds.

and i would like to hear progress at every health commission meeting. this is this is an an extremely important issue for the aging population of san francisco. thank you very much. >> this is the only public comment that i see on the committee right now. >> wonderful. so we'll 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 overdose, in july unfortunately 39 people died of accidental overdose according to the chief examiner. continues to to be the driver of majority of deaths. this number 39 is 59 percent

fewer than we saw in july of last year when there were unfortunately 79. overall this year, we've seen 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 double down on our extreme and to get more people into treatment and save more lives. related to these efforts is, the dph sponsor assembly bill 2115, during the 2024 legislative season, mayor london breed sponsored assembly bill 215-5 increases access to methadone by a loining state law with resent federal rules. vulnerable populations is essential to addressing the overdose crisis and this would help expand overdose deaths and

further improve access to healthcare for the most vulnerable residents. the goal standard for treatment of opioid reduces the risk of death by 50 percent and i'm pleased to says as of saturday, the bill did pass and the bill will go to the govern's desk for his potential signature, so i'm really happy that this continues to make progress. it is so important that we get more methadone out there. also a number of overdose awareness events and international awareness day. so i'll let you read about those events, i was able to participate along with other dph staff numbers and you hear about that upcoming work in the upcoming presentation today.

on a related note, i was able to visit the call center which receives more than 1100 calls a day of patients of healthcare primary health and this is a very busy call center. and the, the call agents 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 center is ohe engagement team launched community practice for promotores, part of a cdc

project. promotoras are health workers in spring of 2024, this month, last mobsinger august 21, 2024, they conducted entirely by spanish by dr. bertha hernandez with support of facilitaters. on the final day, 35 percent received certificate of completion. so really important community base project that we're making progress on. and then you'll see that the staff received alien 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 the behavioral health division. but we're delighted that she will continue that work and you know how much i like data and delighted that our tb clinic was featured in a health issue in the new england journal and care delivery issue. you'll see our covid quick update on the bottom of page 5, and i want to say that we're getting the message out that september and october are good times to get your flu vaccine and covid vaccine. we start today give flu vaccines in our network and we'll start to give covid vaccines. we're still in communication with the distributor, we have no date when we'll receive the vaccines but i hope that's soon.

that's my director's office report. >> thank you for the report and especially on the great news on 21 a b-15, fantastic. is there any public comment? >> any public comment on director's report? dr. palmer, i saw your hand? dr. palmer, please turn off your computer. >> speaker: sorry, my hand wasn't up. >> no public comment on the item. >> okay. was that a public comment? oh she didn't want. back to commissioner questions on the director's report. seeing none? thank you, and we'll go to our next agenda item. >> i have a comment.

>> sorry, i keep missing. i will watch for your little yellow hand there, go ahead, please. >> speaker: okay, and i thank the reporter on the centralized call center, it's really encouraging. i remember when it was a less than robust call center. but then, i was wondering as you mentioned the nurse advise line. 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 can get that very quickly? >> sure and the other question i had was, and i know when we get the printed information but, is there a length that we can look at the article that

you site in regards to the tv screening? >> i believe that link was included in the report, was it included in the report? >> well it was included in the report but we get the written report, so i don't know if. >> okay. so secretary march is signaling that he will send you a copy of the article. and i think dr. yu is on remotely, do you have a answer to commissioner advise lieb? --line? >> no, the hours are not 24-7, at night at 8:00 p.m. and weekend i believe it's 8 to 6 or 7 but they are not 24 hours. >> is there, because 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? we have a large block of patients here under the san francisco health network? >> yes, that's an excellent question dr. chow, it's cover the call hours. >> so if somebody was to call after these hours and i, i realize there may not be a lot but more urgent, is there a referral then to either the county or is it just not answered and they're expected to go to the nearest emergency room? >> well the centralized center

does not operate 24-7, we have coverage on call. it's always a call 24-7 weekend as well as evening starting, starting from 5:00 p.m. until 7 or 8:00 am in the morning. the nurse have advised that they're available next we'll take that first triaage call by the nurse, if they need to route it, they will. the answers and there is advise line disclose the, they will go to the on call doctor. >> okay, no no, that's excellent explanation providing 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 gifts that 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 going to be a recommendation to authorize to extend the gift to the department of public health. >> thank you very much, commission. we're proud to present the program for your approval. this is an innovative program na develops skills and prevention for professional staff by allowing them to complete an extension by hospital beds control practitioners. hospital infection preconvenience programs are

eligible to receive 10,000 by the public healthcare associated program. these funds are to be used by hospital staff members to attend professional conferences or training. the foreshadow the facility ip and combine total of 80 hours for future goals and objectives. thank you very much for allowing us to present this to you for approval. >> thank you, sounds like an excellent program. is there a motion to approve. >> i make a motion to approve. >> second. ?r. any public comment? >> is there any public comment in the room? there is no public comment remotely. i'll start with roll call. >> yes. >> yes. >> commissioner christian. >> yes. >> commissioner greene. >> yes. >> commissioner gi uillermo. >> yes. >> and commissioner chow. >> yes.

>> the item is approved. >> the next of approve to authorize the department of public health to accept and expand gifts of--, 83,253.04, $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. director, and staff. it direct for san francisco health network.

the city and of san francisco has received test kits for dph over the last year. since covid but since the declaration is no longer in place for emergency, other protocol that require us to formerly accept this as a gift from cdph. we currently 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 up of surges throughout the covid event. so it's our recommendation that we continue to receive these kits that are gifted to the other public health, on going and this is the formal acknowledgment for the test kits that were received in the last fiscal year. >> thank you, is there a

motion to approve. >> so moved. >> second. >> and is there any public comment on this item? >> is there any public comment in the room on this item? is there any public comment? commissioner chow? >> yes. >> commissioner guillermo? >> yes. >> commissioner green. >> yes. >> commissioner christian. >> yes. >> and commissioner gi ran do. >> yes. >> so the next is honda fund budget for fiscal year 24-25 and i think leo who is the manager is going 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 gift budget 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 from cash donations. which were about 8 2000 mostly from the estate of johnny cramer and anthony exemption trust. we also received 711,000 from interest and about 13,000 from incline donations wiz include a piano, clothing from saint frances and blankets from grace fellowship church. and expenditure summary, some line items got close to the allotted amount thanks to the activities being open again and the mitigation of covid. we're carrying some wish-list

from last year and we will process them this year. the total amount for fiscal year 2024, was about 125,000. the budge the for this year, as all other years, was developed and approved by laguna gift fund committee. review includes analyzing all items for decrease sxz increases in amounts. for fiscal year 25, we expect to increase the budget, laguna honda hospital has begun admitting new resident sxz we expect new outings for the residents. we also considered the general increase for costs of goods. because of the factors mentioned, we were increasing most items so we can accommodate. we're also adding an outing. covid support will not be increased and we believe the remaining amount will be completed by this fiscal year. there is a notable increase for

miscellaneous for patient benefits because there is no initiative for future residents of laguna honda. in summary we're increasing the budget by about 120,000 for the reason mentioned. we cannot accommodate the amount because of the balance of the gift fund which is 1.2 million. they're for the general benefit and of rehabilitation center. and in accordance with the wishes of the donors. i'll be happy to answer any questions. >> thank you for this information. because it's an item to approve, we take a motion to approve initially. so is there a motion to approve. >> i still move to approve. >> second. ?r. any public comment in the room? >> is there any public comment 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 i guess i'm looking for a show of hand. >> yes, i was checking, commissioner chow no questions before we go to a vote? >> no my question was already answered. and that was to understand the increase in cost on the patient benefit item and the presenter already gave us an explanation as to why this was raised such a substantial amount. >> thank you, i'll do a roll call vote. i'll start with commissioner dwraoen. >>--green. >> yes. >> commissioner guillermo. >> yes. >> yes. >> and commissioner chow. >> yes. >> the budget is approved for this year, thank you so much. >> thank you. >> so the next item on the agenda is hunters point naval shipyard updates. and we have asa director of community health in the

population health commission. thank you we've been looking forward to hearing from you. >> thank you so much, thank you so much for inviting us back to speak with you. as president green said, i'm susan philip i'm the director at division in dph and i'm joined by asa king who is our director deputy, so we're very happy to be representing the work of the disciplinary team that focuses on the clean 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 number one clean up and it operates under a tight federal system of regulation and clean up. and the regulators include the

u.s. environmental protection agency, the california department of toxic control, and california regional control board and california department of public health. the san francisco department of public health does not have a regulatory role of the regulators that i just mentioned. however, we do assume a role of regulation once the land is daemd acceptable and that is done by the the colleagues. dph are following along very closely to understand the key technical issues involved and also to understand the community and expert input and reaction and expectations of the work of the shipyard

because we know it's a very very large undertaking for decade and we need to follow along closely, so we're all providing input as we go. as a key agency that has a stake in the health of 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. i just want to go over our outline, that was the correct slide, just the outline. our strategy, we'll talk about that. community partnership and out reach activities to date. some updates in the way where we're trying to increase and approve communication through our website and other avenues. he will speak about the five-year review process and explain that and then speak about how we've been trying to increase our inner agency

engagement, even if we don't have a regular tory role we can speak to the regulators and we've increased our action on that since the last time we were here. and then talking about upcoming events and activities. so for the next portion of the presentation, i will turn it over to deputy director. >> good afternoon commissioners, asa king, deputy director of community health and population health division. if we can advance to the next slide, please. so when we last gave our update about the department's work, on the shipyard clean up, we introduced for the first time our inner disciplinary team and more fundamentally our commitment what we're trying to achieve in this work and more broadly in the hunters point community.

we know that it's essential to work on improvement health outcomes and centering community voice. this is a part of our overall departmental commitment to help equity and really supporting communities where they need it most. so as a part of that commitment and our overall strategy has been around one community partnership, we think this is essential and we'll be giving some updates on some of the things that we've done over the last several months to increase our community partnership, really work on building trust, better listening and understanding community concerns and really 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.

not just in creasing the volume of the communication but increasing the clarity, giving additional avenues for communication and i'll speak about some of those updates as well. and the inner agency engagement because there are so many regulatory agencies involved in this process, we have found new avenues to be in close communication with other regulatory agencies to further events, the protections to the community and better be involved and under the updates on the clean up process. sxl lastly, equitable health. so this is really about giving the community the tools and supports that they need to improve health outcome and to reduce health disparities. if we can go to the next slide, please. so just the highlights of a few

of the key activities that have occured since our last update on april 5th, we did a community listening session with residents at the hunters view phase one housing community and this is near the shipyard. so this was a specific request from a community group called 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 and speak with residents. and really answer a lot of questions that people had about health related issues, they're about 15 residents that joined

us at the meeting. and you can see here on the slide that is picture of us at the end of the meeting. so this was a to really share resources that we had that are existing within the department around more common issues such as morals and other indoor air quality related issues. and also this was a key tech point for us to give information about how the public provide comment totz five-year review because at the time we were still in the public comment review period. and then, 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 invited along with other stakeholders agencies to draft poster, and have it available to the public. and i really stand by it to explain to people what our clean up role is. as you have seen, there is a lot of agencies involved that you all struggle to know who is responsible for what. this was a way to not just provide written materials. all the members of our disciplinary multi disciplinary team were there. and we had that opportunity to explain our role as dp sxh, what our role is around the shipyard clean up. so that was a well attended

event of about 40 participants so we really got to hear and engage with community members there. another thing that i would like to highlight is on april the 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 offices and invited us to the community stakeholders as well. we got 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. and so we got to hear from some of those community members that work directly with her and about some of the concerns were

so. that was really the first meeting of its kind that we were able to have with that group. 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 engaged with that group to talk about opportunities for advocacy and partnership and really understand what the community has been advancing what we can support and way of resources and way of understanding. and continue to provide information as we receive it from the navy. next slide, please. you may also that one of the

key communication channels that we use was our dphsf.gov website and we continue to previeed information on that page and update it quarterly. now we've provided even more information on the page which gives an overview of each parcel in the status of the clean up, so that community members can really understand it also has a map so we can understand where they are as far as some of the work that is being done and also getting quarterly updates on that page so they can really understand what is the status, what will be happening at each of these pages. so each of those boxes under

the parcel overview image, are quickable and expand to additional pages. so each parcel has its own page with a wide away of information that we have about what is happening at each parcel. additionally what we have learned in our communication with community as well is that 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 to really give another resource for people to find out information and also our website is accessible and can be translated into several different languages which is another benefit of having it as ri resource for community members.

so with that, i will if we can go to the next slide. i will turn it back 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 five years. it is required and mandated under the same federal law, that determines the navy's responsibility and the regulator's responsibility. and that is the federal comprehensive environmental response compensation actor cercla. so every five years, the navy is required to publish this document, this five-year review and this is the 5th one that they're doing this year.

and it evaluates the clean up process in the prior five years. and the goal or what they are meant to do is determine whether the remedies that have been put in place continue to be protective of environment and of human health. they also take the opportunity to look forward to see if the continued plan recommendly also is protective. as we know is this process has taken decades to complete and instead of waiting until the entirety of the time, they look at the five-year intervals so they have--on the interventions that they're doing. and the other thing that they're doing and we'll take about it in a minute, they have trends, and something like climate change might make a remedy that was initial lea

februarying tiff with the modeling no longer affective. so those are the reasons why the five-year review continue to happen. on let's see, so this first draft was issued in 2023 in november 17th. and we will go through the process of the steps that were involved but the final report was then released this summer in july of 2024. and this process does allow for input both from the regulatory agency that's are a formal role and for public comment. and as i mentioned, sfdph we don't have a formal regulatory role so we are included in public comment but it's understand that we're giving technical input at a level that might be different from some of the other document but they're equally important. next slide, please.

i apologize there is a typo in the first section, it should say november 2023, so i apologize for my error. so this goes through the steps starting with the initial release of the draft of five-year review in november of last year. then in january to april, there was an initial opportunity for the public during three months to review and submit some written comments on the draft five-year report. then in november through july, november of 2023 through july of 2024, dph and regulatory agencies that i mentioned and listed there, reviewed the five-year report and issued comments. and we, we worked independently of the regulatory agencies and

did a review, thanks to the work of largely ryan casey who is is our engineer and environmental health but our entire team was involved in discussions around this. and then in jaoushltion the navy then issued its final five-year report taking into account the regular lairtz, public comment our letters as well and then issue the final report. through this process, the navy is required to engage the community and told them about the opportunity for input and try to clearly explain, what it includes in the five-year review. it's a very large document, very technical. so in april, the navy hosted a climate assessment workshop and, deputy director king alluded to that and we'll show you just a snip it of what that looked like in terms of our dph poster and involvement there. this is our first five-year

review that incorporated a assessment so it's very important for it being the first time this is included. and that is going to be incorporated into the remedies moving forward so we'll speak about that. and then in june, the navy did talk about the draft five-year review at its shipping yard advisory meeting which is the avenue by they present to the public and feel questions in realtime from the public. next slide, please. so throughout this process, dph have been involved in the 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 the start of a clean

up the cra has been included. in may 14th, we submitted comments on the draft five-year review report and then, as the navy put out its draft final incorporating some of the initial comments, we additionally put out a final letter, july 18th, comment on 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 on our communication channels, website and social media and other formats. and then as deputy director king said, we drafted a poster for the workshop and participated with the public in a dialogue about our role and federal agencies did that as

well and the impact of climate change. next slide, please. so this is this is a poster that was put together to really talk about the broader work that dph is start to go undertake to assess climate change and we know that that will have an impact on the work that is being done to clean up the hunter's point shipyard as well. and as much as possible when we can, we're trying to focus on the larger effort that we are doing as a department not only in population health but more broadly to really work towards a health equity and good health outcome in the neighborhoods that surround the hunters point shipyard as well. while it's important and we continue to have a core team focusing on the shipyard i'm focus ed on tying it in to the

higher effort making sure that it's good and available to all residents in san francisco including in bay hunter's point. next slide please. so within the letters that we submitted for the five-year review, there were some key themes that emerged, things that we really wanted make sure that we told the navy this is really important for the health for the residents surrounding the shipyard and we want to you respond and incorporate responses into your not only into your report but into your planning, in the actions that you're taking. first of all, improving communication with community. this is so important and paramount and we see a lot of opportunity for improvement and the community has also pointed out the immense opportunities for improve here. you heard about some of the work that we've done from deputy director king.

but here's the place where we're advocating with the navy and with the regulators to use 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 can be done in other situations and other parts of the country. we will do whatever we're able to do with our website and communications and we're pushing the navy to do its part as well. secondly, this was the first five-year review that incorporated the climate resiliency assessment, it's imperative that navy really amplify and make clear they understand the risk posed by climate change. in the five-year review, there were findings that ground water rise and seawater rise could

impact the shipyard by 2025 potentially mobilizing some of the contaminants, we called for investigations. the federal and state regulators have done the same and the navy has said that it's commit today parcel specific more detailed studies of the impacts of climate change including ground water and seawater rise. so we'll be looking for those 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 community has raised, the important question are we certain that the can tam

intents have not migrated to the outside of the shipyard. and we agree na this is a really important question and we support transparency and 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 the residents who are surrounding the shipyard now. and there was a question, thank you commissioners about what the navy response has been to some of the community and questions and concerns. and in some areas it has been to say while the regulators approved their plan. so for instance, they had a plan to excavate certain

trenches of soil for radioactive evidence of radioactive activities. and the regulators have said that rather excavating, they can stay with their original plan to do a sub set of sampling. that was one area where their response was well we're work width regulators and sticking 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 these compounds with climate change and the navy did commit to doing these more specific parcel by parcel reports. so they're, there are some areas in which the, the input from the regulators and the community have changed the way that they're plan to go do some of the remedy. next slide, please. so i think the other piece that

i really want to make sure that we share with you, is that we're engaging with the community as deputy director king laid out. we are talking with the navy giving their input through the letters formerly giving our recommendation and our feedback 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, we have a have a strong voice given our position, role and expertise to protect the health of residents in san francisco. so we are, now initiating quarterly meetings between our dph and the epa, we have just had a few of those. but we are looking forward to continuing that and raising some of the questions that we just outlined as one of our key

priorities that we're hearing from communities and also identifying ourselves. we are on regular inner agencies calls around communications with our communications experts, communications director brown and others participate on those calls. and then, also being part of the community out reach working group. so these are ways where dph does have a seat at the table. where we can and where we're able, we insert ourselves to be able to understand what is happening to be able to voice what we're hearing in our inactions with communication and to be able to raise up the questions and inside from our own dph experts as well. and with that, next slide, please. we'll turn it back over.

over deputy director. >> just to conclude, if we can advance to the next slide, please. i would like to highlight three very important activities and events that we have upcoming that we are happy to engage with. so the first one is event base and it's hosted by 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 meet with regulatory agencies about what is actively happening right now with the clean up, but we have to support youth in this

community who are also going to be future leaders to be supported around environmental justice issues and climate justice issues as well. and so, thank you very much for our representatives from the marie harrison community foundation. it's got to be our second year participating in this event and we hope to continue to do so on annual basis and be a cosponsor and we will be there with the table with myself and some of our colleagues from the inner disciplinary team speaking with you and this will be a key way that we support youth development in this area and we're going to be looking for 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 something 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 will provide written comments to that document. and we'll be happy to share those with commission as well. and with, so, on the third thing i would like to share is also on october, in october we are still landing on a date but we have been invited to speak with the bay view alliance

which is a coalition of community organizations in the bay view who want to learn more about our environmental justice and environmental health work at dph and so myself and dr. philip and dr. aqoiwe will do that presentation and see it as an opportunity to build more partnership with other community organizations in the bay view, not only just on shipyard issues but really understanding the full breath of health related issues that 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 community. this is an important issue for

the commission and we'll start with public comment from the room and we're eager to hear from you and grateful that you came to talk to us. i have a list of names, so i'll read and if there is. the first i have is tonia randall. >> and i've got a little timer, when the buzzard goes off, please finish your statement and know that your time is up. >> speaker: i'm a long time resident of hunters point. i'm also the administrative director for marie harrison community foundation. i just, took all my thunder, brown water study, that was it. we do need underground water study but we need to do the latest technology, chain link

fences, it's it's appalling to see that these big tracks are moving this dirt and there is 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 second we wait, somebody else can die. thank you. >> thank you. >> it looks like marrian harrison, i may have miss pronounced your name. >> speaker: i'm executive director for social environmental justice. we activate science, we do community base science project, we also teach advocacy and set bridges for people to transition into institutes to

do intern ships as well as work with us. from behind your desk and seeing what we're seeing. we just wanted to let you 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 to join us in the community to get to know us because you cannot care about people that you don't know, right? so and i would like to thank, most of you guys very much. you guys have been a very very powerful team at the table, of meeting with the community and which community should be first and anything that you guys are reviewing or processing to the city. know that there are people in that equation and that we're human beings and we deserve to

live life to its fullest and not have such harmful chemicals 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 power to support our the community, you know, your residents, your constituents, however you want to call it, taxpayers, with making sure the communities like this and concerns do not go unaddressed. we need political will and portrtitude, i'm a mother, i'm a grandmother, and i'm, you know, and i'm a community parent to other children 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 has five offers of five universities and that's the kind of work that we're doing on the ground. we love our community and we want you to love us too, fight for us and follow us and we'll fight for you as well. thank you very much. >> thank you very much. i only had two papers are there other people in the room? i thought so, welcome.

>> speaker: i 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 have some concerns about the navy designation of protectiveness status to areas that are historically known to contain nuclear waste. what is i want to do today is emphasize the point that dr. philip made that even though the department of public health has a regular tory role in the clean up, it once did when i was on the rabbit did. the department of public health and has a responsibility to ensure the safety and to address exposure human exposures to chemicals and

radio that we know are present at the shipyard. in doing so, i want to introduce you to the newest cohort register and i'm going to be submitting some data to you that includes raw data. this is the nuclear cluster at hunter's point, it's the combined work by monitoring foundation james medical and 3tm consulting llc and the basic mythology is that we look at four koermer childhood residents who live within the one-mile parameter and the pin was placed to the landfill and defense laboratory. among the 11, they range in age from 15 to 82. 8 were female, 3 male.

among the females one was a non binary and one identified as being lgbt, race gender south african and three european including a male that is a foreign national. and the findings, i'm going to be submitting to you, but effectively we looked at concern documents to be present at the shipyard including product that are 100 percent specific for the hunter's point shipyard. there are a few places in the world where you can be ex mroesed to pla tonium 239. your time is up, i'm sorry. >> speaker: the findings are quite dramatic, they include a family of four that has po

tonium 244 and uranium detected in all. but this is evidence this is clear and convince beyond beyond a reasonable doubt. and i do want you to accept responsibility that these are people living within 100 feet to 6 blocks from the shipyard. >> thank you very much for your work and your leadership and you also brought up, we did receive quite a bit of public comment that came today. but we always review it it will be in our minutes, but we will carefully review and we appreciate people that do send us public comment. are there any other individuals 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 the last time that we were together and the deputy directer taking a more active role. so the great panthers are long time for community. i kusht currently attend the meetings. two individuals about the fact that they started choking so this is the on going multiple emergencies in the community. we support the five-year review report. deciding lack of data, five-year, public comment, we reminded the navy that in the year 2,000, san francisco

voters passed proposition b. i will not ask the question, but a lot of us voted for that, right? and we're still waiting. and also we questioned the protectiveness 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 more action in block thating contaminate that was also mentioned in public comment. so i think that's it. thank you.

>> thank you. if there is no one else in the room. >> i'm sorry, we're not able to read somebody else's comment. oh, i apologize. you've already made comments. so that's only one per item. but please quaoel free to submit anything in writing and we will add it to the comment. and there is one hand remotely. dr. palmer. >> speaker: hi, it's dr. palmer, we do have evidence that ship yards has been migrate anding on going fashion affecting the health of adjacent residents and that there is no adequate containment of the dust for adjacent residents. and and this is something that all should have been dealt with yesterday.

and so, so instead of but what i hear is talking about it as if it's uncertain about it but not specifying that it's going on. that people's health are affected and there is a lot of evidence to that. something putting as dust curtains on a chain link fence. please. this is crazy, thank you. >> that's the last public comment to this item. >> okay, we will go to commissioner questions and comments. and commissioner chow, maybe i should call on you first, so i don't miss your hand. >> oh, well thank you.

i thought the presentation was very helpful but i 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 terms of the dph technical submissions? or is there a process where in your meetings you'll continue to discuss those? i have not seen your reports so understand how the reports are being used. so doing a five-year report is one thing. so i don't know the format, if the public comments including us, did they then, add comments

after that? and then, does that then create some sort of dialogue on the issues that you've been raising? whether they accepted them or not? >> thank you, very much commissioner chow. it varies based on the issue, you know, as we were discussing for the issue of more complete studies and more thorough studies modeling out the climate risk associated with the remedies, they did agree. because there was alignment with the public, with the regulators at the federal and state level and dp comments as well so. i believe the totality of the comments did result in a change to the original plan to have more detailed studies about climate risks. there were other instances in which, they, submitted data and they said they worked with the regulators and were permitted

under the regulators offices to stick to what their original plan had been. so for example, how much of the dirt they were going to test for the radio, strong tm-90. that is an area in which they had different input from the community and from regulators and they determine that they were going stick to their original plan. and so in the big bucket areas that we talked about, we're really going to try to focus on those. in some conversations with the navy but we really want to speak with the regulators and make sure that they can understand our point of view and we're amplifying the community's point of view about, about looking at data, about generating the most

convincing evidence that the actions that are being planned and undertaken are health protective for the residents. sol that is the way in which we're approaching it now and i feel that will be the most affective way to do it because the regulators really have the ear of the navy, because legally they have the ability to change the course of the way that the clean up is happening. >> i really appreciate that. as you just said, you'll be working with the regulators on the issues that have been raised and we're not just dropping them but we'll be continue to go offer to the regulators. and work it through that way so they can help influence the navy's actions which i think is very good.

on the adjacent resident impact, have we taken a real position on this? and are there things that we are doing as a city because these people are outside of you know, technically outside the navy jurisdiction. >> i think that what we will, what we will need to do as we are, as we are developing capacity or bringing on leaders to look at some of the at some of the data and to try to understand how the data and mapping and epimodology are laid out and we do want to engage further and some is building capacity but we are on the verge of bringing in additional leaders in analytics to be able to do that. we also i would also like to

engage with other experts who have been looking at these issues overtime including at ucsf at uc berkeley and other entities that are academic entities as well. so i do think that we have more to do there in order to address the questions that you're raising and that's a really important one. what are, what are potential health impacts and as i mentioned before, we also want to understand that we know that there are, health issues and health disparities that we need 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 part of the work. we understand that there are special and unique concerns related to the shipyard and that's why the on going disciplinary team is coming

together regularly and working together to try to understand and address issues. >> so i think that would be a very nice follow-up in your next report is to lois to understand that and i guess that also wraps in and if anything, data shows that something should be done. so i would look forward to continuation of that aspect 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 i understand that it's very complex thing but working with the community is very important and i really do appreciate this update, us showing the closeness na you have now developing with the 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 partnering with the community you've done it, and i feel grat ified that you're continue to go do it. great job. and i'm hoping as dr. chow was raising, you're trying to partner with the community in trying to keep folks accountable, thal come back to tuesday, on a regular basis or when there is more information because i do know, it is, you know, top of our list of

concerns for the hunters point bay view community. and i know i had requested, i had questions and 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, there is no mission accomplished with this. i just want totem per a little bit the timeline and expectation. this is been an on going issue for decades. 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 and that we're doing it with community input at all steps and we're in the ears of the neighbor, the primary clean 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 understand 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 continue to work not just with the navy but with the entire community on the health disparity that we know are within that community. so really do appreciate your work. and i know that you'll work with the officers and mark too,

have an appropriate time for a meaningful update for us but not to forget. >> 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 commissioner christian take over with questions. in the past and you've said that this has gone on for years. that administration change, if you're showing washington is the navy more stable? we know that epa can really be 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 a climate change approach in washington, that we know what to do and we

know who to turn to. >> i think that is a real concern, commissioner green, and i don't know, i don't know if we can predict exactly what might happen at the stage and even looking at prior administration. as we know the ten or politically has shifted so dramatically at the federal level. i don't know that we can anticipate. but what i do know, is the dedication of this department is to continue to advocate as much as we can and to use the avenues that we have in the levers that we have to do that. i will tell you that the fact that we work with more locally with the regulators and others are very committed people, and so, they will do the best that they can to their ability to continue to use their regulatory power. i think it will just depend on what, what happens and what they are able to do. so it's an unknown.

but it's an unknown that we're going to be preparing for and trying to do what we can now to do as much as we can to try to advocate for plan anding committing to communication improvement, the climate studies all of that in advance. but we will have to see what impact any kind of administration change they may have. >> thank you, commissioner christian. sorry, commissioner seg ada go ahead. >> thank you, thank you for the presentation. i'm new to the commission so speaking about bay view-hunters point, is not new i grew up in the city and it hurts that we're still dealing with this. i remember as a 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 of san francisco has to wait for the federal government to do their part. all i heard today is they're doing this study and that study but i'm not hearing a deadline 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 people can look forward to. does the government give us extra money for medical expenses? do we get any community support from the government, from the navy? 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 we meet. maybe setting this back another two or three generations, no one should have to live like this. so i would like to hear a deadline. let's talk to the people in the navy, the squeaky wheel is going to get oil. i think the people in hunters point deserve with dignity, a date when this is going to end. enough of, they're asking for curtains for the dust, how insane does that sound? so i would love our next presentation if we can hear a deadline of when this will be done.

>> thank you. >> deputy, do you want to say anything at this point? >> it's fine, i just wanted to check in. it's wonderful to see you back and i'm so gratitude and impressed by the work that you've done since our last meeting which was not happy, if this is not a happy situation and that's not going to change. but i just want to thank you for the work na --that you have done and the thought that you have clearly put into the work and the organizing, the structure that you have created for community engagement on going community engagement and i know that you will continue to add and improve, in the ways that you find that you come upon as you continue this work. and i had a couple of questions. you spoke about the quarterly

meetings that occured. can you describe a little bit about just briefly what that looks like? what that presents look like when you're there in the meetings? >> you asked about the community meetings? were you interested commissioner more in the meetings we have with epa? >> yes, the quarterly regulatory meetings first. >> yes, absolutely. so we're meeting in a with a small group with the members of their team some of whom are based here in san francisco and others that are in other parts of the country, they have laboratories and other parts of the country et cetera. so it's a small meeting, it's just our two small groups 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 with larger and the navy. that may be an example of a question that we ask in a smaller group, and we here, what some of the discussion has been. they obviously are not at liberty to share everything that they talk about 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 protect 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 stages, how they have been moving the community engagement. we're also trying to deepen our community to engage with ep a and other regulators to have 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 discussion wz them. >> thank you. i'm glad to hear 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 protect community public health now? in addition to working with the longer range time lines and goals? >> yes, we can ask, we can ask those questions. is there a particular intervention that you're thinking of? i just want to make sure i fully understand. >> well you've given us a report today and we have heard and just recalling some things from the last presentation and documents that we've gotten, technology for preventing the dust from traveling, simple technology or not so simple, whatever exist and whatever is, adequate and it's workable something like getting

something going. even if that's not the goal. >> that's a good question and that's an issue that i will try to raise again and have a more direct response about what would it take to be able to do that, what has been the challenge and is it what would it take to be able to do that? i'm very happy to raise that to say, if this is, is this the standard? and what how about this issue of physical barriers at the defense line, i think that's a reasonable question to ask. >> thank you, i think it would be reasonable for me to say 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 harm that is being caused and have it be the best that can be done until they're identified remediation is in place? as part of what you're doing and advocating with nem or the community. i'll just speak 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 regulators to the navy to anyone who has any responsibility in the space and what they say about about whether it can be done tomorrow. i had a question, technical assistance, what do you mean by technical assistance that we give to the regulators and the navy? >> i'm sorry if i miss spoke, 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 extractors, the engineer, ryan casey is the principal one will review that and with the technical knowledge that he has may ask the question, why are you not using x, x seems to be

what predominated in other similar situations and then the navy will respond to that. so it's acting a technical level why they're using the remedies they are and what evidence do they have or what reasoning do they have with going with this one? that is the level, i'm giving a very simplified example, i have expertise in other but not to this. who is reviewing, reviewing what the navy is proposing and then helping draft the letters which end up being very technically because they're going point by point and each that the navy is planning and asking questions about it, about how we know this is the most health protective way to go and raising questions that the navy can respond to. and many times it's the same

questions that the regulators are asking but it's important for nem to see what we're focused on and vice versa although some of the work is done separately. >> great, that's really helpful. and you know when we had the last meeting, one of the things that we all talked about was the depth of of technical, the depth of technical accuity that we have within the department. and you're standing here before because you're one of those people. did you ever find it inappropriate to weigh in using, your technical comments based on your areas of expertise and other areas of expertise that we have in the department?

>> i'm involved because not only the health director but officer and explaining what that role is. i'll have follow-up, again because i'm not an engineer but i'm asking with the questions with the community in mind and with my understanding as a physician and as deputy director king said, we're fortunate to have director nena as part of our team as well. and kiye raises very important questions so we'll have an understanding technical understanding of human health impacts of some of these exposures and then i'm able to voice that as a member of the executive team and as a senior member representing the 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, is there any reporting out to the community about what happened and what was said 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 the smaller meetings that we've had with epa. >> well i would ask you to consider from based on your experience and 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 forward towards the next meeting. and again, i understand the staffing issues and how much time this very good work is taking. so i leave it to you to discuss. but as somebody living in the city, knowing that these meetings are taking place, my questions would be what was discussed? so just record out as you see appropriate. i think i've taken enough time but i do want to say and i'm echoing comments that have been given, thank you for hearing 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 issues and so, i hope it didn't feel, i imagine that it didn't feel great but i hope it didn't feel like we thought that you understood the departments, the city's responsibility here and our responsibilities as the department to the community to sell usly advocate for them, in way that's are consistent with our expertise and our mission and the things that we can and cannot do, the things 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 all that you're plan to go do that you articulated here and all that we can do to help you,

deeply appreciate what you created. >> thank you so much, commissioner christian and to the entire commission and i'm very thankful to director king and the community for continuing to engage with us and willing to partner with us. so i do think that with the resources we have together, we will have a path forward, so yes, we look forward to coming and reporting back, even when there is some steps backwards, we're going to keep pushing for the steps forward. >> it's nice to see this collaboration. >> it's very good. >> you too. >> it has to be frustrating for you because the timeline is set for the epa so what commissioner christian said about highlighting the community as well as the efforts you have made and some of these meetings, we would love to get the reports as well and it just, highlights all you're trying to do within the constraints that you tais and

we're so appreciative of the work. i know director colfax wanted to make a final comment. >> thank you, i just wanted to thank the dph team in engaging in new ways, this is a lot of work and i really want to thank susan philip and asa king for engaging in way that'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 for being here today. >> thank you. >> wonderful. >> so, the next item on our agenda is dph overdose response update from dr. cunins who is director of mental health sf and crysta director initiative.

>> hi commissioners, i'm hillary kunings director of mental sf. 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 our discussion about the opioid coordinated opioid response as we've been calling it within the department of public health, so it's a larger department, it's particularly important here because while crysta and i are among its leaders, really it's playing from across the department in terms of expertise and resources and really want to

specifically thank dr. colfax and dr. bolba who continue to be instrumental and enabling us to push on all cylinders, whatever the metaphor is to advance on this fact. next slide. so we want to share with you our key strategic areas around the opioid response. our 2024 is to reduce fatal overdose, to reduce disparity in fatal overdose among with particular focus on black african americans in san francisco, people experiencing homelessness and people living in supportive housing. all of these specific groups or populations are at elevated risk of overdose or death. our goal is also to have a

response structure that is coordinated, equity driven and involved in community and advancing policy and doing work na is deeply data driven and evidence base. and this is a subsequent adoration, you can see the slide here as the epidemic has evolved. next slide. the slide in front of you is one that i showed last time i was here, summarizing behavioral health process. this is an updated version. what you can see on this side

is from offer and data. we have data through july and that's the line you see in orange. so so far, to date, we are seeing about 15 percent fewer overdose deaths in the first months compared to first 7 months of 2023. and most importantly, we announced i guess last month in august, that there have been 39 reported deaths reported for july. this is the lowest number of overdose deaths we've seen in the city, monthly overdose since january of 2020. this is given us, i think it's fair to say some sense of optimism and feeling like we're making some progress. 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 crysta g ada who you know and has spoken to the commission on street conditions, street response topics. we have asked and she has been willing to step in to really lead us in coordinated overdose response, to really amplify, speed up, help all of us and our team to think creatively and a ggressively about what else we can be doing. so really a lot of kudos to crysta and she will tell you more. and i'm here. >> thank you, dr. kunings and good evening, commissioner. i'm director of director

initiatives which means i get to work 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, is to really talk about where we're at in the response from our more resent accomplishments and our goals. we're outdated and we've done a lot of things that we set out to do, so happy to report on but happy to come back. we're operating on a quarterly basis to stay focused. let's move things forward, let's get things done. i think the structure has really helped us. so if we can go to 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 accessibility and effectiveness of our substance

use, continuum, that is very large to residential step down but we're focusing on three core component that we're going to be most affective in fight thising opioid cries ris. first is opioid methadone, these are affective treatment sxz reduce the risk 6 death by up to 50 percent. so very affective, we really need to get the word out and get the folks involved. second is management program, so you probably heard of those as well. also evidence, behavioral treatment that incentivized, behavioral changes in folks towards goals so. reducing, stopping attending groups or other treatment session using small incentives like gift cards. this is well study with stimulant disorder and 89 percent of dpaegts volve

opioid, so we're seeing a lot of sim lant use as well. so start to go draw upon those lessons. third is really improving our post overdose responses over the last several years, i've come to talk about street care, it includes our street over depose response team, post overdose engagement but really looking at the intervention that don't have a lot of evidence, we're thinking about how do we learn and how do we strengthen them? so we've given a lot of attention in this response. now i want to go over the next slide and talk about the resent accomplishment. so in terms of expansion, and i'm looking for bringing back data soon, i have some data to give to you. so if you did ask all the questions, i have some data to you. i think in the future update, we're going to have data more. we're getting a lot of data up.

some that work in the methadone data is being inputed but we're starting to see increases and it's really exciting to see and looking forward to share of those. i think in the next quarter, we can come back with that. but first, opioid program. not how much you've heard, a tele health program from 8:00 am to 8:00 p.m. and i've gone out, it's really phenomenal. just going out in the street, letting them know about methadone, many folks had experience and many not. and being able to immediately connect them on the phone. since march, we've had over 1100 tele health calls. 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 we really, that we added to this was a program that we're calling restore. and that is 7-day stay at shelter. of folks that we brought there, there have been 86. and over 80 percent who wanted methadone linked toup methadone, so not surprising when we couple care treatment with stable housing or shelter and we really wrap it around with support, we have great outcome.

so i'll be talking a little bit more about that program and how we're expanding. second, we have exceptions to allow certain describers and we're going to talk more about some of the technicalities here but outside of an opioid treatment program. so traditionally, you can only get methadone in a program, clinic now we have some exceptions where some folks can actually start describing. very exciting. we've secured take home approval from the department of healthcare services for all san francisco's methadone clinic that are in line with federal guidelinesment so many of you know that federal government

lose end up some methadone guidelines, we have a long way to go in california. dr. colfax wrote a op-ed to talk about thed legislation we're helping to support. second is management so really getting the word out there about the programs. i think a lot of folks are not aware of this modelality and we have awarded some new contracts that will start in 2025 that will expand and we're starting to collect standardized metrics on this. something we didn't have. people rin --people are 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 sobering center, taking folks who are starting medication. this is folks who are out of the ed, we've already had 18 patients who have gone there immediately following an overdose. and four of those folks have been able to successfully link to medication. so some promising first results starting that. we also strengthen our poet hope, we have a lot of acronyms, [laughter] but we're able to engage with the mayor of on bridge project, we have an outside consulting firm to help us map out and see where the opportunities are to increase connecting people and getting them the services they need. and then we started to really hone in on our post overdose engagement.

we were trying to follow-up with everybody but we're now narrowing it in. we had a resent cohort of 11 folks that we're following that had over 3 overdoses in a year. we've had some great success five of them we linked to m.o. ud.methadone

clinics-last ly on the policy side our office and along with the mayor and others were able to

pass local legislation to require pharmacies to stop 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 technical systems as needsed to pharmacy. lastly, a v2115 state bill is to help us come into alignment with federal new federal rule regarding methadone so we are working to get that signed by the governor, and really hoping that we can get those rules implemented across the state. next slide. so, for contingency management, we are expanding our offerings and primary care clinics, we are 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. and our second strategy is to really strengthen our engagement and social supports for people most at risk of dying from overdose and so as hillary 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 increases and increase awareness of substance use programs. next slide. so, go through here, some of the accomplishments.

invest in the community to engage, listen to voices and make sure we fund and support black lead organizations deeply indpaijed and have relation ships with the community but maybe not done specific substance use treatment work, so we are work wg the san francisco faith based coalition, the homeless children network and others to provide technical support to get the contracts into place. and then, in housing we have already implemented the emergency--over 50 percent of all city funded permanent supports housing with dpole of hundred percent by beginning of 2025. and then we are starting to socialize our living proof campaign so this is a campaign to really humanize the issue and tell the stories of people with lived experience who have used treatment service and been successful. next slide. what are we doing now?

the community, the black community has let us know they want cultural congruent materials for substance use disorder and treatment, so we are putting together a rfp. we are implementing capacity building plan. we are getting our san francisco faith base coalition contract done and we are working across many communities partners to put on overdose prevention education summit in january 2025. next slide. our supportive housing work, we actually just finished our community first responder training, so knowing people most likely to reverse overdose are also high ringe for overdose and maybe-getting tenants in the building and knowledgeable and spread the education and respond, we will be continuing with our emergency naloxone station and also launching a peer lead

overdose program lead by an organization called delivering invasion in supportive housing, who has done good work. and then also really pushing our telehealth program making sure folks are aware. next slide. indigenous community, this is newer work so bringing the voice of the community to the table. we are producing overdose prevention videos in 4 languages, a building on hour lessens from covid, and knowing the social media videos are a great way of meeting people. and then, building off capacity for spanish speaker s to be able to do overdose prevention work, so training across. and then next slide 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 our substance use card to get the word out there. making buttons can i can give you all later. talk to me about treatment. very excited about this. we just wrapped overdose awareness month so we were lucky enough to participate in a lot of amazing events, one with black african american community, the first time we have done one. we were with mothers who lost children and have children suffered from addiction. on saturday night we had a visual. it has been a good opportunity to raise awareness, morn lives lost and hope to bring more people into this work. that's all. any questions or comments or i rushed through some that? >> thank you for your enthusiasm and

your optimism and of course your speed. it is really heartening for us to hear so many well developed programs that are really actionable. it is very positive, very encouraging and to top it off, we are going to get really useful data, 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 presentation and comments. any public comment? >> any public comment in the room? don't see any public comment. nothing online. >> okay, commissioner giraudo. >> thank you for answering some of my data questions, i appreciated it. my last question or seeing what--do you have adequate staff in doing this work as you are increasing and expanding the work, and i am assuming that it

is difficult even if 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 expand and really 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 made this such a priority that we have been very fortunate to get positions and move hiring fast, so for instance with the beam program. i'm so impressed not only with the number of candidates and the passion of some of the candidates coming into the program so that is exciting. we are facing funding issues on

restore to expand that program. we are-we don't fund them, some of the permanent 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 intake hours and other availability so that is another big place we are seeing it. i think generally speaking behavioral clinicians, everyone is looking for them and they are really difficult to bring into the work. >> on the up-side agree with everything crista just described. on the up-side, mental health service act, which you know about. about a year ago, two years ago

maybe allowed for some funding to be directed to substance use for the first time. historically this has always been only directed at mental health. reinforcing this artificial divide, and so mental health services act soon to be renamed behavioral health service act, supporting this work and the other fortunate source of funding is in part opioid settlement dollars. those two sources have been used to do some of the expansion work that you heard about. the workforce as we all discussed is indeed challenging. >> may i also add to that? that is a long answer, but i think it is important. i think both have-the answers have been very positive and also think it isn't just a funding issue holding back, it is bureaucracy that has not

adapted to the crisis and the behavioral health system in the state of california is vizen teen, it is outdated and incredibly challenging to address and be flexible around mptd we do it because we are financial stewards and remember, we are also a managed care organization within the health department with oversight as the state and taxpayer money and have to follow the rules. things like getting beds for treatment, cfr42 which prevents us-we can't use epic in our--even including in this core effort, we literally cannot look at data we need to look at in our network because of cfr42, which is outdated. you have seen the editorial wrote the insanity around methadone regulation so there is funding and staffing issues, but also huge amounts of bureaucracy that is getting in the way 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 the department, dr. [indiscernible] dr. phillip, they are doing everything we can and pushing bureaucracy out of the way as much as we can. we can only do so much locally. we need more state and federal partners to help us do this. >> now there is--i know the frustration, believe me. just down to little kids. but now, have you been able to access or advertise how many of the psychologists--there is a certification in substance abuse disorder, et cetera, that i heard of many colleagues who were interested in going through this kind of certification, whether or not

we got pr or something that could focus on recruitment? >> thanks to working with our own hr department, thinking about creative recruitments, exploring what our co-practice pathways, so if you come in not certified, getting certified while you are in the job. i also will point out, there is not enough people 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 you had to undergo special 8 hours of training. you could be a nurse

practitioner, p a or physician, but imagine the hurdle of the 8 hours ends up widdling out potential prescribers. that has changed for buprenorphine and not changed for methadone as dr. colfax is saying. in our view, my view, it needs to be a multi-part strategy getting people who we can bring up to speed with appropriate supervision around addiction and substance use disorder, as well as working to recruit 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 of the solutions and the interventions

that this department has developed and tried to quickly with whether the bureaucracy and with the challenges on workforce and all that make available in response to the real issues on the street, not just to the response the public and others are putting on you, because it is clear from what you've described to us, not just today, but dr. kunins, when you come and even to the folks that are describing to us in the planning and finance committee why the contracts look like they do, that there is a commitment across, but i have to say that, it is difficult to understand from a lay person standpoint. if there is a way somehow that

across this multitude of projects and programs and responses and different funding sources and requirements for reporting and such, that that enthusiasm, that passion, that joy when things are showing promise, if that can be shared as well, because i think that superseeds confusion why there needs to be so many different programs at such different times in response to something that 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 questions or who is cynical about this. no, no, no, there is a lot of really 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 that feedback, and this is something that has been very important to dr. colfax, to myself, crista, we are working with our teams to do to the lay public, colleagues to simplify messages, to convey what our objectives are, how we are doing, why we are doing it, why we think it will work, why we are making the choices we are, and we are you know, very grateful for that feedback and we'll continue to do that. any time you--i invite you for any feedback where you see us out there to encourage more or different-we are very appreciative of it. >> great. again, i'm sure you will find

ways to do that, but i just appreciate the way that you help us remember about the human ity and humans regardless of the challenges and costs. thank you. >> thank you. commissioner chow. >> yes, thank you. it is really impressive and we know that as commissioner guillermo said, many of us have seen all these contracts that have come through and here we are able to pull up together and understand all the different programs that we have to be able to try to reach those that are in need. i'm wondering from a different standpoint, because you are adding--you approached it [indiscernible]

buprenorphine cutting overdose 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 from my readings of the literature, methadone is superior to buprenorphine, which one to actually guide people to, 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? >> thank you commissioner chow. that's right up my alley, that question. just to say, the irony reflecting on dr. colfax's point, the irony, right now when you are working with a patient or person who would like the

medication methadone or the medication buprenorphine, you are not only choosing the medication, but choosing the delivery system. in order to receive methadone you essentially must go to a opioid treatment program. you know that those are highly regulated. you have to go every day or nearly every day to receive your medication and be observed taking it. that is because of federal regulations and state regulations, and there are very prescribed patterns to by which somebody might receive what is called a take-home dose, meaning a togo dose. that is part of the editorial dr. colfax and i wrote, which is there has been some recent loosening at the federal level, but it isn't automatic that the state keeps up with those federal loosening and what we did in our editorial is very much urge

the state to come into align with the federal loosening of take-home doses, requirements around familiar counseling. requirements how long you needed to be diagnosed with addiction. so, and buprenorphine could be visible in specialty substance abuse treatment programs or primary care or in other kinds of specialty care, and so while in most clinical studies, there is-i describe small differences in effectiveness of buprenorphine and methadone. it is so outweighed by a person who might not be willing to go to methadone because of all the requirements. either not willing or can't and therefore buprenorphine is 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

program every day. the other point to make is, we don't have a lot of science yet about fentanyl addiction per se and the relative effectiveness of methadone versus buprenorphine. what we are learning clinically from many clinicians and colleagues, the properties of buprenorphine, the properties of methadone may make it a better choice for people with fentanyl addiction. but, if somebody interested--the goal is always keep the person close, engaged, say we want to offer what works, keep talking to the person and switch to the other medicine if needed. it isn't like there is a first line or first line and second line that

is described in the literature quite yet. it is really a focus on here are two medications. we will 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, especially from a clinical side and understanding the complexities of trying to do methadone and to also understand that the buprenorphine therefore is much more valuable and accessible for people at this point. i really appreciate the answer [indiscernible] 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 from you and see you. commissioner guillermo talked about the joy from you today and we see this a lot. we are fortunate to see this a lot from your colleagues who come to tell us about their work. it is infectious so thank you. again, following up on commissioner guillermo's comments, i think that to the extent you can figure how to do this. you are solving problems in real time. there used to be no programs and there was a one street program and then you are solving these problems in real time and critics may say, well, these scattered shot approaches, why dont you 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.

we are solving the problems and creating structures to solve the problems. work with your communication team, i would strongly encourage you to figure out or talk about ways and perhaps if we can help to tell that story about well, this is figuring it out in real time. there was this program and then crista and her colleagues experienced this and so, brought it back to you and dr. colfax and these things developed, and it is a great story and it is a on pp going story and very dynamic story and you asavi lives and humanizing people that are every moment dehumanized by us in the way we think about them, because of the frustrations, whatever it is, or a lack of experience with the problem or experience the problem we don't want to think about.

you are fighting so much with that and what you are doing and presenting the work does help. you probably know from talking and working directly with dr. colfax around these things, but he comes in glowing and like-commissioners if i could-i want to tell 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 some rest as much as you can, take care of yourself, stay healthy and thank you. >> i'm going on vacation. [laughter] >> take care of yourself [indiscernible] >> thank you. >> at this time, there is so much political and explanations for

very stark and inaccurate and it might be really useful time for you to really come forward and display all the work you have done and take credit for all the programs that are so innovative and making a impact because it seems too 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 so many ways, look at the world. people don't understand, don't know, don't understand transgender health and go through the long list we have sensitivity and understanding in san francisco, but we need to play some of those skills and communications outlets to be able to make sure that our voice is heard and your work is highlighted, because it is so meaningful and effective. thank you so much. any other commissioner questions or comments? great. thank you so much. >> thank you so much. >> the next item on the agenda

is the finance and 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 the monthly contract's report, which provided us with information on 9 contractors, with 8 different vendors. eight of the contracts have been to the health commission previously, so they were either amendments to existing because of the amount or the date, or confirmed funding sources. and then one not new, but met the threshold coming to commission for the first time. six of the items were

amendments to existing contracts and three are continuing services with the same vendor under a new contract. all eight vendors are subject to fiscal compliance monitoring, and all of them were in conformance with all the standards accept for three, which have follow up items that will be checked. two of them, it they did not post or hold public meetings as required by the contract, and so that is going to be addressed. one of them i think heluna health because they are not 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 the contracts report. and then we had request for approval of new professional service contract with the san francisco community health center to provide services to support

unhoused trans and gender diverse individuals. and another contract to request to approve professional service system. there is a existing contract with golden gate something that does the same thing and this is a backup contractor. and then after that, we got a update on something has come to the commission a couple years ago on the mra funds that have been or going to be-those are funds that were put into a fund for employers that had small employers and from city contracts and there about $350 million left in the fund and they are going to do a full force effort with a new tool and new

communications to try to find the folks who are eligible for the medical expenses to be reimbursed before 2026 when they think of the funds access will go back to general fund for the department. so, that was the totality of the finance and planning committee. >> thank you for pitch hitting for the report. no public comment. >> there is 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. >> we had what was a very common normal jcc meeting for laguna honda and reviewed the executive team report, the regulatory affairs report and

human resources report, and then the policies that will be on the consent calendar today. just one thing of note, there was a q & a to clarify again the readmission and admission policies and process for what is now sort of a opening up of those residents who had prior-who were prior residents of laguna honda, in addition to at some point new folks that are going to come in and then just a update on the 120 bed request waver request for the beds that we will be hopefully being able to request at some point relatively soon, once there assurance by the state and the feds that we are satisfactory moving in the right direction with all the new

policies and procedures post recertification. >> thank you. is there any public comment on that report? >> there is not and commissioner, i might have missed the committee also recommended approval of all the policies. >> any commissioner questions or comments on that report? the next one is commissioner chow who will give us the summary of the zsfg jcc meeting from august 27. >> thank you. the committee met and discussed two very important presentations, which were quite robust. one had to do with access and flow of the hospital. that is how the patient experience would be able to be enhanced through the hospital flow, and also discussed the issues of hospital flow and why we had so many borders so to speak

in the problem of of course the bottleneck and trying to discharge. and the work being done to try to respond to all of these areas. the other presentation was just 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 just in capitated dollars for hospital care, but now over 50 percent of our work is actually being done on the fee for service basis, so this means gearing up the hospital billing services in order to maximize the revenues that we can receive for the work we do. the committee also reviewed standard reports including the regulatory report human resource and [indiscernible] new data elements which align with

the hospital true north metrix which may become part of the routine reports. we will be trying that out to see how this will work out, which would be then more then--which would be a monthly tracking of the true north metrix. the medical staff report, the committee is recommending to the full commission to approve the neurology rules and regulations we had a very extensive discussion with the medical staff, executive committee reviewed the neurology department, but the regulation changes are fairly miner. in closed session, 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 september monthly contract report that commissioner giraudo brought up and policies and procedures for both zsfg 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. >> no public comment. >> alright. we'll do a roll call vote. [roll call] >> consent calendar is approved. thank 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 health and both of our presentations were excellent. to give you the highlights, the community priorities and top needs currently are access to care, for women, housing security, homelessness, mental health, infant economic and family support. child access to care, social emotional support, learning and development issues, adolescents, housing security, mental health and economic family support. special needs population of kids is being able to cover some of the basic needs, case management, access to specialty, providers, mental health and care giver respite. the next steps is really the state guidance and the report should be out shortly, which will also help

guide and look at helping with some of the top needs. the second part of the report was a update on the foster care system and the integration of dph. there's about 600 to 900 foster youth in san francisco currently, in out of home placement. the healthcare program that is case management focused, the child welfare referrals in 2022, they didn't have anything past that. it is coming out. there were 4975 referrals to the hotline. but it was interesting the majority were from not surprising, but majority were from educators, so came from the schools, from the teachers, from the

school administrators, teachers. and, then also of the needs of this population is consultation and resource guidance. the medical, dental and medication needs. challenges is the lack of mental health providers, as well as placement issues. for the group that takes care of the foster care youth, our public health nurses, and they are case managers, but the case load is 125 to 150 cases. it is rough. it is a super challenge and the objective currently is to hire more public health nurses to be able to meet the challenges and needs of the

foster care youth. so, it was very interesting. very interactive. our second was a return of the public health emergency preparedness and response group, and we discussed their accomplishments, which were many. at laguna honda, they really built emergency the operations program. they coordinated with the direct market agency coordinator center in responding to the overdose. there was a lead for coordination between behavioral health service, jail health, hospital and others, which was very interesting. another area is training and planning and gave examples they were involved with apec when the apec

conference was here with operation encore, a full scale exercise to test the--if there was a instance with overwhelming hospital search and it was really fascinated what they were telling us, but it was very very successful. fortunately they had a increase--significant increase in staff since 2022, which was also why they were able to do operation encore. there is staffing contingency management planning currently, on going for every dph branch. the highlights too is they moved climate health to their branch, and there is a 24/7 duty officer and response team for any disasters.

challenges is orienting new staff to public health emergencies, and continual performance improvement. they are doing a great job and they have really expanded their services within the community and within dph. those were the two extremely interesting and exciting presentations at our committee. >> great summary. very interesting data you shared. especially about the foster system. incredible. >> no public 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. second.

[roll call] >> thank you everyone. >> happy birthday. >> thank you. [meeting adjourned]

my name is doctor ellen moffett, i am an assistant medical examiner for the city and county of san francisco. i perform autopsy, review medical records and write reports. also integrate other sorts of testing data to determine cause and manner of death.

i have been here at this facility since i moved here in november, and previous to that at the old facility. i was worried when we moved here that because this building is so much larger that i wouldn't see people every day. i would miss my personal interactions with the other employees, but that hasn't been the case. this building is very nice. we have lovely autopsy tables and i do get to go upstairs and down stairs several times a day to see everyone else i work with. we have a bond like any other group of employees that work for a specific agency in san francisco. we work closely on each case to determine the best cause of death, and we also interact with family members of the diseased. that brings us closer together also. >> i am an investigator two at the office of the chief until examiner in san francisco.

as an investigator here i investigate all manners of death that come through our jurisdiction. i go to the field interview police officers, detectives, family members, physicians, anyone who might be involved with the death. additionally i take any property with the deceased individual and take care and custody of that. i maintain the chain and custody for court purposes if that becomes an issue later and notify next of kin and make any additional follow up phone callsness with that particular death. i am dealing with people at the worst possible time in their lives delivering the worst news they could get. i work with the family to help them through the grieving process. >> i am ricky moore, a clerk at the san francisco medical examiner's office. i assist the pathology and toxicology and investigative

team around work close with the families, loved ones and funeral establishment. >> i started at the old facility. the building was old, vintage. we had issues with plumbing and things like that. i had a tiny desk. i feet very happy to be here in the new digs where i actually have room to do my work. >> i am sue pairing, the toxicologist supervisor. we test for alcohol, drugs and poisons and biological substances. i oversee all of the lab operations. the forensic operation here we perform the toxicology testing for the human performance and the case in the city of san francisco. we collect evidence at the scene. a woman was killed after a robbery homicide, and the dna

collected from the zip ties she was bound with ended up being a cold hit to the suspect. that was the only investigative link collecting the scene to the suspect. it is nice to get the feedback. we do a lot of work and you don't hear the result. once in a while you heard it had an impact on somebody. you can bring justice to what happened. we are able to take what we due to the next level. many of our counterparts in other states, cities or countries don't have the resources and don't have the beautiful building and the equipmentness to really advance what we are doing. >> sometimes we go to court. whoever is on call may be called out of the office to go to various portions of the city to investigate suspicious deaths. we do whatever we can to get our

job done. >> when we think that a case has a natural cause of death and it turns out to be another natural cause of death. unexpected findings are fun. >> i have a prior background in law enforcement. i was a police officer for 8 years. i handled homicides and suicides. i had been around death investigation type scenes. as a police officer we only handled minimal components then it was turned over to the coroner or the detective division. i am intrigued with those types of calls. i wondered why someone died. i have an extremely supportive family. older children say, mom, how was your day. i can give minor details and i have an amazing spouse always

willing to listen to any and all details of my day. without that it would be really hard to deal with the negative components of this job. >> being i am a native of san francisco and grew up in the community. i come across that a lot where i may know a loved one coming from the back way or a loved one seeking answers for their deceased. there are a lot of cases where i may feel affected by it. if from is a child involved or things like that. i try to not bring it home and not let it affect me. when i tell people i work at the medical examiners office. what do you do? the autopsy? i deal with the enough and -- with the administrative and the families. >> most of the time work here is

very enjoyable. >> after i started working with dead people, i had just gotten married and one night i woke up in a cold sweat. i thought there was somebody dead? my bed. i rolled over and poked the body. sure enough, it was my husband who grumbled and went back to sleep. this job does have lingering effects. in terms of why did you want to go into this? i loved science growing up but i didn't want to be a doctor and didn't want to be a pharmacist. the more i learned about forensics how interested i was of the perfect combination between applied science and criminal justice. if you are interested in finding out the facts and truth seeking to find out what happened, anybody interested in that has a place in this field.

>> being a woman we just need to go for it and don't let anyone fail you, you can't be. >> with regard to this position in comparison to crime dramas out there, i would say there might be some minor correlations. let's face it, we aren't hollywood, we are real world. yes we collect evidence. we want to preserve that. we are not scanning fingerprints in the field like a hollywood television show. >> families say thank you for what you do, for me that is extremely fulfilling. somebody has to do my job. if i can make a situation that is really negative for someone more positive, then i feel like i am doing the right thing for the city

>> (clapping.) >> in san francisco the medical examiner performs the function of investigating medical and legal that occurs with the city and county of san francisco from a variety of circumstances in san francisco there is approximately 5 thousand deaths annually i'm christopher director for the chief mr. chairman the chief my best testimony a at the hall of justice on 870 drooint street

that is dramatically updated and not sufficient for the medical chairman facility i've charles program manager public works should a earthquake of a major are proportion occurs we'll not continue to perform the services or otherwise inhabit the building before the earthquake. >> we're in a facility that was designs for a department that functions and in the mid 60s and friends scientific has significantly changed we've had significant problems with storage capacity for evidence items of property and also personal protective if you're doing a job on a daily basis current little storage for prirjs are frirnlsz we're in an aging facility the total project cost forever ever commercial is

$65 million the funding was brought by a vote of go bond approved by the voters and the locations is in the neighborhood the awarded contract in 2013 and the i'm the executive director we broke ground in november 2015 and that started with the demolition of existing facility we moved into the foundation and january so pile foundation and then with second construction of the new facility. >> one of the ways that we keep our project on time on budget and we're having quality to have regular meeting and the variety of meetings with construction process meeting as well as cost of control meeting and i'm a project manager for

public works the office of chief commercial we want walk the project site when we sign up and also with a contractor insinuates for a change over we need to verify what or what was instead of. >> the building is 42 feet tall so it is two stories and 46 thousand square feet roughly we're that's a great question to be on time and budget have the roof complete a the exterior moving with the site work. >> and as you can see we've got a lot of the interior finishes installed. >> in an effort of an differentiate the facility that designed to work for 72 hours. >> not taking into account there was a lot of structural updates made into this building not seen in other construction throughout san francisco or other barriers we have friday

morning examiners from 8 to one public comment monday to friday because of air circulation we literally have to shut the doors and so the autopsy is done without staffing being able to come and go or exit the space and literally lock down the autopsy in the new facility we have bio build one door opens and closed behind you you can gown up and go through a second seizures of doors that has its own independent air supply and now in the exterior opt space having that middle space have greater flexibility of staff as they move in and out of the area. >> in the current facility investigative unit has small tiny, tiny place in the area of

the new facility is almost doubled in all divisions from the current facility and the new facility. >> the planning we have here gives them the opportunity to have the pool needs to complete theirs jobs in a much more streamlined fashion. >> we're looking forward to have secured parking to minimize the egress of you know visiting and the members of the public but really to minimize the investigators remaining remains from our advancing and so the facility. >> we have a new visitors area we're building that is a little bit more friendly to families. >> one thing you may notice in the room no windows there is no natural light not good for most

autopsy but in the new facility at new hall we made that an objective they want to insure we were able to look up in the middle of exam and see the sky and see natural lights. >> that's one of the things the architect did to draw in as much light as possible. >> we have staff here onsite we insure the design of the new design enables the investigators and other investigators skiefksz to consider to house on site this meant we needed to design and plan for locker room facilities and shower rooms the ability to sleep. >> third of the construction going into the building has been by contributions of small businesses. >> part of the project is also inclusive to the sidewalk have

all new sidewalks and new curve cuts and landscaping around the building we'll have a syrup in front of the building and rain guardian. >> the medical examiner's office has been a several if in their contributions of the understanding the exception and needs. >> it's a building that the chief medical examiner has been looking forward to quite a few of the. >> it is extremely valuable contribution to the, neighborhood address san francisco as a whole. >> the building will allow is to have greater very much and serve the city and county of san francisco and the neighboring >> conduct a field shelter

exercise where we open up a number of tents that animal control has they have supplies and equipment and staff and volunteers. we simulate the need for cape ability after a disaster or earthquake. >> animal care and control is your city's animal shelter. we care for approximately 10,000 animals a year. we are opinion for san francisco's animal in thes upon effect of an emergency. we got our tents and practicing how to deal with that. >> this is the shelter is overwhelmed with animals after a disaster this shelter is full regularly. if we torch have an event that would cause a number of animals to escape or injured or stray or separate friday their people that's where we would respond.

>> pets are part of the family and need to make sure they are taken care of like people with the supplies and equip we are able to provide shelter for pets in addition to the existing shelter. >> we have formulated a plan so this in the event of a disaster we are hear ready to help and support the city. >> we are able to use the muni bus to transport the people. animals and other equip if the shelter. >> encourage people there is an evacuation order to take your pet with you. >> very first thing everyone should do is microchip the pet. and pack a bag >> shelter cert not a place where you want your animal to end up unless the last resort and like to keep most out of the shelter when we can. >> take care of your people and

your friend and family. >> s need to be taken >> shared spaces have transformed san francisco's streets and sidewalks. local business communities are more resilient and our neighborhood centers are more vibrant and lively. fire blocks and parking lanes can be for seating and merchandising and other community activities. we're counting on operators of shared spaces to ensure their sites are safe and accessible for all. when pair mets, firefighters and other first responders arrive at

a scene, they need clear visual access to see the building entrances, exits and storefront windows from the street. that means parklets should be transfer in the areas above inches above the sidewalk level. it's best if these areas are totally unobstructed by transparent materials may be okay. you can check with fire department staff to make sure your site meets visibility requirements. emergency response crews and their equipment need to be move easily between streets, sidewalks and buildings, especially when they are using medical gurneys, ladders and other fire fighting tools. that means that parklet structures need a three foot wide emergency feet every 20 feet and 3 feet from marked parking spaces and emergency access gaps need to be open to the sky, without obstructions, like canopies, roofs, or cables and should always be clear of

tables, chairs, planters and other furnishings. emergency responders need to use ladders to reach windows and roofs to buildings and the ladders need unobstructed overhead clearance and room to be placed at a 72-degree angle against the building. clearances needed around the ladders to move equipment and people safely up and down. so not all parklets can have roofs ask canopies depending on the width of the sidewalk in your area. please make sure that your electric cables are hung so they are out of the way and (indiscernible) to the structure, they can be pulled down by firefighters. cable connections need to be powered from an outdoor reciprocal in the building facade because hard wire connections are much more difficult to disconnect quickly. these updates to the shared spaces program will ensure safety and accessibility for everyone, so we can all enjoy

these public spaces. more information is available at sf dot gov slash shared spaces. [music] san francisco emergency home program is a safety net for sustableable commuters if you bike, walk, take public transit or shares mobility you are eligible for a free and safe roadway home the city will reimburse you up to $150 dlrs in an event of an emergency. to learn more how to submit a reimbursement visit sferh.

>> hello, and thank you to the san francisco league of women voters forviting me today. my name is aaron peskin the president of the san francisco board of supervisors and running to be the next mayor of the city. i love san francisco spent most of my adult life working to make it better. i fought to secure hundreds of millions of dollars for affordable housing, pass rent protection laws to stop unjust evictions and reduce crime with real community policing in my district. championed better public transit and help prepare for climate chaimpg. i know how to bring people together and hold the government account frbl results. that is exactly what we need to face the immense challenges before us today.