providing that safe place so to protect against leaks and hacks so that can be routed more accurately. we're all actively working on providing some of that granular data. and some is proinvited on reports that is published online. >> would that be searchable? is that part of the vision or is there any constraints? >> it depends on the level of granularity, so there are some considerations there. we want to make sure that we're not publishing too much information that makes the person reidentifiable and that would be a violation of the individual and also liability for the city against the federal state and local statute violations. >> got it. and i see that this source data

sets by age, ethnicity and gender, they live in sf, can the booking charges be looked for there in data sf? >> currently, we're still working to expand that process with data sf those are future initiatives. >> okay, and then so if here's a member of the public or media, what is the process to request records that are not online? so if i'm a reporter how do i get stuff online or a concerned citizen? >> we have a person who handles our public records acts request. sol she will, there is a portal basically that you can go online and it makes it really easy so you can go on and make your request, it will go to her and if it does volve the media, that's when i jump on. but we have a certain amount of time within the public information account and all the

different acts in which to respond. we have a ten-day window where we're suppose to respond and we can either produce all the data or provide it on a rolling basis if it's a really deep dive if we received a request that goes back a whole decade worth of information or we can you know, basically say that we need an extension. >> and then, what processes do you have for maintaining the quality control of your data for accuracy? i mean, do regular updates? how do you maintain? how do you make sure that the data is accurate backwards and forwards? >> well, continuously review our data. so we do audits on it, we do analysis and data cleaning where we identify issues and, there is a robust system of data review through the

analysis and auditing. >> and i know, we've heard there are certain technical con straints. are there any financial, given that if you can do whatever you want, what constraints do you have that are budgetary? >> thank you supervisors so some of our constraints is staffing, some of our records are still very much manual so. that transition from manual to data, that takes manual entry. some is space to archive records. it's time consuming and it's a slow process especially when you want accurate records so because of that reason, you have dedicate the time and just really also the technology then to get away from the manual right and transfer that over that takes time and funding.

>> i know we talk about sfpd but we have to share that the lapd has extremely so we need to work on that. i guess the question is, the more we get, we auto mate things, the more you getaway from the manual imputing into the actual database, will that help you with the staff shortage in a sense? >> right, we'll go to that data information faster and easier. for example, we have a newmanagement process that started last year. the newmanagement system will help us improve our record tracking and keeping. it's a project that is going to touch all aspects of our department. >> is it like that chicken and egg, meaning like get the database up and running so you

can free people up? >> right, correct and then those people audit the system, it's a chicken, very much so. >> chair dorsey any questions? >> all right, thank you for presenting, i think we need to do public comment now. >> yeah, quickly open up for public comment. >> yes, members of the public who wish to speak on this item, should line up up along the wall. all speakers will have two minutes. >> i was born on 11-17 of 63. another fellow shares my first and last name born on the same day my milled initial is a j and his is l.so you can see where law enforcement can get things wrong in reviewing social security numbers. so i was arrested on a felony

last christmas and spent two days in jail, with severe jetlag, i had been out of the country, i discovered when i returned for my arraignment, i discovered the assistant district attorney who made the same mistake, conservetership and absence that required findings that require organization and approve, yeah, i believe many prosecutors and public defenders are very duely meanted attorneys like with one year of having passed the dar. --bar. so i'm still on the hook on

diversion but i still got to see the nutcracker before i left and was able to help ain mate with severe asthmatic reaction from pepper spray so it was a couple of eventful days for sure. >> thank you for your comments. do we have any additional speakers? that concludes public comment. >> great, thank you, madam clerk. seeing no more public comment. public comment is now closed. vice chair, engardio do you have any concluding remarks? >> yes, i want to thank the sheriff's department for being here. this is part two, earlier we had the district attorney and department reporting in on their efforts. this is a little wonky but important but to gain the public's trust we need transparency and it starts with data. and if you're a journalist and

want to report to the world what is going on, the easier it is to access information the more people are followed and if you're a crime victim or concerned sit en, it's important that you have information without relying on a journalist or something. i think it's important to doing. i know everybody is strapped for resource sxz staff, i totally understand that, but the efforts you're putting into having data transparency is going to serve us all and so thank you for that. and we will keep working with you to make sure everyone, i mean there is this push and pull about what people want to know, people want to know everything and what they should know. so at the minimum we need people have access to what they deserve to know. so thank you very much and with that, i would move to file this hearing. >> great. >> before we get to that, i want to express my gratitude to vice chair engardio for calling

this hearing and your quick action. i want to express my gratitude to mr. rylee and mr. cure airy from the superior court, ms. marili and mr. jennings from the sheriff's office. and we have a motion to file the hearing. >> yes and on that motion, that this matter be heard and filed vice chair. >> aye. >> chair dorsey. >> aye. >> i have two ayes. >> thank you, madam clerk. the hearing is filed. madam clerk are there any other items before us today? >> no that con completes our meeting agenda. >> thank you everybody, we are adjourned.

>> welcome to the december 3, 2024 meeting of the san francisco health commission. secretary morewitz, please call the roll? >> commissioner green, present. commissioner guillermo, present. commissioner giraudo, present. commissioner christian, present. commissioner salgado, present. >> thank you. i believe commissioner christian will read the land acknowledgment. >> yes, thank you very much. my honor to do so. we acknowledge that we are on the unceded ancestral homeland of the ramaytush ohlone who are the original inhabitants of the san francisco peninsula. as the indigenous stewards of this land and in accordance with their traditions, the ramaytush ohlone have never ceded, lost nor forgotten their responsibilities as the caretakers of this place, as well as for all peoples who reside in their traditional territory. as guests, we recognize that we benefit from living and working on their traditional homeland. we wish to pay our

respects by acknowledging the ancestors and relatives of the ramaytush community and by affirming their sovereign rights as first peoples. >> thank you. the next item on the agenda is approval of the minutes from november 19, 2024. commissioners, you have before you the minutes. are there additions or corrections? seeing none, is there a motion to approve? >> i move to approve the minutes. >> second. >> and then any public comment on this item? >> any public comment on the minutes in the room? alright. i don't see any. folks online, the three who received permission to provide remote

public comment, this is your time to raise your hand for the minutes. i see no hands commissioners. >> all in favor of approval say aye. >> aye. >> wonderful. the next item is general public comment. secretary morewitz will read a statement before we begin. >> sure. at this time, members of the public may address the commission on items of interest to the public it within the subject matter jurisdiction of the commission but not on this agenda. each may address the commission up to three minutes. the brown act forbids taken action p. please note each individual is allowed one opportunity to speak per item. individuals may not return more then once to read statements from other individuals. written comment be sent to health.commission.dph@sfdph.org. if you wish to spell your name you may do so.

city policy along with federal state and local law prohibit discriminatory construct and will not be tolerated. >> thank you. so, we have commenters in the room and i'll call you up as i see. christopher cline. >> i have 3 minutes on the timer. when the buzzer goes off that is your time to end your comments. >> thank you. for the record, christopher cline and been here quite a few times. i want to provide updates. now on the one [indiscernible] public health has oversight and i think that is the number one reason we saw decrease in overdose so nice job for public health for getting part that training. the things not going well, there is [indiscernible] one system is surveillance system used by department of technology and with it you can give someone a false ptsd symptoms to force medication.

that is very concerning especially if you are a veteran because everything you have went through is concerning but now you have cities and counties trying to give false ptsd or covid or hiv. if you can take grant money and deny benefits it is a bribe and the reason i bring that up, 250 kearney street hsh gave $283 thousand to swords to plow share. [indiscernible] i talked to the city attorney earlier today and the human rights commission, we are moving in the right direction but there are people still trying to force us to go to court. if we go to court it is class action against the city and county of san francisco and nobody wants that. thet is the updates. nice job for public health getting involved with the training of the privacy data the number one reason we saw a drastic decrease.

i'll continue to provide updates and go from there. thank you. >> thank you. the next person i hope i read this right, paul. >> there were a few who put down finance planning committee, please come up. because the finance planning committee meeting was canceled i move #d to general public comment so your comments could be heard earlier in the meeting. >> thank you for the time to speak. i'm speaking to request my name is paul [indiscernible] a resident of [indiscernible] the only low income housing cooperative for those in the united states for those living with hiv and aids. it is currently basically under attack. since i moved in the last three years, deloris street community

services now calling itself mission action [indiscernible] starting with eviction notices, and making false allegations on how marty's place is doing business and it is using public dollars to do this and i don't think a organization that claims to be supporting and helping the most vulnerable populations, those who are asian with hi virks should use public funds to pay for eviction notices and attorneys to remove us from our home. marty's place has been in the mission since 1990, established by father richard persell and named after his brother who was homeless and died of aids. he bought this building, opened it up to people with hiv and aids at the height of the aids pandemic. people with no where else to go.

it was their last piece of comfort and when he passed away he left it with the explicit instructions that it be housing for people living with hiv and aids. it saved my life. as somebody who found homeless at 58 years old in the most expensive city to live in in san francisco during the height of covid, i was sure i was going to die. fortunately i was referred to marty's place and i stand here before you because that. it is a community asset that can we reicated across the country. the model used is social housing and i urge you to look into the use of the public funds, received by mission action/deloris street community services to insure that they are not using these funds to displace people who they claim they are protecting. thank you for your time.

>> thank you. michael from marty's place also. >> good afternoon. i wont take much of your time. i believe my friend, colleagues, friend paul spoke of the concern. we want to make sure the public is getting the best use of its dollars and we hope there is some accountability and we do have some concerns with our accounting and some of the practices we have seen. there is a substantial large sum in dispute they have not been able to level with us about and this contra dicts the mission in the commitment to you and the organizational mission to us and as paul had mentioned, yes we are also dealing with the threat of eviction. right now it will play out, but i will not waste your time or color with simple words. i used to fight for to prevent

evictions in the city and we know that people with hiv live longer because we accept that housing is healthcare. thank you so much for your--real specifically, what i was asking for and why we put number 8 on the agenda was at least to try to get into finance committee at some point to make it priority to maybe do a audit. that would help at least provide the answers. thank you so much. have a great day. >> thank you. [indiscernible] i apologize if i mispronounced your name. >> that is probably the first time. i have been dealing with that all my life. anyway, [indiscernible] speaking to you today as the chair of the hiv caucus at the harvey milk and it is connected to marty's place. the thing is, people living with hiv, the long-term survivors were doing this the day after world aids day.

in your words you note we need to respect and honor the history in the city. marty's place is a place they try to honor that history. i have known the residents of marty's place. i've helped them set that up about 9 years ago and think it is appalling the organization is dragging them through court. these are people on fixed incomes. is that a example people want to set after world aid day during the holidays. i assuming they are city funded. i dont know the funding source, but i think it is time to stop and think they people will not fight back, but we said this in the 80 and 90 people livling with hiv is not disposable and to take their homes and treat like this is not acceptable in san francisco. when the new administration comes in [indiscernible] that doesn't start here and i

think we need to set that example to show that is not starting here and so, there is a few cruts dates for marty's place, december 13 and december 24. a delay until they have time to-it is very reactive and when people lose their homes they can't think straight. the body may not be able to do anything, but we will go to every body to speak about this and hope somebody does something. we set the example for care in hiv in the 80 and 90 and need to do it again. 74 percent of the people with hiv in san francisco are over 50. they do not have time to [indiscernible] or drag to court and this needs to stop. marty's place is a asset to the community as people age and grow older. i run a program called [indiscernible] 700 active members and do a

event at marty's place 2 or 3 times a year and have a sense of community so to lose that would be appalling. i want to draw your attention to [indiscernible] in the examiner-the one in the examiner is today and there is one from sf standard so please read those and if there is anything you can do i beg you to do so. >> thank you. the last one is [indiscernible] for walk sf. >> my name is molina. the campaign associate for walk san francisco. the city only advocacy non profit representing everyone who walks and lives and using transportation in san francisco. as of today, 22 pedestrians

have lost their lives in traffic crashes. this is more before the city adopted vision zero. this is not acceptable and public health crisis and here to ask when the next vision zero policy and action strategy will be brought forward to the body and for adoption. unfortunately this hasn't happened in 2024 and no time for delay. the department of public health is a critical city agency. dph crunches the data to understand how and why and where crashes are happening and who is most effected by traffic violence. here agencies cutting edge data drives all the work of other city agencies, working making our streets safe like sfmta, san francisco police department, department of public works and sf fire department. i where can't stress enough the importance of the department of public health role in vision zero. through your agency research we all understand who is most effected by

traffic violence. older adults, people with disabilities, low income residents and even children. the high injury network map where crashes are happening vusear and fatal help sf mta prioritize quick build project and where to focus fliment r limited stach and resources and helps understand whut straet design treementds are workish. the high injury network helps the san francisco police department focus limited traffic enforcement resources on places where data shows the most crashes. walk sf is here to ask, when will the next vision zero policy strategy be brought for adoption and see the next injury map? lives are on the line and no time to waste. thank you for your time. >> thank you. any other public comment in the room? general public comment? and is there remote general public comment? >> no hands up. >> thank you all for being here and for your eloquent comments. we very much appreciate and will take them to heart.

the next item on the agenda is resolution to honor dr. barry [indiscernible] deputy director will step up and begin our presentation for a resolution. >> thank you. good evening commissioners. it is with mixed emotions we present the resolutions. when i first joined the department i knew san francisco was a giant in the public health field and one of the giants is barry zevin. dr. zevin contributions to caring for the homeless population are not just locally renowned but throughout the country and his caring his ability to meet people where they are at, i learned so much from him. i am trying not to get emotional because this is a banner day for dph in terms of all the knowledge, all the heart, all the love barry has given to

the city since he firs started. we are going to miss him enormously. his patients are going to miss him and colleagues will miss him. at this time he deserves a retirement and to really enjoy all of the fruits of his labor over the many many years. so, i just wanted to really give a heartfelt thank you to barry and for all his decades of work and honor him and i will invite [indiscernible] to come up and read the resolution, dara papo, director of whole person integrated care. >> thank you. bitter sweet for somebody who is a friend mentor and teacher to me and so many. we have a resolution honoring barry zevin, md.

whereas, dr. zevin served san francisco as a exceptional leader at the department of public health over 30 years making tremendous contributions to the department's efforts to address health disparities and issues of racial equity for vulnerables individuals and people experiencing homelessness. whereas, dr. zevin health several dph positions including medical director of whole person integrated care, street medicine, host overdose ingraijtsment team, shelter health and health resource center and medical director [indiscernible] dr. zevin provided healthcare for thousands of under served individuals as a physician throughout his career, whereas dr. zevin has been a leader in creating substance use services for vulnerable populations, including sobering, medical detox fiication, low barrier connections to

medication and overdose prevention and response programs. whereas, dr. zevin lead many integrated healthcare programs, including launch at the maria x martinez health resource center formally 550 ivy urgeabout care and resource center for people experiencing homelessness with over 2,000 encounters a month. whereas, dr. zevin has championed jnder affirming care, including transgender tuesday and gender health sf first in nation dedicated public health clinic programs, dedicated improving access and care to gender affirming surgery and other healthcare. whereas, dr. zevin trained generations of medical and social service providers and is a sought after presenter and training locally, nationally and internationally.

whereas, dr. zevin leads a legacy of service and leadership to support and improve the lives of vulnerable san franciscans. he will be dearly missed by many at the dph and the greater san francisco public health community by many colleagues and his family that will appreciate having more time of him coming, and resolved that the san francisco health commission honors dr. barry zevin for outstanding service and leadership and wish him well in retirement. >> thank you for that beautiful resolution. we'll entertain a motion to approve. >> so moved. >> second. >> and now we'll start with public comment. anyone in the room that would like to comment on the resolution? >> [indiscernible] [laughter]

>> [indiscernible] is there any remote public comment? >> i do not any hands. folks online, this is your last chance to make public comment. >> what about commissioner comments? commissioner giraudo. >> congratulations. this is a well deserved retirement and honor that i'm also proud to be able to be part of the vote for this resolution. congratulations. >> commissioner guillermo. >> just want to join all those who are congratulating dr. zevin on his retirement and also, on behalf of the citizens and residents of california or san francisco actually, california and beyond, because of the influence and impact that you had throughout

your career. the resolution seems hardly enough, but i'm glad we were able to do it publicly and with obviously the support of many of your colleagues and family here. wish you all of the rest and best that you deserve as you leave the department here and get on with the best part of your life hopefully. >> commissioner christian. >> thank you. want to say thank you for your work and for all you've done. the department of public health and the clinics and hospital have enormously great reputations and it is because of the people that built those institutions and worked in them for decades tirelessly and created new innovative programs and it is one reason why i feel very blessed and

proud to be a commissioner to do what i can to support the work of people like you and so, just looking at what is listed here. i'm sure there are many other things not listed, but it it is groundbreaking works and these institutions saved lives and will continue to, so thank you so much for all you've done and i really wish you a wonderful exciting retirement and chance to watch this little one grow up. >> any other commissioner comments? well, i will make one. it is such a honor to be in the presence of a trail-blazer, because dr. zevin was focusing on discussing topics like transjnder health and hiv, aids and addiction medicine at a time they were misunderstood and rarely brought up in departments of health, and i think you are such a x example

of having the courage to step forward to make changes has had an amazing impact not only locally, but nationally and internationally and you're just a living example of what compassion and empathy and persistence can bring to bear and have pass, so we are so incredibly grateful for your contribution and of course wish you the best in retirement. we are hoping you'll step up and say a few words after perhaps our director also had comments to make. >> thank you president and just to reinforce the comments of commissioners, i can't believe this day is actually here. yeah, i [indiscernible] [difficulty hearing speaker due to audio quality] excited to see what happens next but i want to acknowledge all the work you have done and your leadership.

the accolades and meetings and lectures, i'm sure you have a few book chapters and lots of articles, maybe a couple books even, but i think the thing-i had the honor to work with you directly in clinic and [indiscernible] taught by you and i think the place that is the most inspiring is that you listen to patients. that doesn't happen as much as it used to in medicine. you listen to what they need, you dont listen for what you think they need. you listen to them as people. we often will [indiscernible] patients you refer to them as people and i think that that has been so grounding and so important as you've brought that leadership and mentorship to the department and beyond. i want to thank you for always

keeping the patients center, the person center in everything you do and we will always hold that as a department. thank you. >> thank you. would you please come forward? we would love that. >> commissioners, while he is doing that if i may, i will probably start crying, i had the privilege acting director of the friends [indiscernible] 25 years ago, we worked on a project together. i worked to help include folks with hiv into the community. this is the best guy and what we want everybody to be like. so, the thing that want said today is you are also a pain in the ass in the best way, because you nudge the system to shift and change and you use your privilege in the best way. anyway, thank you. >> thank you commissioners.

thank you dr. colfax and thank you mark for saying that. when i started in 1991, i am sure i had no idea what a job with dph even was. i knew i wanted to do hiv work at the time. i knew i wanted to do work with people experiencing homelessness at that time, and there was a opportunity in san francisco to do that. it was not at all in my mind this opportunity is with san francisco dph, and it has been a incredible opportunity. number one, as several people said, to take care of patients, the most vulnerable, highest needs folks and be able to hear what they needed

and be able to then really think about what that meant in terms of system change. and to be in a position and this is where it has been so extraordinary working in sfdph, to be in a position to say, yes i see these system gaps. i see where these needs are, based on the people i see in front of me, are there ways beyond saying, well, i'm just a doctor and nothing to do about that. are there ways to change that? and to be able to work in dph where i had a chance to make to advocate, to be innovative in ways i never would have been able to in the private sector, in the non profit sector, or in

the academic sector for that matter. this has been a incredible 34 years of being able to put together from that moment of seeing a patient to being able to conceptualize, plan, implement projects, grow clinical programs, get support from leadership. get support from health commission, and yes, it is amazing to me that things that i was interested in that were marginalized and marginal have now become central and i feel very proud to have been able to have furthered that and to have had the support in dph for doing that over this period of

time. when people ask me, often mentoring people, what should i do and what kind of career? working in the public sector, working for sfdph, there are many things where i sometimes feel i need to be a pain in the ass, but the opportunities are way outweigh the problems of working in a big system, because the opportunities. the heart is there and the opportunities are there working in dph. i'm very grateful for the years, very grateful having had the opportunity to mentor and train leaders who will be able to continue this work. i retire without a doubt that the work i have valued so highly is going to be

able to continue and that the support will continue to be there, so thank you. thank you. huge thanks to my family, who have been hugely-people say supportive. it is so far beyond that. necessary to my being able to do this work and yes, i will be changing to harder work. doing grandfather work for a nia. thank you to colleagues who have shown up for support. everyone who has shown up for support and to my wife maggie, my brother ritchie, [indiscernible] emma, ania, son in law and my team i will not burden everybody with naming. thank you. >> stay there. how about a round of applause. [applause]

>> thank you for what you've done. thanks to your family and thank you for leaving us such an amazing legacy and all in favor of the resolution please say aye. >> aye. >> please carefully walk over the cords. dr. zevin can you come up and we'll do a photo op right here?

[applause]

>> so wonderful everybody can be here. really nice. really nice. wonderful. the next item on the agenda is the director's report, and director of health, grant colfax will present the report. >> thank you president green and good afternoon health commissioners. grant colfax, director of heth. health. to go over key items in the report. really pleased to announce that the health network is welcoming several new outstanding leaders to do our work. [indiscernible] joined dph november 25 as the health network chief operating strategy officer. this role will provide oversight of healthcare delivery system and a member of the network executive

leadership team and many may know that [indiscernible] has a long history here at dph, instrumental in moving forward many policy initiatives and she had a storied career in other health systems and we are delighted he has come back to dph to help make the network the best it could be and therefore making dph the best it can be. really want to welcome tan dreen back to dph. in addition, later this month we will welcome dr. todd barrett as the chief medical officer of the network. dr. barrett is expert in clinical transformation invasion in value based care leading evidence base cross programs at multiple institutions. he will be responsible for strategic oversight and management of the clinical practice.

really delighted to have him join and you can read more about his career. we have a third leader joining, welcoming [indiscernible] our new chief administrative officer for ambulatory service. over 20 years of healthcare experience bringing expertise and enhance patient experience strengthening provider and staff engagement and driving operational efficiency. especially in including value based system. so, really delighted to welcome these three new leaders to the network to again, continue to make sure we provide the best care possible and that patients have the best experience possible at dph. second item is pleased to share san francisco general skilled nursing facility named the 2025 best nursing

homes. earning highest achievement with high performing rating and overall rating of 5/5, which sounds like they did well. the hospital is part of the elite 19 percent of sniff recognized for providing essential care to community and community patients so really glad and congratulations to the skilled nursing facility at zuckerberg for that. and then on sunday- [indiscernible] december 1 every year and it is our time to honor all those effected by hiv, aids wrenewing the promise to continue this fight and many of us going back to public comment earlier today, many of us remember the early dates of the aids epidemic. thank yous to hard work collaboration and advocacy we have turned the tide on

hiv and just as a example, last year dph reported the lowest number of hiv cases reported in the city. continuing to do that work and in fact, we are continuing to do that work through the getting to zero san francisco, over 300 members who focus on driving down hiv infection to zero. that includes dph, ucsf, community organizations and members and industry. incredible progress continues to be made in the city in hiv, including through getting to zero consortium. and then i want to highlight with regard to the dph partnering with community organizations on training overdose prevention. partnered with institute [indiscernible]

to conduct series of trainings on preventing fentanyl overdose. this is a example as we work to continue to drive down overdose death and partnering so everybody knows what to do and have the tools necessary to prevent overdose as much as possible. and then finally, not in the written report but i want to give the commissioners a update. the mayor's office published their initial budget goals going into this upcoming year and the target for the year and year after is a 15 percent reduction in general fund expenditures, so this was just came out a couple hours ago. we will be working of course very closely with all of you and the mayor's office to establish a budget that

realizes those goals and of course we have been through challenging times in the past and this will be a very challenging year, but we have a system in place. we will come back to you early in the year with proposal for your consideration going forward, so i just wanted to provide you with that update. that's my director report. happy to answer any questions or concerns. thank you. >> thank you for the report and for recognizing world aids day for the accomplishment at the general and also on behalf of the commission, please extend welcome to the very talent new leaders joining the department, we are delighted. any public comment on this item? >> is there any public comment in the room on this item? folks-yes, would you like to come up? please wait till you are at the podium.

>> vince--i have been living with hiv since 1989. i was part of the whole thing. i was on the un aid board about 5 years and helped [indiscernible] and i said something when i saw the final strategy because it was watered down what was originally conceived and they said this is aspire to. may not be something we can accomplish. infections and lowered might end the epidemic but people are still losing their homes, the human rights violations that come along with this, that human-i can't say the word. degrading of the human beings. the intersectional issues, it is like hiv is treat able, we can live with that. the residents of marty's place, when they told us the story, i am like why did you wait so long? you are giving two weeks and so

i really think it is time for san francisco to go back and look at the history and stand up and do the right thing, because yes, we have the pills, yes we the only city to succeed getting to zero, but we need to take care of the other issues. we need to save the lives people dying from overdose and keep people in their homes, we need to give people-make san francisco the safe haven it was in the 80 and 90 and throughout history. this past sunday i are was honored at the aids [indiscernible] unsung hero. i feel i have been sung a lot, but what those who don't get their stories told and just lose their homes and go quitely and the people that are supposed to defend them don't say anything. they didn't know if coming to the heth commission was the right step. i said it was the right stop.

it is something to rather then sitting at home and coming to take your home away. i just want to bring that back and in the light of worlds aids day. we should applaud we have come a long way but there are all these other things we still need to work on. thank you. >> thank you. >> and then i don't see hands for remote public comment. give me one more chance folks. the three who have permission. no hands. >> any commissioner questions or comments on the director's report? alright. seeing none, thank you and the next item on the agenda are the amendments to the laguna honda hospital rehab center governing body bylaws and are you going to present secretary morewitz? >> i am. i'll go stand. can you hear me?

i never stood here before. i'm presenting the work of the laguana honda leaders and city attorney office who have done revisions and proposed amendments because i'm your staff member and this is about the governing body. i will introduce this and there are folks online that can answer questions you may have. i also want to say, there is a lot of public out cry. we know around the issue, and i want to apologize not putting more explicit language to give context. that is what i could have done. not explain everything i will now, but at least have noted there is a survey coming up and this relates to preparation for the survey that would have given more information to the community, so i want to pay attention to the fact we are still in the building stage with the community, both department and commission. i want to own that. okay, laguna honda is awaiting acute unit survey. my understanding the end of the year or beginning of the year.

bylaws are requirement for facilities and the bylaws were not a requirement for the cms recertification process, so why this hasn't been done before. the amendments in the draft reflect current practice. they are not attempting to do a sudden change of any practice. they reflect what exist now and what they plan doing moving forward, but it isn't a change, other then change of language in the document. the body bylaws revised in 2012. the proposed amendments intended to reflect current practice. to give context, laguna honda is licensed as acute hospital even though it has more skilled nursing bids. they have 11 acute beds and [indiscernible] the acute unit is for laguana honda resident to receive treatment when they need acute care and there is a

added benefit that the city-receives much higher reimbursement because it is acute hospital which is benefit to everybody there and the budget. public comments submitted to the commission regarding these amendments stated concern over two things. one, most people talked about the removal of the term long-term care. thinking that meant there was a shift in intention of what laguna honda will be doing from long-term care to more shorter term stay. there is also concern that the vision statement is changed as part of the passage of the document. i want to clarify some that. the laguna honda value mission and vision statement was revised in 2016 to state the vision is "building healthier lives as a leader in post acute care".

that language is seen in all most all the documents since that time, so this document st. not showing a shift in that direction. this is just reflecting the verbiage that has been used since 2016. post acute is inclusive of long-term care services and does not include intended changes to the length of service provision. per the american hospital association, which the laguna honda leaders used for this terminology, post acute care settings include long-term care hospital, inpatient rehab and skilled nursing facilities and home health agencies. does not include home health but includes all the other services. the assumption on the laguna honda leaders if i may speak for them and city attorney is post acute was just all encompassing term, understanding this is a flag to the community in a shift of services offered. there also was concern in the

community that the term post acute indicates admission come from a hospital, because the term acute indicates acute hospital. again, all this is understandable and based on the fact there is trust issues bedween the community and us so trying to clarify so you understand as they do. earlier this year you approved the admission policy and had discussion about this. the policy number is 20-01. it is entitled, admission to laguna honda and [indiscernible] the policy clear ly outlines 5 priority groups and i posted this online for folks who are at home and want to see what i'm talking about. [indiscernible] if i could, the interim nursing home administrator and acting ceo, f. . if you can review those

categories. >> good afternoon commissioners. interim ceo for laguna honda. i wanted to go over admission priorities for laguna honda. basically we have 5 priority groups, and first group was the residents discharged as part of the closure plan. we went through that already. priority two was anybody not in a medical facility, they were home but in need of a skilled nursing or rehab services and not adequately cared for at home. the third priority is patients at san francisco health network facility, who need skilled nursing or rehab services. and priority four is any person

not in a medical facility but receiving skilled nursing level of care at home, but being adequately cared for. and the 5th group are other community hospitals or facilities, which have patients of the network patients in need of skilled nursing care. those are the 5 priority groups and taking admission based on those and the mission and vision haven't changed and it is reflected in our policy that dated back to 2016 and our admission policy review jd approved by the commission. if you have any questions, happy to answer. thank you. >> any changes to the admission policy have to be approved by you. so any practice at laguna honda

have to come through you and then here. so, i want to reiticate the intention of bringing these proposed amendments isn't to change practice, it is to really just prepare and adhere to regulatory bodies requirements to prepare for the licensing survey. so, you may consider the proposed amendments today. you will discuss and hear public comment. there are issues with the procedure i will quickly explain and we got the city attorneys online. if there is something that is substantive and outside of what is copied from another document that exists or correction of typos, then we may need a long er time to notice the intention, intent to make amendments and it might come back at the next meeting. it depends how substantial those are. you all could approve the document as is and request it be amended in

another way soon. that is your option or you could say differ the item until all the corrections are made. i'll check with laguna folks to see how that may impact and play out with the survey preparation. i want to make sure you all know the lay of the land before you discuss it. i will go back-- [indiscernible] >> thank you for all those clarifications secretary morewitz, very helpful. we do have public comment. norman is here. please step forward. >> hello commissioners. revised bylaws in section 1 and 2 december 3 define the mission of post acute care implying only short-term care will be available.

the proposal repeatedly deletes long-term nursing home care. this is disaster for san franciscans who require nursing home for long-term safety and survival. while short-term post acute hospital stay care and or rehab remains a important function of the hospital, so long as term nursing care for those who need it. lhh has 1/3 of the skilled nursing facility nursing home beds in san francisco. for many san franciscans, long-term nursing home residents is or will be necessary for quality and length of life. it is unacceptable for the health commission to approve of a mission statement that may lead to rejecting san franciscans who need to reside in the public nursing home long care term. thank you.

>> thank you. benson nadell, please come forward. >> good afternoon. i head up the ombudsman program in san francisco. felton institute program, but we contract with city and county because of some of the organizational conflict. i will focus basically on pitfalls we have been running in to among the community based skilled nursing facilities who shifted to [indiscernible] if i may. i provided a written testimony but will not recite it. we run into the following problems, the dist charge notice required and [indiscernible] residents right to appeal or have participation are only in english. the date of notice we receive for all the skilled nursing facilities are not dated with advance notice of the day before or few days before or the day after or the day of the discharge plan.

[indiscernible] because their notice we receive for discharges come way ahead of time. i think a reason is, the other facilities in the community are driven by medicare coverage and medicare requires accelerated discharge plan. by contrast laguna honda has a gradual discharge plan with greater inclusion. reading the page in the bylaws we anticipate a shift towards post acute care. even at laguna honda. i notice some of the long-term care language canceled out and more hospital based language. i might be overreacting, however that is the initial reading of the bylaws. sniff residents-i use the word sniff, do not understand the rights when they receive such a notice. the rights to participate in the care plan meeting and a planning meeting for discharge. these are community based

skilled nursing facilities. not all who are admitted to post acute beds are able to participate in therapy. hospitals are sending people where they aret noweight baiter and not able to get out of bed and in recovery and yet the time clock is ticking. it takes even on the weekends when there is less therapy. number six, community based skilled nursing facilities discourage residents from applying for medi-cal under the federal regulations. they are supposed to inform individuals at the time of admission they are eligible for medi-cal. that's not happening. we got calls from family and residents that they are told they need a skilled nursing facility that bills medi-cal even though the facility is required to bill medi-cal. it is a form of medical discrimination. number seven, there were a

focus on culture change in skilled nursing facilities. someone from [indiscernible] came to the old laguna honda years ago. you might remember that. provided- >> your time is up. >> consistent assignment and post acute the [indiscernible] who they are working with because they are out the door in two weeks. >> sorry. >> thank you. is there anyone else in the room that wants to make public comment? i also add that we have gotten quite a bit of written comment and will review everything received and if you want to snd more in writing we will read and review. thank you very much. commissioners, on the point about long-term care, i understand about the-there is a current definition that includes that. i would feel much more

comfortable if you put in long-term care. i don't see how that will be a problem. it may be the legal people have a reason not to, but putting that in will make more assurances to the public and it will not damage laguna honda. we do need it. as you know, it is valuable and we need to get it fully filled too. that is my request. put the two or three words back in. >> thank you. anyone else in the room that would like to make public comment? what about remote public comment? >> that was my landlord. yes, we have three people. >> anything you say, we'll do it. >> alright. folks we have three people. you each have three minutes. please let us know you are there. >> [indiscernible] >> yes, hi, please begin mr.

manet shaw. >> [indiscernible] posted online have merit? no, it doesn't. right off the bat, it is worth emphasizing eliminating long-term care from the mission statement will lead to increasing the number of elderly and disabled san franciscans discharged outd of county for long -term care [indiscernible] to this commission. these bylaws were last updated 15 years ago on july 31, 2009. on november 22, 2024 commission secretary morewitz told me proposed governing body bylaw changes need to be updated to align with regulatory requirements. cms regulations do not mandate or require nursing home stop provider long-term care to nursing home residents. it is a complete ruse.

lhh1994 institutional master plan mission statement section states for over 125 years san franciscans relied on lhh main provider of long-term care beds. i agree with dr. palmer. this remains a bate and switch. noted lhh plays a role of provider of last resort and the largest municipal long-term care institution in the nation. eight years ago the [indiscernible] issued february 2016 documented that the 992 long-term care skilled nursing beds in san francisco, lhh provides 67.4 percent, [indiscernible] the jewish home provides 32.6 percent. 323 beds. the claim these bylaws need to be replaced because lhh is

awaiting a survey seems to be pretext. as far back as 1999, [indiscernible] the bylaws revised,x lhh passed acute unit survey with long-term care included in the bylaws. why has this changed after 30 years? there was no reason these bylaws must be passed today. go back to the drawing board and not wait until the commission december 17 or january 6 meeting. before passage today, introduce a amendment to revise the definition of post acute care to state post acute care includes long-term care skilled nursing care and rehab services. as a alternative, just table approval of the bylaw changes until the definition is clearly included. that ask a easy amendment to make and should do so today. you should specifically include in the bylaws they apply to both lhh769 skilled nursing beds and 11 bed

acute unit. after all, it is one skilled nursing facility and hospital. >> your time is up. thank you. next caller, are you there? >> yes. this is michael lion. my code is a a a. >> thank you. please begin. >> i got to say, dph is inability to forget is is breathtaking. a year ago dph was begging cms to restore laguna honda accreditation, talking how badly seniors and people with disability need long-term care. and after laguna honda recovered the cms accreditation by the skin of its teeth it pledged to absolutely it would never reintroduce anything like the slow project which crowded out hundreds of old and disabled san franciscans who could not thrive in any other

settings. only months later, dph is trying to do a obscure around the promise to accomplish the same thing by removing long-term care and substituted post acute care in the hospital mission statement. if this change is in consequential why are you so insistent on changing it? 12 of 41 people died when transferred out of laguna honda. how many people will die for not being able to enter laguna honda in the first place? thank you. >> okay. we have one more. caller, please let us know you are there. >> hi, this is dr. palmer. can you hear me? >> yes, please begin dr. palmer. you have three minutes. >> i want to emphasize post acute care does not indicate long-term

nursing home care in the minds of the public, and this term is often used to illegally discharge those who no longer qualify for medicare, and lost pay by medi-cal in the community. it is not reassuring that long-term care was removed from the mission and vision statement in 2016. this was done at the same time laguna honda stated to be a integral part of the san francisco health network. it was at the same time that san francisco health network and laguna honda managers ignored the fact that a nursing home is not a acute hospital and neglecting the proper mission of laguna honda until the federal and state government decertified it.

my strong-i'm urging you to put long-term nursing home care back into all the bylaws, and it is time to revise the 2016 bylaws, which were apparently a vehicle for neglect and decertification of laguna honda because that is lot of rules came in laguna honda ignored and lead to decertification. please, reassure the public and reassure us that long-term nursing home care will remain a part of the vision and fix the bylaws. all of the bylaws. thank you. >> that concludes public comment. >> thank you. thank you all. commissioner questions or comments? commissioner christian. >> thank you chair green. so, i'm deeply appreciative of the public comment that is being given today for the people able to

come in person and the online comment. thank you. so, i fully support the need for there to be transparency and reassurance to the community and to everybody who reads the documents that we put out about what the terms actually mean. moreover, we have a oversight obligation to the community and to the organization, and it is difficult for us to fulfill that obligation when we have less then the necessary time to consider documents and to intear gate them and to ask questions to make sure

we understand, so to the extent that perhaps if possible for us to do something today. i dont know that it is wise for us to do something today based on the upset that the current document has given rise to to make sure that-i think we should make sure we have all questions answered and all t's crossed and i's dotted and we got the city attorney online who perhaps can speak to some of this. i think that this is-i'm not-i don't write bylaws, it is a long time since i reviewed any, had the responsibility for that. i assuming there could be a definition section, or as number of people have suggested that the words-the terms most important to maintaining confidence and creating assurance for everyone

involved for the community and everyone who read the documents, if the definitions can be appended as an appen dex to state all the things post acute means or the very least to put in the term long-term nursing care as inclusive of what we are speaking about. i think everyone needs to be able to read the bylaws and understand what laguna honda is, what the obligations are, what it provides and not be left guessing and having to pick up a dictionary of some kind to understand what the terms mean, so not pleased as someone who is called and held responsible for oversight this is presented to us in this way in this timeframe, and i think we need to get it right, whether that means that we do some editing today, or whether

we come back later. >> thank you. commissioner guillermo. >> wanted to express support for commissioner christian's comments, and in addition to that, i had a couple clarifying questions. one, since this is the first revision of the bylaws in many many years and surveys have been conducted in the interim, is it necessary that this particular revision be in place prior to the survey that may or may not come some time in the next month or so or could the existing bylaws such as they are worded, would that be impediment is the first question of clarification that i had. and that might be something the city attorney's office might have to answer. >> actually, commissioner, if you wouldn't mind if your question

answered one by one. mr. troy williams is online. >> thank you commissioner. i think thanks for the question. i think through our recertification journey as we- >> please introduce yourself. >> troy williams, chief nursing officer, chief quality officer for the health network and incident commander for cms recertification. so, through the recertification journey, we have done everything we can to make sure that we are survey ready. i think if we don't update, i can't speak to the 2019 survey again where they didn't complete the acute care survey, but i believe it would be a vulnerability and potential fine if we don't update the bylaws to insure it captures the current practice and operation of laguna honda so i hope if

there is delay scr need to do definitions or what have you, fine, but i believe it is a vulnerability when they come in for acute care suvai if we don't have the bylaws updated. >> okay. but we don't know when the survey will occur and we don't know what level of finding it may be if this set of bylaws is not approved by that time? >> i think our acute care survey is imminent. i don't have a date, you are right, but i think that the cms and cdph, since it hasn't been surveyed since 2019 are very-now we are recertified on the sniff side, wanting to insure that our acute unit is in compliance. >> thank you. and then i had a clarification or i guess question. on article 7 under hospital administration.

the qualification for the chief executive officer don't mention anything about the need for certification as a nursing home administrator, which is something that we had history with and so, i wanted to know whether the statement that says that the director of health and governing body may adopt such other qualifications includes that or should we have that explicit qualification outlined in the bylaws? i think it is a important consideration. >> thanks for that. troy again. commander for laguna honda and the network. as mark pointed out, the governing body bylaws are acute hospital regulation, and for acute hospitals, the

regulations require a ceo and for the sniff beds, it is our requirement now that they have a nursing home administrator certification. we can certainly talk about including that in there, but that is the reason for the acute care hospital, the requirement is for chief executive officer. >> i am getting confused in terms of this is-i know this is the governing bylaws for acute care but it addresses in the vision statement laguna honda being post acute so post acute including long-term care, whether that ends up being included or not requires us i believe to address the qualifications for long-term care, post acute, however we define it, including certified nursing home administrator. >> yep, i hear that and i don't

think that should be a issue. >> that's it for now for me. >> commissioner christian. >> thank you. thank you for your questions commissioner. i really appreciate those. again, i have to say, there has been so much amazing work done to bring laguna honda back online and to rehabilitate it and create the institution that it needs to be, and so don't want to get-lose sight that, don't want to lose sight of the amazing people who have done that work and continue to do that work, but for us to hear now that this is the-if we don't have approve these guidelines it is vulnerability, it is completely unacceptable for us to be

presented with this document in this timeframe and have it have-have raise such alarm in the community and also just for somebody who is not a medical person, someone who doesn't have history of laguna honda, just questions about well, these words that i have been hearing the last two years are not in here so what does that mean, it is not acceptable and i don't think we should not be pushed to-i will not be pushed to vote on this document tonight based on the uncertainty we have. we are getting some answers, but we need to be certain what we approve is what is necessary and is clear to everyone who has to understand it. and so, if that means-i dont know whether the existing bylaws could be used interim until we get this

done in expedited way or if there needs to be a special meeting. i don't know what it needs to be but i won't vote to approve anything tonight. >> thank you. if i can summarize, i think public made very good points. the first being that part of the problem was supervision in acute care rather then nursing home facility and the fact it was critical nursing home administrator to be in the leadership position in long-term care component. the second thing, there are multiple very clear definitions in this document, including with the health commission is, but there is-to make assumptions one talks about post acute that encompasses long-term care is not clear in the document at all. i hope that is a summary what people have been saying. so, with that in mind, i wonder if we can hear from the city attorney

as to what our options might be in terms of going forward. >> [difficulty hearing speaker due to audio quality brash ] you have a few options. if you want to make any non substantive changes you could move to amend bylaws tonight and vote on those changes. if they are non substantive. i may need to confirm with my colleague whether the amendments are substantive or non substantive. if you want to consider the bylaws at a later date, then you could continue this item to a specific future health commission meeting and specify

that date. :otherwise, if you continue it and not specify the date, you need to provide the public 10 day notice of when you will be considering the bylaws. >> and in terms of what's been brought up, can you give us any insight as to what would be substantive compared to non substantive? there are many places with the wording of post acute is within the document and yet if we were to amend this with a repetitive addition of long-term care, would that constitute a substantive amendment? >> also the addition of the definition of ceo and [indiscernible] >> those two elements. >> so, if one of the amendments you are seeking to make is to in addition where it says post acute care to add in

long-term care, then that would not be substantive and you could make that amendment tonight. if you are seeking to add in a definition and requirement as to the qualification of chief executive officer, i think i need to hear more about what exactly the language is that you are seeking to add in. confirm with my colleague ann pierson. to me that sounds like a substantive change. >> commissioner. >> sorry, go ahead. so, if we were to consider at a future commission meeting as soon as we could consider it would be the first meeting in january, would that give sufficient notice for the public for any changes or amendments that get made and also give the commissioners enough

time between now and then to review the other kinds of changes that may be not as drawing as much attention as the two we mentioned, because there is a lot of changes even if they may not be a significant as those that have been named. it gives us 2 or 3 weeks to make those changes, review the document, give the public notice and possibly still be in time for an early january survey. i just don't feel comfortable rushing at this point in time, even if one of the amendments may be substantive and another may not be. i feel like in order to do the oversight job that is required we might need extra time. >> secretary morewitz, can you comment on the timing? >> you all could also have this

item on the december 17 agenda, which would give-i dont know again, you all have the actual document since friday but in the past 24 hours i sent you conceptual information, but i am not sure how much time you need to review anything else and get us comments. if you can do in the next few day or this week, i think the staff will have to comment to see if they can have it done by the 17, but there is the january meeting and don't know if that puts laguna honda in jeopardy knowing the survey can happen before them. maybe start with laguna honda folks to say timing wise, would the 17 versus january 6 put in jeopardy, does it matter? it sounds like the commissioners like more time then less time. >> my thought is i think both of those dates would be fine. again, trying to get those to the finish line before midjanuary,

for example i think would be fine. just as long as we have those before they come in for the survey. >> commissioner giraudo. >> i agree, i propose the january meeting and to having more in depth explanations of the items brought up today as well as those we did not have time to review, because this is a significant oversight responsibility of ours and i believe if in fact the surveyors show up in the mean time, the current bylaws could be stated as they are interim until the january whatever it is, 6th meeting where the updated bylaws will be presented and

voted upon. and this is part of the health commission's due diligence. >> commissioner, okay president if i ask a clarification. based on what you said, i did the introduction but not the work, would you prrf go through line by line and page by page? i want to do my best to meet your needs the next time you all see this. how would you like to review the document in the meeting room when you decide to vote? >> i do think--we didn't have enough time. i think with--so, more specific. for example of the items brought up today, i think would be needed, as well as a forum with both maybe you and the city attorney if needed for us to submit our questions to you,

and then if to the city attorney, prior to the january meeting. >> thank you. director colfax. >> commissioners, i want to acknowledge the concerns the public raised and you raised and timing of this. a couple things, typically these large documents would go to the jcc and that didn't happen this time for reasons that you all aware of, so i want to acknowledge there is usually another step in the process that gives the commissioners on the subcommittees time to review and ask questions and go through it and have-and essentially prepared for the whole commission meeting, so i want to acknowledge that piece. that is one reason this may be more-may be less smooth then some of the other areas and questions being raised. the other thing i just want to-i will

ask mr. williams to come back. there is-i want to for us to be clear, there is some risk here and i understand the concerns about the bylaws. there is concern surveyors could come before the bylaws are revised for the commission direction and approved and that could result in fining. this is speculation. there is a lot of if, if, if there, but i wanted to be clear that there is that and i hear the commissioners concern, but i will ask troy to speak to that just to be completely transparent about the dynamics here. >> troy, before you jump in, if i may the city attorney provided guidance the jcc cant consider this and has to come to full commission, that is why it wasn't discussed at the jcc, which is in the alignment of our

culture, but like thep budget items only come to full commission and not committees it is something only the full commission can approve so that is why it is here instead of pre-digested by the committee. >> thank you dr. colfax. i think there is a chance the surveyors could come and so any time. i think there is a definitely -they want to make sure our acute unit, which hasn't been surveyed since 2019 is in compliance. i think from my perspective, if we all work together and get you all everything you need and answer the questions qu feel more comfortable with the 12-17 date and laguna honda is committed to making sure you get what you need so you can make a informed decision, but there are vulnerabilities and like you said commissioner

guillermo, we don't know what the finding would be, but if our bylaws hadn't been updated since 2012, that would be a big vulnerability for us. >> so, i think i can speak on behalf of the commissioners, we will do our diligence and homework and as long as the information can get to us, we can't probably put this on the agenda for december 17. does everyone agree? >> i'm certainly in agreement we should do everything to get this done before january. my only concern is how we would communicate loffully lawfully if we have questions. do we send to mark and mark gets the answers and gives the answers? we need to be able to have a conversation legally about questions we have. >> commissioner, i think it is

like any other items. you send me questions, get answers through written form and discuss the answers here. that is how we do every other type of item. i understand and hear the concern but think it st. the same-for instance the contracts, commissioner submit lots of questions and or any item and before the meeting you-commissioner giraudo is as every meeting and commissioner green. also, i could get the information you could have the answers presented at the meeting to have a robust discussion. i hear concern but not sure- >> thank you for that mark. i want to make sure i understand that we routinely send questions. i'm talking about being able to have a discussion, which pings something in somebody's mind not necessarily on the table. i realize we have constraints.

so, i'm certainly willing to extend and don't think i'm alone, extend myself to do this at the december 17 meeting, but i want someone who has listened to everything tonight go through this document line by line and see whether there is anything that comes to them that maybe should be expanded or changed. i want that done before we are expected to do anything. >> so, if i am hearing what people said, would it possible for laguna staff to review all the public comment in addition to the comments made at this meeting to create a redline document so we can all see what the revisions would be? i wonder if we could get that for example by week from today, which would give us time to review and get

back to you by friday the 13th by the end of the week and then have further time if laguna can respond if there is anything meaningful so we are ready by the 17 to have a discussion and hopefully not involve further revisions or substantive items that would be brought up at that time. does that sound reasonable? >> it is accept i need to alter the timeline. on the 13th i need to post whatever is going to be presented at the meeting so if you are giving comments back then i guess we have to alter and in the meeting say there is a vision online, but here is since then the commissioners asked for this or that. if you are all okay with that, because you are looking at two different versions. does that make sense? if you can get the comments i think on thursday versus friday the team could turn that around so the version in the packet and the version online is the

same version. that would be better work flow wise. >> would you mind working with the laguna honda team to come up with a timeline and let the commissioners know so we can carve out time in our schedules to make sure we do our share for review and oversight. i think that would be a great conclusion. >> absolutely. i can talk to you each of you to see [indiscernible] yes, of course. >> thank you. thank you so much. do we need a motion to continue this item or where do we go legally from here? >> i need ask henry, because not sure this is outside normal practice. henry, could you advice us, or ann? >> somebody. >> henry or ann, are you online? thank you henry. >> [indiscernible] [sirens in the background] [unable to hear speaker]

>> good evening. deputy city attorney ann per seen. pierson. i recommend you make a motion to continue the item until your next meeting and as long as it specified to a specific date, that will suffice. >> thank you very much. so, i will entertain a motion to continue this item until the meeting of december 17, 2024. >> so moved. >> is there a second? >> second. >> any public comment on this item? >> public comment has been done. >> great. all in favor. >> aye. >> thank you fwr for your input and the hard work the teams have done to bring this to fruition. very appreciative for the insight and help. wonderful. the next item is population health division update and susan philip our health officer and director of the division will be presenting.

welcome. >> thank you so much president green and good afternoon commissioners. director colfax, secretary morewitz, my name is susan philip the director of population health division. i'm so pleased to be here to represent the incredible work of the talented dedicated people who are the heart of phd. next slide and thank you so much projecting the slides. so i won't have time in this presentation to tell you all about the varied and wonderful work done by our team ranging from public health to community base service, cbo service, regulatory enforcement and policy making but i wanted to give you a very high 30 thousand foot level overview and you will be hearing more in depth from leaders about specific

programs they lead throughout the coming year. next slide, please. our organizational chart reminder where we sit within the department. just a note we look larger then we are and like to think we play larger then we are. we are 7 percent of the department budget and same amount of percentage of staff. next slide, please. zooming to the structure, just over 2 years ago september 2022, we created a new organizational structure with deputy directors, over seeing branches doing relaitded areas of work. we did this to support our branches and branch leaders and allow to grow capacity to meet shifting or emerjing public health needs. i'm fortunate have a stellar executive team in phd who are here. daisy leads operations, people infrastructure and has been doing

incredsable work to build the team and processes necessary to maintain and improve the work. this is often invisible work but crucial to the public serving work we do to protect and improve health. you have all the opportunity to hear from acea king leadsing community helths. they are centering and strengthening our relationships with community partners with a equity focus. and i want to introduce dr. jane who leads public health service and also a deputy health officer. been with us four months but years of experience under her belt at cdc and cdph. getting to know the large complex branches and hit the ground running and so happy to have her in phd as well as daisy and asa who are here. next slide, please. this is a slide that i have shared with the commission before. it really bears repeating,

because this is context for our work. on the right is the recognized 10 essential functions of public health. our responsibility is within all these areas with equity at the center and everyone who lives, works, studies or plays in san francisco. we deliver many of these core functions of public helt. we advise on city wide public health policy. you will hear how we advance public health research and invasion and leading public health accreditation for the entire department. next slide, please. so, we have many key roles as i mentioned advancing the vision. we have varied activities but our focus is summed into three very large areas. the first is monitoring preparing and responding to emerging and wide

ranging potential public helths threats, including h5n1 bird flu, climate change and others in partnership with community academic and health system partners. the second bucket is strengthening data system and workforce to communicate data and measure our efforts to improve and protect health. and then thirdly, reducing health disparities broadly across multiple condition deepening and broadening community partnerships, developing and promoting research to allow equal opportunity for good health for all san franciscans. of course to make all the three possible we must invest in the people of phd. next slide, please. now i will give concrete examples of some of the major themes. our public health emergency preparedness and response branch lead

by dr. tenor has grown since covid-19 and they are helping insure that we are ready as a city for future public health threats. one example of how they are doing this in preparing us was operation encore spring this year. this was a full scale exercise partnering with 17 agencies across san francisco including the department of emergency management, and emergency medical services agency, the san francisco fire department, sf state and multiple health systems. the initial scenario was staged at san francisco state and director colfax, deputy director boba and i and leaders were present to witness some of this. it was really impressive. an attack and mass casualty events at a concert and included acting patients, which [indiscernible] a term i learned this year which is make up that simulate injury

and it was impressive how they enacted everything from initial response on scene and they had scenarios on cards at various hospitals across the city to prepare for influx of 200 patients taxing our ability and capability as a overall health system. next slide, please. we don't have just hypothetical public health concerns emerjing and we have to deal with. h5n1 bird flu is in the headlines increased detection of the virus in polltry, dairy cows, raw or unpastureized milk and few homan cases. most human infections resulted in mild symptoms and no confirmed cases of human to human transmission but many teams in phd are preparing together including through incident management

teams to rehearse and be ready and have systems in place. this includes leadership at disease section, public health laboratory testing available so we can do that locally when needed, environmental health branch. there is a raw milk recall across california and environmental health is going into stores making sure the recalled lots are not available for purchase. [indiscernible] at the heart of emergency response preparation and arches apply research community health epidemiology and surveillance branch is important in actually documenting and recording the cases and epidemiology when that occurs. next slide, please. another type of health threat is not necessarily communicable but climate change. matt wolf leads the work housed

within the [indiscernible] brarch. [indiscernible] the medical director for climate health. increased heat wild fire smoke and sea level rise are potential impact to san francisco. we approach the work in collaboration with other city departments, and with community organizations and leaders. i think we heard about how san francisco is preparing to strengthen the infrastructure against sea level rise and other climate change impacts. what matt and others and mena and others do is bring a health perspective to the policies and actions contemplated and do with a equity lens to mitigate the health impacts since communities with fewer resources face higher burden from climate change impact and their health impact as well. next slide, please. a important opportunity we have been leveraging throughout for all our work and building our infrastructure is the cdc public health infrastructure grant

named project invest, invasion that value equity and strengthen teams. san francisco receive $14 million over the five years of the grant lead by dr. jonathan fucs, director of center for learning and invasion. cdc allow a unusual amount of flexibility for the agency to use the funding and the cdc intent as noted here really aligns with our focus to support and sustain a diverse public health workforce and phd and strengthen backbone operational fiscal and performance resources for the division's work. next slide, please. so, one ways we are using project invest and going back to the point i made about how we must invest in people in phd to serve the public in the best way we can is that we are working on improvement suggested by the racial

equity leads and champions in alignment with the office of health equity and human resources colleagues. the group this year prioritized focus area 6 from the dph raiblsh equity action plan, which is fostering culture of respect inclusion and belonging within phd. to that end, they made a few recommendations that are in process and development now. one is launching a equity focused leadership academy for phd leaders including 360 evaluations from the teams. promoting the respect policy aligned with hr and department of human resources efforts city wide and insuring protected time for staff engagement and wellness activities among all depands of the phd goals and work. next slide, please. and we are also using invest not only for supporting our internal workforce and to support novel important

models for public health workforce including community health workers. the past year phd leaders, [indiscernible] supported a learning collaborative who are so important and successful saving lives during covid-19 and that cumulated in the first conference in september lead by [indiscernible] and it was really wonderful to have mayor breed in attendance for the conference. next slide, please. so, this community focus is critical to all our work and it centers health ucwety. we have informed the commission about the work with community impacted bire the navy clean up of hunter point naval ship yard. the picture on the left is from 2024, youth climate environmental justice summit. in september presented by the marie harrison foundation with support from

our teams and dph and many teams in attendance. we do health fairs with the community as well and have been working to provide covid-19 and flu vaccinations for people who are home bound and in neighborhood settings and partnership with community organizations. next slide, please. the same recognition of the importance of community lead efforts for equity resulted in the health access points model for integrated hiv, transmitted infection, hepatitis c and behavioral health service, under the leadership of [indiscernible] there are a variety of funded community based organizations with expertise serving priority communities for low barrier public health service. the goal is insure all san franciscans can easily access prevention and treatment for hepatitis c, hiv,

sexually transmitted infection and overdose prevention tools and if not in house connection to primary care and behavioral health and mental health services. next slide, please. so, we know that person centered service as described delivered by the team and phd directly or trusted community partners are critical to building the relationships and trust that are necessary to increase health equity. we also know structural barriers to health exist and public health policy approach can have the most population level impact to increase health in san francisco and we are fortunate to have leaders now in phd who are organizing and elevating our opportunities for policy input to the overall office of policy and planning lead by director patel at dph.

eduardo and andrew rodriguez have been helping think globally about the policy opportunities. i want to talk about one policy success. 2023 marks the 5 year anniversary of the shurgry drink tax or soda tax in san francisco, which is lead throughout from the first conception by [indiscernible] and team in the phd community health equity promotion branch. the tax on distributors of the drinks resulted in $50 million turned around into contracts with community organizations that promote healthy eating and active living in communities most impacted by shugerary drinks and targeted by shugerary-a important policy with city wide impact is tobacco control.

the [indiscernible] and environmental health branches play a key role in this work. in one striking example a year ago, background work and documentation by jeanine young and environmental health and others lead to a lawsuit by the city attorney against online retailers illegally selling flavored tobacco banned under the san francisco health code since 2018. flavored tobacco is marketed towards youth and communities of color, so this leg work and documentation plays a important role in insuring health equity through the legal avenues as a city. next slide, please. i am going to pivot a bit but related to policy. fortunate to have house world renowned research teams including bridge hiv, center for public health

resurs, substance use and health and sti and hiv prevention including city clinic lead by dr. cohen. lead research in [indiscernible] last year they were awarded nearly $25 million in competitive research grants. dr.mic farland mentioned this is larger amount then awarded to u.s. schools of public health. the research is focused on advance with the promise to improve public health in san francisco in high priority need areas. the work makes dph unique among health departments in california and throughout the counry and we can be proud to have them as part of the department. next slide, please. i'll give a stellar example that was shared 2 weeks ago at city clinic, our city sexual health clinic in

the hiv and std prevention section. [indiscernible] commonly used antibiotic and available in generic form. starting in 2020 city clinic was part of landmark mument center trial showing doxycycline taken could revent syphilis and chlamydia. it is relevant and important to san francisco with the highest rates nationally of the infection. the trial was success and showed doxy pep worked and quickly translate the science to city wide guidance thrks first anywhere in the nation moving faster then cdc. this is a really stellar example of moving science to implementation to policy to results. next slide, please. since those days the clinic has started gone on to provide this prevention tool to over 1700 people and it is

seen chlamydia and syphilis decrease who had very high rates of infection. you will hear more about the city wide impact hopefully two weeks from now and don't want to steal dr. cohens thunder, but it is exciting to this powerful translation of science to heth. the data are based on patients you will see city wide and it is great data. so, in areas phd has expertise such as doxy pep, we share knowledge and support our colleagues across the network and in behavioral health. doxy pep is available to network patients not just those at city clinic and subject matter experts are consultants to network colleagues. next slide, please. saving lives through overdose prevention is no exception to our eethoes of joining our

expertise to the larger department. 18 staff are activated for data and community engagement work through dph core efforts including valerie kaplan doing a incredsable job as overall data lead. the free public health clinic city clinic, tb clinic on csfg and immunization and travel clinic downstairs dispense naloxone and refer patients. the health access points offer behavioral health service or active linkage. next slide, please. so, finally, phd leads national public health accreditation for dph. a nationally recognized marking for quality for state and local health departments. we are in the midst of first 3 accreditation effort and expect to have site visit by the public health accreditation board the first quarter of 2025. the commission will also be

hearing next year from priscilla chu and others on the team about the 20s 24 city wide health assessment which is part of the accreditation process but separately important in that same timeframe. next slide, please. so, i want to thank you so much for this opportunity to share the work of the division. i am so proud to be part of this team and work with so many wonderful colleagues. thank you to the commission for your unwaver support and expectation that we keep improving our work city wide and we certainly intend to do just that. thank you. >> thank you for the excellent presentation. the body of work is incredsable. it is clear the contributions are vast and greatly appreciated and have a huge impact, so we really appreciate everyone on your team and the work. is there any public comment? >> any in the room?

any public comment in the room? we have one public comment. dr. palmer, you got three minutes. >> so, hi. it is disturbing to me--i think the department of public health and population health division is doing great work, but there seems to be a blind spot about addressing the bayview hunters point community about the ship yard and contamination from the ship yard. it is kind of shocking to me that there is no mention of this. in fact, dr. [indiscernible] was told that the ep a meets every quarter with the population health division and why wasn't that presented? today?

the bayview health hunters point committee lives every day with the toxic legacy of naval ship yard and burden of industrial and abandoned sites polluting bodies, air soil and water. residents are tired of siloed responses which ignore the cumulative impact. they need you to listen and act decisively, act and address the cycle of harm and neglect that perpetuated the crisis. listen to the experts in the community like [indiscernible] marie harrison foundation, all things bayview. bayview hunter point muckter and father commission and green action. data is emerjing from the community that will guide you. we need to hear that you are advocating for this community. even if you yourselves cannot

do the testing you can advocate for the testing to be done and the protections to be put in. there is still a chain link fence with no dust curtain in a contaminated area, and every time someone diged up the dust it flies into residential community. this is nuts. we need to hear more from the pop ulation health division about this. thank you very much. >> that is the only public comment on this item. >> any commissioner questions or comments? commissioner giraudo. >> thank you commissioner green. yes, i have a number of questions. the first is on slide 9, where climate health program. the third bullet point that states, acts as a bridge. could you give examples of specific programs that is on here where

it said both on a city wide basis, and within dph and how and where what specific programs that you act as a bridge? >> yes. so, city wide one of the examples here is this health heat and air quality resistance project which brings together multiple departments and matt wolf represents dph from phd on that as well, and has cochaired that effort as well. see, that is one city wide effort. i think there have been increasing efforts as well to work with our network colleagues and others and within phd to look at ways in which cal aim allows reimbursement for mitigating

factors for air quality and those types of things which had not been rebim ursable. we are looking at ways we can work collaboratively across the department to insure that patients are aware that these are now reimbursable. we have more to do, but this is a start that hasn't been organized in this way before to have eyes on big picture and find where the points of connection could be. >> great. these specific examples help at least me understand more specifically rather then on a abstract basis how it the work is actually done. then i have on slide 10, where leveraging external funding resources. when you mention strengthen foundation capabilities, canned you give me a example of what that is and

what-how it is implemented? >> yes. one of the examples has been that this work has been utilized to fund positions, 19 positions across phd. many of which are within operations people and infrastructure and as part of our equity group. the office of equity racial equity of anti-racism and equity. those i believe we are foundational. our core pieces that no longer had to be funded by general fund while we have the fund ing available, but the grant is enabling us to strengthen and maintain those positions that will allow us to do the work of strengthening people, becoming more equity focused organization and also doing the day to day work of communicating internally about

our work of doing the planning, the policy, the operational work that needs to happen in order to make all our programs possible. >> are these new positions? >> some are yes. some are new positions. >> great. then, on slide 11. how many participated in the leadership academy? >> it hasn't happened yet. it is still being developed so happy to report back. to your point commission, i gave a broad stroke here, but there is a lot more to dig into and climate health is one where we should come back and talk more, but there are other areas as well mpt . >> that was my-slide 13 with the community partnership and you mentioned bayview, but as we talked before, it is

a focus of our commission and so i think more timely updates on your reach out and your community meetings of what is happening with the community would be extremely helpful and something that i believe we would all like to hear on a much more specific timely basis. as you have done before in describing a couple of different community meetings and i think it may have been to the committee, but i think that was really helpful information and i also want the community to know that we are listening and i think as your presentation and just updating us on that, i think is a crucial issue. so, i appreciate that.

then i will keep going on ya. slide 15, which was on the soda tax grant. my understanding is that soda tax was a presentation that was going to be presented to the community and public health committee and it had to be recalendared. is my memory correct, mark? >> yes, you are correct and i thought there was a issue around the funding or there was a complicated situation that it wasn't just a delay because of a presentation, it was a larger issue. >> there are issues around the fundsing in the current budget climate, but it doesn't take away from the fact that it happened and there was this work and policy initiatives and out flow from that so that was the reason. it is because there is shifting offunding and the way the funding is now supporting some direct

nutritional services. >> i think that again would be helpful for us is to know with as you said here, $50 million and what in 2023 did the soda tax, what programs did you fund? and so, that would be helpful information that could be back to us and to the community and public health committee to start, even though it doesn't need to be a full presentation, but i do think an update on that would be helpful. i would really like to-i would suggest that. my last question on slide 20, could you explain more about the dph core

efforts, the core efforts? >> that are efforts i believe you heard about before that are lead by dr. hillary kunins and others. behavioral health work but department wide. i only want td to describe phd contribution to that work to prevent overdose dweth in san francisco. >> again, that is always helpful if that is it the specific phd. i understand, but it wasn't clear you were the data lead, but then the next two bullet points with the dispensing of naloxone and refer patients, it wasn't clear to me that that was still part of core. just how it is written is what i'm trying to say. >> thank you. i appreciate that. >> if the title was phd

contribute to overdose prevention efforts through core. >> you are right, the last two bullets are not core. this is more broad. we are both involved in core but also doing what we can with the resources, the clinics that we have to refer people. >> i get it, but it just is again for further understanding how things are not siloed and how things are integrated, i think would be helpful for our further education and understanding. thank you for answering my questions as i go through this, but yes you are right, many of the presentations at least to our community and public health committee are you know, the under-they are great. they have been excellent, but more specific understanding how

again, what you do is integrated in the tentacles within the whole department is helpful. >> thank you. >> commissioner christian. >> thank you president green. hello dr. philip good to see you and thank you for the presentation on a lot of amazing work and we always-i always enjoy having you come present to talk about the work you are doing and feel guilty you are taking you and your colleagues away from doing the work but thank you for providing the information and i join commissioner giraudo's request about giving a little more as much as you can in certain places. also, one thing i'm grateful for with you and your team is the way that you have been diving into bayview hunter point work and work wg the community in

a way the department has not in the past and building that work still and building those relationships and looking forward to having updates as frequently as possible in whatever venues are probel appropriate whether public health committee or full commission on a regular basis about how the department is walking with the community in the places where the department has no authority, and what the department is doing in the places where it does have some ability to act if not outright authority. p a update around the dust screens and at the last presentation i think you gave, we talked about whether the department could look into providing working with someone to provide mitigation measures before in the interim before the federal

authorities acted to do any mitigation of their own. interested to what if any additional conversations or inquiries have been made and it's clearly an important issue and one that the department is deeply responsible for doing whatever we can do to help move this along, including the meetings you spoke at one of the last major presentations you spoke about the fact there were these ep a meetings the department did attend and has no-i don't know whether there is real-i think you listen and don't know if there is authority in the meetings but where there is no authority just reporting back to the community and to the commission about what's going on and whauts what's being done, and and can't do on

a regular basis and again, don't want to take you away from doing the work that is so important, but we do need to kind of keep it live and keep it -keep hearing what is happening so thank you. i have every confidence you are doing a lot of work just the next update and thank you for doing that work and looking forward to hearing it and i do thank you for that org chart. it is always helpful and thank you for attaching it to the presentation. >> thank you commissioner. >> commissioner guillermo. >> just wanted to thank you dr. philip for the presentation and i know it is trying to encompass so much work in a few pages and so it makes it for a both comprehensive overview, but also trying to give good examples of the work that

we don't get to hear as much i think all love to hear about all of the fantastic work that historically the phd has done in san francisco, because there is so many other issues i think often times take the headlines. but i did want to commend you on the and the department on the focus on the applied research, because it unique for a county health department. not only to engage in groundbreaking research applied research, which as you said i think in at least the example you gave is doxy pep is able to be applied in a much more rapid fashion and academic setting which isn't that surprising. but i think the advantage in san

francisco with having a department that is so intent i think on the research that you do and not only doing it but leading in the research that you do, that benefits not only san francisco, but benefits i think public health as a whole, and then to leverage as the report says, $25 million is not small feat, especially given as director colfax said impeneding additional cuts. i just hope we are not-those continued leverage as possible, because down stream the work that we have established in the reputation i think in san francisco has established in the contributions that it makes to

the overall wellbeing of again, not just residents in san francisco and not just for the issues that effect us, but that really do effect health and wellbeing of residents and citizens throughout the united states and i don't think that gets enough attention so i want to point that. particularly the doxy pep example that you gave, because it is quite unique and so, just wanted to sort of point that out and thank you and to encourage you to continue. not that i have to encourage you, but i think would like to be able to verbalize that here. >> thank you so much vice president for the recognition. on behalf of the leaders, i'm not a researcher any longer but i agree with you. they are very special and they directly benefit the public health in san francisco. >> i think we all associate ourselves with commissioner guillermo's comment and she was stating them i was

thinking about dr. zevin because he is a living example of everything you describe and what this department has been able to do in so many ways, so you are continuing that tradition, which is wonderful. i had one question and you may not be able to answer it now, but there are so many changes on a national level and when you talk about the grants we have and not knowing if the grants running through 2027 whether that can be tampered with, i wondered especially in the future as you get a better feel what is going on in washington, of course we are worried the ep a will be decimated and not just the leadership it is the number of people working within the organization who will leave. it happened in 2016 and i fear it may happen to greater extent now to people i know who work locally in that organization. i wondering what you are thinking will be and how san francisco in

particular can pivot as we may face some unaccepted funding cuts or lack of recognition of our programs, whether we can turn to the private sector because we have seen in climate change, as that kind of dropped in national importance, a lot of companies as well as non profits and other organizations stepped up to do funding, so wondering that is giant question, but wondering how you begin to think about that and whether you feel there are immediate threats to the work. >> thank you so much. i don't have a answer right now. i am concerned about that as i know that you are and the rest of the commission. i know what i have under my control is to work with the teams we have to try

to be prepared to respond for the next public health issue and to really invest in people and invest in doing our core work, but we know that this will be a challenging-this will be a challenging number of years for our colleagues and leadership at cdc, which translates how we get information in order to protect and promote health in san francisco. i think it remains to be seen and may be something that as we come back if i come back and talk with you, we incorporate how we are adjusting and how we adapt and what the reality is. that's not a satisfactory answer, sorry, but the honest truth is i don't know what it will look like and trying to focus on our people and processes we know are necessary in san francisco. >> thank you. especially if there are big funding concerns as you give reports and as everyone said, the hunter point

bayview situation is front and center for us and any aspect of the response from the ep a or the department navy or anything that these changes would impact the speed with which we can get resolution to things in their control, would be grateful to let know about that as quickly as we can, but we are so appreciative for the work and very important that we support this department, because we got to continue to lead in the same way that other organizations lead if the government diprioritizing the work, so vastly appreciative of everything you are doing. director colfax. >> thank you. i wanted to celebrate phd and dr. philip leadership and happy the commissioners brought up the org chart. iment emphasize how much dr. philip recruited [indiscernible]

challenging times. dr. philip is getting very best people to lead and to be responsible and dealing with some of the changes president green that you brought forward. i also just wanted to take a moment to get more to the ground level in terms of somebody who-if you are in san francisco phd touches you. i had a break and went to farmer market in civic center and somebody tapped me and said dr. colfax you are head of there department and it was the weights and measures people checking the scales at the farmers market. and then if you go to any of the restaurants or permitted food establishments in san francisco, phd

has been there. how many inspections environmental health, two a year? >> i believe-thousands. >> thousands. there is that. if you may need to-if you have a question about your sexual health, you may drop into city clinic because they do thousands of visits there and may get doxy pep because of the research done in dr. philip team and if you have a test sent it may go to the public health lab which is leading in terms of doing testing and invasion. i just wanted to-this is truly population health and we don't always see it. one challenge in this world is if you prevent something people don't see what you prevented and that's the paradox in public health so i want to appreciate and celebrate phd and dr. philip. >> thank you very much.

insightal if comments and we want to associate ourselves with those so thank you very much. >> thank you. >> great. the next item on the agenda was the finance planning committee update but that committee couldn't meet because we didn't have quorum. the next item is consent calendar we can't address or vote so those on the agenda january 6. we will bring those back. is there any other business? hearing none, is there public comment? sorry. >> i have other business. i was ill when the last meeting took place so wasn't able to hear what dr. colfax had to say about the living proof campaign and the presentation i was so glad to be able to attend. i like a update in the near future about how that campaign is

going and i just want to say that it was such-it is astoundingly beautiful campaign. the first time i had seen any images and it is-i'm sure people have seen them around town now and what a extraordinary accomplishment. the campaign itself. and also kudos to the team to the communication team and to the department for the way it is sharing the information with the community and the-thank you to the people who stepped up and were willing to be spokespeople for their experiences and encouraging people to know that it is possible to get treatment and now we do as dr. colfax said at that event, for years and years and years the city has been demanding and hoping for and the

department is working towards treatment on demand and we are now in a space where i believe that the department can say that the department is providing treatment on demand in a way that we never did before that we never had in san francisco before and now we begin to see challenges that follow from that and i think that it will be really necessary for us to examine some of the challenges we are facing with drawing in making treatment so available that there are people who are really at risk coming into the treatment facilities that exist in the city and dph funds and now how do we address those problems that come on after the success of having expanding treatment. looking more to hear more about