>> >> welcome to the city and county of san francisco health commission meeting this afternoon at 4:00 pm., tuesday, april 16, 2024. secretary morewitz. >> commissioner chow present. >> commissioner christian presents. >> commissioner chung present. >> commissioner giraudo and next item on the agenda is the land acknowledgement and commissioner commissioner unceded ancestral homeland of the ramaytush (rah-my-toosh) ohlone (o-lon-ee) who are the original inhabitants of the san francisco peninsula. responsibilities as the caretakers of this place, as well as for all peoples who reside in their traditional territory.

ramaytush ohlone community and by affirming their sovereign rights as first peoples. >> thank you. >> next item on >> 2. approval of the minutes of the health commission community and public health committee meeting of march 19, 2024, meeting. i believe secretary morewitz a few corrections. >> i'm sorry on the bottom of page 5 the word um, skilled should say guide. and actually i

need to run and get a copy of the minutes. >> so i wear my sneakers and on page 6 commissioner chow asked for a correction so at the top of the page states out of the $91 million spent on health services on the spec addressing medical conditions. >> any other any additions or deletions to the agenda? all right. seeing none, a motion to approve the minutes. >> so moved. >> second. >> second. >> and any public comment and then short statement about public comment autopsy let's see - in the public comment in the room first on the minutes. >> there is a hand before we

begin i have a statement members of the public can make comments up the three minutes. feedback in the individuals and community the process is in the meeting for the public comment to engage with back and forth with the commissioners and members of the public when discussing items making requests and individuals will have an opportunity to - public comment maybe sent to the health commission the word health dot and commission and.org if you wish to spell your name for the words with the state and federal

prohibits harassment and all right. so we have one hand everyone gets limited to 3 minutes per speaker as i noted before and first caller let us know you're there >> this is patrick code aa 24 minutes on page for about the march 12th la j.c. meeting and the court asked how many appeals the results has been unfortunate despite my records request the commission never answered me simply to file an appeal and that is totals 34 people with 10

cases unexplained and on troy williams come out to be get the good government award with dr. colfax in 2019 to change the recertification and williams was there then and now the quality officer by choice failure to have - for decertification and might not had the $26 million for insuring the process is against mr. williams is bad and then promised to reform the program in 2019 but causing the recertification so not honored for something that was partly responsible for creating and owe would resign in disgrace. thank

you. >> that's the only public comment on that item. >> take a vote. >> all in favor, say "aye." >> aye. >>. thank you. >> next item is general public comment and the script i read before answers one additional statement you may address the members of the public on commission from taking action or discussing any item not appearing on the posted agenda, including those items raised at public comment. i believe we have one one minute sir, to bring it up. >> go ahead. >> as you know i'm chief financial officer and previously talked about the illegal system and provided you that led to the

patient harm like sherlock's and others and into the home invites people with solutions and outcomes but talking about a citizens arrest can execute one. i prefer not to place individuals under arrest. i prefer we let people to stay in their room and move forward without compares and today, i'm your honor, the health commission to have a criminal complaint on multiple people this is illegal. and people talk in a negative way and i ask you include in our health those charges and recommendations should have california code 502

damages and unauthorized access to computer data and systems and california penal code makes it a crime to send electronic communications with reasonable fear for his or her immediate family and i urge you the health commission to kwefrmg you're the right people at the right time to make that happen to put san francisco back in the right direction within our gentrification i want to read what several people said you have the right to remain silent anything you say can be held against you in the - if you can't afford an attorney do you understand those rights?

>> i will make myself available for questions or comments for the health commission, however, i strongly urge to assist with needs and tomorrow to the commission information technology this is coming out and i think i would urge us to get ahead of that and i would recommend getting the department heads and communications so anyone that is miss using it people are dying over doses suicide because of this so i urge your assistance in this whole communication. >> thank you. >> we have also a remark public comment. are you unmuted please begin and it is patrick again. i'll provide written

communications for this agenda item. thank you. >> that's all there is. >> thank you. >> and i would say definitely read all the written communications we received secretary morewitz sends our way we to review them indeed the next is the director's report dr. colfax. >> thank you, president green and good afternoon, commissioners we have the director's report in front of you referring to that i'll not read all but provide highlights number one, is the laguna honda hospital with the center recertification update the hospital diligently working for recertification for the centers for medicare and medi-cal and called that in august laguna

honda member mathews row certification and now to recertified or service the laguna honda submitted the plans for the ems recertification safer the fire life safety was submitted on january this year and the health portion within january 17th this year we eagerly await in the department of health and the next steps towards april ems recertification and in addition in march of 24 laguna honda submitted the response and we are pleased to share those communication have correction for it and this department has an ongoing work with laguna honda and brings us closer to full recertification. we anticipate that we must

successfully complete the safer for the laguna honda to be recertified in ems. >> and laguna honda team working with the survey and decided yesterday saferers arrived at laguna honda and have currently conducting a very expensive survey. keep i updated as - when that more information becomes available if cms and dph is leveraging from across the departments for reducing overdosing in san francisco and this on increasing access to treatment we epic that the two key treatments for disorder and medicating done are cut the risk of death by 50 percent. and that

which is remarkable if you think about others like diabetes and people are effected and want to get the word out and make sure that people have access to the treatments. and ore dozing team making progress targets those goals and strengthening the goals and support for high risk for overdose and in the last month dph has expanded access for people with disorders in the south of market and between the night navigation program and worked with the state regulators to standard the retention across san francisco and specifically assembly member haney has a bill that will modernize the mebt

done in the state of california and along the lines of california policies around medicating done with the federal modernization of messaging done so the state is more restrictive at that point the makes mepth done more flexible we are in strong support of the bill and hoping that that will pass the state so people can access medicating done and speaking of surveyors in march had three survey teams and with the follow-up from their training and in their cancer surgery the health surveyed the psychiatricy

department and looking at at the system care and it went well and one surveyors or our was impressed and wants additional level of finding so she continues to be responsive to surveyor finding and quickly addressing the issues and then finally, i want to recognize health information information week which started yesterday information professionals week this week and our dph helped the professionals work with data and adoption for the quality patient care and so many more i want to thank the teams for they're

important work in supporting this and making sure they have access as well as revenues can be generated for the department and personally for the health information i appreciate the work to make sure that that system is up to date and are secure so that's my presentation and i'll be happy to answer any questions you may have thank you, any public comment? >> none in the room but one commenter. >> mr. shaw. again happy anniversary of the recertification think april 14, 2022, and a half month later dph hired to clean up the mess by the managers miss managing our

key hospital and reservicing the physicians and a senior agent director dated april 15th, frour to be recertified and years and years and still no progress we need an update and though dph has chief quality officers overseeing this and a 60 day rereform program so many gives to service 2022 and a lot of (microphone feedback) decertification. and up to one hundred and $27 million in actually costs and potentially one hundred and $54 million. why has recertification been to lenient and for two years doing it and another facility survey

inspection adding another 6 months before they're recertified?. thank you. >> that ends public comment. >> any other public comment great. >> commissioner giraudo. >> a couple of questions. >> a couple of questions. on the overdose work is there data how many people were actually engaged in the outreach of this 26 supportive of housing sites? >> as well accessed to tenderloin at the reach outreach. >> we have those i don't have those numbers in front of me but can get you those numbers to enforce what we're doing here.

>> will be helpful just to really give us a better- >> (multiple voices). >> we have them. >> great. >> my other question on um, the public safety inventors and response branch i'm wondering in the branch members of the branch folks are members of the national pedestrian erratic coalition? because continuation worst asking if they have excellent nationwide training virtual for pesticide trick i'm aware of their training i'm not

aware of that until a couple of years ago. >> i don't have the answer but we can for the. >> the pesticide erratic national coalition not thought of as a separate group. >> thank you for raising that. >> another commissioners comments and questions. >> commissioner chow. >> in regards to the fine work for the environmental branch is doing i'm wondering there is a percent on here of the number of additional enforcement operations i wonder um, if there is a way to understand how this has actually impacted those communities in terms of at the - i'm not sure after hours

operations at giants and warriors people went home that is what we're looking at there and in the others have we been able to bring this to a minimum or what will it take to that as we heard in the report that unpermitted food vending is unhealthful i want to know aside what it looks like increasing our activities but um, can we say what is still out there on the streets? >> so i think i'll clarify if i understood you're wondering in the after hours operation what we. >> yeah. that's a sort of a separate thing i was not quite sure what after hours are but i

understand a pregame- >> (multiple voices). >> oftentimes i've exercised and others when a game is over, or shows at night a number of vendors line up and many vendors are not permitted so there is lots. >> (multiple voices). >> okay. that's the case in that situation and in terms of the other question you, you asked about i believe online virtually provides more context to that. >> patrick are you available? >> i am my video i've been looting my video it it takes time sorry. >> we can hear you fine. >> great. i want to turn that on. thank you dr. colfax and commissioners for the question. there is quite a little bit of

vending that remains and otherwise and has grown after the pandemic and remains a challenge i you know our environmental branch is tasked with making sure the safety of the food that people eat and unpermitted food vending on the street is an ongoing risk so quite a number of situations and quite a number of incidents a large number of people who are selling food without permits including dr. colfax mentioned with the special events but in the neighborhoods of san francisco. >> as a follow-up a wonderful feature in the chronology of the night market in chinatown and talked about the thirty or show

booths were those all permitted in terms of having varies foods appropriately um, i guess supervised? >> yes. yes commissioner that situation in which again, our environmental health branch is involved to make sure the food safety that was a fully permitted venue that is that is a way in which we hope to encourage that type of food vending but not in a way that has oversight and aware of the safety is better for the public that is eating it. >> that's great i appreciate that and like to ask one more question flarmdz to the current survey what do we think will be a step will be taken either from, you know, past and present

it sounds like there for a few cases and after that do we expect a report back from them and have the usually back and forth. i know may not know but i want to understand the steps following the survey. >> i take the question and it is had a right to speculate. there's not a do you mind um, protocol but baselines what has happened in the past the surveyors complete their visit and there is a period of time can we get the report back with finding and have to respond to those finding i expect that will happen the same way.

>> right. >> i want the public to understand what we're expecting with the surveyors go on friday or something all surveys find issues that needs to be resolved i understand and therefore we again respond and um, of course, any point if they have to like what they saw they can tell us; right? >> we can get them recertified. that's their option. >> so i think again, it is very hard to speculates what will happen they're there to look at the different following up on the correction plan and to consolidate the correction plan and again, i think will get a

response sometime in the future to see what they're finding and once we respond to those finding we'll see what happens. >> at least waiting for sometime for them to be able to look at our correction plans and our review of the work that was done so at least that is a - another move forward to our recertification so- >> that way is important we submitted the questions in january. and it is april. >> they provided april 15th to come and visit for the corrections. so let's see - this is helpful for any other finding addressed quickly. >> thank you. thank you very

much. >> any other commissioner questions or comments. >> all right. seeing none, hope for a favorable outreach for the survey we know you'll keep us abreast what is going on and the next item we're looking at for the neighborhood the written presentation was exciting. >> thank you, commissioners. for having us. >> and um, she is remotely diagnose her slide and just say next slide, please. i'm kathy less than i'm the program manager for the program of the 2023 national hiv behavioral

surveillance and willi mcfarland, md, phd, director, center for public health research with healthcare for people experiencing homelessness and next slide, please. a today, we're going to do an overview at the stuart street response and go into more details about our street care teams within dph to answer the questions that was asked and then will discuss the recommendations next slide, please. um, so i'm very proud to share the citywide has made a lot of progress there's a motion on the floor part of cross effort to work instead of in silos to find out how to do that together and wrap

around people and with the dependents so we work closely with the department of emergency management and the fire department and department of homelessness and supportive housing and this is no not only communicate but make sure the timely responses are and with the department of emergency management you asked explicitly the street coordinator the manager somebody whom i started with and been in context and helped mow move forward seeing the essential coordination we'll talk about a little bit more next slide, please. as with a lot of healthcare we love our

acronym and so i think you're familiar with that street ore dose response team many past year was the launch of homeless engagements for response teams and um, and that is this is the healthy street operation center that organs san francisco hot street medication and the post overdose engagement team the office of triage team and my program and using those acronyms a lot next slide, please. and so in following with um, mental health and the attitude towards that

the city's response overall trying to make sure we are meeting people where they're at we have a response team 9-1-1 those are emergencies and so they are triaged to the overdose response team and also rapid response the community is once available and that is how the before mentioned heart team responses and our teams are focused on planned engagement focused on individuals. and so that is also there the encampment work as a team and street medication and as well as the triage in the neighborhoods. next slide, please. and so those are objective have a lot of civil service teams engaged and also working closely

with community based providers with the services providing peer services for the best neighbors and the center providing mental health work and couldn't do this without them an overview of the process that is the level of coordination we do across the departments we do have more flexibility and agreement about how you we are working with people experiencing homelessness and behavioral health crises on the street so this is sort of illustrates that and we develop our cup president green asking do we have target we're surveying and we're moving

people closer to the safety and health stability and how the street teams is by treatment and care and how people improve their access to healthcare and people that are experiencing substance abuse we are offering services to meet people in different stages of change and we're going to share a few examples like connections and the healthcare and behavorial health care will showcase where we are leading people in the stages of change and um, and again to slide 16 we want to go out of order i can offer an anecdotal story to highlight what we're talking about with the care coordination stabilization for people and

this scenario is mary and this is someone we came up that that scenario based on realtime experiences with hospitalization and she is 43 she experience bio policy and uses fentanyl and she's unsheltered and in a crisis 9-1-1 is engaged and the street crises response team meets mary. they asked about engagement refer her for follow-up for behavorial for the triage team so if dispatches into the neighborhood my team. our team responses to the following day and mary is highlight visible person. next slide, please. and staying on the street experiencing crisis and has substance abuse. so that

neighborhood team i mentioned outreach the following day they find her and she expresses not in a shelter not interested this physical healthcare and very clear she's in need of all those things with her communication from the street crisis response team and the adoption there and she does agree backpacks the neighborhoods to come back to speak with her again so we do. next slide, please. and we provide another engagement the following day. and we this time are accompanied by a nurse in the care and as of an initial engagement mary allows care and on the street with street medication and so we follow-up quickly and so this in

this case three times a week um, will be a many times and needed if this person is in crisis and building trust by coming back after several weeks she opened up to the team about some of our mental health challenges and the team offers psychiatry as well as street medication and psychiatrists addressed her and recommendations mentioned. mary has medication but concerned about being on the streets and taking those and can compromise her safety the team visits the shelters because an opportunity to motivate someone and she's able to agree to that we hope her move into a shelter next slide, please. and scientists are able to start marion medication and provide

that medication for bridge support and mary connects with the shelter team instead of medical nursing team by the management and other medical needs. >> she continues to decline the treatments and the best neighborhood team and shelter teamwork on using activation motivations and simultaneous is the team works on obtaining permit for mary by connecting her to another team. they becomes more stable for shelters but work on her car to intensifies case management people in shelters housed and serves in the community. the

case management takes over her mental health treatment and helps her to move forward and she has reduced the stress a packet to housing. and so if we could go back to slide 8 please thank you for the detour i wanted to share what we think is a success story a really beautiful path for someone to follow i'd like to talk about that in a way that with he if we have the lowest moments of our lives to see people through care to coordinate on a level we are a remarkable and we are i'm very impressed with the coordination we're doing. so our 17 street team we as you can see we in 2023 have over 23 though

encounters with people experiencing homelessness and offering a wide range of the overdose preservation and make sure we wrap around all people's needs and go into that in the next few slides. next slide, please. um, like many dph teams in behavorial health care we find a disciplinary approach is the most successful those are the way people are compassionate and also a way to really work people towards goals quickly an example is mary in the moments she is open to medication the quicker we can get her into shelters and treatment better so having nurses street psychiatry with

the behavorial health clinictions and i dictionary medication providers fortifies building that needed trust with the system. >> and focused on short term and long term i think that mary needs both there is in stopping to wait for one thing to happen before we move forward we are pushing supportive housing additional assessments meeting needs around psychiatry and supply food and transport and other resources next slide, please. and i'm happy to share about the best neighborhoods one of the streets care teams um, and so we launched in march of 2023 as part of office of corresponding care with behavorial health assessments for people living on

the streets with acute behavorial health needs and our team is placed we are neighborhood based and the same teams in the same neighborhoods through the the week so not just people experiencing homelessness but getting to know the geography for other community-based organizations and find that approach is incredibly helpful to wrap around people and level the information needed to work with people. um, we are working closely with the e m street medication and why think any of our work is done on the owner it is alcoholic and our clients are like mary referred to the follow-up for the teams come to the triage team and we also work with shared clients those are people that are having contacts

and garnering many 9-1-1 high-risk and not doing well experiencing homelessness so we work to elevate their needs. um, in march our first year of service march 23rd to this, 85 engagements on the street and we had 11 hundred offering 11 hundred links to the services and medical care and sheltered and our budget is over $6 million and we currently are staffed about civil service and peers (unintelligible). thank you. >> next slide, please. we also

sorry have the street crisis team those are actually led the work on the ground by the fire department. the dph did collaborate with the build contracted staff on the rigs or the 9-1-1 dispatch vehicle and graham peers on the response team in addition to the hsh staff. and dph contracts other peers on the streets for over dose response team next slide, please. kathleen thank you for your leadership and we are in meetings and communication not daily but many, many times a week it is longer-term 6 days a week and statements are provided for in the moment for you are talking

about care needs oftentimes when they're seen by another outreach team and providing what we can transition to primary care people that have a hard time connecting so in a number of situations the street medication providers is oftentimes through someone you might think of we go to them and people find care we have 16 offline clinics at home reduction we want to go where people are experiencing homelessness. so in this community um, our street medication clinic providers work at the center and a lot of times 1340b will be connected to street medication by a outreach

team and get to know the medication and get software and we're going to build a relationship and street medication in the past year about three thousand mentioned for over 11 thousand folks it is $5 million and there is about 18 and a half staff that is nurses and house workers and medical providers and also have peers who help out on the peer services. there was a follow-up question. so - and can we go to the next slide, please. >> our next slide the teams that is in about one year and reading with survivors

experience a non-fatal overdose but the paramedics that respond to the new any call and the post overdose compensated team that works with the follow-up in engaging people in an ongoing way that team has about 15 hundred in clournts in the past year for 6 hundred clients and seven hundred and 8 three treatments and commissioner giraudo had a question about accessing treatment and how to get the integrated data about mebt done and a door of opportunities to connect people for disorders and knowing that people may slow over time when someone says no they're not

interested we take that as we're to refer to another way to engage people. we've done a lot of counseling about the owe dose and talk about in a minute. but we look at the numbers for fy2022-23 our team did a lot of clournl on ore dose prevention and providing medication and describing a little bit of referring to management the budget is four and a half million dollars and that is the staff dph staff and health workers and providers and the community-based organizations contracts. for behavorial health. >> what we really found and

president green asked a question about is we had a really found out was an amazing window of opportunities for people to seek change after on overdose we found that it is try that is really the high road for people and other people were in a state of crisis feeling sick not wanting to engage at that moment we spent a lot of time looking for people that we couldn't really find so we got the information from the fire department. about who they had seen the day before our staff goes out and loose for people and people offering information and hard to get to know we've been doing a lot of work what is that model for the program that

the program around providing at the right time to do this work and we have been shifting from running around the city looking for a market and 7 to try to identify more individuals with a higher and i cut and higher priority like people that have experienced overdosing and to move forward those in is in a overdose and needs treatment for medication people that are interested in medication for opioid disorders or other treatment we want to make sure we are there for the windows of opportunities and people that are referred by community partners who have higher risk conditions who might be pregnant or oat health issues to make sure we are focusing on our

vulnerable survivors our clients are in two groups those we're working with that are interested and people that are really hi risk and not interested in care we're looking at how do we sort of come up with the metrics for those models and making sure we're providing care i know that president green had a question about the testing and screening which is a offered for through our street medication team um, and people have a positive test we have two people in the field to get to people and make it as easy as possible. next slide, please. we have had a number of improvements and really working

on reporting on that goal we know those are questions you asked us about and really want to make sure we are capturing the data across the teams and doing a lot of great work in the neighborhood and tracking and supporting them and street medication on a number of quality goals computing monitoring the number of clients that are screened important alcohol and tobacco and we or able to bring our healthcare services to the street and using telling help services we launched looking at the metrics around hiv and undetected fiber left side and there our medical

team reporting what we're doing and as part of the our coordinated iron collaborate in the use of acid on a citywide level to identify the citywide serves and the players and individuals that can attest moving forward i was in two meetings about this and after reporting today so we'll have the board informed about that and. next slide, please. we had several recommends for things we want to provide i update on one of them was the service model. to improve the success rate and follow-up for clients referred to services and the follow-up rate at the time of the street audit was 64 percent that increased from up 20

percent in 2022 and beyond. and merged the response team into the office of care that provides health coordinates and photocopy for people that have multi contacts and i know we talked about some of the changes we made that we're spending less time looking for people. and who may not be in san francisco. and really focusing our effort on the higher acute and for poet we are working with the specific through the mayor's office of engagement to make sure the team our poet team and work with people if permanent housing and really have a connection so we

don't lose people as at the move through the system i know that president green had a question about follow-up and a lot of is the office of coordinated care with the fire and the contacts and we also do a chart to insure that we're in a position to learn more about the individual we know where they are in the system so we are not relooking at services and bring in the partner that people maybe working with a lot of time our team - and then by triage and we connecting important potentially a new service. >> and. next slide, please.

we have talked about this scenario again to define that intensive story to look at working with the vulnerable people in the community really takes a number of teams and our team developed specialists in certain ways i know that brings a lot of questions and really wonderful in the past year to come up with the coordinated ways in which we're kwopd and working hard to help support people. >> thank you so much for the presentation it is encouraging to hear about the coordination working together with that is important we appreciate all the work you're diagnose a huge challenge that we all have great concerns my public comment on this item. >> yes. we have one remote public comment.

>> hand up the person. >> mr. shaw you're unmute. >> and i didn't lower my hand. >> no public comment. >> commissioners comments and questions? >> commissioner chow. >> yes. um, thank you for this whole list of 9 different organizations in cooperation and i was looking at all the numbers and you actually were answering some of my questions where you want to go in the future. >> what i'm curious about right now with all of those teams is whether or not the individual - well, first of all, a central file on those individuals so that all the diversity teams what look at that additional then the

individual side is there a particular person that the individual can identify as being they're what we call in clinical medication primary care but would be somebody they trust and then look at where they want to go you 2345ekd mary through a different team but if i were mary, i might really want to know, you know, who can i count on can look for the teams for me. >> those are kind of two questions. >> i'll take that [off mic.] >> i would say in terms of where the centralized we our team in street medication in the best neighborhood of coordinated

care that is will be helpful essentially getting the data how many times this person has been to the hospital and how many engagements with the software and that is also information we're sharing across the departments helping us the coordination allows us to see most updated care plan and the next step for the person the point person for them and so those - that is what we're communicating in realtime. um, the office of care i'll say is filling that piece of people transitioning the point person is mary is in the best neighborhood we're talking her through the roll and being there with her transitioning for her ongoing care in the interim is meant to be that for people in the best neighborhoods serving

that role for the point person living on the street and for the primary care. >> in the person it depends on the individual that is important for them to feel trust in one individual all helpful for them and team we get to know and we don't want them to be on vacation or sick and a lot of times medication is with a disciplinarian team is gathering for healthcare working we try to have consist staff that is helpful they get to know more than one person so they're familiar and so someone is on comfortable talking with one person we'll find a way they can identify a point person. >> so we looked at the example

i'm trying to picture how this all groups or teams kind of work together. how did mary, i guess get all the information different team members come to her? >> and then was she able or someone like mary for them to guarantee i'd like to see if i want to go here and start treatment and if they did feel they wanted some person how do you assign in that which of those blocks or teams. >> so i think in this situation that neighborhood will be the point person. and i think for mary usually a lot of like getting to know her asking her questions can we give her water

has she thought about open to telling us about you wear red a better color and find ways to work have you thought about going inside. and so a lot of times when we talked about our staff identifying we're concerned about mary for the monitoring the first couple of times people met her they went away but building the relationship and planting the seed we're taking mary to place maybe next week i'll be here and introduce you and we're going to get you into shelters and introduce you to the staff. and we have a helper feel free to

call me, you talking about free to call moan in the team? >> yeah. it mary was connected to a person they'll be saying student shelter we need you're having a hard time connecting with mary, i, join you. >> okay. so you look at significant your offering a team and if they're comfortable with the team you're taking the team and they work with the team and people otherwise somebody really look like to be able to make decisions with one person and then ask that one person probably out of best program and i think, you know, even one person for the best program mary

had specialized needs that require medical services so that's the best coordinated i'm there making the introductions and having her connected with the services. >> thank you. >> no, thank you. >> a lot of hard work corresponding with the teams and needs to help the individuals really appreciate the report. thank you. >> vice president guillermo. >> thank you for your report and all the work and that been able to put into that and report for the progress i know a lot of this in the coordination is new the collaboration is new so difficult to be able to reports peacefully are but you helped us to understand. it is analytic out labor intensive and skill

intensive and intensive this whole effort across the city for such a large challenging problem i'm wondering as part of the your evaluation of how this is going we think about the numbers on growing is that possible to stress test this model and think about what is the capacity for this model, you know, to serve the number, you know, in the judge a scenario planning thing whatever. however, that might get done and probably need more data to do that but is it potential we look at the success and missing 5 ftes and i think

that are in the best interest the best and then recruiting the kinds of clinical and other specialized talent to this. really need i think real critical realistic look at what is possible and how much of it is possible. um, so is it possible to estimate that? >> and then to plan it accordingly assuming as you described are the best ways to do it? >> i lost. >> thank you for at acknowledgement of coordination i know to step out and the leadership of the dph and in a collective way with the

departments never works in silos but a leadership directive that people are not take care i can't tell we're working together and the same goals and clients and that has been really level for our work in some of the organizational changes are working together and we think this it partnering from our sister, you know, department (unintelligible) so the place of capacity feels to me we're in the best practices we work with the authority and really looking at each of the teams has that capacity of individual (unintelligible) oftentimes in the thousand and for the people that really need the alcoholic coordinated work together that is vulnerable and oftentimes seems less interested what we have to over that is the place

we're to identify with what are the numbers we can work with. um, understanding some people will be coming in working with them intensely and hoping backing off and destable them and connecting them to others things why have a concrete answer but backing both that and i curious what my colleagues. >> the pirate list working with the staff and you're talking about the stress test with the most at risk who are they and to begin with you. >> part of what i was getting at can we predict or estimate

the capacity that requires needed the resources all the kinds of resources and what might is take? for our job, you, know, we need to be able to put that in the connection as we look at the individual programs that come to us. and we, you know, um, maybe will be annual report on the coordinator effort but in a time of dylan resources and higher - assuming we're making a difference it sounds like we are. we have to say then and be able to support more of this; right? we're a modification and the other priorities; right? this really important to have that from you

what is potential not just in terms of outcomes of individuals but it totality and prediction into the future. >> so that will allow us to take some of the integrated data systems and people are experienced homeless with multiple departments visits and multiple fte visits with over dose with which one health issues you're the integrated data to identify this and help us tell you what we're seeing as the collective data. >> commissioner giraudo. >> thank you for answering my questions i appreciate it excellent presentation. within

the things i often do i represent the general hospital foundation and also present at the meeting something here on i've done it video think those initial crisis response team and i'm presenting again which i'm going to use some of your slides but will be helpful i don't need a slide but to um, mark a 5 sentences and what it is because i think, you know, what you're saying this is going to be a key. >> yes. >> in pulling things together will be questions of many of those techie members and, etc. so you wouldn't mind just.

>> (unintelligible). >> i'm not incorrectly quoting you. thank you very much. is helpful i looked forward to continued information from you. >> thank you. >> i echo that looks like you have a really thoughtful infrastructure in place i think that we will especially about the poet team i'm wondering when you look at our prescribed morphine 15 percent for the management what kind of context can you give us for that i thought that was interesting obviously, the moment of crises people are not thinking beyond the moment i guess the question if you could create and realistic statistic what will it be? and secondarily another

thing like boston many years involved the best practices to accelerate our work and hips us avoid effort that exact may not be as effective as others i'm wondering if you can create help us understand if you you were to refer back in a year on poet what will be europe dream presentation and then are there lessons to learn to accelerate the work. >> i know our teams are working across the country and going to healthcare for the homeless and a number of medical doctors and frequent speaker at at number of, you know, national conferences and thank like i said and i can get the information about the specific partners as well as we're work

with the partners and co-author what might be expected outcomes as far as, you know, medication starts and other patients to care treatment is supposed to have that i don't want to misquote that information off the top of my head. >> it will be helpful to have a benchmarks from other jurisdictions trying to had the same work like a fat problem so appreciate what you're doing everything including to the loss of collaboration and objective every success is tremendous we support our work entirely and in the commission can help you most honored and appreciate what

you're doing. thank you. >> amazing. >> staff you're out there everyday and had a lot of rain recently and you're out there in there in the rain and with the air quality is bad and you're incredibly condominium to building relationships for vulnerable neighbors. >> thank you to your team as well. >> wonderful. >> all right. next item on the agenda is committee report for laguna honda. >> thank you. >> at the april 9th laguna honda hospital j.c. meeting the committee reviewed the reports for the executive report and the vacancies the h.r. vacancy report and also had

recertification updates as dr. colfax noted we had at the time i participated and hoping that the survey team was going to be arriving at the laguna honda any day and fortunately, we heard they arrived yesterday and as far as we know hadn't been anything untoward to report from there but, you know, there is a lot of that so hopefully, we'll hear they have completed their review and we're going to continue to move on is recertification june in a positive way and reviewed the regulatory affairs report and, you know, is in the midst of recertification and stabilization issues that laguna honda has been quite a

recognition of some of the work going on otherwise at laguna honda. and the leadership were asked to present as conference and in reporting back to us sandra simon at laguna honda noted a number of the folks at the this as national conference whatnot just healthcare but a lien across the lots of implementers ask what they thought was an interesting unique complication of the liens with realignment care that is blazing a trail i think that is important for us to know a lot of good work coming out of an

unfortunate um, period over the last couple of years um, so said to make sure we noted that and during the review policies the committee requested that one policy approval delayed to the complexity of subject matters and the need for additional clarification we'll be putting that on the consent agenda for today except for one policy we'll hope to review in the meeting next month and in the closed session we approved the report. >> any public comment on this item? >> one hand up. >> mr. shaw you have limited to 3 minutes per speaker. >> thank you. >> this is patrick again. the j.c. meeting summary presented didn't men the chart on april 9,

2022, with the certification two years on april 14th a total of 4 hundred and 15 facility incidents reports on a regulatory affairs report present for the jcc those after recertification occurred one had the and 29 roecht 1/3rd for the events 5 three major incidents 41 percent including 26 events and 11 major injuries one thousand corrective action incidents costing $40 million. and unfortunately, members of the public do the right thing how many of 11 injuries included about the residents and were in the regulatory report finally

revealing the jc dying within - and number 7/forward regulatory affairs report complaints not investigated is concerning the 70 - the march 16th, predicament finding may change due to the patience to investigate they received a final citation and unfortunately, didn't indicate in the jc had anomalies

complaints are not investigated. >> thank you. >> that's the only comment for this item. >> any commissioner comments or questions on the committee report seeing none, next item is the consent agenda have before you the policies that were reviewed and recommended for the full commission approval for this um, group of amount of policies is there a motion to approve um, the consent agenda. >> so moved. >> second. >> any public comment. >> i see one hand. >> mr. shaw you're unmuted. >> i want it thank the commission for house voting the um, policy from the jc meeting for additional revisions but other than that no to the public

comment. >> but thank you, commissioners. >> all right. that's the only comment. >> okay. thank you. so you see is before you an action item go to a vote. >> all in favor, say "aye." >> aye. >>. thank you. >> so it is approved. >> and the next item is the report from the public safety commissioner giraudo. >> two interesting presentations. the first was health and it focused on the medical behavorial health programs of j ph the jail and their goal to screen stabilize and link um, the incarcerated the services include both from primary care and control mental health and substance abuse disorder. in last year were 11

thousand three hundred and 6 incarcerations seven hundred and 7 thousand plus and 82 percent male and 6 february of 24 this year 26 were latino and black and 44 white and three 23 percent and the average number of patients from july to march was um, those that were screened for opioid per month were seven hundred and 67 people. but today 7 which is a very few are still in in custody and only 19 agreed to further treatment out of those folks. 76 percent of those

that are incarcerated are released within 7 days so today 1,000 plus people in the jail. um, what is interesting was noted there's a 5 three percent they're in um, those that are in jail from may 20, 2022, to now. um, one of the areas we really decided and they gave us great information was on the difference that kelly aim 97 percent in the jail were qualified and allows the providers to come in and link with the patient for post relieve services. um, they have are um, jail help has an application to cal with bulk to start month of services under

cal aim are jailhouse programs have already are ongoing services but there are new and as of april 2025 have their applications approved and be able to build those services and be able to connect those do not have medi-cal and it was a interesting data driven report and with the challenges that they definitely have. >> our second report was the hiv 2023 national hiv behavioral surveillance which is fund by grants and paralleling nih that is reported is men who have sex with men and the goal of the study was to look at preferences

approximate and care programs and emerging health issues the example that was conducted in san francisco were 5 hundred and 45 were enrolled up the in n h in 2023, 24 percent and were one in four men who have sex with men are living with hiv. um, there is a disparity in with in the numbers of those 45 percent of that population are black african-americans with the last x population on the other hand, merging and their numbers are rising. >> of those surveyed 92

percent have insurance and 82 percent were tested for hiv a slight increase of 82 percent and settlement on the engagement with preparing that is statistics in san francisco for those engaged with preparing are higher than in the rest of the country. um, but those who used prep in the last 12 months the numbers are slightly down. in 2022 since 2022 that is the last figures they have one had and 57 new dialysis one of the concerns is that the numbers might be stalling because of the use of the medication for a variety of reasons. um, one multiple which they noted but many of the

providers one the biggest one it is the primary care providers not asking the patient about whether or not they have used prep or access to prep that is surprising but within the questions i asked they came up with the data. but the positives that came out was in p.o. box we're still one of the most successful in the country and as well as in hiv not only identification but prevention continue to be one of the leaders in the country so was an update on the study. >> um, cannibis a little bit different which is great different than proving we can

presented for. >> so that concludes my report. >> anything more to add. >> thank you for the report any public comment? >> i see a hand. >> actual the hand went down in public comment. >> i have a question commissioners questions or comments. >> commissioner chow. >> incidental the only comment or perhaps we know since the amount of the money is a work order from the sheriff if we do do billing will we be able to keep that? >> my understanding is that one be separate. >> oh. >> okay. thank you. >> and also pay for additional staff they're going to be hiring a mutual budget. >> oh. okay. so we should be getting more. >> (multiple voices.) >> and that is double.

>> part it is fair right now targeting at least 15 staff they will be hiring to be able to implement the program. >> right thank you. here we go no other commissioners questions or comments thank you, again. and we'll two to others business. >> any other business? >> no public comments. >> in public comments. >> the next motion to go into closed session. >> second. >> and any public comment. >> no public comment. >> i will unmute the caller mr. shaw limited to 3 minutes per speaker. >> thank you secretary morewitz. >> here we go. >> as i go into closed session don't forget this commission

clearly do you mind the declaration as it is coming up as the governing body didn't perform it's fiduciary duty it costs the city $1.5 million for the hospital and failing for two years for emissions the declaration was clear and replace the governor brown body failures and san franciscans deserve better oversight mechanism and the declaration that lawsuit is not my journey and with objections for - double and trip that is preposterous. >> city attorney is asking us,

we for our lying is referring to the 5 hundred and 7 pages of documents for the $268 million and document the pms (coughing) why does i expect us to believe without our own eyes for the recertification this doesn't be how they operate and now we are asked to look at the pages with double and triple mismanagement and by the declarations for the fiduciary objections. thank you. >> that's the only comment for this item. >> great. >> all in favor, say "aye." >> aye. >> going that closed session. >> please give me me sfgov

we'll be back sfgovtv i'm going to move you to (in closed session). >> by disclose or not disclose. >> i make a motion to not disclose. >> all in favor, say "aye." >> aye. >> thank you and now consideration for >> so moved. >> all in favor, say "aye." >> aye. >> thank you, everyone [meeting adjourned]

>> item 50 is resolution calling on department of public health to provide medically necessary transition related care for transgender related people and remove restrictions. >> in 2012 gender health sf was born out of advocacy from community stakeholders and local leaders. really as response to providing quality, accessible jnder aaffirming care for the most under-served. (indiscernible) the way i see it, there is two ways of folks we serve at our program. the first wave of folks who never imagined surgery access was accessible to them. many folks who had to save money or par ticipate in underground economy to access the surgery outside the country. (indiscernible) really to make

something real in terms of being able to connect with the gender identity and external (indiscernible) and so transform so many lives of many of trans folks who never imagined it was accessible to them. now we are in the different era and time where transrights is in the social political and general (indiscernible) and now we are serving young folks to support them and making sure their gender identity is connected to who they are, so providing a space to support transfolks to live authentically and that is the goal to provide the level of care trans folks deserve. >> when it comes to access to healthcare, while we all believe in cost control and make sure we deliver healthcare in a cost effective manner, i dont think that cost is a reason or legitinate

rational to exclude people from healthcare (indiscernible) colleagues i ask for your support. >> thank you supervisor wiener. colleagues on this item can we do this without role call? same house same call, without objection the resolution is adopted. [applause]book. thank you. >> (music). >> my name is orlando i'm the owner and operator of sf pizza. >> pizza is my expansion growing up i loved pizza and loved to cook and been in corporate banking jobs my that whole life wanted to own a pizza or and moved to san francisco 45

years ago and couldn't find pizza i like so one day of saving and trying to figure out what i would like to do to fulfill my dream and to literally must be that i went out on my own toes an interesting things skills i again have to working on the slight changes to find the right product and came up with something i enjoy and continue it. so the positive important thing in years and years and years of trying to get it where i like it is for the sauce i use a unique sauce to bring out the flavors have to mats and capital improvement plan any and using use a high quality of cheese the products work together more important to me have a high

quality of pizza and made with love and what i try to keep it to be a comfortable foods or food and that's what i try to over and offers so having a really bus illegal day in the community and rile appeal to me and that's what i was trying to accomplish i have thought when i got into pizza the main thing if i can, make a great cheese pizza he can do anything like growing up that's what i brought to to and now called san francisco

>> [music] you are watching golden gate inventions with michael. this is episode exploring the excelsior. >> hi i'm michael you are watching golden gate inventions highlighting urban out doors we are in the excelsior. pickleball. let's play pickleball! pickleball is an incredited low popular sport growing nationwide. pickleball combines tennis, bad mitton and ping pong. playod a bad mitton sized court with paddle and i plasticic ball. starting out is easy. you can pick up paddle and balls for 20 buck and it is suitable for everyone in all skill levels you see here. the gim is played by 2 or 4

players. the ball must be served diagnoty and other rules theory easy to pick up. the game ends when i player or team reaches a set score 11 or 21 point bunkham win bright 2 pickleball courts are available across the city some are and others require booking ahead and a fee. information about the courts found at sf recpark. org if you are interested in playing. now i know why people are playing pickleball. it is so much fun you play all ages. all skill levels and pop on a court and you are red to g. a lot of fun i'm glad i did it. all right. let's go! time for a hike! there is i ton of hike nothing

excelsior. 312 acres mc clarin the second largest p in san francisco. there are 7 miles of tris including the there was fer's way this spreads over foresxeft field and prosecute voids hill side views of the city. and well is a meditative quiet place in mc clarin p you will siendz labyrinth made of rock:now we are at glen eagle golf course special try out disk golf >> now disk golf! so disk golf is like traditional golf but with noticing disks. credit as the sport's pioneer establishing the disk ballsorption and the first standardized target the disk

ball hole. the game involves throwing from key areas toward i metal basket. players use different disks for long distances driver, immediateerate. mid range and precise shot, putters. players begin at the t area. throw disks toward the basket and prosecute seed down the fare way. player with the lowest number of throws the end wins the game. disk golf at glen eagle cost 14 dollars if you pay at the clubhouse. there is an 18 hole course this is free. du see that shot? i won! am i was not very good now i have a huge respect for disk ball player its is difficult but fun. thank you for joining me in the

excelsior this is goldenate adventures.

when i shoot chinatown, i shoot the architecture that people not just events, i shoot what's going on in daily life and everything changes. murals, graffiti, store opening. store closing. the bakery. i shoot anything and everything in chinatown. i shoot daily life. i'm a crazy animal. i'm shooting for fun.

that's what i love. >> i'm frank jane. i'm a community photographer for the last i think about 20 years. i joined the chinese historical society. it was a way i could practice my society and i can give the community memories. i've been practicing and get to know everybody and everybody knew me pretty much documenting the history i don't just shoot events. i'm telling a story in whatever photos that i post on facebook, it's just like being there from front to end, i do a good job and i take hundreds and

hundreds of photos. and i was specializing in chinese american history. i want to cover what's happening in chinatown. what's happening in my community. i shoot a lot of government officials. i probably have thousands of photos of mayor lee and all the dignitaries. but they treat me like one of the family members because they see me all the time. they appreciate me. even the local cops, the firemen, you know, i feel at home. i was born in chinese hospital 1954. we grew up dirt poor. our family was lucky to grew up. when i was in junior high, i had a degree in hotel management restaurant. i was working in the restaurant business for probably about 15

years. i started when i was 12 years old. when i got married, my wife had an import business. i figured, the restaurant business, i got tired of it. i said come work for the family business. i said, okay. it's going to be interesting and so interesting i lasted for 30 years. i'm married i have one daughter. she's a registered nurse. she lives in los angeles now. and two grandsons. we have fun. i got into photography when i was in junior high and high school. shooting cameras. the black and white days, i was able to process my own film. i wasn't really that good because you know color film and processing was expensive and i kind of left it alone for about 30 years.

i was doing product photography for advertising. and kind of got back into it. everybody said, oh, digital photography, the year 2000. it was a ghost town in chinatown. i figured it's time to shoot chinatown store front nobody. everybody on grand avenue. there was not a soul out walking around chinatown. a new asia restaurant, it used to be the biggest restaurant in chinatown. it can hold about a 1,000 people and i had been shooting events there for many years. it turned into a supermarket. and i got in.

i shot the supermarket. you know, and its transformation. even the owner of the restaurant the restaurant, it's 50 years old. i said, yeah. it looks awful. history. because i'm shooting history. and it's impressive because it's history because you can't repeat. it's gone it's gone. >> you stick with her, she'll teach you everything. >> cellphone photography, that's going to be the generation. i think cellphones in the next two, three years, the big cameras are obsolete already. mirrorless camera is going to take over market and the cellphone is going to be better. but nobody's going to archive

it. nobody's going to keep good history. everybody's going to take snapshots, but nobody's going to catalog. they don't care. >> i want to see you. >> it's not a keepsake. there's no memories behind it. everybody's sticking in the cloud. they lose it, who cares. but, you know, i care. >> last september of 2020, i had a minor stroke, and my daughter caught it on zoom. i was having a zoom call for my grand kids. and my daughter and my these little kids said, hey, you sound strange. yeah. i said i'm not able to speak

properly. they said what happened. my wife was taking a nap and my daughter, she called home and said he's having a stroke. get him to the hospital. five minutes later, you know, the ambulance came and took me away and i was at i.c.u. for four days. i have hundreds of messages wishing me get well soon. everybody wished that i'm okay and back to normal. you know, i was up and kicking two weeks after my hospital stay. it was a wake-up call. i needed to get my life in order and try to organize things especially organize my photos. >> probably took two million photos in the last 20 years.

i want to donate to an organization that's going to use it. i'm just doing it from the heart. i enjoy doing it to give back to the community. that's the most important. give back to the community. >> it's a lot for the community. >> i was a born hustler. i'm too busy to slow down. i love what i'm doing. i love to be busy. i go nuts when i'm not doing anything. i'm 67 this year. i figured 70 i'm ready to retire. i'm wishing to train a couple for photographers to take over my place. the younger generation, they have a passion, to document the history because it's going to be forgotten in ten years, 20

years, maybe i will be forgotten when i'm gone in a couple years but i want to be remembered for my work and, you know, photographs will be a remembrance. i'm frank jane. i'm a community photographer. this is my story. >> when you're not looking, frank's there. he'll snap that and then he'll send me an e-mail or two and they're always the best. >> these are all my p

[♪♪♪] [♪♪♪] >> so i grew up in cambridge, massachusetts and i was very fortunate to meet my future wife, now my wife while we were both attending graduate school at m.i.t., studying urban planning. so this is her hometown. so, we fell in love and moved to her city. [♪♪♪] [♪♪♪] >> i was introduced to this part of town while working on a campaign for gavin, who is running for mayor. i was one of the organizers out

here and i met the people and i fell in love with them in the neighborhood. so it also was a place in the city that at the time that i could afford to buy a home and i wanted to own my own home. this is where we laid down our roots like many people in this neighborhood and we started our family and this is where we are going to be. i mean we are the part of san francisco. it's the two neighborhoods with the most children under the age of 18. everybody likes to talk about how san francisco is not family-friendly, there are not a lot of children and families. we have predominately single family homes. as i said, people move here to buy their first home, maybe with multiple family members or multiple families in the same home and they laid down their roots. [♪♪♪]

>> it's different because again, we have little small storefronts. we don't have light industrial space or space where you can build high-rises or large office buildings. so the tech boom will never hit our neighborhood in that way when it comes to jobs. >> turkey, cheddar, avocado, lettuce and mayo, and little bit of mustard. that's my usual. >> mike is the owner, born and bred in the neighborhood. he worked in the drugstore forever. he saved his money and opened up his own spot. we're always going to support home grown businesses and he spent generations living in this part of town, focusing on the

family, and the vibe is great and people feel at home. it's like a little community gathering spot. >> this is the part of the city with a small town feel. a lot of mom and pop businesses, a lot of family run businesses. there is a conversation on whether starbucks would come in. i think there are some people that would embrace that. i think there are others that would prefer that not to be. i think we moved beyond that conversation. i think where we are now, we really want to enhance and embrace and encourage the businesses and small businesses that we have here. in fact, it's more of a mom and pop style business. i think at the end of the day, what we're really trying to do is encourage and embrace the diversity and enhance that diversity of businesses we already have. we're the only supervisor in the

city that has a permanent district office. a lot of folks use cafes or use offices or different places, but i want out and was able to raise money and open up a spot that we could pay for. i'm very fortunate to have that. >> hi, good to see you. just wanted to say hi, hi to the owner, see how he's doing. everything okay? >> yeah. >> good. >> we spend the entire day in the district so we can talk to constituents and talk to small businesses. we put money in the budget so you guys could be out here. this is like a commercial corridor, so they focus on cleaning the streets and it made a significant impact as you can see. what an improvement it has made to have you guys out here.

>> for sure. >> we have a significantly diverse neighborhood and population. so i think that's the richness of the mission and it always has been. it's what made me fall in love with this neighborhood and why i love it so much.