the san francisco health commission. welcome to the public who have come to testify today. commissioner guggenheim. >> hee >> commissioner guillermo. >> here >> commissioner christian.

>> present. >> commissioner giraudo. >> present >> [ramaytush ohlone land acknowledgment] >> thank you. next is the approval of the minutes of the health commission

meeting of january 13. commissioners you have buffer the minutes are there additions or corrections? >> commissioner guillermo, notified me i made an error and included her as present when she was not in town. i will correct that. >> and given this correction, is there a motion to approve the minutes? >> a motion. >> is well a second >> is there public comment? >> any public comment on the minutes? >> a.m. all in favor say, aye. >> aye. >> excellent. thank you. the next item is general public comment. and morewitz will read a statement before we entertain the comment. >> for each agenda item members will have an opportunity to make comment for up to throw minutes the press is designed to have input from individuals in the community. process does in the allowed questions to be answered

or back and forth conversation with commissioners. commissioners consider comments from the public when discussing an item. note that each individual is allowed one opportunity to speak. individuals may not return more then and there know once to read statements from others not able to attends. written comment sent to the commission at health. commission. dph @sfdhc. org. prohibit harassing conduct and others during meetings and will not be tolerated. is there any general public comment. >> i got 3 requests but they are all for the budget is there anyone for general public comment about something not on the agenda. a topic not on the agenda. >> no hands in the room. i see remote caller.

are you there? >> yes. >> you got three minutes. >> thank you. this testimony regards something not on today's agenda. please issue don't cut me off. this testimony occurrence doctor grant coal fact director of public health. i am not sorry to see him g. after all, admit fiscal year 2024 paid 546 thousand dollars, way too much. in june of 2019 the san francisco examine are quoted him in saying that he was concerned a culture of silence this permitted sexual abuse to continue unreported there is no evidence that they continued past january of 2019, coal fax said. we are confident that laguna honda is a good place for

patients. that was not true and [inaudible] dessertified. it was in large part the 6 page laguna honda hospital reform plan creates on september third of 2019 by try scombims doctor colfax and health commissioner chow was not implemented by the time it was decertified. and the hiring promise in september of 2019 never occurred until june of 23. colfax 60 day reform plan lead to the city spending 53.aches million dollars in consultant costs, 212. 8 million dollars. direct to the recertification. someone needed to be held accountable for the failed plan that could have prevented the expenses. the disasterous decertification

and slow admissions to the 759 incentive spread capacity criminalitied to forcing doctor colfact out as director. he should have been forced out 6 years ago when the scandal erupted. thank you. >> the last public comment. >> and the next item is the finance and planning committee update from commissioner chow. >> thank you, president. the finance committee met this afternoon. . just before this meeting. and -- we welcome the commissioner guggenheim to the meeting and thanked her for joining us. there were under the contract support eight different renewal contracts. including the san francisco study center pilot project. the civic living proof public

education program for substance abuse service the twhoon had the public campaign throughout the city and heard extensive indepth report of success and the contract continuingation which is buffer. and reviewed the ward 86 health access point service. for hiv and the alliance health project if market street for the ap i communities, iv programs. the we also did review the positive resource -- positive resource funding for lee land house. and understood that the positive resource, which was under scrutiny for financial

instability had passed the 2023 audit. with a considerable turn around. and -- and -- we asked what the presence stats was. they are also in the positive. and there will be an audit of the company again in april but it appear that with at least monthly if not miles an hour often, there is a conference between positive resource and our finance people in regards to maintaining financial stability. that contract is before you. there are three other contracts. these three contracts for institute delarosa is the result of the city attorney requesting that the contracts broken up that would then require single

source funding rather than a merging of the funding into major contracts. a differents approach that will be before us for a number of months yet. there are 3 contracts from instituteo, dealing with adult to come the latino population the sunnydale and trial services they had before under one contract. they are now broken up. and so we discussed the some of the performance, that seemed to appear in the performance record. these were noted to be either from documentation which may be resolved now with the implementation of ethic and also small numbers in the performance objectives where there were not

enough to measure. there was one new contract before you, which is data x. this is actually a management of a contract for sf general. for all of the san francisco health -- network policies and procedures. tell put them in an electronic format. and allow them easy access. and search. and this includes the numerous once at laguna honda. so, more important low, staff can find it more redly. this contract is observe you -- it also has a way of taking incidents and merging them to whether or not they are meeting and regulatory components. a number of organizations do ud them, this company has like throw,000 organizations throughout the world in which

they use this type of product. and closer to home, ucsf anesthesia departments are using them along with ucla and uc irvine and other like institutions that is a new contract before you on the consent calendar. these are all recommended by finance and planning for your approval. thank you. >> thank you >> is there public comment on the finance and planning committee update? i see a hand remote. >> that would be great. >> you got throw minutes. thank you. >> as for the commissioner to guggenheim refresh to see a socialite reported to the d. public health.

i did venture she'll bring expertise to this body. thank you. >> thank you. you are welcome. >> that's the only public comment. >> thank you. and we'll get to consent after commissioner chow gives us the jcc report from the general. >> at general on january 27, we met as jcc and reviewed our standard reports in open session a review of the nower quality data elements. remember i reported left time we are following. also highlighted by the ceo was mayor lurie's visit to the hospital. sounded successful. hoping that we will continue to have the support of the mayor

for general. during the medical staff report. committee recommended the full commission approve the zsfg policies on consent for today. in closed session we approved the property and the pips minutes report. >> and i guess i will ask if there are public comment on this report and then the next one. >> because it one item. >> and -- commissioner chow will give us the report from the jcc from laguna honda. >> it is vice president guillermo. >> oh. >> i was at that one. not the full commission in january. so -- due to the extra time that was needed to finalize the draft budget will be presented today's meeting the laguna honda hospital jcc meeting was held at

the first monday opposed to the second. and thank the staff and all involved for making the adjustments to get the reports and to attends the earlier meeting. during the meeting that committee reviewed our standard reports including regulatory reports. during the executive team report the committee heard laguna honda will work to improve efficiency of the admission's process. there was a lot of discussion with they whooef medical officer cho who is heading up that process. and look forward to hearing more about the efficiency. that -- at the next meeting in beyond. the committee reviewd and recommended all of the laguna honda policies and procedures. to -- put on today's consent calendar and in closed session

approved the pip monitor report. now is there public comment on either jcc reports? i see one remote. i would. >> thank you. regarding commissioner's guillermo's report on the jcc meeting the over head chart morewitz displayed showed between the january 14 presentation and today's presentation the number of patient admitted increased by 11 since it resume in the july and since january 13, lhh lost the same number of parents from deaths and discharges. lh heart attack the same net

admissions that it had on january of 25 despite received 22 referral packets. >> my chart shows [inaudible] dropped net admissions from 4.6 to an average of 3. 8 over now 6 months. and average of throw.8 month low shoes resumg admissions moving slowly and will take dwreers reach the capacity of 7 huh human plus patients. parent census decreased between december 22nd by 5. from 431 to 426 parents. also, on november 22, the census was 425. over 2 months the total increased by one patient. increasing the total census is take too long san franciscans are exileed out of county

facilities. following february 23rd meeting the public requests question average census of 428 patient in december of 24. and dropped to 426 in january of 25. that's two fewer parent on the average daily census. that does in the bode well. clearly, the paves admissions to lhh is too slow. thank you. >> this is the only public. would you like to comment? madam president >> i'm jim natty. [inaudible]. and today's director's report talk about thes 4 star rating from cns. and that is good. i will tell you how they do that. >> also this is important this

is not the director's report this is laguna honda jcc update. the director's report is the next item. >> i will wait. >> any commissioner questions on the conference committee report? >> all right. we'll move to the next item our consent calendar you have before you everything listed on consent. in detail and heard about all the items in the committee report system there a motion to approve consent. >> i second. >> public comment on this item? one remote. you can vote. everyone in favor of the items approving them on consent please say, aye. >> aye. >> thank you the consent is approved. we will move to the director's

report. and bobba our acting director will give our report. >> thank you. commissioners. il be brief. there are two items. one the laguna honda hospital securing 4 stars [inaudible]. on february third, laguna honda announced it received 4 star ranking from cms, which is above average skilled nursing facility. laguna honda achievement is a testament to the quality provided laguna honda had successful surveys the past fall. and as well as you know review of their residents care and safety including interviews with residentses and benching care. both lead to the 4 star rating and laguna honda is proud of this mile stone after wee

recertification. the star ratings on a quarter low basis. this first star rating did not include laguna honda staffing because of the initial certification. once the staffing does come in we expect that will be included. we are look forward to the next rating. the second item i want to discuss was the commissioners had a question on the new mobile triage unit on sickth street. this is a mobile triage unit provided by public safety. where police can provide efficient means of processing and supporting people they come in contact with. the hours are sen a.m. to 11 p.m. monday-friday. enables officials from the city departments to also provide support to those that police come in contact watch there are several dph and other city teams

out there providing support and care to those who request it. the mobile site is a 30-day pilot to see how well it does in helping that area. our main role is leveraging inviting people to treatment and care. we also can triage people to soma rise or urgent care. and the staffing now is including the street health team usa include both our street medicine and health teams. and i will stop there and see if there are questions. >> is there public comment. i know there is one individual. thank you firefighter your patience.

>> i'm joe i was [inaudible]. laguna honda hospital. it says here clearly that cms including completing surveys with residents april benching resident care. why? out right bald faced lie. randy was falsely diagnosed and kept in the hospital and helps his father and [inaudible] has never been interviewed by anybody. anybody and especially during the recertification process. they don't do -- if you want to talk to people and ask them they have done surveys or interviews. don't tell anybody going of i know i'm there regularly. i would be happy to visit with

ranldzy with you. it would [inaudible]. it is an out right lie. my partner has not been interviewed ever. ever. for anything. nor i. we are not allowed talk to them. because they say randy [inaudible] for his dad. we lost our standing. and does not [inaudible] power of attorney with me. i'm his domestic partner and we are not allowed talk to anyone. performed because they [inaudible]. and lied about his condition. and this is the truth i have the evidence to prove it in my bag here. thank you. >> any other public comment in the room. upon one hand up.

are through? >> yes. would you like to comment? >> i would. >> you got 3 minutes. >> thank you. >> director's report [inaudible] lhh for a cms rating slashed. you must know this is meaningless. as of today the cms website does in the show star rating for lhh or individual star rating for health inspections or quality ratings. that's because cms report there is is no data available because the certified nursing homes available with the nursing home opened less than 6 months ago. one question why after the city laid off in consulting costs total of 212 million dollars to lhh in recertification. they did in the receive a 5 star

rating. the healing inspections surveyed dragged them down to a 4 star rating. in may of 2015. doctors west side observer article documented the cms5 star rating went down to two. for years following the article lhh scandal in june of 2019 and lhs slammed with new [inaudible] consumers by november of 2019. mafrnl of 23 before cms removed from the website completely. thank you. is there commissioner comments

or questions on the director's report. >> commissioner chow. yes, i think -- i really do appreciate the acting director's report here. and -- did note that -- the report that -- were some of us more extensively did a demonstrate the 4 stars and the fact they could not rate the staff. because of technical reasons which are. i guess resolve. so, i -- i after all the years we really also allment to commend that cms has recognized we have gone from nonaccreditation to a 4 star, which is really remarkable.

in my estimation. and i appreciate the wall green store closure report. i think it is important that weep keep track of this and understand that as much as we can not sure if -- you know the mechanism may be throughout primary clinics to make sure that everybody got connected and were able to get their medications as needed. this it is not a service of wall greens to our city. pulling out from the vulnerable population. and -- i think also we want to be sure that the capacity at general is -- sufficient to also handle the neighborhood down there. several years ago we had very large backlog of pharmacy.

i sh say they took a long time to get a pharmacy script filled at general. and i don't think we want to start that again or we will have a room full of people here. speaking to us again. about the lengthy waits at the pharmacy. so, we will, if the director will update us on the progress as these closures occur. and i commend the that network for having achieved and taken away from general doctor williams. doctor [inaudible]. had done so much at general. and i want to acknowledge his work in terms of having a created a report for us at pips. and i look forward to him doing

the same for our entire city system. so. thank you. >> thank you. any other comments? >> commissioner christian >> thank you, president green and thank you doctor bobba for the update. specific low on the sickth street, street change happy to hear about that and this is 30-day pilot i expect we'll be hearing how it went. and i think the things i would like to know what happened with the city with 11 p.m. and sick whaim well is no presence of that team in the space. whether or not any whether the team will continue. but were there modifications to the schedule might be made based

on what finalings they have, whether or not it would be useful for there to be a presence with 11 p.m. and 6 a.m. thank you. >> i will note that our telea view program at night goes to 2 a.m. might not be [inaudible] tell be around that area so people get care if they choose to. and as well as the hotel as long as there is availability. ja no other questions. we will go to the next item which many of the members are here we will look forward to hearing the second hearing on the 25/26 and 26/27 budget. we have john louie and drew merrill. >> and before you begin. i'm mark the health commission secretary i have two housekeeping a lot will be coming in if you could move on

the aisle move to the center so there is a place to go and if you like it make comment you are welcome to without filling out a card but helpful to us in terms of record who is speaking and organization. if you would like to fill out a card, raise your hand. and give it to my colleague and she will pass it to me. thank you. i wanted make a few remarks prior to turning it over to the finance staff. the d. public health. first i want to thank the commission for having the special meeting. mr. sir have done in the w we have a proposal for you about

355 million dollars of revenue overnight next 2 fiscal years include to 200 million. city's fund deficit. many of us much significant portion of the revenue we have before you is a result of state changes that a formula change worked but enhandled payment program and the quality. rate change that resulted in significant revenues we have. i will all note that there are several initiatives under doctor colfax leadership we have been working on the left several years that got us over the finish line that includes loug loug recertification.

we have been look at ways we can reduce expend tours without impacting service levels. i will note part of the presentation members of commission remember we had a 10 million dollars place holder of reduction to cbo programs that was placed in the budget that was slated go to affect on july 1. i'm pleased we have proposed an alternate scenario how we achieve the savings that through a combination of revenue and expenditure as well so we don't implement across the board reduction. despite the magnitude of the proposal before us at this time, i think there is going to be a lot of work that needs to be done on the city's budget. i think that this is not.

the left time you will see us. you know it will be important to watch what happens in the city and work with the mayor's office. we will keep members of the commission appriseda we move forward. i will turnover the presentation to drew chief financial off and emlow our department finance officer. >> good afternoon. commissioners. >> drew, chief financial officer for dph. jenny indicated, really happy to be here today to present a budget that achieves the mayor's target. which was a level of reduction to yes or no fund support and achieved through revenue assumptions. we think is -- clear --

projection for why we are assuming them. so. happy to get in the details and then i will rely on her. department finance officer manager emily gibbs to present the further detail it is before bee get there. so far. on january 13th. we brought the initial mayor's budget instructions you recall a 15% reduction target for every department of the dph met within 50 million dollars each year of the budget cycle. that was. born out of 5 year budget instructions and assumptions from the mayor and controller's office. which in the out years assume close to a billion dollars of annual deficit begin nothing late years. >> today. and weave have a details list of

initiatives that will get touts mayor's target. these cover 25-26 and 26-20 budgets. requesting your review and approval of these listed initiatives. next slide. so. items that we are keeping in mind. as we development proposals. we know this is am a dynamic environment. as the administration come in, develops the priorities we anticipate that during this phase from march through may, we will be actively work width mayor's office to develop the citywide budget submission and make sure the budget the mayor puts ford reflects priorities. that is an environment of significance policy uncertainty.

we have seen the array of federal executive orders we are monitoring and anticipating and projecting about the impacts. and in addition there is legislation forth coming. state budget news we know there are no cuts to health. a slight surplus but as we have seen time and again, january through may proposal may revise likely to be changes that we are monitoring. and locally the updated 6 mont report is coming. we don't expect there to be revenue improvement. that's something we are making sure that dph will be able to make sure our projections follow the city needs and meet our budget targets. that's the policy environment as we develop this budget this does show 355 million dollars over a

two year budget of improve am 200 million dollars of on going revenue improvements. >> that gives way our approach. our prop for the budget was to focus leveraging revenues to meet general fund targets where we could. consistent with what i presented on the january 13th meeting look for revenue opportunity where we find them. reasonable, aggressive assumptions we identified that with could use to close the meet the mayor's instructions. which was a focus more with existing funding. look whering we leverage building to increase ref now for services we provide. we needed to do the same with or do more with existing funding with the same funding. there were targeted expenditure

reductions and savings. you will see in the proposals to come there are vacancies. there are contracts that were not implemented we could finds savings. and so that included adjusted budgets for cost protections. finding operational efficiency. and e eliminating vacant positions. and context that is after last year's budget identified upwards of 1 huh positions for vaccance e elimination. this is us being detaild and focussed on implementing and know we were achieving savings. so. our budget submission meets general fund targets with no reductions to the concern service.

that is achieved through forecasts of continuing revenue growth over throw00 million of the two year budget. that's a mix, state and federal funding changes. directored payments in case for medical waiver epp, q ip, these were state formula changes in the works and have been realized. we feel good about that revenue. increased volume and service. a lot of the revenue initiatives in the base line growth reflect the default direction where our services are going. they reflect volume we are experiencing and expected recently. and a continued focus on improving opt miization and bilge efficiency across primary care and an initial other areas. we meet the instruction for no growth in ft e through this

another part of instructions we have med sure to meet. and as mr. louie indicated, this budget proposal includes the restoration or allocation of previously budgeted reductions from left year. no change in current services. we found place where is programs lead to savings that achieved the cuts already budgeted. >> a company things before i hand it over for the details. i appreciated the questions commissioner chow, we will answer your questions in the slide to come. president green. baseline revenue growth. so. the question was how do we sure we are the funding will be

maintained including laguna honda revenue and behavioral billing and expected increase in collection revenues from patient billing? a lot of it reports trends we are seeing. we seat patient flows and this increase in activity. you will see that is complimented and several others with expenditure increases with revenue increases. them is activity we are already seeing. but there is a risk of change to that. you know in addition to the federal, state and local budget risks we list elsewhere in the slides, there is risks cross the board we're monitoring to these assumed trends. also commissioner giraudo we are

working with the mayor's office to implement the priorities and expect that when we submit the citywide budget, the needs will be addressed. it is an active planning phase and you know with this submission we hands it over to mayor's office for final preparation. >> thank you for the questions with that to get in the details i want to introduce deputy finance officer gibbs to review further initiatives. >> thank you. department finance officer. i will go in the numbers in more detail. we split to throw major buckets the largest is the first one. baseline revenue growth and this

is our trends we are already will seeing or state and federal approved increases that were expecting to see. we have a second group of revenue initiatives. these are places we are going to impelement or propose to policy and changes to increase revenue and our final group to get us all the way to a balanced picture. the first is recognizes the state changes to the medical payment program and the pool programful these are both medical is up elemental programs worth 13.throw million in the first year and 40.upon 75 million in the second year. that's net of both the payment transfer to the state and expenditures to implement a new staffing and cost accounting

system important part of us earning the enhanced payment program dollars. the second a2 recognizes baseline revenue. growth at the network and for zuckerberg general. this is estimated 32.2 million in the first year and 58.4 in the second year. that is met with governmental transfers and expenditure adjustments to reflect the higher census. we are trueing out materials and supplies. pharmacy, some staffing costs and holiday and premium pay in line be cost living adjust ams they are are what we are seeing and projected need to continue to earn the revenue growth here. that we are seeing at the hospital and across the network. >> a3 recognized the behavioral

health service area of the department. also seeing growth here. driven by full implementation of cal aim of the state's medical waiver. as well as transition of behavioral health on the epic electronic medical record's system. projecting almost 36 million and 43 million in 26-27. as a result of all of those changes allowing us to draw more behavioral health revenue. increased revenues for laguna honda hospital. also due to state payment changes under the partners facility supplemental payments as well as increased sentence following recertification. you see a high number in 25-26 for laguna honda because of one time payments we are owed while

the state is in the transitioning the rate models under the partner facility and they owe us from a prior year. we will get a balloon payment. but for the 49. 9 million come from. and in 26-27, we predict an increase of 22.7 million. those are the 4 learningest yours of ref now growth. a couple of smaller glirs a5 for whole person integrated care. we are noting a net increase of about 1.throw million in the first year and half a million in the second year. this is really reflecting vol unanimous across whole person integrated care. martinez urgent care clinic. where we are the increase in volume is leading to of. increase in revenue t. also

increased need for staffing and there are additional nursing costs built in to true up to the current staffing models in the programs. in a6. we are -- projecting 11. 5 million a year from 2 efforts that -- finance is under taking with our partners. one it look at the health center rates on the hospital adult misdemeanor center part of the campus. those rates are set and then inflated. but variety of reasons that inflation factor has not kept up with our full costment we are under take an effort to feel reset those rates.

which we believe will result in 10 million a year in increased revenue. when we completed that. and we are talking about another million and a half from continued improvements to implementation integrity work. the last number here syrup -- a bit of additional half a million a year in grant revenue. this is recognizing that as our grants grow over time, the administrative support we provide from operations, and acounselling and hr we can -- collect more of the grant revenue in line with the gross grants that will off set the costs in our initiatives. that our baseline revenue growth initiative. and next slide. we are moving on to a couple of revenue initiatives where we are looking to make additional

investments or practice in policy changes allow you to further leverage revenue. first is operating room capacity with a few other small revenue generating investments. opening statement 10th operating room allow you to reduce weight times. like cataracts and will generate net positive in terms of revenue. that space -- there is also -- net positive investment in dementia care navigation and prescribing of antibiotic. at the hospital. b2 is an investment in jail health. under cal aim we are moving with an expansion that will allow you

to draw medical revenue behind services in jail. make an investment in the pharmacy adding pharmacy capacity to make sure that eligible inmates who are discharged are able to leave with medicine in hand. well is staffing off set by med cat revenue. b athlete primary care billing opt miization. this is an initiative coming to us from primary care to maximize the use of provider's time by work close low on how they schedule. making sure they are able to fill all time and account for cancellation. they rule third degree out to a few clinics and plan to role it

out to all of them. we believe we can recognize 4 million dollars in 25-26 and 6.5 in 26-27. b4. behavioral health services. here we project 5 million in revenue across two years. i think commissioner chow noted a sentence in our the idea through monitoring and standard wragz of billing result of payment reform and epic electronic healing records, we believe we can earn additional revenue by you'd living the capacity we have with the clinics. we have more tools to understands howol are --

working and billing and filling schedule. 12.2 million in the first year and -- 14.6 in the second year in revenue initiate 55s. which we have tom this year the first is -- proposal to eliminate 28.04. vacant positions from a variety of places across the department of the there is a partial ft e available won't don't intend to fill. siems e eliminating from an expiring grant we no longer need and identifying operational officials where responsibility can be shiftd and managed and

reorganizationed. under throw million dollarsier in savings. it is worth noting that our over all proposal is net neutral in the second year. we have 28ft e attaches to the revenue generating proposals we talked about. mostly of the pharmacy positions we are not repurposing the 28 naresults in -- i think -- one of the commissioner's noted a slight decrease in positions in the first year. we recognize the new positions they will be hireod july first and be hired later in fall. we add 22 positions back in the first year and 28 in the second year for our net neutral

proposal. works through how we restore the 10 million reductions built in the -- our budget last year. next slide we have further break out of how we propose this last year part of balancing plan the mayor's office assumed a reduction of then. 5% of funds from used to match external funds. dph has worked to mum with a proposal that allows us to not implement reduction. the first strategy an additional 3 opinion 7 million in revenue

and behavioral health through the mental health medicate activities. this will require us to work with a group of cbo's to do additional work to scomplam draw down the medical revenue. but we have a group of 15 contractors and programs that are already approved with the state and eligible to do this. that's where the throw.7 million our number come from what that group of contractors can draw down. so in that case, we are able to grow over all contract budget without adding additional general fund costs. the remaining items are places where we will be rugs our contract budget and back to undot across the board cuts.

covid related contracts for information and guidance and isolation and quarantine for 435 thousand dollars. they are not contracted for next year. throw.2 million will come from proposal to shift a couple of contracts that are supported by the general fund. to behavioral health service act the new name for the mental health funding. these are programs that can meet the partnership under bhsa an area that following the state prospect position passed last spring. nkdz our investment in full service partnership them is a

win library win to work with the programs. and then a bit over -- ierjs t the most significant piece where we have dollars not in contract either because when we bid it came in lower or our estimate was too high or can provide all services at a lower budget. between all of the measures we are able to fully restore the 10 million in cuts and not move forward with service reductions.

so, our 15 percent general fund target was 150 million in each year. in addition the mayor's office had assumed revenue. in the budget. in their predictions and that -- really left us with looking at 355 million. in revenue, growth or savings that we needed to identifiment

with that i will turn it back to drew. thank you. to wrap up here. this is a mile stone a significant mile stone represents work by budget staff to find the budget plans. it is a mile stone. we are submiting to mayor's office for further development throughout the spinning to develop a budget submission through may 31st. we know one thing we anticipates work around cbo out come and accountability. we don't know what that looks like. i want to tournament a point we made to be clear. n includes no service reductions we identify how to restore the

full 10 million dollars budget change budgeted left year through a variety of strategies. we know there are more development this has no service reductions.

thank you i can speak on behalf commissioners thank you for your work. the idea you were able to do this without service reductions and with respect for all the contributions our cbo's make it is remarkable. we want to thank you who are in the room and police extend gratitude to your teams this is difficult. and we are pleased you were able to come to conclusions and recognize there are uncertainties in the future. but we have confident that you will address them and work with

the mayor's office to end up with conclusions appropriate for everyone in the city of san francisco. we are appreciative now. i want to take a moment. y only have 7 sheets for public comment. is there anyone else. why don't we collect them now. anyonements to comment on the budget item collect the sheets to have you come up. i will call throw people up and get to you come to the podium. the names i have are april krofrng. and i apologize --annia whirly. and eon james. everyone i have a time are everyone's got 3 minute there is is a 30 second warning it is a buzz when your time is up i will

tell and you end your statement and move on.

we're here, have your back and dph's back as we serve the people of san francisco. thank you all and look forward to working with you more throughout the budget season. >> thank you. >> apple krofrng. good evening. i'm apple and i -- stand with you. vulnerable and human a survivor of substance use disorder and formy homelessness in san francisco. i am deeply moved speak on

behalf of the need for funding of over dose prevention programs and treatment services. i can say that if we are not for the resource, being available the oured it is i would be alive before you today would be very slim to none. i struggled with substance use for years. my journey lead me down to the streets of san francisco. and a large majority of the time i was broken, sleeping in cardboard boxes to give you an idea of where i was. but once i got connected a path of recovery opened up with the help of life lines stabilization program. women's help treatment program with health right 360 and medical treatment that provided me with tools and opportunity to make changes in my life.

i cannot over emphasize also this if in the for harm reduction services available to me from the start, i like so many others would be in early grave before a path would be a glimmer in my future. the harm reduction initiatives are in the services they are vital tools that save lives. give individuals a fighting chanceful i'm two year's clean have a partner and mother to a baby girl. i'm moving forward with my professional and personal goals. i want to thank the department for efforts thus for. over dose deaths decreased in 23-24 by 22%. this is an improve am and demonstrates the effectiveness of solutions. it is imperative we move in this

direction. focusing on strategies this are making a difference and confronting the fent until crisis. we can build on the progress and w to a healthy 40 for communities. thank you. i want today say that last time we had wonderful testimony of people shared stories. heart felt stories like yours and we appreciate you come coming here and the elkwans we hear from the public. left time people left you i had a chance i thought i would say it now. people do before we end up with our discussions of the budget that you realize how much we appreciate and you congratulations on all you have been able to succeed. it is irrelevant wonderful. story of recovery. eon james from glide.

>> hello. i'm eon james the manager at the glide center for social justice, at glide we offer evidence based public health practice aimed reducing harms associated with drug use. we are seeing hope. over dose deaths decrease in 2024. at glide medical assisted treatment and case management work effectively to mitigate the risks. program it is provide the spread of imfekz diseases. i don't think i need to tell thank you crisis is far from over. hundreds of people passed away last year including many members of collide community. this is absolutely not the time to be backing down or stepping

down it is the time to double down and what we have been doing. i wanted share a story from a doctor who volunteers with glide. i was work width general hospital when i met my patient. she is throw years older than mow in and out of the icu.

matt forman from aids referral panel. charlie wilson. roma guy who served on this

commission for 12 years and is incredible advocate for everyone in san francisco. we will start with matt foreman. >> good afternoon. thank you for being here. i want to say two things one to thank you all and the department of health for really i think a miraculous job. preserving funding for cbo's. it is deeply appreciated. we had our site visit for contract it is today. worked in government in other state this is is the only place i feel like there are our partners not there to ding you but they are partners, thank you all for this. the second thing is -- it is a tough budget year, as we go through you heard storyies about the work you fund. and i'm here to speak on the funding has been provided to the hiv treatment service community for the last 40 years. first

city to rope city dollars to address hiv. over the years the gentleman taken money back and every year the city of san francisco back filled dollars. and as a result we have we have the highest proportion of people living with hiv in san francisco the highest proportion of residents at risk we have the lowest rate of transmission in the country. more living longer than anyone else. facts are facts and00 althoughed not that have been way but for the city's support thank you. >> thank you. good afternoon. madam president and the honorable commissioners here today. i'm charlie wilson with hahn and

i wanted just talk to you about your budget. first i want to recognize the hard work every year do you to have to figure out how you will budget all of the programs and community and service. my concern today is hiv funding cut potentials i'm aware of the new administration's 15% directive in each department. and i want to -- go back. for a moment. next among will be 34 years that i have been an hi very close services. and one thing i can tell you although i'm gray and older now, i look back and i still see the various patients are work with as emotional and practical support volunteer and i look back at my timesace a medical

case manager and a program manager and other roles. but -- my energies today are focused on -- finding a miraculous way to not have to dot cuts. i understand the mayor the chief executive of the city. i understand the budget process. i know you have to work together with the coo of the d. public health. and in concert with the new administration. it is my hope that this commission, which is one of the most indepth commissions in the country and more forward thinking in the country around health. my hope and my prayer and it is my meditation that we will find a way together those of us who are add vocates. and those of us in cbo's and those of us who sit behind the

dias. that we can find ways to do less impactful cuts around persons dealing with substance and homeless. program this is are around people living with aids and housing. thank you for your service as well. and i will have [inaudible] guy. >> good evening, commissioners and president green and -- commissioner guillermo. congratulations on taking it on in your second round.

and i'm thrilled see that you got appointed. so thank you very much. and for the new commissioners also, welcome to taking on the challenge of this era. which is different. and i sat in your seats. when we went through a different epidemic for example. the mist we disease we call aids or hiv. we went through and stilling in typed people and then and we are doing it now. i want you to pay attention to this so. we are humans repeat ourselves often. and so, i realliment to make two points if i can. one is on data collection. when you collect the annual report on unhoused people who die of drugs, on the street. a tendsance tow target them as,

the problem. and so i realliment you to expand and i have been working on this. when you have a property everdeath report if drugs should include the unhoused or the housed we have -- when we did this with hiv/aids it changed the narrative immediately. boom. okay. all the sudden it was not the star who is now dying of aids. it was not a gay person who was stilling in typed. this is happening now if we talk about the unhoused.

i want to you think about that at a policy level. and to make sure it does not happen again. let's try. the second thing is -- that there is a huge polarization going on around the stigma. of certain treatments in recovery. so, substance treatment on demand. which as you heard doctor fun kungs bring forth our progress and how she and her team in the left commission report -- housing coalition? and taxpayers for public safety? really support doctor cunnings and her staff. do not cut treatment on demand exit know can you do it by policy. i have been there i sat in your seats. you don't say you cut the budge say you would not cut service

you cut the policy. we don't do treatment on demand we do you go in and if you can't tough it out you are out. thank you. >> thank you. the next throw names i have our ben hiesz from sf aids. brad shave en the. [inaudible] sorry. this is item 8. i'm sorry you mean -- i see. the next i'm sorry. we will go to brad shave en and mancini and june bug.

all budget. thank you. >> hi. >> i'm brad, one of the vp of milk club i speak for myself. i republican a suicide prevention program here for a couple of years the volunteer kourns being program. [inaudible] before leaving there and did management research psychiatric research after that. working with alotment of our homeless neighbors in the area. my obviously, it is fortunate advocate for filling any gaps that in fundsing might be missing or come up and given the federal administration around hiv funding. i also would like to urge you all if possible to ensure that

the fentanyl emergency funding is also going to the d. public health. my understanding a lot go to the police and my experience with police is that if it didn't most of the a lot of inefficiencies with the way they handle --s the absolutely last resort torgo to the police and have someone 51/50ed. if i can do that it a priority. it would be great for us to irrelevant demand that we have an increase in treatment providers and get to the heart whf public safety actually would look like on our streets. i than public safety is code for getingly rid of people in an area. that's what it feels like. it would be nice to see people getting the service and the

support they deserve and having folks on the street providing the service. yea. that's it. thank you very much. >> hello. i'm eva mancini resident of d 11 with san francisco rising and a volunteer with hiv advocacy network. in a time massive inflation and

public health crisis of still the pandemic. over dose crisis on top of each other. obvious fierce of deportation for folks seek medical service its is crucial no cuters made to services available to people. we are treating people with sxrp autonomy when they seek the care that works for them. this is crucial with the over dose crisis. we need moreover dose prevention options. it is heartning on hear there

are no cuts to services but contracts are not guaranteed. and so the implications to our neighbors in the world an inch will be deadly. i ask the commissioners to continue to commit to filling any federal funding cuts and stands with communing organization who is work to make sure that everyone calls san francisco home is able to not only survive but thrive. thank you. >> thank you. >> i'm june bug and scomborn raise in the san francisco. a former san francisco youth commissioner and served on san francisco health plan committee. for over 10 years. i love san fan. and all of the issues intersect in my life. i come buffer today not only as a parent leader with voices.

not as san francisco community health center and policy board. not social just academy with glide and end help c. i work with every organization in the city because off the issues are very dear to me we will need to invest in over dose preventionism think the department for funding solutions medical treatment. management, residential out patient treatment. hiv, help c testing syringe access. and end supplies and case manage. cofounded harm reduction support group. why i do work on the issue sns because my parents used substances. my daughter's father over dozed. a 47 over dozed. because my father dealt with help c daughter's further dealts

with it i was homeless as a child and glide was a threshold for my family i'm a parent who struggles with childcare and have a child with special needs. political is personal for me. so i want to say we need a budget that continues to support our lives not to cut it. you know now is the time not to maintain services but we need to expand the service. like near safe cites my frepdz would probably be alive if we had safe sights. showing that throughout history they have helped in switzerland and canada. we need that we need to continue on protect our children and not use our children as a way to attack people housed using substances. we need to figure out solutions that don't pivot communities together and bring us together i stand before you with every issue on the paper. as affected my life personal

low. so i say we need victim in over dose prevention and hiv, and make sure we help end help c. thank you. >> when you in up fidon't read your organization's name tell when you say it is. some of the of handwriting is hard to read. good afternoon. i'm maria and i was a member of the san francisco healing [inaudible].

i would like to express my thanks to the commissioners for coming down [inaudible]. from the community and addressing the budget reactions. san francisco is one of the few counties this provides universal health coverage and that is very good public health policy. i said it already. we have addressed the opioid crisis. surverified covid. we have managed pain. we dp pilots giving prior appointments to critical case, it is difficult to get appointments if you have a special you need a special appointment take an among by the time you get the appointment the problem is gone away or it could have killed you. it is important that the pilot

programs continue to be supported. addressing homelessness is the biggest threat to one's health t. is one of the things that san francisco health plan afford addressed. all this explains why dph budget is the biggest in the city. and we thank the staff for making sure that we don't cut service. it is important that this programs we are doing in san francisco i think the rest of the country is looking at us and how we address the health crisis. thank you very much for your service. thanks. good afternoon. i'm with [inaudible]. and oo00 i served on the before

on the san francisco for 20 years, and -- i loved it and thank you for your support and also -- i'm on the waiting list to receive therapy. it has been a year i have been waiting. i have a damaged nerve. on my left side i'm using a cane. and still waiting to receive my physical therapy. i guess waitoth waiting list. i wish there was more to do for -- go everything more faster and -- so people don't have to wait long.

i got chiropractor but that is not enough. and in past years if not for the services my daughter would in the be here. has 4 children now but in a coma when she was younger she was freg nan in the coma. she is alive now and starting to be a doctor in a year. so. yes. thank you. good afternoon president green and commissioners each michael.

i am the title i do three i'm the founder of the hiv caucus i'm currently a home member and the pedestrian board directors for the own self governing housing cooperative. martis place. this. caught the conversation and i'm happy to hear well is a commitment to keeping the funding for the hiv budget. i have occurrence tie enning away from dph in hand's on places like law enforcement to deal with medical emergencies. i think that commitment keeps san francisco the model up to an exit standard we are bombarded how much they are coming for us

and i preerpt the time it takes all of you. my second order of business is i do have an any in the hiv dollars. i encourage to you look speaking of my co-op there is a nonprofit bringing thousands trying to e vict a house of people with hiv this . is mission action. i know dollars are critical. the funds are public dollars this should in the be used for these purposes thank you for your time. may be brings your forms. take them in order.

hi. i'm conner watson a foodservice worker and server and a community organizer. i wanted to speak to say that this year without the healthy san francisco program i would have lost my housing. ton defend, protect it and expand it. and recognize the envy of the country. had i tell people that i love san francisco and it exists people can't believe it. recognize naprogram is saving people from financial ruin. >> thank you. >> marney. anyone else who wants to

comment. may be can you stand in line on the side of the room and come up one by one. i'm getting forms from people now. hi. i'm marney reagan with larkin street youth services and cochair of homeless provider association. on behalf of our organizations i extend the gratitude to thoughtfulness and hard work you put in the budget. we care for the vulnerable people in light of the war waged by the gentleman on our trans, queer and immigrant population this is news of no service cuts is welcome and relieving. thank you for sustaining with vulnerable and those of us who care for and about them.

good afternoon. thank you. i like to acknowledge -- the time we are in the historical times we are in. i extent grad taoist for taking time of i'm going on 20 years of recovery. a drug and alcohol councillor and peer specialist and graduate from masters in clinical psychology. i will never be licensed i will always be a voice of the people. we changed the nation to flip their vowos people dying in the

city. you have to look at staffing. people with lived experience, peer specialists can fill the gaps. we can escort people for warm hand offs get the bill nothing place the 49th state this woman did not do this in vairn i'm not a specialist of 19 years. i help people all the time because i hear them. when you talk about staffing models, really? it has been 7 yers i can't get client center care. revisit your contracts. put the monwe it is needed. you had throw testimonies of

medical detox. could happen to you and have helped to machine in your family we near another crisis abuse, substance abuse and on going trauma at levels we cannot contain. it is time go back ask me to come back and show you my blueprint to scomplns recovery before 2014, we need to dismanual coordinated care and start putting people in front and not numbers behind because we are killing people. i >> hi. thank you very much. i'mt j.

i'm with hawn and i served the program manager [inaudible] i serve on the san francisco hiv council in my fifth term i worked at san francisco aids foundation. stop aids as well with prc. machine who just had their 25th anniversary being positive i have the perspective of how the system works. i got great service at ward 86. received mental health services here around this. i was not able to work for 4-5 years because of working with different organizations around hiv care i got back to work and now doing that. i'm concerned and think that it is grit there are no reductions the idea the billing will increase that much they will generate more revenue it is unrealist and i can worried about the federal government and the cut this is are coming.

we know what is coming. i'm concerned that the federal government refuses to cuts 25% for hiv care and city back fill its rumors now the mayor may not nail 25% cut. you don't the to see what happens. we have people on the streets. we will have more on the streets and more dealing with mental health issues. the former mayor stopped funds for example housing. subsidies. we need to do that housing is care along with every other service we receive. so, please, continue to fight. thank you. >> thank you. >> hi. thank you for being here. and listen to being us. i'm [inaudible].

i have been a part of [inaudible] for -- 7 years. i'm a help c survivor. and the same way you get hiv is the same way you get help c. i blood on blood. i wanted to share that i was a victim of a violent xroim did not work for 11 years. and when i became infected with help c, i was able to learn about resources in the city. so, i worked with aids foundation. glide. and en help c and the service here in the city have saved my life. and i wanted to just -- be able to share that, i know how to do something now.

can i do respectid testing and a bunch of other things and i'm in school to be a community healing worker at city. and hopeful low this will be my last semester. the fence fentanyl. they don't have nar can. police don't have nar can on them what will they do with the fentanyl funds. i'm jim. resident of laguna honda has been falsely diagnosed concerning shared cost money

have you heard in laguna honda revenue report patients share up cost specific low listed. during the recertification process, i collected about 27 articles about laguna honda. 91 of them does it state that laguna honda receives patient share of costs. the help of laguna honda employees to embezeled have the documents to prove it. have you heard had listed. share of costs? has it been listed in the report? i have not heard it here. is there anyone else whatments

to comment on the budget item? no. >> what about remote public comment j. i don't see hands. mr. i'm calling you out you are one who receives commissioners to provide remote comment i don't see your hand. no remote comment. >> thank you, everyone for coming here for sharing your store and hes so many of you made contributions to the care of the most vulnerable. we appreciate your services as well. now we will take comments and questions from the commissioners. commissioner guggenheim? i'm wondering -- how sure you are of the federal money that is

going to be in the budget? with everything -- e approximately in the with standing the left month; there are daily uncertainties. there's active monitoring going on. the budget proposals listed here are the initiatives we feel are solid. and they are a product of a variety of legal mechanisms, announce am and patient flow that we think is the most likely scenario. as with everything -- there is a dynamic situation. and something this we are monitoring closely. this it is -- what we feel in confidence can reasonable to expect. commissioner giraudo. [inaudible]. with the federal funding, in --

flux, that your creative staff is trying to then see where the cuts would be and what you might be able to -- juggle? to make things work. okay. it is just a significant concern since the funding, the for the doj just paused funding for sanks sanctuary cities. in our conscious of trying to do this. that is would make me feel more secure. >> there has not been a day that has gone by in the last throw-4 weeks a daily thing to

monitor. announcement to interpret. we are working and one of the points that came up in public comment, this proposal is in partnership with agencies that serve our folks. there are a number of things we found that ways we draw down additional funds. we're looking for ways to expand our fund and provide expanded service. it is something we are -- there are many things we monitor and the -- string of federal announcements in the last 6 weeks and will be something we actively monitor. >> we are working closely with our city departments and city attorney to monitor as well as our state and local advocacy groups to ensure we are all on

the same page. >> commissioner guillermo. i just want to acknowledge the effort that the department and the coo and the cfo's team. has put together. and you have reflected very much the priorities of the commission. and the department. and -- i guess the needs that we anticipate. and the challenge this is we anticipate coming. really -- want to implore the department to continue to work with the cbo community and those who serve who are not associated with the cbo. but those who have the interests of our public at heart.

and we know. >> we than the challenges that are coming from governments that we can't control necessarily. we do know there are still opportunity. san francisco -- has a troll play in leadership cross the country. on what can be done. given the challenges and the difficulties that we are all going to face. we look forward to leadership in the department working with other departments the mayor's office and the commission. in addressing that and to be aprized on a regular basis and frequent basis as needed on all thing this is may affect and impact the negotiations through may and beyond. first to to acknowledge the hard

effort that -- the being able to find revenues that as you say, you have high confident in. that is an punish statement to be made. commissioner chow. thank you i echo in the regards to the work you have done it is fantastic in the last few weeks the skeleton need are an e normous take back you have been able to in this period of time,

create a proposal to the mayor. that has no service cuts. no real employee cuts and then restores to the ceo's what you were proposing to cut in the next budget. i think, a -- task you achieved in balancing i had in the pedestrian that asked we have additional hearings, which because i anticipated we would have a need to try to work with you to preserve the needs of our communities and yet, meet the budget the major's requirements in the budget and you have dhn without us having to go through this. and i -- feel confident this --

this type of budget that you are proposing is one that hopefully will meet the needs across the -- in the building now.

a positive towards the favorable towardrousing the journey fund. so, we were going to take 10 million away. i understood. the logic in which you are not taking it away but on top of that, you are putting in the that were we are awfuls gaining 3.7 million. 3.7 seek to restore funding for the previously budget reducks. by look at services and finding services that are eligible for medical, administrative claiming. it is taking when it was essentially -- unleveraged out reach service. and -- working with the cbo's to redirect that to leveraged out reach service. well is a mental health claiming

eligibility. it is taking 3.7 and finding an opportunity to draw down mental health ref now for the same service. >> we are not taking away 10 million from the general fund but adding with this initiative? i think we are taking what was a general fund expenditure reduction and taking a slice of that and saying, this can be leveraged. this same service can be. >> and bring in revenue. >> correct. >> we are not losing the 10 million. or taking your 10 million general fund but going to bring in ref now for that, exactly. i will take your word for it.

them is done with the cbo partners we move forward in partnership and alines and hopefully are identifying realistic, real options for preserving the important service. maximizing where we have opportunity for ref now. it is very much a collaborative project. >> thank you. commissioner christian >> thank you. president green. i join all the other commissioners in the comments about our gratitude and

amazement and gratitude what you have been able to do today. tonight is another night when you get more information and you will do something else. thank you how hard you are working and the dedication that each of you have in your staff have to the people in the city is apparent. and i want you to know we see it in your work and the way that you come to us and spoke with us about your work. thank you very much. i also.ed echo something that speakers said tonight focusing on community. and how it will save the city in partnership with the government of so. i'm look when we have -- hr presentations and budget presentations i'm looking at

funding for the critical workers not only in the cbo and the city workers. the clinicians and healing workers who the city had a lot of success in hiring and have vacancies and the needs that in the we have in the city that individuals have for substance use disorder and mental health treatment. all of these needs can be met irrelevant by people who have either a training whether they are navigators pierce working with others or other city employees who are health workers or otherwise in the clinical sphere. this is not a -- minds blowing suggestion. don't know how practical it is there must be ways for all the city gentlemans to work together

and also noween more given the climate we are in. people who have resource the communities. i know mayor lure sefocussed on that. one way i think that -- we might should be explored by the appropriate departments is to see whether there are other ways to support the hire and retention of the critical workers we need clinicians, health workers in the city. by providing housing. or other day care. something this takes away.

thank you for the work and wishingut best and look forward to hearing how you will solve our problems. >> if there are no other comment wes need a motion to approve

this proposal. is there a motion. >> move approval >> second. all in favor, >> aye. >> thank you. again and thank you everyone all members of opinion for shirring your time and coming forward we are very appreciative. so. thanks so much. the next item on the agenda is community input regarding the process for hiring the director of health. as many of you know grant colfact resign third degree month as director of health. and in match we'll honor him with a resolution acknowledge the impact of his leadership on the dph and the san francisco community. but today the healing commission is exercising the chart are mandate to vet possible candidates for the directorship. it is really important to us to hear from the public because we like to know when you regard

important qualities and qualifications so we can take your input in consideration as we move forward with this process. so. at this point i know we have been ben from the san francisco aids foundation whomented to make ape comment on this item. >> it is okay. go. hello xhfrns. i'm ben hiesz choef of staff at aid foundation. thank you for considering our comment in search for the new director of health. i'm shareing on behalf our organization and our c eo doctor tyler. the san fran aids foundation a 40 year history with the department of public health. we share many goals with the department. including getting to zero new infection and ending over dose.

selectings the right leader is crucial. we urge you to prioritize candidates with experience in government, nonprofit and social service collaboration. they should value commune collaboration, respect standing public healing expertise and open to diverse viewpoints when setting priorities in the face of the over dose crisis the new leader should understands community behavioral health and harm reduction strategies, face being decisions on science and data they must support hrm reduction programs with meaningful measures. the next director of health should have a commitment to san francisco's hiv history. championing programs for continued practice. they must address lbgtq+, advancing the rights of marginalized community. and finally the director must be

committed to race equity using a racial equity 11s. and many pressing healing. as many pressing health, affect black and brown communities. thank you for your time. anyone else in the room themes to ment on this item? is there remote comment. >> yes , there are two. >> yes. would you like to comment? >> i would, please. >> begin. >> here we go. >> the memo from the dr report about the selection process to hire a new director of public healing. doctor colfact stepping down. next month.

end quote. but many reports indicate that doctor colfact last dailied be today. which is it. colfact gone? or not until march? today's agenda indicated the healing commission solicit input on qualities for the director of public health. not considering candidates nominees. as for this criteria any employee involved in the s this lead to the decertification or involved in the delayed recertification should be disqualified as a potential nominee that includes excludeing try williams and roleand pick ens and disqualify doctor novel [inaudible]. the process out lined is that

this commission to forward up to throw potential anymores to the mayor with recommendations who should be hired. in the agenda during the closed session the will discuss the employee nomination. which is it. will you vote today on making a nomination or up to throw applicants for the open to the mayor during closed session today? thank you. there is one more. >> caller, were you there? yes. >> do you have i code? b. please, begin. >> okay. so, my name is [inaudible] i belong to a group that is

organizing in california including san francisco we are called, family advocating for mental health. and my input is that i never thought colfact was open for a discussion with family members. so, i know he did a great job with -- all the rest but. we would like very much to have a neurologist for the head of the department. someone who understands this to treatment in this is not necessary low always with people who are using drugs. my son used drugs because he could not get the care he needed begin with. so, what i hear a lot we are talking about addiction problems

but don't hear about -- putting more beds in the hospital. or making sure the police will take people 51-50. my son had to move to another counsely took me throw months. that because i after he graduated from throw 60, he they were going to put him in the tenderloin which is like a war zone and of course the drugs he was gone all the way back to where he started. so he moved to concord and i have to be a social worker to get him the services he need. so. it is important to also address mental health sprit from addiction problems. and not graduate from a program they need infrastructure which prop 1 is providing.

so, please, pay attention, please have a director that understands the neurology part of the brain disfunction not like a behavior. not the behavior it gone wrong in the brain. thank you >> >> that concludes the public comment. >> great. is there commissioner questions or comments on the item? commissioner chow. >> thank you. and i thought it might be helpful as we are considering this item. to understand a bit of proisz as i have been through several of the selection processes. in the past. may be about 4 or 5. in the years. and this is one of the few times we have actually opened up and taken public testimony in regards what had be the public's

interests in seeing the at tributes of a director of healing. i was at a reading over the memo again and realizing that public is in the aware of some of the things within it says that the commission and the mayor basically agree on a director of health. this is done by at least providing a candidate or up to throw or more. and that, that's for the convenience for the mayor. and -- in the past, the mayor has either create indicateed the commission his desire of whom he would like. or he or she would like. or the mayor has asked as in the case of doctor colfax a full

search. and left it to the department and the commission to decide on the process to work with it outside firm and run through an extensive process. there have been other times which we have been given other direction such as we would like to see this type of skill. for the director. whether a higher clinical level or one with administrative responsible.

the mayor's office which is the administrative arm of the city. an opportunity for public inmutt for public health policies and procedures. so, it is not this there was one fixed way if people are looking at the manner in which we -- did the search for doctor colfact. they might thank you is a prescribed process. it is not we have gone through allity rigz and informed who the

mayor would like. within informed to do a search. and we have been informd that we would like to have the opportunity to have member who had administrative skills and those are options this need to be discussed as to how we will carry out a search and whether or not we will you know have a process that interviews candidates or a candidate. but i thought this might be a useful historical note in regards to how we have over the 30 years since the healing commission was formed have been involved in the selection of director. for half this time the commission was the final authority. today the dmigz recommend being

and the mayor accepting or -- accepting and and appointing the director of health. but in any case. there is a process which is -- within the commission and the mayor to decide upon and -- i -- believe that -- mystery public may not have understood that is thank you.

no one has knowledge about the wait health department better than commissioner chow. and this after all is the first time that half our commission is burglar to be involved in recommending 92 director to the mayor and the mayor has the final say in all of this. we really freesh the input from the public and we will take it in consideration as we start our process. >> i think of that we had the budget meeting today also because from the testimony of the public, this really i think informed the commission of the deep occurrence the public has for the priorities that we have. we always had but more so going forward. i appreciate that. we had an out pouring of

testimony from the public. as we are at this point considering both inputteen those it was formal on the director's -- job description or the process but i think it has informed us. of going how to go forward with the process. >> thank you for bringing that up. we heard that very clearly from the public the anxiety that will happen in washington and our need to be creative and cutting edge. and any other commissioner questions. >> i guess we can any to other business. is there other business? >> commission. public comment on other business? >> i see a hand.

i'm check nothing we are on other business will you like to make comment? >> no. thank you. >> then the next thing is to entertain a motion it go to closed session. is there a second. >> second. >> and is there public comment on this item? public comment in the room on this item? i don't see online. >> all in favor of going in closed session. >> aye. >> thank you, everyone. thank you. close off the room and commissioners give me a few minutes. patriots pas

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

>> i'm san francisco's first drag laureate and the first one in the world. the drag laureate program and the position is one this celebrates an artist for being the best in their craft and i'm proud to have received that xroel it it is afternoon ambassador role. a role that represents the lbgtq+ community in san francisco the focus on the drag performers and trans-activists and performers in san francisco as well. when i heard the city was creating the drag laureate role i was so excited because it did foal like they were paying attention to us. and cared about when we gave culturally and economically to the city

>> here is your new drag laureate for the city and county of san francisco! i'm getting the call from the mayor i was chosen was fantastic day. i will always remember. i thought that it would just be about the bay area. because of what happening in the world it became a national story. i hope it can shine a light on san francisco and how they take care of the drag community and the lbgtq+ community. i hope that i can help carve out this position and create a role with programs and events this can be passed down to future drag laureate this is come after me and can set a stage and standard for what this program is in san francisco and national low and inner nationally. there is a rich history in san

francisco. that the drag community has been part of. i'm very proud to follow in their footsteps and able to maintain what the drag community has done in the past and move forward with creating a bright future. my job is to elevate and celebrate >> item 50 is resolution calling on department of public health to provide medically necessary transition related care for transgender related people and remove restrictions. >> in 2012 gender health sf was born out of advocacy from community stakeholders and local leaders. really as response to providing quality, accessible jnder aaffirming care for the most under-served. (indiscernible) the way i see it, there is two ways of folks we serve at our program. the first

wave of folks who never imagined surgery access was accessible to them. many folks who had to save money or par ticipate in underground economy to access the surgery outside the country. (indiscernible) really to make something real in terms of being able to connect with the gender identity and external (indiscernible) and so transform so many lives of many of trans folks who never imagined it was accessible to them. now we are in the different era and time where transrights is in the social political and general (indiscernible) and now we are serving young folks to support them and making sure their gender identity is connected to who they are, so providing a space to support transfolks to live authentically and that is the goal to provide the level of

care trans folks deserve. >> when it comes to access to healthcare, while we all believe in cost control and make sure we deliver healthcare in a cost effective manner, i dont think that cost is a reason or legitinate rational to exclude people from healthcare (indiscernible) colleagues i ask for your support. >> thank you supervisor wiener. colleagues on this item can we do this without role call? same house same call, without objection the resolution is adopted. [applause]

[music] >> office of initiative start in the 2017 and started as a result of community advocacy. our transgender nonbinary community advocates were really letting our government know that we needed to be heard. we needed to be considered and policy and budget decision and so, then the mayor lee and founding director of spark created officeof initiative that allow us to advocate for equity for transgender and nonbinary communitiful we focus on 4 areas. training, education for the city

employees. we focus on civic and community engagement making sure our leaders have a voice and are heard by our elected officials. we work on policies and programs to make sure our city is responsive to transand nonbinary community and add voice to departments to integrate transinclusion in policies, procedures and practice. >> we still have, lot of work to do to improve and address equity in san fran for our community upon i that we are on the right track and seeing how people's lives are improving thanks to those changes. i do think it is unique that our local government is sponsive to transgender communities so i hope that people can remember that despite the work we had, we seat progress. we seat change and there is hope

for transpeople in san francisco and wherever we come together and organize to improve our lives. [music]mean today so today we ae announcing that we'll be filing a lawsuit against the trump administration in the northern district of california this effort is co-led by san francisco and santa clara county and you'll hear shortly from our santa clara county counsel tony lopresti. since his first term, donald trump has tried different ways to coerce cities into doing the job of the federal government and carrying out federal