did miner upgrades so soon we will be able to serve diners here so they can try wild salmon. right over there shoulders they are able to see where it came from. if you are one of the people that likes having super fresh sea food, this is about as fresh as it gets. we want guests to interact with the people who create it, get to know them and be part of this movement is of creating sea food for 21st century and beyond.

the all the members of the public here welcome to you all to the march 3rd, 2025 meeting of the san francisco health commission and a warm welcome to our new health director dan sigh we will begin the agenda with a call to order. sure. i'll start with you commissioner guggenheim we're taking role commissioner chao president commissioner guglielmo present president green present commissioner girardeau and commissioner christian president and now commissioner gerardo agreed to lend acknowledgment to ms. the san francisco health commission acknowledges that we are on the unceded ancestral homeland of the premature colony who are the original inhabitants of the san francisco peninsula as the ancient indigenous stewards of this land in accordance with their traditions the parameters of colony 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 ancestor elders and relatives of the romita aloni community and by affirming their sovereign rights as first peoples. thank you. the next item on the agenda is the approval of the minutes of our commission meeting of february 10th, 2025 and secretary moritz i believe there are a few minor corrections. yes. i want to thank commissioner chao for pointing out some errors on page two at the bottom of the page under the consent calendar under be the contract name is it's a data usa contract and the third line it should not say zuckerberg general hospital. it should say the san francisco health network and then at the bottom of the and the end of

that sentence there shouldn't the new contract request to tbd should be taken out. >> thank you again for your patience with me. thank you. and is there a motion to approve the minutes as amended moved back in and are there any other commissioner comments or corrections? seeing none is there any public comment on the item? is there any public comment in the room on this item now public come on the room but i do see hand and i'm going to read a statement before i take the public comment for each agenda item members of the public will have an opportunity to make comment for up to three minutes. the public comment process is designed to invite input and feedback from individuals in the community. however, the process does not allow questions to be answered in the meetings or from members of the public to engage in back and forth conversation with the commissioners. the commissioners do consider questions from members of the public when discussing an item and making a request to the. please note that each individual is allowed one opportunity to speak per agenda item. individuals may not return more than once to read statements from other individuals unable

to attend the meeting. written public comment may be sent to the health commissioner the following email address the word health dot the word commission dot at sfo board if you wish just by your name for the minutes you may do so during your verbal comments without taking your lot of time. please note that city policies along with federal, state and local law prohibit discriminatory or harassing conduct against city employees and others during public meetings and will not be tolerated. all right. we've got one comment. one comment. mr. monette, are you there? >> i am. all right. so you've got three minutes. please begin. >> thank you. this is patrick. well, that's your code anyway. there are two problems with the february 10th, 2025 meeting. first, although these minutes report that when the commission reconvened an open session following its september ten, 2025 closed session and reports unanimously forwarding the name of a candidate for the director of public health positions to the mayor. unfortunate to be assessed your

videotape recording of the commission's february ten, 2025 meeting abruptly ended without this commission reconvening in open session to discuss and vote whether to disclose any or all discussion in closed session or provide a report on actions taken in closed session. if any actions were taken. so essentially taking public comments on agenda item nine to solicit community input was a useless perfunctory gesture because the commission had already chosen a candidate. you misled the public by pretending soliciting community input was important since you already had a candidate picked out. second the minutes repeat an error from the director's report agenda item l h.h. had a seat on this one star rating at the time it was certified not a two star rating. >> thank you. all right. >> that ends public comment. all right. commissioners, given the amended minutes all in favor, please say i. i thank you. >> the next item would be general public comment and i

believe secretary moretz may have a statement regarding what's appropriate to discuss in this agenda item. >> yes, at this time members of the public may address the commission on items of interest to the public that are within the subject matter jurisdiction of the commission but are not on this meeting agenda. so again for topics not on the meeting agenda. i didn't realize i was so big and i think let's see do we have any public comment in the room? oh, i'm sorry. yes, mr. ward ward kline you president green i'm sorry. >> is it okay if we move forward? yes, sure. okay. >> mr. weir kline you may go. thank you. and as most of you know, my name is chris ward kline. over one year ago i provided documentation to the health commission and to the public health concerning my health records which were tampered with altered and i was given multiple double blind experiments without my permission and that year i have

patiently waited for public health to clear my health record with kaiser. the va and ucsf but after 14 months not one phone call to invite me in to discuss and to move the needle for some of this came out this morning on abc and additional commentary will be done by the new york times and the new york post. so why because of who made a mistake and thought i would not figure this system out. see when your diagnose when research or have a prolonged disease you are placed on health surveillance for various reasons which if used illegally are outside the scope of legal protections could be used to influence you with voice and phone technology to enhance or greatly place you at a disadvantage. so i'm presenting this once again and i've been cleared 100% by multiple countries and multiple states that i am 100% healthy. the bigger concern is that 250 kearny street and this was reported to the mayor this morning and other key leaders within the last 12 months there have been over 12 deaths of veterans, multiple arsons, violent incidents in which staff members have been targeted as well with injuries, health issues and other issues

that were caused by one system which we have discussed before. the bigger issue is not is that during or after all pandemics people use health surveillance in a manner to attempt to write their own ticket and always always ends with a scandal. for example, during the 1918 pandemic that led to the black black sox scandal in baseball the ccny point shaving scandal in 1951, the dixie classic scandals in 1961 boston college point shaving scandal right after the swine flu of 76 and the russian flu of 77 and the tulane's basketball point shaving scandal in 1984 all during or after a pandemic. and if you're not aware there was a massive point shaving scandal being investigated currently by the fbi, the ncaa and others that will topple all of these combined. >> that is why the nfl has mandatory protocols for injuries and concussions. they force players to sit out for certain number of weeks as they know of health surveillance and the illegal advantage it will give your team. >> for example, magic johnson was not allowed to play

basketball not because of hiv but because he would have been on health surveillance by l.a. and that would have given him a potential advantage over other players not that he needed it. it's also not just sports. the abyssinian scandal that broke in 1980 was people using the same technology to attempt to bribe and extort people. it is often used in san francisco and often and always followed by corruption charges. i look forward to working with the new director of public health and health commissioner clearing my medical records as soon as possible and thank you for allowing me to speak. >> have a great day everyone. >> is there anyone else in the room who would like to make public comment? all right. all right. we do have one person remotely . oh, i'm sorry. >> there was a yes. come on up. all right. you've got three minutes, sir. my name is kim maccabee. this is from the appointment letter. it it's my great pleasure. i'm daniel, the mayor.

it's my great pleasure to appoint you the director of the department of public health. >> this is daniel. so i persuaded to section 3.100 parenthetically 19. well, that's good. well, if you didn't include parenthetically 18 the notice of appointment shall include the appointees qualifications to serve and a statement how the appointment represents the community's other interest and neighborhoods and diverse population of the city and county palestine included. >> this is pursuant to 3100 19 well actually 18 this was 19 you didn't include that also in your memorandum today talking about the financials for department of public health concerning laguna honda it mentions patient revenue. it's my understanding that patient revenue is separate from patient share of cost

which is a patient's social security. >> neither the newspaper nor the department of public health report patients share of costs or patient social security and they're never revenue report my the best my diverse partner and you all choose a resident of laguna honda and his dad managed to embezzle about $8,000 worth of his share of cost with the help of public employees obligation on the hospital and his pay which is a city contracted payee lutheran social services. >> it is important that you guys investigate patient share of course and do new audits as opposed to once we know that we're not truthful we know the audit that was done when an issue of cost was or was stolen that obviously any audit was

done was incorrect please pay attention to the fact that this is people's social security that needs to be reported as revenue by the department of public health. thank you. >> all right. anyone else in the room? all right. we have one person who would like to make a comment remotely . mr. minnich, are you there? yes. >> all right. you've got three minutes. thank you. i welcome daniel saying that that his new director of public health it was great mayor laurie, just someone who was brought experience in public health care to lead us rather than just another hiv aids physician like dr. colfax lacking experience in broader public health administration as a former l h h employee and l h h for a decade i welcome mr.

insight broader experience. mr. singh needs to carefully and quickly review the senior leadership running laguna honda hospital after all sam and said one at large to recruit and hire senior leadership at the nursing home administrator and i take my censure as a precondition for obtaining medicare recertification filter so do i like change this current ceo isn't qualified in terms of ten years experience and one of his previous energy positions resulted in that facility also being cmc certified and closed down. so does previous assistant nature position at la and you vacated remains vacant and elected a second assistant a.g. jennifer presently was promoted to being an assistant nature on the condition she obtained an h a license and within one year of june 2023 she hasn't obtained an nhl license. the assisted job posting announcement in 2023 stated assistant nhl applicants were required to have an nhl license or sit in pass the national and state energy exams within 12

months of hire three records request placed to the california department of public health on july 15, 2023 april 14th 2024 and december 15th 2024 revealed currently has not enrolled in the required 1000 hour administrator and training program and that is a pay to nature license i should replace and waited once for failure to obtain nhl licensure if only to prevent l.a. judge from another l.a. judge decertification disaster and mr. sipe should work with mayor to win the election to the second district an nhl competition and request for a replacement rapidly. mr. sikes should also replace filters to do as the ceo was an at will employee. >> thank you that ends public comment on this item. wonderful. well we're looking forward to the next item on the agenda which is the resolution honoring dr. grant colfax and we'll start with our deputy director of health near vina baba.

>> good afternoon commissioners and everyone today we recognize a truly exceptional public servant leader and advocate whose impact can be seen throughout throughout all of our city. for the past six years dr. grant colfax has served as the director of public health and his dedication and vision has strengthened the health and well-being of all san franciscans. he has an extraordinary ability to ensure that we are using the best evidence data and science to drive our decisions while also making sure that every voice that felt heard and supported. dr. colfax has led with integrity, compassion and a deep commitment to improving health equity, increasing accountability and producing results during our city's most challenging times and leading a community centered focus. >> dr. colfax has been a driving force behind the positive changes we've seen in

san francisco when the world changed overnight during the covid 19 pandemic, dr. colfax led one of the most effective public health responses in the country. thanks to his leadership, san francisco's death rate remains significantly lower than the state and national averages. >> when our city was faced with the impacts health emergency under dr. colfax moved quickly ensuring over 55,000 vaccines were distributed protecting our community and limiting the spread of disease. >> and in the face of the fentanyl crisis, dr. colfax worked to ensure that we transform the way we deliver mental health and substance use treatment. i also want to highlight that during his tenure 430 new treatment beds and care beds were brought online with an additional 135 currently on the way. laguna honda hospital was recertified in both medicare and medicaid programs by the

federal government. >> the first unified electronic medical record system was implemented and nurse vacancy rates were reduced to 0% after years of national pandemic related staffing shortages. beyond the policies and programs dr. colfax has remained we remained connected to the work as he continued treating and supporting patients living with hiv aids at zuckerberg san francisco general hospital. >> dr. colfax guidance and strategic thinking have saved countless lives transformed public health systems and strengthened san francisco's ability to tackle future challenges. and he leaves behind a legacy of progress. compassion and unwavering dedication to the people of san francisco. on behalf of sfd we want to express our deepest gratitude for his service and wish him the very best in his next chapter. thank you. and now our secretary where we

will read resolution he crafts beautiful resolutions and thank you commissioner christian for your input as well. >> and i'll try to get through this without crying whereas dr. grant colfax served as an exceptional department of public health director of health for six years leading the department through a tumultuous and transformative period of time. and. whereas, during the covid 19 pandemic, dr. colfax led as an implement and one of the country's most comprehensive responses that kept san francisco's death rate to half the state rate and one third the us rate the city was the first in the nation to establish a testing for essential workers along with the development of an extensive network of covid 19 vaccination sites. this resulted in san francisco having one of the highest vaccination rates in the country and where as dr. colfax shepherded the transformation of san francisco's mental health in some of these services by implementing a metrics driven quality focused approach. under his leadership innovative programs were implemented to

support the treatment of substance abuse disorders such as contingency management, deploying behavioral health workers in shelters and supportive housing pharmacy delivery to those trying to maintain recovery development of new street teams and expansion of existing street teams to address evolving crises. an immediate shelter for unhoused people who accept treatment during nighttime hours. during his tenure, 430 new treatment and care beds were brought online with an additional 135 currently in the pipeline. and whereas, dr. colfax improved and invested in the infrastructure systems and delivery of health care with key milestones that included a reduction in the city's general fund contribution to the budget implementation of the first unified electronic medical record increasing billing rates by 36%, collections for medical billing increased by 32%. staff vacancy rates were reduced by 49%, turnover reduced by 25% and and retention increased by 6% in the last two years reducing nurse vacancy rates to 0% after years of national pandemic

related staffing shortages resurface station of laguna honda hospital and both the medicare and medicaid programs and zuckerberg san francisco general hospital earning an additional star under federal quality rating program. and. whereas, during his tenure at the doctor colfax continued to treat and support patients living with hiv, hiv aids ed zuckerberg san francisco general hospital. and. whereas, dr. colfax leaves a legacy of service and compassionate leadership supported by data to support and improve the lives of vulnerable san franciscans, he will be dearly missed. he is dearly missed and by the health commission staff and greater san francisco public health communities. i didn't do it sorry. resolved that san francisco health commission honors dr. grant colfax for his outstanding service and leadership and which is doing well in future endeavors. >> yes commissioners you have

before you a resolution honoring dr. grant colfax. >> is there a motion to approve motion to approve? >> is that all right now? shall we take some comment? yes. is there public comment in the room on this item? all right. and i'm sure we're going to have one remote public comment. let's see. yes, sit down maybe while we have this public comment. mr. barnett so i'm going to mute you and would you like to make comment on this? yes. yes. you've got three minutes. >> it's good seeing dr. colfax his tenure end as director of

public health is $536,000 salary was way too high in june 2019 the san francisco examiner qued colfax as saying quote today we are confident that laguna honda continues to be a good place for patients and quote that wasn't true. l.a. chase became decertified because the pathetic six page 60 day l.a. reform plan dated september 3rd, 2019 written by sfa chief quality officer troy williams and dr. colfax wasn't fully implemented before l.a. changes april 14th, 2022 decertification an l.a. chastened ceo wasn't hired until june 26th, 2023 colfax is ineffective 2019 reform plan led to the city having to spend $53.6 million in consulting costs among a total of $260.4 million and still counting to rescue l.a. and obtain cms recertification. nobody has been held

accountable for the failed reform plan that could have prevented these massive expenses. colfax should have been forced out six years ago when l.a. hhs patient sexual abuse scandal erupted in 2019. i won't miss dr. colfax. >> thank you. that's the only public comment on this item. >> i think the standing ovation is probably the most important public comment that we've heard. i know commissioners want to make some comments and we'll start with commissioner christian. okay. i'm following in mr. mort's footsteps so as a new commissioner i'm not currently the newest commissioner on the board but a couple of years ago i was and it was just before

covid really hit and things shut down and so completely new to the department of public health. i'd been a commissioner on the human rights commission and chair of that commission. but public health is something something that is that touches my day job as a an assistant district attorney, a managing attorney of our treatment courts, our collaborative courts and our mental health unit. so it's very it always has been important to me and in my work during the day with the city i'm able to do it and i was thrilled absolutely thrilled to be appointed to the commission . >> you know, things change and people come and go and we all do. and i'm grateful to dr. colfax for the way that he was present for me and the way that he's continually reached out and answered all of my texts to check in about questions and and things. very generous with his of his time and his expertise and i

bothered him a bit about treatment, the availability of treatment and the available modalities of treatment that we need needed more and we still do need so much more in the city on all levels but particularly from speaking right now from my perspective with the work that i do in the da's office to have the criminal justice forum we all want and seek, we really need continuing investments in public health and treatment to make that possible. >> and dr. colfax from what i have seen during the last couple of years and his colleagues that he works with in behavioral health especially have done their level best to increase the availability of treatment to make after years and years and years to make treatment on demand something that has been realized in certain very important respects

. >> and i think we all have some sense of how extraordinarily difficult it is for a bureaucracy to be responsive of let alone nimble and inventive . but from my perspective where i have been sitting in the areas that i am most familiar with, dr. colfax and his team have been as inventive and as nimble as they can be and they've specifically one of the things that has been important to me and i've appreciated is the attention to the street teams. the expansion of them, the creation of new street teams to address the evolving crisis on our streets and in our communities. i can't i can't exaggerate when i speak about how important i think those efforts have been.

we still have a lot of things to address structurally in the city with treatment providers, things that need to be different and need to be changed. but i do want to thank dr. colfax and his team for working with his team so diligently, so continuously to bring the resources that we need. so dr. colfax, i wish you all the best in the world. i can't wait to see what you're going to do next and i hope that you will not be a stranger to us. thank you, mr. gerardo. >> yes. >> i just want to say thank you for many different things and you and i started the same time give or take a couple of weeks and i also came from another commission of 12 years at the children and families commission. so this was a significant

learning curve to say the least . and i in my first meeting with you i had asked yes, i need to know all of about the department but my bottom line was to please learn from you. and i have and i continue to do so. and as we were both starting as i had mentioned to you, i was very interested in focusing on data outcomes and which i had done in my previous commission and you highly encouraged me to push, push, push which for better or for worse i have and and i really have appreciated you as as a leader and the team that you have put together for the department is stellar.

this has not been a department of non-communicative silos and i think i know that that has also been very much your push and i really appreciate and thank you for for teaching me and helping me understand further where to go with my data questions etc. and i'm very grateful as are all my colleagues on the commission but also the city and county of san francisco is extremely grateful. yes covid laguna honda but you brought a vision and a mission and in the in the six years you made a significant difference.

so thank you very much and i as well look forward to your next chapter. >> commissioner guillermo, can you say really great if you could if i could see your face while making my comments. >> so most of actually the vast majority of my career and professional life in health has been at the national level and the systems level as you know. and when i came to the commission seven years ago, the reason that i agreed to to join the health commission was i wanted to have an experience of what it was like to make policy decisions and involve myself at the local level. so how fortunate was i to come

in at a time maybe a year before you came in but at a time where with your leadership and those that worked with you in in leadership orchestrated created i think the best response to the most difficult health challenges that any local jurisdiction could have not just to respond but to lead and show the rest of not just the country but the world. and so my desire to have a sense of what it meant to be on the ground was very easily accomplished by being able to sit in partnership with my colleagues here on the commission as well as to be in partnership with a director who saw us truly as colleagues

collegial in the the mundane as well as the very high level decisions and concerns. so i'm not going to speak to all of the great things that you did because it's it's on paper and it's in the the archives and very clearly but what i do think the most impactful thing that i experienced in being able to and witnessed was at every juncture and in every opportunity that you had to show humanity you weren't afraid to show that whether it was saying goodbye to one of your colleagues or to in speaking about what the department was responsible for

in very human terms. >> and so i don't you know, that's not an easy thing to do when you're supposed to sort of sit above all of that and have the the 300 or the whatever have you bird's eye view. so i want to thank you for that and and and i think and i believe that that humanity that you showed and continue to show really permeated throughout the department. so so you can speak to all of the other accomplishments but i really want to be able to say that it reminded it that the goal that i had about experiencing things on the ground was very much enhanced by being able to witness the leader of this department and showing that really at every at every turn.

and so i, i just i just think that that's something a legacy that you leave that won't be forgotten. so thank you, commissioner chao . >> yes. thank you and thank you, dr. colfax for standing here because in our ability to speak to you it's better from our side of the table this side that we could see you. so thank you very much. and and i'd like to thank you also because during i had the privilege of being president leading our search committee at the time that we were able to have you nominated to the mayor's office and that we were very pleased that the mayor accepted our recommendation for you to come to san francisco or return to san francisco. >> and and i think that was justified in within your first year with the pending attack in

which with your approach towards the public and with the public, we kept a very calm and probably the safest metropolitan area new you and an ability to not only look at the issue but also to treat the issue convince the mayor that we were going to have the mandatory closures and mandates that were needed to keep san francisco safe. and that's all cited in our resolution. >> and and as we come out of it happened for you to then gradually bring the department back never losing and of course our core services during the pandemic but then tackling the issue of the fentanyl and the drug b the drug problems and

our substance abuse issues and devoting your time to building out the department to bring in dr. cummings and others in order to make an effective response to a very difficult problem. >> you were always respectful of not only the commission which of course we could understand but to the entire public. and i think we were very appreciative of that and all of your actions were really based on science which those of us within the profession really feel are a necessary component of our decision making and you remain compassionate and treat it a patient your patient population at s.f. general whom i'm sure you know also feel the same about your skills and abilities. >> so as i have seen directors

come and of course directors go on to other ventures. i look back and i say well what would be the measure of a successful director? >> and i think the measure would be whether or not as we move from one director to another we actually have moved from one place to a higher place as one leaves. >> and i think that if there was the question then in my mind well has the city and then you know regained and improved over your stewardship the period of your stewardship. i think that answer is really a resounding yes. i am so pleased that we were able to bring you on board. we wish you and i personally

wish you well for your future endeavors and thank you for your service to our san francisco population. >> thank you dr. colfax. >> commissioner guggenheim oh geez i only got to work with you for like two months so i can't really speak to your my time here on the commission. what i can speak to is my time with san francisco general and your firm support for the programs the people and the things we needed to keep it and make it a really first rate hospital over and over. i as i go around the country i ,i know how lucky we are to have a first rate public health

department and a first rate hospital. and on a more intimate level even i have friends who end up in the icu and i'm able to assure them that it's the finest place in the world that they can be. and i know that you've been a large part of that and thank you and i wish you well. >> thank you. secretary horowitz? oh, sure. i'll make it sure i first you don't remember this but i first met you when you came to the ada all of a sudden it was in 97. >> i had just left the aids office and everyone talked about this really handsome guy who came in and he's very smart and he had to take a look at him and by the way, these are standards that are from the past like this is a bookbinder ,you know that's not today. >> but anyway. and i never i never worked with you until later on but i've worked under six directors and so i have a doctor sound.

i probably have interesting perspective because we get like the taste of all of it and i'm not going to go to much in detail because i'll cry. but i want to thank you for bringing your heart to everything you do and then but you brought incredible professionalism to the epa. i mean we've always had a phenomenal group of people and but you brought the infrastructure to make us where we need to be and you right sized us and i don't think anyone said that but i think in the world that you led us through it was very difficult to see an end goal and you you had kind of the target at the end of like making us the best we could be. so i want to thank you for that and thank you for all that you've done for me as a person and everybody in the room because the the standing ovation is not what we normally see here. so thank you. >> yes. well i certainly associate myself with all these comments as as i was thinking about it. i can't think of a universe where someone would have come into a position and had an unprecedented pandemic surging overdose deaths, a growing

behavioral health problem and a skilled nursing facility struggling for survival and to be able to walk through all of that and lead through all of that requires a very fine balance of head and heart and you have shown that balance with such integrity and such humility. >> and i look around this room and i think every corner of this department is represented in this room and i hope you realize what a testament that is to how how much we respect you, how much we value your contributions and how you've brought us to so much of a better place. when you think of other municipalities, other other states, what happened in the course of the pandemic and you look at san francisco and that only happens not only because you are a fantastic leader but you've assembled an amazing group of people i think all of us have, you know, different jobs. but this department is really the most inspirational thing that i am a part of and i think

that has a lot to do with the way you developed. you were had also i came on about the same time you did grant and i think this experience has been phenomenal largely because of the way you've you've led and i know you're leaving an amazing team here for our new director to work with and hope you not only have a wonderful next career and we know you will but you get on those ski slopes the number of times rod was out ski with rod doing his skiing with let's grant doing dealing with all these problems. >> so i hope you have plenty of time on the slopes to enjoy yourself and we will also look forward to your next accomplishments which we know will make everyone very proud. >> i know director, i wants to say a few words as well. grant this is the passing of the torch i suppose so i just wanted to say you know we didn't have deep hours of

interaction but from when i met you previously it's very clear you care. you're kind. you you have a heart for public service and for people and you bring incredible competence and excellence to your professional endeavors and i, i think that one of the signs of how successful or how much integrity you have a leader as as a leader is how not only your colleagues and peers and others but how your team feels about you and you have a full room here you have a team that you have helped to steward and shepherd and care for and build and that speaks magnitude. so i want to thank you for what you've done for the past six years. i will look to you for advice counsel for help, anything of that. but most of all thank you for caring. thank you for pouring your heart and soul and i'll do my

best to honor that legacy. so thank you, grant. >> thank you. thank you. thank you. we'd love to hear from me. oh, okay. well, i so appreciate the comments and i appreciate so many people coming. >> yeah, i know how busy you are. i really do know how busy you are and just yes, i want to thank you and congratulate you on your appointments. i know you will do great things at the department for the citizens and residents of san francisco. so really looking forward to seeing what lies ahead for you in the city commission. i've been so grateful for your leadership, your guidance and kindness and one thing i value no matter what was happening is i told myself and occasionally others you know, we have such a

great commission, such a great commission that just just cares about the work and you always were available. you're always there to help guide you were always there to support. i could call any of you whenever i had a question or needed something or just needed to check in and that that is a amazing situation to have been in for six years with all commissioners is that that doesn't happen within the city and i'm just so so pleased that that you know that we had that relationship because i think i know that it made the department much stronger and will continue to be strong. and i really want to thank former mayor breed and mayor lurie for for their leadership and appointments and in ensuring that the health department continues to thrive and and maintain and and meet

its mission. so i, i appreciate the data in the in the resolution and i just want to say that you know in public health and clinical delivery we base our work on data science and facts but we deliver the services with compassion and empathy and i think that is so important and the work is hard and at the same time as director, you know, in a in in this position the work happens because of the people because of the teams that no matter where we are and i also feel so grateful to have served in a department where people are so mission driven, so mission driven and i think one thing that is not always highlighted enough at least in sort of the public is you know, we are a 24 seven department. we are a 24 seven department whether it's at zuckerberg hospital, whether it's within a honda, whether it's the street care teams or whether it's jail

health. i mean it is just going all the time and i just so appreciate the fact that no matter where people are and people are compassionate, they're committed, they're community driven, they're really innovative, they're really smart and they're accountable. and so when people say oh, you know, how was san francisco able to make it you know, do so well through covid or impacts or get in a honda recertified or you know how were you able to meet your budget goals or drive down you know, the vacancy rates it's really about what we were able to do as a team and it's because san francisco we we attract the best talents, we retain the best talent and it's a collaborative approach. and so you know, my my job was really to bring the right people together in the room and occasionally ask for an agenda right.

but but just to let that talent just flow and you know, one of the most and bring the right people in the room with and and then also making sure that community always had a seat at the table because i think you know at the core what the the foundation for the health department being so successful is the investment the community makes in health in san francisco i think we saw that in the passage of proposition b which was that you know, $200 million for public health infrastructure. some of us worked on that on our private time and you saw that passed. and i think that that community support for the work that we do is is just so important. so thank you. i'm greatly honored. it's been a privilege to serve for six years. i'm so honored and so grateful and really look forward to seeing what comes next in san francisco. and again it's been the honor

and privilege to serve and i look forward to ensuring that all of us continue to do that work in whatever comes next for any of and each of us. so thank you so much. >> thank you. >> i thought all these people were here for our consent calendar item. >> all right, commissioners, you have before you the resolution all in favor please say i i and we would like to present you with. >> yes. so what i'd like to suggest since there are so many staff here let's do something different. >> how about if commissioners you go i'm going to stand here and you i'll face you and everybody stand up and take a picture with you in the commission with your resolution. that way we get the whole team.

>> how's that feel? so good. great idea. and if you don't feel yet the commissioners are going to be center. i'm tall. okay? and at the end of this we're gonna have one more clapping session. but right now everyone just let's see. oh, that's good. okay, i'm going to count one, two, three. one, two, three. one, two, three. >> great. that's clap us up. come on back. commissioner.

>> let's get back to business commissioners. thank you, everyone. >> all colleagues. it's nice to see some faces i hadn't seen in a while and we get some water inside. yeah. yeah. it's people chance members of

the public. we will continue in a moment. thanks for your patience. you know so i know it's going to happen.

so are we ready to go and it is the directors report and we'll introduce again director saying maybe one introduce yourself and tell people little bit about you. sure. good afternoon. should i don't know which way to face the camera. >> let's look and see for the cameras as i've got tv. can you get a close up of director? >> i mean well good afternoon. today is my first day on the job and so i'm seeing some folks i think i think these are some folks on my team too though i have met many folks i've met i've not met many others but i am very, very excited to be here with you all. thank you to the commissioners . i think i've mentioned in some public remarks the two hours i spent with you one evening were

very i don't know what the right word is for they were enriching. they were i, i enjoyed the dialog and i'm really, really excited to get to work. i just wanted to note a few things. one i think just reflections even as i've been preparing to start this role very rapidly one i think san francisco the our public health care system has some of the most stellar assets anywhere in the world and you all and others have talked about that. i think that's true relative to our to the general, to our our clinics are the type of expertise and clinicians we have the quality of our staff who i've had the privilege of starting to to meet and so i am very excited to step into the room also relieved because it's

easier to do your job well when you have such incredible assets to work with and that's both what we have in our network as a provider, as a as a health system but also really importantly our people. the second thing i just wanted to note as well as i think i think the department as i'm chatting with folks has incredible energy, has resolve, has commitment, has been doing an incredible amount of work and i think we're excited for what's ahead and want to both affirm and recognize the work that the team has been doing is doing and also we're committed to making real concrete practical progress on some of the largest challenges ahead of us whether that be around the mental health study crisis that we have or as we think about the opportunities to really continue to advance how we function as a world class

integrated delivery system and then finally i think one thing i just want to really note is we will be coming at this from a posture of listening of being responsive to the community, of making sure that we are here to serve all san franciscans and especially the folks that most most fall through the cracks and you'll see us engaging asking for ideas, hearing, listening we will not make everybody happy. i already know that i've had a rapid acclimate whatever the word is to san francisco but i'm really looking forward to that. so thank you all for thank you to our team given it's my first day i just going to highlight 1 or 2 things from the director's report if that's okay and then i'll quickly turn it mark back to you for our subject matter experts to walk through the other items on the agenda.

one thing i just wanted to note and i must confess i know nothing about this except catching todd and navin oh, i want to say one other really, really important thing i can't see you if he was still here the way that popped out lavina ,i have questions. no, i just wanted to say and recognize naveen. i thank you for stepping in and helping to lead the department on an acting basis with steadfastness and with grace and with great, great competence and steering throughout. you know, there's a lot happening not only here but at the federal level and thank you. you have such tremendous respect from the team, from everybody i've talked to and i already know who i can rely on for everything. so thank you in a vein i just want to say i recognize the the

two things maybe i'll highlight from the director's report which caveat is if you have any questions i don't know. but the first is i was reading the report the ambulatory care process improvement update and i was talking to todd who is the chief medical officer of our network right. who i just met. you'll see a broader description here. but i think what's really, really important and interesting is one of the themes i hope for us to be able to focus on is how we as a health care system not just a public health care system can really think about the speed and ease of access for 2 to 2 to care in a way that every one of us would expect for ourselves. and that's a theme that in my prior role at the federal level i in my past team pushed a lot including how do we think for medicaid about having the type of care the same world class

level of care as well as speed of appointment timeliness that so many of us expect and receive outside of the public health care system because i firmly believe that our health care system should function equally well for everybody and our public health care system should be exactly what we would want for for everybody. and i really appreciate what the team is starting to pilot and experiment on with how to solve some really challenging issues on even primary care and ambulatory care appointments you have an issue as i understand for scheduling folks out you know, multiple months out and you have no show rates which holds calendar slots but also isn't good for both patient care and the clinicians and you also have really long appointment wait times which is a real challenge and as i understand from the team piloting in a few sites the team is thinking about how to address that in a range of

creative ways both how to have more open access in certain clinics, how to do more. i think the team has called it short scheduling model but scheduling not scheduling folks three months in advance where you have high no show rates. i think todd just told me from the network that you now in some of these pilot sites can cancel an appointment via text or schedule an appointment online. it is 2025. it's great that it's exciting to see these sorts of things. so i must confess i know very little beyond what i just said about what the team is doing but those sorts of things are exciting to me. i affirm that and that's an example of the team really trying to make progress on the ground in a way that matters to people that people will notice . so that's one thing i thought i would highlight and the other thing i thought i would highlight is because i think it's so important to recognize the team and staff i see here recognizing nursing director joan torres from the general and i see susan here from the general and obviously others

from the network but i think recognizing our people and making sure folks feel that recognition is incredibly important and i thought what was written here was really great. so maybe with that and since it's my first day i should pause before i say anything else that i don't know the answer to. >> thank you commissioners. is there any public comment in the room on this item? i see no hands. anyone remote? yes there is. >> mr. mitchell, would you like to make comment on this item? mr. mitchell, are you there? all right. i will come back to, you know, public comment. seems like i are there any commissioner questions or comments on the director's report? commissioner chao well i know we're off to a good start because of the director just pointed out what i was going to

point out which was really commendable which was the ambulatory care process in which we were trying to get patients through a lot sooner than they were before. >> so i think i think i hope that is a signal that he's going to be people centered and i found that that was the one item i had just flagged as being commendable and he actually picked out as the first item that he was going to discuss with us. so that is really a good sign. >> thank you very much. thank you. anyone else? commissioner christian thank you president green hello director. >> so the culturally congruent care in the news it was great to see about news about about these programs and i know that the commission does and i especially do look forward to hearing more about hearing an update soon about the programs

that we have and how they are faring funding wise and hopefully some expansions and things like that. but definitely want to commend the department on this work and also keep up with it. >> great. i just made a note to make sure we come back with more at some point. >> thank you. all right. seeing no other commissioner questions or comments. thank you and thank you. go to the next sign of which is are avian flu h5n1 update and our health officer dr. susan philip will present. >> good afternoon. good afternoon. commissioners and director cy welcome. i am dr. susan philip. i'm the health officer for san francisco and the director of our population health division here at d h. and i'm very pleased to be here to give this commission an

update on h5n1 and represent the work of a really expert multidisciplinary team from across the department who's being led as senior semi by dr. seema jain who's our deputy health officer and deputy director for public health services. >> next slide please. >> so as a top line, the current situation with avian influenza h5n1 is that as of february 26th there have been 70 confirmed cases in humans in the united states. more than half of these 3838 have been in california. >> almost all of them in dairy workers. one case has been in san francisco. we'll be talking about that in a little more depth to give you some information. >> so far almost all of the u.s. cases reported have had mild illness. however, there have been four hospitalizations and one death reported in louisiana. >> in terms of detections in

animals in the united states detections are very common among wild birds. >> over 12,000 wild birds have had detections as of february 18th over one hundred and 66 million poultry have been affected as of february 24th and 973 dairy herds across the country have been affected as of february 21st, 16 states are represented with outbreaks among dairy cows and california is among them. >> the one piece of good news is that no person to person transmission has been demonstrated to date. the risk to the general public currently remains low. so thus far transmission to humans has been from animals or animal products such as raw milk or unpasteurized milk. >> sfd has communicated to the public to avoid a few things to decrease risk. avoid direct contact with sick

or dead birds especially wild birds or poultry and avoid consuming raw milk or raw milk products including raw cheese. next slide please. now we'll talk a bit about the san francisco case. on january 10th of this year we announced the first h5n1 positive result in a san francisco resident. >> the test became positive on january 9th. from enhanced surveillance testing of a specimen at our sfo public health laboratory. >> i'll talk a little bit about the enhanced surveillance. what that means is rather than a clinician having a suspicion of avian influenza and requesting a test which is also possible. this was a test done on specimens that are selected at at random from those that test positive for the broader

influenza a in san francisco. >> the specimen was subsequently confirmed after being tested at the centers for disease control and prevention as being h5n1 one and genetic sequencing also done at cdc demonstrate that it was a gene a type b three that has been associated with the larger california dairy cow outbreak that's been ongoing. the the index patient the case was a child with no known exposures who does live in in san francisco in an urban environment. next slide please. the clinical situation leading up to the testing was that the patient had symptoms with a fever up to 105°f. body aches and abdominal pain but without diarrhea and in both eyes had red redness of the eyes or conjunctivitis which has been reported in human cases of avian influenza

in the emergency room. the patient was tested for flu, covid and rsv based on the symptoms. a respiratory swab was taken and it was positive for flu a so that was the specimen that was then tested as part of enhanced surveillance in san francisco and which is not being done in every local health jurisdiction on the symptoms fortunately resolved in this patient within a week. >> next slide please. a very extensive exposure. >> history was done and the patient and their family reported no direct exposures to dairy cows to wild birds to raw chicken or raw milk or rashes. there were dogs the patient was in contact with dogs but no cats. there was no backyard at this individual's home and no travel reported outside of san francisco and no visitors from outside visited the home.

>> they did attend daycare but no animals were present at the daycare and family members do work outside the home but not in jobs that have known occupational risk such as agriculture work with either cows or poultry. next slide please. so the communicable disease team did an amazing job of very, very detailed contact tracing and investigating asian among the household contacts no adults or children were symptomatic after extensive interviewing. >> all household members had negative respiratory specimens and the adults had a negative serology results and serology can be useful because even after acute symptoms have passed serology tests for antibodies to h5n1 which would could be associated with having prior infection they were all negative on serology for school contacts of this individual symptomatic children had

negative respiratory specimens and previously symptomatic children had negative serology results. >> there were no symptoms among health care worker close contacts and there were negative serology results on all tested health care workers . >> please note that specimen collection of course is voluntary so serology was not completed on all close contacts but a large number of people in contact with this individual were interviewed and offered serology. >> as you can see. >> next slide please. so as a summary after very extensive case investigation which received kudos both from our colleagues at the california department of public health and our colleagues at the u.s. centers for disease control and prevention no exposure could be determined and no further infections very gladly were detected and serology testing indicated that there was no person to person transmission from this case.

next slide please. >> so i'll speak a little bit about the ways in which we are communicating with providers and the ways in which we are doing enhanced surveillance such as the way in which this case was detected. >> so for providers we have been informing providers city sites citywide about h5n1 and consulting and testing any suspect patients that they may be seeing in their clinical practice either having clinical symptoms or risk factors including potential exposures to cows or to birds or who have reported drinking raw milk or their or milk products. >> so for enhanced surveillance as i just described it, our public health lab is subtyping the general influenza a specimens to look for h5n1 which is a subtype of influenza a all flu specimens that cannot be subtype from s.f. hospitals

and clinics are able to come to our laboratory for subtyping and at least 70 other influenza a positive specimens a week from multiple hospitals are also coming to the laboratory for this testing. this is a way in which we are actively looking for h5n1 that might be mild or might be missed clinically more than nine hundred flu specimens have been subtype using this enhanced surveillance since june of 2020 for the third modality that we are looking at is wastewater water monitoring, monitoring influenza trends in the wastewater or via wastewater scan can give insights generally into the amount of influenza that is circulating in san francisco. and we look at the next slide here. >> the actual numbers are not as important as looking at the graphs and understanding that there are two watersheds in san francisco we have the

oceanside watershed and the western part of the city that takes about 20% of the wastewater. and on the on the east side we have the southeast processing center which receives about 80% of the output. >> the highest levels here for influenza are purple which is h one subtype of influenza a in red is h three and in blue is is h five and you see that the blue the h five which could include h5n1 remains remains very low. >> wastewater detections are most helpful if it is able to be associated with an outbreak or clinical signs or symptoms for instance in the central valley when dairy workers were testing positive, they also saw an increase in wastewater. our wastewater levels are very

consistent with the rest of the bay area. another thing to note is that san francisco has a combined sewer system ú= so it's both wastewater and its storm drainage and wild birds as we have said earlier in this presentation are carrying h five and one. so there is the possibility that that would enter our our treatment systems and be detected in that way. >> next slide please. so four months has had an h5n1 incident management team imt for planning for different scenarios and we'll talk about that a little bit more. using this imt system is a way of organizing resources within the department to prepare for and respond to emergencies. as we all know from the covid 19 experience, the planning structure is used to quickly organize departmental subject matter experts to update and prepare our plans for a variety of scenarios. if this turns into a full response operation the team can

quickly pivot into a response imt similar again as we saw during covid 19. next slide please. >> so this is a org chart showing all of the subject matter experts across d h that are very involved in our management team and are thinking regularly about how we plan for response to h5n1. >> so the we are led by dr. andy turner who's our current incident commander. there are many others in our emergency preparedness and response team and others in p d as well. we have smbs in communicable disease and environmental health. our public health laboratory epidemiologist in our arches branch and leaders that work with the community as well. we also are really fortunate that we are represented across the department. we have network san francisco health network leaders as well

as we have communications and finance and of course our operational leaders from within d and within the department are critical. >> next slide please. so the work of planning that has been going on for months has really been aimed at three possible scenarios the first of which the first bullet we have already experienced an isolated human case of h5n1 in san francisco. >> in this case, again after extensive investigation determined that there no public health threat, there has been no transmission documented from the case. >> but coordinated messaging is needed and was needed. a second scenario that is being planned for is if h5n1 develops the ability to transmit person to person which could be a moderate public health threat on its own and requires different responses and different messaging. the third scenario is h5n1 can

both be transmitted person to person and is spreading rapidly and or associated with a high morbidity or mortality rate really making it a significant public health threat. next slide please. so the h5n1 incident management teams planning steps have both been going in progress so some steps have been completed. they have developed anticipated mitigation strategies based on the three scenarios subject matter experts have reviewed and built out the plans for the different strategies. the public has been informed and we continue to inform them to avoid contact with wild birds, poultry and drinking raw milk. and there was a tabletop exercise that was completed on january 31st to test these plans and to address any gaps. >> so currently that tabletop exercise after action report and improvement plan draft is being reviewed by the

leadership of the imt and the in-depth plans are being reviewed by the leadership and the future. we anticipate very shortly that the final after action report and improvement plan is going to be expected and the plans will be finalized by the end of march for scenarios that include person to person transmission. so in this way we are really preparing for the different scenarios that could occur and having all of our smes engaged and thinking about it now. >> so next slide. so in summary of where we are as of today with h5n1 situation response, there's an ongoing outbreak in california and the u.s. largely in dairy cows and there have been some transmissions to individuals particularly those that work in agriculture poultry or dairy cows california dairy herds are heavily impacted. there was one case in a san francisco child with no known exposure and with

no subsequent transit action beyond that child after extensive investigation. so today the virus has not gained the ability to transmit easily from person to person. that is i'm saying that not just based on our case but on what is known as of now by the science and the public health globally and nationally as well and at the state level the risk to the general public remains low. >> however, influenza viruses are known to mutate and thus require ongoing monitoring and planning. >> so we are preparing for multiple possible scenarios using a multi-dose binary approach. >> thank you. thank you so much for your presentation. is there any public comment in the room on this item? >> i don't see any and i also don't see any remote public comment. >> all right. any commissioner questions? commissioner toronto the question is do you feel

confident that you're getting the most accurate information updated from the cdc? >> well, we're we're we're watching the cdc very closely. we're watching what information they put out. and thanks to dr. jane and others, we also have informal relationships and networks with a lot of subject matter experts at cdc. so we do rely on on information gleaned that way in addition to official channels. we also work very closely with the california department of public health experts as well. so i do feel that in san francisco we are in as good a position as we could be based on our local expertise and our relationships with the state and national experts in this area. >> okay. >> thank you. i just have a little anxiety that we have communication. >> so thank you very much. we we do continue to monitor communication and we'll certainly let this commission

know if there seems to be a challenge to us protecting health in san francisco that we can't surmount. >> okay. thank you. thank you. commissioner christian, thank you. a bit of a follow up from commissioner. >> first i want to thank you for this exceedingly clear presentation. >> oh, credit to dr. jane. >> yeah. thank you. well done. really appreciate it. um, so you're monitoring the cdc in california? what about the other states? are you also like looking at what is what you can find on the on the newswires and the comments from other states? >> i mean, yes, our subject matter experts are keeping abreast of of things that are reported. but this is really where we see the need for our colleagues and the full strength of cdc because it is, you know, the interstate transit. >> it is what's happening elsewhere that we don't fully

have eyes on as a local jurisdiction. so we we do we do pay attention and try to do the best we can to see from insights of other health partners. we also are part of an association such as the big cities health coalition and others that are national groups that represent the largest cities and their health jurisdictions in the country as well as you know the national association of county health officials and others. so there are ways in which we are also able to share information through those networks that can be quite efficient also. >> thank you. at this point is the incident management team centralized or are they located still in their offices and communicate virtually? >> they are communicating virtually working together, meeting together on a very regular basis and but but not coming together into a central command as of yet. so you know, i'm sure we'll be thinking through the different

scenarios i have not yet seen the report is still going through the process of being drafted. but there would potentially be a scenario in which we would all come together if if we were at scenario three where there was spread person to person and people were becoming ill from h5n1. >> so but at this point we're able to successfully work together in our individual areas but all coming together to bring forth the entire depth of expertise of the department to bear on this issue. >> thank you. and finally, has there have you heard any more about vaccination, any thought or chatter nationally or locally about that? >> do you want to talk about that? >> thanks. so there are approximately pleasant oh, sorry. >> dr. jane seymour, deputy health officer. >> yeah. so i think there are really two different things around vaccine . >> one is that there is an actual supply. my understanding is there's about 5 million doses and that have been in the stockpile. those are not federally

released because it's for that population. it's difficult to really sort out what to do. >> in addition, there are also current vaccine development also occurring through industry. >> and my understanding around that is that the the concept around that those are going to have better immune responses than the vaccine that's already in the stockpile. >> thank you. welcome, commissioner chao. >> yes, thank you. clearly you've done a very extensive review of this case. >> i'm wondering if there are any other isolated cases in the united states. i mean they're only 70 or so so and and whether or not you know, there is some sort of thought as to having gone through this extensive review or i mean just out of the blue

. what do you make of that? what do we do though if it's the only case in the nation that's even somewhat more concern every once in a while you read in anwr. right. isolated cases. so is this reportable or what should do and what do we do with this? >> thank you so much, dr. chao. yes. well, we have been in close communication on both with the california department of public health and the cdc from the very beginning around this around this case. so they are aware there actually was another case reported before ours in a child in alameda county also where there was not a clear source and i believe there's one other u.s. case correct that there was not a source identified so i think you're bringing up a very good point. this becomes concerning because we would like to see that there is some connection to a known risk such as dairy cattle or poultry or raw milk. >> and when we don't have that that makes that makes us a

little bit concerned as where is then this potential person, where is this person becoming exposed to h5n1? >> i think that's a very important question. it's one of the reasons why, you know, our laboratory experts and our communicable disease experts have really been making sure that we do some enhanced surveillance. and again, we've done this since since since june and it really there's been one specialist one this is the one specimen that has tested positive. so it offers a little bit of reassurance but it's countered by the fact that with extensive interviews and a very a very cooperative family and child which is also another thing i want to point out is like thank you so much to the family and when we are reaching out to people in the public especially when it's something early on like h5n1, we are so grateful for the the willingness to talk with us and even to, you know, give specimens so that we can understand better. that is how we try and understand the epidemiology and

despite this very good relationship that our communicable disease team established and this family was so generous and willing to talk with us we were not able to to find anything. so it is an open question. dr. chao, that i think we'll need to continue to keep our eyes on you and thank you if you get any further updates or there are some sort of more national, you know, approach to these isolated cases, i think there are much more concerning because that might be some sort of right spread we're not all understanding and yes and we're may go especially in the light of our pandemic in the past it while we do have you and could i then ask one question then because now it looks like your covid testing is so very low almost less than 1%.

right. in terms of positive tests do and and and and the studies or i should say the data seems to show that, you know, rsv and influenza and particularly are rising very rapidly. do we actually feel or how do you feel in terms of confidence that we may or may not see a covid rise? >> i don't know that i'd be able to to predict that it has been interesting to see that it's been influenza predominating over this winter respiratory season and not and not covid i, i think we we always have we have learned that we can't say that covid is is done and so we want people to continue following the recommendations. as for vaccination and then the general respiratory virus protection recommendations which should protect people against flu and rsv as well which is hand-washing getting the vaccines that they're

eligible for for those infections as well. and staying home when they're sick and using masks, you know, when when appropriate and crowded situations or if they are themselves feeling ill you know, thank you very much and i'm sure you update us if you find out more information on either the state or national level in regards to yes, i mean we're happy to to to come back to to come back and then i'll give another update just as we're doing today as well as we as we hear more and as our planning continues. >> right. excellent. thank you. >> thank you, commissioner girma thank you. you mentioned that not all jurisdictions are doing this enhanced surveillance. >> so is it possible then that because of that that it's not being observed or followed? it's not it's it's not surfacing because the enhanced surveillance is not happening.

that is that is very, very likely. commissioner. it's it's possible let's say it's possible because this case this seoul san francisco case would not have been picked up without the enhanced surveillance. so what we're doing is both reminding providers hey, we have testing available if you have a suspicion if you are talking to someone and you are worried because of the history that you get or the clinical presentation, then we will do consultation, our sms will consult with the clinical provider in any health system across across the city and facilitate testing if it's appropriate and in conversation with them. >> but this this specimen that was not the route that it came that is available to providers but this was one where we were saying let's just take some of the specimens from various hospitals and test them to see what we find. so yes, it is very it is very possible and it goes along with what dr. chao was saying is we don't know if there was a connection.

we couldn't find the connection and this was a specimen that would not otherwise have been tested. so it does talk about the potential for subclinical or you know, things that might be missed as well as underreporting. right? yes. yeah, correct. >> correct. because this testing is not h5n1 and testing is not necessarily routine clinical practice that is not a result that comes back to a provider they would be told you know, mostly it's outpatient flu positive yes or no or if they're getting a panel it would might say flu flu a but there are not in every lab would they necessarily say this is h5n1, which is why we we take a subtype as well. >> some of the clinical systems are doing it in san francisco but not all. so we are trying to also fill in the gap and make sure as many specimens are subtype as possible. >> so this is just another example of how lucky we are to have the resources and the assets in san francisco's

department of health that we have great, great people working on this in the background and in the foreground and we hope that scenario three does not come to bear but we are preparing as if it would. >> thank you. yes, i just had a follow up. it suddenly dawned on me because your presentation was so excellent and also the the holes that we're looking at in terms of the data have we then outreached such as to the san francisco medical society or the end or the hospitals to really tell them that it's important to do this and you're doing this enhance yes testing because i think that you know, the medical society, for example, puts out a weekly bulletin to all their members which now are going to a very large number of even the well, the department of health is part of it as you are. >> but it might be good to outreach so that we can get the information out to the practitioners and possibly even

through the medical groups so that they can understand better because there seems to be as commissioner grijalva and you were discussing a lack of understanding of the importance of doing the testing and that we're doing it and i think that's really information that if it goes out to the practice community might help bring in, you know, some more of these cases and try and understand what the underlying underreporting may really be. >> absolutely. >> and we are working directly with clinical laboratories and and telling them to send specimens and they have been great partners in this. we're sending messages out to providers generally that want to get updates and i will look into the medical society. >> that's a great that's a great thought. if it has it may very well already be happening but i will take that back. thank you. sure. >> yeah, i guess i had just a quick question. i know h5n1 was discovered in rats in riverside county.

does that heighten your concern at all? i mean rats just seem like they could be around homes as opposed to confined to farms and such is is there any heightened concern because of that? >> yeah. thank you for bringing that up. and you didn't mention this but but cats have also been known and those are in people's homes but for now what it looks like is that the primary risk has been with these agricultural exposures. but i think that that is something that we'll need to keep looking at the science and the public health data that that continues to come out. but we are not making any specific recommendations or telling people specifically anything right now about rats or about cats other than saying don't feed your cat raw pet food or raw milk. same things that we were telling you know people about for their own health as well. >> but we will we will keep an eye on all of those possible sources and certainly will

adjust our planning and communications to the public and into this commission as well if needed. >> thank you. and then in terms of mitigating illness, tamiflu, what's the thinking about that? and you know, if vaccines are not available i know recently there have been some shortages of tamiflu. so i'm just wondering, you know, what our contingency plan might be were there an issue with vaccines? but a potential treatment to mitigate disease? >> yes. and so fortunately cases have been responsive to a full tam of your tamiflu. and since we're working with our public health emergency preparedness team, we're making plans as well for how we would distribute if it did become a limited resource. and so we are that's that is part of the planning as well. we don't have vaccines yet but we can incorporate that into our thinking and we can start thinking about how we might allocate medication treatment

if it became scarce as well and there was a high need. >> thank you. and then then the last question is i think the concern that it would jump to humans in part is kind of the genome of the regular influenza and the genome of h5n1 coming together and making it more contagious. but given that flu season is allegedly on the wane, does that give you any comfort or is that a positive thing where maybe we'll get a little reprieve until the fall or how how does that impact this worry that it might go human to human? >> i mean i think it i think that that can be helpful but we don't know in which particular individual in which particular time there might be there might be some of that exchange of of material or that mutation as well. so that's again why we want to pay so much attention to this now because it is it is somewhat unpredictable. we can't predict what the trajectory would be and it might be that we look back in a

couple of years and really we say well you know, nothing happened. but again this is what we do in public health to prepare for a scenario in which something does and hope and hope that it doesn't. >> so i think it's good that less people have flu for many, many reasons. but it doesn't make me feel fully reassured that we stop or we change the trajectory of our planning now. >> well, thank you so much for your work. thank you. dr. jane dr. philip thank you. your team. as commissioner damaso said so well this is obviously san francisco leading and using resources and not being afraid to delve into the necessary research and effort to make sure this doesn't become a pandemic. so thank you so much. so the next two items on the agenda, greg one one who's the administrative analyst will present and these are resolutions that we need to approve. one is to recommend to the

board of supervisors that we authorize the department of public health to accept an a gift of $37,000 from the epic systems corporation. so mr. wong will elaborate the commissioner's we would like to present for your consideration a resolution to recommend to the board of supervisors to authorize the department public health to accept and expend a gift of 37,000 from the epic systems corporation. this gift has been donated to the department of public health to support the richmond area multi services project. the funds will be used to provide high quality i.t support services to behavioral health services and to engage some cisco resident consumers for improved emotional fiscal well-being and quality of life. we ask for your approval in recommending this resolution to the board of supervisors and we welcome any questions regarding this funding. >> thank you. is there a motion to approve the resolution?

i so move and the second second. is there any public comment on this item for public comment in the room? there's no public comment remotely or in the room. >> then all in favor of approving resolution. item seven on our agenda please say i. i thank you. the next item is a resolution to authorize the department of public health to accept and expend gifts of $78,696 $110,000 11,009 $48.38 $72,000. 10,000 $5,000.30 $7,000. $110,000 and $20,000 290 and $0.68 from the epic systems corporation. mr. wong the commission's thank you again. >> we would like to present for your consideration a resolution to authorize the department public health to accept the expanded cash gifts from the epic systems corporation. these gifts have been donated to the department public health for our role as a federally qualified health center that

provides primary care services to underserved populations and as part of the epic safety net program which provides gifts to entities that help low income and at risk populations. we ask for your approval and authorizing this resolution and we welcome any questions regarding this funding. >> thank you and is there a motion to approve this resolution and so moved? second seconded. >> is there any public comment? there is no public comment in the room and there's no public comment. all right. all in favor of approving item eight. >> oh, sorry. just just a quick question. the the first resolution was to recommend to the board of supervisors to authorize but the second one doesn't go to the board of supervisors. i was just wondering what the difference was. yes. the gifts that for the second resolution has been included in the budget and annual budget for 2324 and 2425 as well as 2526. >> okay.

and the first one wasn't in the budget and unfortunately this one was a restricted gift. it was a gift restricted to the richmond area multiservice project. so we decided we needed to take this sort of water supplies. i'm sorry. >> i didn't hear you. i'm sorry. we decided that this gift would need to go to the board of supervisors for approval as it was restricted to the richmond area multiservice project. >> okay. thank you. >> all right. see no other questions or comments all in favor of approving the resolution i recognize in may please say i. >> i thank you. thank you very much. the next item on the agenda is the department of public health second quarter financial report and andrew mural who's our chief financial financial officer will present. >> good afternoon commissioners director sy thank you excited to be here today to present our projections as of the second

quarter of 2425 and appreciate the questions i going to endeavor to answer the questions in the presentation but i will make sure i come back to any edits. so thank you. so next slide please. you'll see as a as a as an overall matter we expect to end the year with $5,959 million revenue surplus and about a $2.6 million expenditure savings which after you account for mayor's office instructions on sugary sweetened beverage add back funds in specifically putting those on reserve really negates out our surplus to bring us relatively on balance for expenditures with a slight $100,000 savings projected. so next slide. when you compare that to where we expected to be as of the end of the first quarter, that represents about a $46 million

improved mint in our revenues which really spread throughout our divisions between zip g behavioral health and primary care that in slides to come will get into some more details about what's driving those. next slide please. >> so some some highlights i think to draw your attention to from from these numbers laguna honda revenue projections reflect a continued deficit primarily due to $48 million revenue deficit for patient revenue which is as recertification has happened and as the census net emissions increase we expect that that will continue to shrink the deficit will and revenue numbers will continue to improve that $48 million deficit is offset by a one time payment of distinct part nursing facilities revenue dpf said bringing the total to 28

to bring the total revenue deficit for laguna to 28.6. >> behavioral health services continues to exceed budget. we project to end the year $45.6 million to the good due to sustained improvement from payment reform related to the claim waiver and epic goal for mental health services in may 2020 for so. and commissioner green, thank you for the question. we do asking so specifically do we expect the behavioral health surplus to continue? and then how does that relate to continued vacancies that will get into some some expenditures or savings? one one thing to note for behavioral health revenue, the overall revenue level is relatively consistent between last year this year and some of the budget that was just approved february 10th. >> and a lot of that came into

focus after epic go live when we really were able to get really precise crystal reports of where we were. the attribution of the portion of the impact from payment reform compared to the portion of the impact from epic go live is something we're still looking at closely. we really haven't been able to distinguish the two but i would say this is sustained over three years. we expect this to continue and it's really a story about successful billing and successful reimbursement for services that we are providing. >> and to that note the vacancy rate. while there are big savings that we'll see in salaries and personnel for vhs. but i would point out that the vacancy rate has halved. we see this story across the department but for behavioral health in particular we can look from march of 2024 through current day and see the vacancy rate has gone from 10% to about 5%. so that really is a dwindling

of the vacancy and are focused on hiring. and then one specific to mention going into behavioral health and detail but this is really an exciting program a behavioral health clinician fellowship program which aims to bring on clinicians and be a pathway to hiring clinicians. really kicked off in summer of 2024 and 20 plus fellows were selected and really should provide an onramp to hiring this really difficult class to fill for us. but more details to come on peter's next note. zuckerberg general hospital san francisco general hospital is expected to end the year roughly on balance which is comprised of a $26 million expenditure deficit with about 2.2. 1% being offset by a revenue expected revenue surplus of 26 million. finally, projections across the

department see personnel savings of about 9.8 or 0.7% which is largely based on underlying vacancy trends. we've seen a continued reduction in vacancy. so a lot of these savings are baked in. and it's also important to note that impacts from the mayor's january night hiring freeze are still being evaluated and finalized. we expect more to come in the in the third quarter financial report. but certainly appreciate the recognition of many important job classes for carry out its important mission. next slide. >> so going into us san francisco general hospital specifically these provide the kind of summary of the numbers i just reviewed showing on balance relative revenue surplus expenditure deficit on balance. and next slide please. >> so going into some of the

patient revenues specifically we expect a $45 million surplus in patient revenue. consistent with the budget conversation we just had. higher than expected patient volume and patient census really driving both expenditure needs but also revenue results . an additional $2.8 million surplus revenue from the 340 b pharmacy program. so continued higher pharmaceutical utilization and of high cost medications. and i appreciate the question and we'll look for the confusion in the memo. it is kind of counterintuitive. we participate in the 340 b program and as medications particularly high cost medication use goes up. the 340 b program allows our revenue to offset. and so we're reporting both that increase use for more expenditures or expenditures above budget but that that does

come in some form of revenue offsets. >> so yeah, the higher cost medications are contributing to an expenditure shortfall but what we see here on that is the revenue impact. and finally the revenue increases are being are partially offset by a $41 million deficit from prior year settlements. this is almost exclusively entire to 34 or $34 million state realignment clawback related to f y 15. so about ten years ago they're recouping and that that is a one year thing. >> it was the first year of medicaid dish funds in that year. public health systems were told not to collectively claim all of all medicaid dish funds due to a handful of cms regulations

in 2017. the it was on hold for litigation that finally wrapped up i think last year. and so we have a one time payment for that portion that's on hold. it is not a continuing obligation. this is this clears what our risk for ab 85 related payments is. >> not sure if i explain that clearly i'm happy to take more questions on that but it's a one time is the bottom line. and then in addition to that that ab 85 recoupment 77,000,007.4 million and lower than expected medicare and medi-cal settlements this year relative to budget. okay. next slide. >> so other operating revenue includes $37.8 million surplus from our global payment program as we were increasingly able to

claim services provided to the uninsured and agree with the question. commissioner green that the waiver is set to expire this. so global payment program is a creature of the medi-cal waiver that expires at the end of december 2026 source of gpp or disproportionate state hospital dish payments. so payment reductions for that are actually scheduled to reduce in april of 2025. >> and that is that's been a story a consistent story over the last several years where we wait and see what actually is passed with the federal budget. so this is one area we're watching closely and seeing what develops. and then i had one other question on the gpp. sorry, i'll come back to it.

>> okay. and then the surpluses of 4.9 million in other medical and 4.3 million and capitation fees are being offset by 20 a shortfall of 22.2 met in medi-cal managed care supplemental revenue. and that really for components of that $22.2 million deficit for medi-cal managed care a lot of that was from lower than expected payments for our one of our direct payment programs epi enhanced payment program the that and that was 13 million the change to epi came as a result of a transition we did from capitated payments to fee for service which put us in a different pool and gave us

ultimately a lower share of the payments for epi than we expected. that though is being offset by or contributed to with additional there's new state requirements for san francisco to pay an administrative fee on our intergovernmental transfers . so that is also contributing to the managed care deficit. and then those deficit direction impacts are being offset by higher than expected rate range net revenue of about $10 million. next slide please. so operating expenses that the general $26 million expenditures are deficit largely from contributed to by $5.7 million shortfall in personnel costs. these come from cola driven

increases increased costs to holiday and premium pay that were not budgeted. and so we're recognizing that deficit that previous labor agreements introduced an additional $1.6 million shortfall and non-person health services due in part to unforeseen contract needs related to equipment failures and as well as some overages and registry expenses. important to note for context that still that represents a 50 to 75% reduction year over year reduction in registry utilization but nevertheless is slightly over budget. and then finally a $19 million shortfall in materials and supplies attributable to inflation, census growth and pharmaceutical expenses we discussed earlier. next slide. >> so at laguna the revenue

story is largely the patient revenues shortfall being offset by deep one time payment. in addition there is $5 million in expenditure savings primarily from $3 million in personnel related to underlying vacancy rates. next slide. >> behavioral health similar to what we discussed $46 million revenue surplus due in part from medi-cal revenue 25.6 along with a kind of a switch where payment reform is accelerating the pace with which we recognize and claim administrative costs related to payroll. and so that's showing as a surplus but really it's catching up to make it make us timely with when we claim administrative costs. and then expenditure wise we have about $10 million of

savings comprised of 6.6 from personnel savings and then an additional $3 million from non personnel savings. just to note commissioner toronto the we monitor everything happening at the federal level very closely in partnership with the mayor's office with city attorney and many other stakeholders california association of public hospitals and we we try to keep our pulse our fingers on the pulse very, very closely. there's a couple of mitigations that we do have though i would think of as our security or our, you know, hedges against putting all of our eggs against the expected revenue increase. one a management reserve as you can see in the last slides we have in place, it's available to guard against revenue shortfalls, unexpected news news that comes in the

middle of the year that we cannot plan for. in addition, i think what you approved in february 10th in our budget proposal represented a lot of our thinking on looking across our revenue, looking across our operations where can we dig in and do a good job on billing, improve our billing so that we are getting reimbursed for the services that we're delivering and maxim izing those opportunities? it's true that these risks are ever present but we're trying to do the best job for opportunities that we have in place right now. >> thank you. next slide. >> in primary care we see an expected 12.7 million our revenue surplus due in part from surplus ship revenue. so in 2023 fully met quality metrics that continued a long story of meeting quality metrics many years prior. and doctor chang will have more

information to come on this year's qip outlook. but we are recognizing and expecting that we will have a year similar to prior years. and i would just note that there is a portion of the expected ship revenue that we always defer to hedge against audit risk or other revenue risks. in case something happens, something unexpected happens. >> in addition to that sharp revenue we expect about $5.5 million in surplus medi-cal revenue from increasing volume and improvements to billing efficiency. and then on the expenditure side about $5.8 million related to personnel savings reflecting underlying vacancy trends. next slide joe sorry. thanks mark.

so joe health expects $2.2 million shortfall all net shortfall driven by the similar cola related holiday and premium pay increases and a slight increase to or higher than budgeted use of registry about 200,000 and increased inmate population using increased pharmaceutical costs of about a million. these are partially offset with slight worker's comp savings. next slide. >>ea network services with whole person integrated care billing is increasing and we think we expect to see about a 5 million dollars surplus which really remarkable for those services and it's an accomplishment testimony to what they're doing. in addition improvements to health at home billing and these are partially offset with

continued reductions in similar medical administrative activities claims. these are a lagging time study where we expect to see these turn around in the year to come . and on the expenditure side there's $3.5 million of expenditures for savings related to personnel salary and fringe savings from underlying vacancy. next slide. >> and finally population health. oh no. population health shows about $600,000 revenue shortfall related to expected fee and license revenue declines. and these are offset by improvements for medical billing at the public health lab after epic life was implemented and certification was achieved at the lab. these savings are contributed or increased with $10.1 million

of expenditure savings from personnel related to vacancy and some non personnel savings for prior year purchase order. so contract savings and then the $2.5 million from the mayor's mid-year instructions to reserve the add back funds for sugary sweetened beverage are recognized in the public health population health division. and finally for public health admin about a $700,000 revenue shortfall related also to medical administrative activities claiming. and then that shortfall is made worse with a $3.1 million expenditure shortfall driven by growth in overtime expenses and temporary position expenses. and then there's a offset with it savings from annual projects . >> and then finally a slide on the management reserve just to update this balance is only updated at year end to the extent that revenue surplus

revenues are available. so as of last year our balance and currently our balance is 148.9 million or 5% of our budgeted medical medicare and patient revenues for the next two years. so if there's to the extent there's surplus revenue available at the end of 2425, we certainly would be looking to increase the management reserve deposit. >> so happy to take any queson i'd hopefully hit the questions i got in advance. i appreciate that and i'm happy to take questions. lex issues across the department so thank you so much. any public comment in the room ? >> i know we have one remotely i have to pull up give me a pull up chart.

>> mr. minutes are you ready? yes. okay. >> give me 10s to pull up your slide. >> all right. thank you. tomorrow at okay. this slides up. you may begin. >> thank you. it's disturbing seeing the second quarter financial report . the report asserts l.a. hhs massive loss in medical and medicare revenue was the direct result of the hhs continuing registration census following its decertification just shy of nearly three years ago. in april 2022. >> speeding up admissions could obviously stop the hemorrhaging tens of millions in lost medi-cal revenues since admissions resumed seven months ago in july 2020 for hhs

patient census has increased by just 30 patients an average increase of 4.3 patients per month. as the chart mr. more witness displaying for me shows l.a. chases lots of $47.6 million in medi-cal revenue reimbursement alone during the first two quarters of the current fiscal year july 1st, 2024 to june 30th 2025 suggests be extremely slow pace of patient admissions to l.a. james continued severely adversely affecting net revenues to l.a. and sfo costing san francisco taxpayers continuing millions admissions resumed eight months ago in july 2024 at the beginning of the current fiscal year. why is patient revenues still down so much? directors i should note that nobody in s.f. l.a. or the san francisco health network sfo has been held accountable for the $260.4 million in combined costs to rescue l.a. james from a disastrous decertification in april 2022. the $260.4 million in costs to date will continue to go up due

to an unknown costs for several outstanding lawsuits from the 2019 patient sexual abuse scandal. lawsuits involving deaths of patients evicted from l.a. jails during a decertification and massive city attorney legal costs from the 26 month decertification. directors should look at removing those responsible including troy williams as a patient's chief quality officer, sfh and ceo roland pickens, l.a. hhs, jennifer gordon white and other sfo employees whose mismanagement of l.a. case led to l.a. chase's decertification. >> thank you. >> that is the only public comment for this item. we will go to commissioner questions and comments. any? >> i guess i just had one. there are so many things that are changing and i think if there were a way that we could even get a primer on some of the background because i know a

lot of the money especially some that comes from the state has to do with the provider tax and various things that were done at a very high level administrative decision making process to try to bring more federal funds to the state and so forth. and when we read this to a degree it's hard to have some context. so i don't know probably director ci is the best person in the room who can really give us the full perspective on now not only we're sort of in the middle of this where it stands but also what is going to be you know, likely to be, you know, at risk in the future. and what we can still guarantee in terms of revenues in the future. so maybe we can have have that discussion at some point. the only other question i had is i thought that last year we had gone through negotiations with all of our unions and so when you talk about the the cola and those expenses that were unanticipated, was that

because the budget was made before and if we did have those negotiations, how long or when did when do the various contracts expire? in other words, how long in the future we you be able to have accurate budgeting based on on the way the contracts with our unions ended? that's right. so i'm addressing just the salary question. typically the the mou is are signed towards the end of may well after departments are out of the budget system and budget prep and as a practice the city will roll in the impacts of those colas and salary but it often doesn't impact or it isn't a citywide impact to include the increases to certain categories like premium spend or holiday pay that is at 24 seven facility we're going to incur and reflect the cola increases so that this is a lagging indicator that will be

fixed in the 2526. but you can see it in the budget variance for 2425. >> well thank the thank you for the clarification very much appreciate any other commissioner questions or comments. right. well thank you so much for the presentation and we will go to the next discussion which is related to this which is the quality incentive qip program update very interesting. and kathleen chan who's the medical director of value based care for the network is presenting. >> thank you. thank you commissioners and welcome dr. director time so we have our slides pulled up. thank you and i am going to review with you a little bit about the value based care team within the department of public health as well as the go over program overview of the quality incentive pool program. i'll talk through some collaborations and partnerships that have led us to success and some future work on the horizon for our team. next slide.

next slide. >> thank you. the value based care sits team sits within the san francisco health network organizational structure and that is appropriate because most of the qip program is measuring care delivery and outcomes that are affected by the care delivery systems underneath the health network. >> next slide california department of health care services or do you see us as quality incentive pool program is a statewide managed care directed payment program meant to align priorities and address and improve health equity. >> this provides a significant financial reimbursement structure for public health systems who serve the medi-cal managed care population and this program's achievement is

achieved through challenging pay for performance targets for medi-cal managed care enrollees and is supports improvements in primary care, specialty care and inpatient care. >> this program has existed in some form over the last ten plus years and it started as a demonstration program called district. >> and over the years the strategy from dhs has changed and evolved and shape has been reflected. uap program structure has been reflected in the state's bold goals for that they've aimed to reach for 2025. so what that means is the shape program has come to incorporate more measures that focus on improving maternal child and adolescent health, addressing substance use and mental illness and reducing disparities in care and health outcomes. next slide. >> sorry you're here. yeah. the financial impact of this program is significant. >> this program the program value is determined by the

number of medi-cal managed care enrollees who are assigned to receive primary care with the health network in 2023 that was about 51,000 enrollees and that led to a program value of about $68.9 million for 2024. we're estimating that to be about the same that 2024 is our numbers, our estimates and projections because our reporting program hasn't closed yet. we report to the state in june of 2025 and i believe that was a question that came up around the 2024 numbers and big news from cms is that as for the year program year 2025 cms has approved expanded funding for the program of 70%. this means that if our enrollee numbers stay exactly the same that our program value is $110 million per year and our program is made up of 40

metrics that we report to the state. so that would increase the each metrics value from $1.7 million to $2.45 million per year. >> as i mentioned, the program is made up of 40 metrics. 20 of those metrics are required metrics and that means that every program across the state that participates every hospital across the state that participates in this program reports the same 20 measures. >> we have no flexibility around that. >> the other 20 measures are made up of 20 measures that we select from an elective menu. there are about 34 measures in the elective menu and we have flexibility around what we report in order to ensure the greatest financial opportunity and operational effectiveness. >> we selectively report measures that we are at target for. however, our strategy around

improvement is slightly different. we drive improvement on metrics that we are not at target for that align with the department's true north in order to improve health outcomes. next slide this is a list of the priority measures for program year eight or which is measured during calendar year 2025 and they are grouped by subject matter. you can see that there are a handful of cancer screening measures childhood measures, chronic disease management, behavioral health and substance use as well as maternal care. >> commissioner gerardo, i believe that you had a question around if we expect any changes for the childhood immunization measure at this point we are not expecting any changes in what is measured that measurement that those two measures that look at childhood immunizations for children under two as well as immunizations for adolescents are for at least for program

year 2025 are unchanged. >> the next slide shows you the effective measures and there are more measures listed here as there is a larger menu to choose from. but again several measures show up looking at preventive care, several measures around patient safety and that's mostly looking at patient safety in hospital during hospitalizations and utilization management, chronic disease management, care coordination and care experience as well as several other metrics looking at behavioral health and substance use new measures looking at column utilization and several measures looking at maternal care. next slide. >> throughout our participation in the qip program from 2017 to 2023, i am proud to say that our network has achieved 100% of the available funds and targets program year 2024 while

the calendar year of 2024 has closed and our opportunity to provide services that we count towards 2020 for that window of opportunity has closed. we report to the state our our 2024 performance in june of 2025 and we are diligently searching seeking additional opportunities to capture data and as well as records from outside systems to be able to count that towards our patients health outcomes. we estimate and i should explain here on the previous slide we estimate more than 95% achievement in 2024. >> i always i wait until we've been approved through reporting and through audit before i confidently say that we've achieved 100%. we are slated to do very well again this year with some ongoing opportunities but some bright spots to be able to

highlight as well. >> next slide. >> the way that we've done so well is there are several people to acknowledge and several groups to acknowledge. >> first, the team leadership with strong executive support has led to our success in the program. we have strong, deep, wide interdisciplinary clinical team partnerships i.t and data analytics support and support from even americorps and these teams are key and the reach is very broad in terms of which teams participate in the contribution to improving health outcomes for our patients and commissioner gerardo, i believe you had another question around data sources and i think this is really where i want to highlight the importance of our partnership with the i.t and data analytics teams. >> data for each metric comes

largely from medical and pharmacy claims from our health plans which speaks to build services. we know that not every single service that is reported in all of these measures is a build service and and so we also captured data through our electronic medical record. finally we search outside of our system because we know that enrollment in medical does fluctuate for individuals based on income qualification and they likely receive services outside of our system. and so we are in we have a strong partnership with the analytics and it teams to be able to capture some of that data to contribute to reporting and so that services aren't duplicated for patients when it's not needed. >> it is through strong communication and coordination on each of these teams that we're able to plan implement

and have strong data for each of these measures. >> next slide please. >> on the left here you'll see the organizational structure for the value based care team. and i think the thing to take away from this is that there are five individuals on the value based care team. >> these five individuals cannot achieve program success without strong partnership and collaboration across the network. the figure on the right is meant to represent what some of the strongest collaborations that currently exist are with the central teams who coordinate and project manage what is needed to be able to report and drive improved quality in the center being the primary care population health and quality team. >> san francisco general quality data center. the value based care team and the metrics analytics and data and integration team each of these teams partners with additional folks so that primary care population health

and quality team is coordinating its efforts across 14 primary care clinics the csf g. >> quality data center is coordinating efforts across the hospital and the maddie team are the metrics, analytics, data and integration team is coordinating and exchanging data with the health plans and the reach is very wide. >> it takes a village to do this work. >> next slide. historically our strongest partnerships throughout the dpa have been with ucsf g and primary care. for the exact reasons that i outlined previously. >> that is largely what is measured in the qip program. as dhs has evolved their strategy to try to meet the needs of californians in core and incorporate behavioral health and substance use treatment into the qip program, this is creating future opportunities for partnership outside of csf and primary care that we look forward to.

>> next slide. some of the successes around quality include the robust quality reporting and improvement infrastructure that exists within primary care at the csf g campus and with maddie. >> we've also seen improvements in cancer and colon cancer screening as well as childhood metrics in the last several years. >> we've seen a change in health care delivery that has resulted in reducing disparities in outcome for black and african-american patients for cancer screening, diabetes control and blood pressure control. >> finally, san francisco health network excels in several metrics at the state level. >> we are the top performer for exclusive breastfeeding in the state and we are in the top three for performing performance for cesarean

section rate. screening for hiv developmental screening in children and lead screening in children. next slide. we've also had several successes in the data front. we can't do high quality work without strong data systems and high quality data. >> and one of the major accomplish moments in the last several years is transitioning our data sources from multiple different records systems to a single enterprise medical record. starting in 2019 as continued through 2024 with vhs coming on to epic. we've developed internal processes to include two to ensure high data integrity within improvement in data teams across the health network. these are standard processes that look at data capture data validation and data analyzes. >> we've also partnered with health plans to improve the data exchange and thus data integrity for not only uap but

also for the managed care quality incentive programs. next slide please. >> our successes on the financial front have already been mentioned but i think it bears mentioning worth mentioning again for the first py1 through six the first six years of the uap program we have brought in over $300 million to the general fund through this program. >> since the program inception the health network has achieved 100% of targets and we are expecting to exceed 95% of the targets and would happily accept and not be surprised if we hit the 100% mark again this year. next slide. >> for my last point i'll just talk a little bit about the future. >> we know that we have heard from dhc us that there will be major changes coming with this

program. do you see us is currently undergoing a strategy cycle that will be released to start a new strategy cycle that would be released in 2026 and we'll learn more at that point in time. but we have heard that while we will shift reporting processes currently our system and our team holds the responsibility for reporting, gathering all the data and reporting this to see us for this program. there is a shift that is happening that this will become the responsibility of the health plans on our behalf. >> this highlights the importance of that partnership that we've already developed around data exchange and data integrity with the health plans . >> we are working to improve billing where we can to capture some of the work that our some of the very important work that our team does that we're currently capturing through the

medical record to try to transition that over to billing so it shows up on claims for improved integrity of data on quality reporting. >> we are working to stabilize staffing to ensure processes for quality reporting and improvement continue to occur. as you've seen the participants and the key people who ensure that this program is successful are many. they're far reaching. they range from frontline staff to data analysts to health program coordinators and this is an important point and just for us to continue to think about what the role of each of these individuals is to ensure the success of the program. >> we have begun strategically partnering with the calling team in order to reach the most medically socially and behaviorally complex clients to improve health outcomes and the calling team here serves as a proxy to our connection with

the the teams who do the frontline work with these patients. teams like whole person integrated care, phc, the hospital primary care and outside of s.h. and hsa and we believe that through this partnership will be able to nudge the quality of the care of our residents and our patients just a little closer to target. that concludes my presentation. thank you. thank you. thank you for that very excellent presentation. any public come into the room? you know, hands and uh. i see no hands for remote public comment. >> i would probably add that our directors cy probably had something to do with the improved funding and the qip program. >> just just guessing me. i would about commission. commissioner gerardo thank you very much for the report and also answering some of my questions and and i just want

to make sure i understand. so i'm going to bring it down to kind of basics here is we've got targets of primary care in the general hospital right? and with the 20 categories plus the other 20 that are out of the 32, you take those categories and you are compiling data from multiple sources from health plans etc. the billing etc. and pulling together numbers. >> got it. then it's those numbers that you've compiled for these two for the general and primary care that you send then to for that qip. so it's okay you got it.

>> am i correct? yes. i was looking for yes, i would see how it was being compiled. i mean i get it now but i always i'm kind of a hard data person sometimes and so that's where i was looking like where are the numbers that's in my question. >> well first i would like to commend you on tackling a very complex program. we have a saying in medical education that you see one you've seen it do one, you just explained it now teach one and you've got it. >> i would say there are only adjustment that i would say to that is that the measures really look not necessarily at the specific department service but rather the in the patient and what the patient has received or what the patients control of their diabetes for example is whether it's primary care or jail health or even

outside of our system if they're assigned to receive care with us then that we in partnership with the health plan are responsible for their health. that's the way it is now and then the health plans then in the next year they have to first compile some of their own data that will be in the far future. and so we're taking a step wise approach towards tackling this very large problem. >> have opportunity i should say. no, no, i appreciate it. it's just i wanted to see where where all this data is and i appreciate this but also your other explanations. >> so to address your other question regarding where are the numbers? we track these numbers very closely on an internal dashboard and it is an internal dashboard because qip measures

these measures and the qip metrics look largely at the medical managed care enrollee population. >> but we know at the health network that that is not in our entire population. so we have a dashboard to track our qip progress but our improvement teams are using broader report that look at health outcomes regardless of coverage to be able to drive that care delivery system to improve processes to improve the health of everyone who comes so we don't share those numbers outside of the qip population because they can be a little hard to understand sometimes the nuances behind that and i did my best in the appendix to sort of estimate where we where we land. >> one point i think i'm not sure i can't remember right now off the top of my head who asked the question but one point i should make is that there is an opportunity for what's called overperformance and what this means is that through kind of a bonus points

type system we can make up for missed metrics and so every year we actually missed target for a couple of metrics and however we've been able to achieve the 100% 100% of the program because of this opportunity for bonus points or over overachievement that's allowed us to take a highly excelling an area and recoup up to us an entire metrics worth of achievement and apply it to a missed metric and it's allowed us to balance well thank you. >> i appreciate it. >> now i now get it. >> commissioner chao oh yes. thank you. thank you for this very well. >> thank you for your explanation for a very complex system and i have several

questions. >> one is you marked down that anthem blue cross. so are we a participant with anthem blue cross and these are our patients. they're not anthem blue cross is right. >> okay. right. so the medical managed care enrollees who receive medi-cal through anthem make up about 10% of the population that's assigned to us to care for through primary care and then the remaining 90% comes from san francisco health plan. >> so if health when do you expect health plans are green to actually the manage this data because i think it's a bigger problem than you think. and every time i learn a little more about the data, the health plans, i am humbled by how much work we have ahead of us starting in 2024 the state has given the option for us to choose the health plans rate or our rate to report in a system

they call better of reporting. this is expanded to other metrics in 2025 so it's optional and a choice for us right now and only available for certain measures. i expect though in the next i couldn't put a number on it but in the next several years probably not in the next one year but we're probably looking at a time frame over the next five years that this transition would happen. okay. well leases be perhaps out to five years because i think once we have another agency actually submitting data there is a real problem of of well first of all the delivery of care really being able to deliver that information. i mean as you probably know, medicare has had a system for many years with quality improvement with and and if we're dealing on a plan level it's something because then the

individual doctors have to even moving it from group to plan you lose something or you have difficulty in managing it and i, i like the fact that you can make a choice right now because you have i would imagine that your measures are better than the plans measure reports and i think that's a real challenge getting it because as you have said some of these measures do not carry a financial implication. so that has been a problem in the private sector■x. maybe not as much a problem here and it's probably a data problem here which if we are able to put those measures in i mean those of us in medicare continue to get these little lists that says, you know, here's the service vendor is zero. >> well because it's a quality measure i don't know how many people know that because they're just wondering whether the doctor got paid or not. >> so i'm pleased that it's not

going to be immediate but i would rather you know, i really challenge that if it's going to go to the health plan side that you also be sure that the health plans really improving their data. >> so if they're matching yours we have been in strong partnership with both of our health plans over the last several years and the work that our director of data and analytics has done with san francisco health plan was highlighted at a statewide conference recently. so i think we're ahead of many systems in improving the data exchange and you are spot on in terms of what you are concerned about and it is aligned with our concerns which is why we have a plan to continue to deepen these relationshi and now have more clarity around what it looks like to to exchange data and to partner

with them to ensure that the data reflects the work that we do. >> yeah, i do think you have a better advantage because you're not really dealing with the private or group sector which has problems getting the individual providers to really put those numbers in because they don't come up with any dollars or they come up with minimum dollars if you really have low volume and so forth and then you would start losing. but i really commend you for the explanation of of what the talent in program in your metrics are actually doing. i like your appendix which shows you which ones you now have the greens ad reminds me of work i used to do on quality assurance. i know what you mean and mining the data and trying to really get it right so when you can hit 100% just like you're doing you really deserve commendation . thank you.

thank you. >> i just have one question and it's amplifying what commissioner chao said which is is there any way that over time we can encourage people to move to the san francisco health network in away from anthem? it's wonderful. you've had a good experience with them but i don't think in my world the only good thing is they have to answer to the department of managed health care but other than that they've not been shall we call them collaborators? i don't think they have in particular. sutter from what i've heard there is quite a bit of money that needs to change hands so i'm wondering whether that would be at least the san francisco health plan is are true collaborate and wondering if as we plan for the future there would be a way or whether that's part of a strategy to try to help individuals change their plan. >> it is certainly something the relationships and the progress that we make with both

of our health plans is certainly something that we are tracking and monitoring as well as the quality indicators between the two health plans and our sharing. i'm sharing that regularly across the san francisco health network leadership team as a point to consider in when and if that becomes necessary. >> great. thank you. i all right no other thank you so much seeing no other questions or comments on this agenda item, we will go to commissioner chao who will first give us the finance and planning committee update from the february 10th, 2025 meeting . thank you. the committee met this afternoon just before the full health commission and reviewed the monthly contracts report. >> there was an extensive, extensive discussion concerning health right 360 and and not too much to financial because they have passed their last two

financial audits but in regards to the complexity of the contracts and what can really happen also at that meeting director tai indicated that they were also going to be looking at the issue of internal performance measures also and we had a good discussion again about the whole issue of trying to reach the information regarding really outcomes of of these programs. so that we can understand them. so it was really a healthy discussion and we're looking forward to further, you know, updates on that. there are two contracts that were on the monthly reports which are amendments. one is the health rate three six the very complex multiple programs in in in the main they all performed well and and the other contract is the registry

network which is really one of our registry networks and is used as needed and so the committee is recommending that we approve the contracts report . then we have a third contract i should say a new contract which is with crestwood behavioral health for a 16 bed voluntary crisis stabilization unit down in the tenderloin area or lower hill and this is for an $8,092,444 it's been in the works for several years. there has been community discussions on on the program and the committee is recommending approval of that program as one definitely needed for our stabilization

efforts and therefore we are recommending the approval of the contracts report and the new contract with crestwood. >> thank you. just by way of clarification is just the february 10th and march 3rd meeting. >> so it's a clerical error. >> it's only the march 3rd itself. so i will correct that because i said february 10th on our agenda. is there any public comment on this item? my my computer just shut down from me one second. i'm trying to use this one to to check it. is there any computer in any public comment in the room on this item? >> okay. >> no, there's no public comment on this item. all right. any commissioner questions or comments? all right. seeing none, commissioner chao will now give us the report

from the joint conference committee at zg from february 24th. the jcc had met february 24th. we discussed a very extensive safety construction update from multiple sources including some of the ten year plus i think upon issues. but but there is just a whole list of hours of renovations going on. i'll read them out because they are of interest and everybody may not be aware of all those that are going on. there is of course the seismic upgrade to building five then the intimate know that there's also then are a construction of a new adolescent psychiatric unit and the new family health care clinic location which i know commissioner geragos quite interested in we're putting in the new chiller tower everybody has heard about that and the

dialysis clinic relocation and the the the dialysis clinic issue has been going on for many years. but now it looks like they're going to be able when completed to have a nice dialysis unit, the public health lab as you know is moving out of one on one grow once the build out is completed. i believe they said it was now at about 50% completed. >> there is new space for the piece which should then operate much more efficiently and comfortably. there's about 300% increase in the space in pierce there's a building three retrofit which renovations are to enable the csf g to meet at the car auditorium again and there will be a new child care center somewhere there's a whole

discussion about where the location will be with the unions. the committee also then review standard reports on human resource regulatory and the ceo reports the committee was pleased with this new format from the ceo reports and we're looking are we are looking forward to the new metrics being introduced at the next meeting and during the medical staff that is the 2025 metrics not not a new format but during the medical staff report item the jcc is recommending that the full commission approve the z sfd policies which are on the consent calendar and in closed session we approve the credentials report and the pips minutes report so thank you is there any public comment on the jcc report? there's none.

>> there's no remote or in the room and is there any commissioner question or comment on that report? all right then we'll move to the consent calendar commissioners you have before you the consent calendar because commissioner chao has outlined all the items on the consent calendar and is prior to reports is there a motion to approve the items on the consent calendar? i so move to approve the consent calendar and is there a second second is there any public comment on the consent calendar? >> is there a public comment on this item in the room? there is no hand remotely either. >> all right. everyone who's in favor of approving the items on the consent calendar, please say i. all right. thank you. the next item on our agenda is other business. >> is there any other business ? and there's no remote there's no remote or in the room public comment so our next item is to consider the consideration of going into closed session. is there a motion so moved? >> second, is there any public comment? >> there is. let's see.

here we go mr. miniature you've got three minutes. >> okay. thank you mr. moore. hold on a minute. i read aloud the these to guys on as this commission goes into closed session to consult with the city attorney's office on the existing tommy thompson and john doe lawsuit against the teacher in the city. i urge this commission to encourage the city attorney to rapidly settle this case now before it heads to a trial by jury. as it is, the city attorney's office has been fighting this class action lawsuit since it was filed five years ago in march 2025 years of running out city attorney time and expenses have already worsened. how much it will cost to fully settle this lawsuit in your role as the quote governing body and close of laguna honda hospital you have a ministerial and fiduciary obligation to san francisco taxpayers to restrain costs of this. now five year old lawsuit settle this case now and put

thank you for that sort of help. >> but i know it's a little abuse scandal that lay behind the city. the move on. >> all right. so all in favor of going to closed session? please say i, i right. >> all right. so would everyone clear the room except for the attorney who was here and i believe the director and maybe deputy director folks who are watching you will not see us while we're in closed session or hear us but we will be back afterwards. >> we apologize for the the technical issues that occurred last time as i've got to be. i'm going to switch you over and i will call you back once we're done then please consider most of all in favor i thank you everyone please give me a second. >> try this down.

okay. we're done

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clearer 70's behested payment rules. but every situation is unique. we encourage to you build upon when you learned and roach out to the ethic's commission any time for advice. for specific questions condition tact the ethic's commission at 415-252-3100. or ethics. commission @sfgov.org thank you for your service and ticking the time to learn more about behested payments. in case there is is a discrepancy with this sum row and the law >> you would walk into the door

and encompass two doors with the stitch and clothing and factory side and fellowship ensure educational component of the development program workshop, classes, internships and apprenticeships. it's a pipeline through to the four deposit and i got in trouble with graffiti and fell into the law and the land and had to make a change. it's a wall, a gallery. three days after i got in trouble and got out and the other things, i took a nap during the day and in the middle of the nap something said learn how to sew. i thought why. i called my mom immediately and she said i used to do that in japan and i said why did you

stop, because i had you. so i thought i would keep that going. everybody presents printing the shirts and skate boards and t-shirts. i thought what is another commodity than t-shirts and it was jeans. i took a sewing class and they said don't do it. and i started sewing jeans. that's how i started and never stopped. my friend said she's a residential counselor for youth and that's what got me into education. i thought, what's up, bro? i didn't want to criticize and these kids and it just clicked. whatever happens. this is it. i'm going to use that skill that

i got in trouble for translating into this and now i'm sewing jeans and behind learning is also teaching. education and graffiti, that became the holy stitch that synergy of youth, art, community, safe space. the safe space questioning and why aren't jeans made here and how come youth are generating jobs and empowering themselves and get your clothes fixed. to be able to distribute that off the screen, vacant vibrant allowed that. vacant vibrant helped to pair new businesses with storefront to create new opportunities for downtown. this project has

given it a number of kinds of businesses the opportunity to test the waters in downtown and explore exciting new models that work for an evolving downtown neighborhood for workers, visitors and residents. >> vacant vibrant allowed a wider audience to the work and empowerment that holy stitch does. the reason that it's important for small businesses, the ones that their applications that didn't get accepted or approved, it gave them hope and a different perspective on what vacant vibrant spaces can be. i hope that vacant vibrant helps to support the businesses because there is a height of abandonment issue in san francisco where it's a prized treasure and disappears. vacant

vibrant can do more. >> vacant vibrant can do more than a pop-up and see what that looks like. >> that can allow them to be the the same scope public works commission to order it is thursday, february 27th, 2025 and we began at 11:02 a.m. mr. shotwell please call the roll. >> good morning chair post please respond with hear or present. eleanor bloom lauren post you're gerald turner paul woolford present