Mental health respite programs perhaps looking this is an opportunity for overturning the imd exclusions as a long term goal. Lastly, at the state level, we might keep active ton safe injection issue, i guess that was a two year bill, that tha may come up in another year, so if that could be considered, those are my wishes, very excellent policies, i think you guys have always been ahead of the curve and as you know, as San Francisco goes, so goes the nation. Commissioner, was there something specific in either to have paragraphs or some area that you wanted to have consideration of asking for . No, these are justice ewes as i went through and looked, i didnt see them, they could be in there, if you feel theyre appropriate, i would add that as my suggestion, if you dont feel they meet our overall goals, ill also no, i think the federal policy on couldnt tra accepting is something we can add, the federal legislation on cannabis is something we could add, there is some language around confidentiality agreements and data sharing within haoe, but we can specify the 42cr. The imd exclusions, i dont know if theres anything specific on that but we did we could add that, there may be some federal action coming down on that soon and then yeah, we can talk about how we want to address the safe injection sites. Commissioner pating, i think tho are really right on to targets of our concerns. On the issue of imds, well probably have to travel from the federal to state because we will need to be able to get medical approval for providing for programs that have over 15, 16 beds, so that was one of the issues that we may have a problem with getting funding, but absolutely, i really i think your items are appropriate. Yes, excellent document again and then take it for consideration, if you feel they add value, feel free to add them. Put my name at the end. I think we just did. I think on the cannabis which is what commissioner chow also brought up last time in terms of the environment and so, perhaps you could go into that section too. Not so much federal but in terms of even you remember, we were talking with the Planning Commission at that point or the planning regulations and commissioner chow did bring up that the environment around potential Cannabis Factory should be considered as an issue which i believe planning said that they were open to making that one of the things that were talking about. Just when you talk about the environment, are you talking about the Natural Environment or the social demographic political environment . More ton Climate Change idea, she was concerned there could be certain factories that then would have certain odors that would be tracing and maybe offensive in a particular neighborhood type environment versus in a factory, sit ining an Industrial Area that we seem to have less of today, so i think that would be something that she also would appreciate that could be helpful as were looking at Climate Control or various cannabis regulations. Okay. Commissioner loyce . First of all, thank you for your indepth report and i look forward to reading more of it. I know that the [inaudible] bill came out today, im interested in following that because of the implications it presents to us, so its something today, it will be something tomorrow, it will be different, but as you track that legislation, please inform us of what your thinking is of the department and what reck m dashing you would like to make because it has concerns for San Francisco and california and the nation, but thank you for that report. Thank you, any other reck recommendation, if not, we will move forward on a motion for the resolution and we are assuming that those recommendations will be taken into consideration and placed into the plan. Motion is before you for adoption, i need a motion. So moved. And a second. Second. Okay, a motion and a second is received. Any further discussions on the resolution . If not, then were ready for the vote, all those in favor of the resolution, please say aye. Er aye. Inger all those opposed . The resolution has been passed. Thank you very much. Inger thank you very much. Thank you, commissioners, item 8 is the Emergency Medical Services update. Good afternoon, commissioners, my name is dr. John drowning im the medical direct door of the San Francisco ems agency and im here to give you a report, it eats a pleasure to be in front of you again after four years or so to talk about the ems system and the ems agency. Im going to be joined by our new ems agency administrator, mr. Jim duren who will introduce himself and his background and were going the share the presentation as soon as i can bring it up here. Thank you, and welcome back, dr. Brown, to the department. Thank you. Thanks for your help, mark. Sofrjts, what im going to do is to just give you a very brief overview of what Emergency Medical Services is and its role in the department of health and then were going to talk a little bit about the actual transition of the agency from the department of Emergency Management to the department of Public Health and then talk and highlight about three or four of our key issues that were dealing with currently. I want to also very strongly thank and this will come up in the presentation as well the investment the department of health has put into this transition and into the ems agency and the ems system. Why is this critical for Public Health and why is this a very Important Role in the department . Ems, Emergency Medical Services, provides the response for emergencies throughout the city, medical emergencies and its xo esz composed of multiple components with multiple agency, City Department and is private agencies as well, the response is generated through generally a call to the 911 center which is part of the department of Emergency Management, dispatchers are tha are present at that department then query the caller to take if you will the unfiltered patient issue or chief complaint and then put it into a system that gives us a call determinant or a specific way in which to respond to that call based on lots and lots of medical evaluation, medical research into efficiency of ems systems. First responders are usually the first people on the scene, they are frequently the Fire Department, i would say thats 98 of the time, but they could also be other members of the Public Safety community such as Police Officers and sheriffs deputies and they provide a basic level of care, first aid and cpr and automatic defibrillator if thats available for cardiac arrest, this is followed by plans transport and this is shared duty with the Fire Department providing approximately 80 of the plans transport in the city and two private Ambulance Companies that back the Fire Department up, and then those ambulance personnel determine once the patient is assessed and stabilized a destination and well learn about the destination options in a minute, theyve been expanded in San Francisco to include other destinations besides the hospital. So, in general, First Responders stabilize, then they transport the patients, continuing the treatment of the patient during the transport and then the receiving facility provides ongoing care. We have two levels in San Francisco or three levels of responders, we have dispatchers, the 911 dispatchers who are the first time zero responders who will give prearrival estruses and help patients bhiel they are being assessed and the ambulance and the First Responders are dispatched. We have First Responders who are usually Emergency Medical Technicians with about 200 hours of training, they they can provide basic life support care and we have paramedics, paramedics on many of the fire engines, about 60 of our fire engines have paramedics and all of our ambulances in the 911 system have paramedics and they provide a higher level of care, 1600 to 1800 hours of training, air way interventions as well. What is this transition all about and what is the relevance of this system to the department of health . We were in the department of health up to 2009, there waser a lot of reorganization at that time due to various economic issues, we were move today the department of Emergency Management. The thought being that we would have a synchronization of our mission, 20 does touch on disaster preparation and response to things such as special events and medical surge situations. But also we were able to colocate in office space that was unutilized and been fit from economies of scale such as our i. T. Needs were transfer today the department of Emergency Management at that time. However, over the years, the Disaster Mission of the city and the department of Emergency Management became larger and larger and we became if you will a smaller and smaller portion of the department and many new challenges developed such as the Sobering Center and its role within the ems system and the development of mobile integrated health care which is also called community [inaudible] along with a lot of evolving research and specialization, ems medicine for instance since 2013 has been a new specialty within the house of medicine, so theres been a lot of new information, new research that we want to apply to the system, and at that time, our staffing had dropped from an original level of 12 down to a level of 6 personnel. So, director gar see yoo, director oregon, the department decided it was important to invest in ems system and this is a multimillion dollar investment with a lot of help, many resources devoted from outside the ems agency to help make this possible. Parlt of the reason were doing this and looking at this process to get more resource and more integration with the Health Mission is our enlarging workforce and workflow. We currently have over 2000emts in San Francisco and over 500 paramedics. I can tell you from my experience in meeting with my colleagues in other ems systems, this is a very well resourced system in terms of personnel and in terms of personnel experience in years, the number of years that the individual has worked before they come into the system is relatively large compared with other systems, we get a lot of experienced personnel who come here. We have an increasing number of ems calls in San Francisco, the graph that you see there takes us from 2010 through early 2017 with an increase of approximately 4 per year in ems calls, these are calls specifically with medical needs that are attached, and at that pace, our resourcing at the agency, our ability to keep up with these call and is the needs these calls generate in terms of training, education and Quality Improvement has not kept pace. We are a nexus, we are not if you will the king of the hill when it comes to determining how ems care and ems medicine is practiced within the city, the upper part of the slide gives you a visual representation of the state issues and the state entities that interact with us at ems, in some sense, i have many bosses and one of those bosses is the state Ems Authority medical director, dr. Howard backer, state laws around ems medicine, they translate those into regulations and then we in the ems agency have roles and responsibilities to the state. The lower portion illustrate it is portion we have with our various providers, our communication and research, our policy and procedures, protocols and then the agreements that we have with each of our providers. We have as i mentioned the three 911 ambulance providers, we have the dispatch center, the 911 center, we have 6 private Ambulance Company that is perform interfacility transfers for us and then we have 13 receiving hospitals including two that are out of county and many of which have Specialty Center designations as well, so thats the environment in which we interact in the number of organizations and entities that we are working on. This is just a refresher chart for the department of Health Organization and it shows the specific spot where the ems agency lives and who we report to. At this point, ill turn the presentation over to the person thats in that slide which is jim duran who will bring you through the Current Initiative and is the transition there. Thank you sx, i appreciate the opportunity to address the commission and talk about the ems agency. My names james duren and just a little back grown, about 30 plus years of ems experience in king county Public Health system, ive been a system developer and a real passion for patient care advocacy, so a lot of what i do is all about patients and giving them the best opportunity possible in a very dire situation. So, ive been here six weeks and the running joke is every time i come back on monday, they say that week was a week that is record setting, so then the next week is the same thing and then the next week, and they always say, hey, thanks for coming back and it wont be like this next week, so im seeing what happens for next monday, hopefully its calm. I have to say one thing, in the snapshot and n the time ive been here and our staff that we have in the Health Department of Public Health has been amazing. Theres been so many people involved in this transition process and they are just behind the scenes making stuff happen and the support that ive been given right off the bat has been welcoming and i appreciate that and i i have to give a shoutout to the staff that was transitioned over from dem, as youre aware, any type of transition is very difficult on staff and weve inherited a small staff to do a very, very big job and theyve been holding the fort down for a number of years and i just want to let them know that we appreciate the work that theyve been doing and happy to have them for the wonderful opportunities for the future, i wanted to thank them. So, one of the things that whai came here for is that the transition from Department Emergency management to department of Public Health and i look at that as an opportunity where ems really should live and the fact that Public Health is all encompassing and its not just the response to the call itself, its the holistic approach to patient care, anywhere from prehospital instructions or even trying to create a Safer Community so they dont even utilize the system. If they have to utilize the system, we give them the best possible care and with the coordination of all of our stakeholders, it is a very seamless transition from the time of call until the time they get discharged from the hospital. So, the other part was creating a world class ems system for a world class city, and that was really what drew me in along with the Public Health so, with that is just like what do we need to make that happen, so this is just a arrow down. Arrow down, thank you, somebodys looking around for that, so what is it going to take to make that happen . , so, this is a draft organizational chart as you can see, the real main things is a couple of things we want to focus in onsinger one is medical direction and the medical director and ems fellows apply to come here and they can learn from our system, they can stay in our system or take it back, this provides direction for our ems system. The other thing is creating of an admin section, sections that look at fiscal responsibility, contracts, information, developing our i. T. Support which we dont have right now. The other one is research and Quality Assurance, so part of medicine is always research and being able to publish what you research and thats whats kind of lacking in the system currently, and then the other one is operations and the operations is anywhere from liaisons between hospitals and ems providers to training, to certification, recertification and in the worst case possible would be an investigation of poor care. So, a snapshot, my six weeks of being here, we have some strengths, the strengths is we have a very large group of dedicated ems professionals, not only in ems but Public Health professionals and i look at that as its really integrated which is a really nice thing. The other one is that we have a united 911 dispatch center where the dispatchers do police and fire and ems, so its a single source. And gnash namely accredited programs which is nice to be part of which is a really good thing because theyve met the criteria for excellence. So, some opportunities that i see is part of the thing that we had was a Strategic Plan that was developed in 2013, part of it was rationalized train, the development of rationalized training for our city as well as national trends. Some state requirements that were mandate today do as dr. Brown showed you in that chart, were part of a bigger system, some of those things have been lacking over the year sos we have to kind of clean that up and make sure our reporting is really clean. And policies, our user agreements with our hospitals and Ambulance Services need a little bit of updating also. So, planning as far as ems goes, you know, we have a lot of help with that, we have subcommittees and committees to help with our direction of our ems program. We have our trauma and prehospital committees which look at the different aspects of care. Some opportunities i see right off the bat is being able to hire somebody that can really understand the data and to make sense of it and to write a story about it. Having Quality Assurance positions available i think is really important because not only do we look at and we ask people to provide a level of care, we just want to make sure that level of care is up to the level of care that were asking them to provide. I mentioned a little bit about the master plan, i think the master plan is really important. A lot of work went into producing that document. We still have a lot of work to do to accomplish the tasks so far. Medical base research, we talked a little bit about that. Well, the other thing too, to do best practices and to really look at the plan do study act and thats just an integrated program to look at medicine and we go out and try something and we evaluate it and we tweaked it a little bit and then we learned from it, we retrain and we do it again. The whole idea is everything that we do provides the highest level of patient care possible. The other thing too is partnering with Public Health agencies and where we can look at trends from maybe certain communities or certain zip codes and we can use what we call st elevation mi where people are having a myocardial infaction, we can vao er row in on the zip code x see how long they had symptom onset from the call and certain zip codes can have different legates of time, the longer you have an acollusion of your coronary artery, the more heart damage that you have, the nice thing about working with the Public Health or integration with that, we can study with that and then look at doing some Preventative Care to those communities and then look at the outcome to see if its made a difference. Monitor thing system, all of our components now are electronic, so weve gotten away from paper reporting and so now we have the data but we dont have any rationalized program to look at the data, so thats something that is really needed, centralized data hub where we can all look at the same data which is lacking from the system. Which then would provide reliable data that we can share with the state which is mandated. So, and part of that is we need personnel to study the data, to look at the data to make sure that were doing what we need to do. And then also the ability to monitor our fiscal responsibility. Patient care, the regulation part, so part of this system is a very regulatory system, so we have good policies, we just need to make sure that theyre updated and are current. The development or the use of Lean Technology in our process, and again, i talk about that, the plan do study act a bit, and then be able to provide feedback to the providers which is really important, so how did their care improve with patient care, and what they thought their impression of what they were treated, did it match up with hospital diagnosis and discharge dice sis, we dont really link those together and thats important as far as providing good care and a good feedback loop and then again provide rationalized training, the department of Public Health has a learning Management System that we can use and were in the process of looking into to see if we can provide regional training which is a real plus. So, a couple of the top four, if you were to ask, so its a commitment to being a patient care advocate, so every decision that the ems division makes is based on patient care advocacy. Is this decision going to improve patient care. And then the improvement of systems of care, so we have a system, an ems system but we have a lot of systems within the system, so we have cardiac arrest, we have stroke care, we have stemmy care or st elevation mi or mayo cardio inf. O. B. Singer mi, all of those are in the system that make up good patient care so we need to look at that and improve upon that. The quality of care, again, with the good Quality Assurance department, we are able to make sure that were providing the best possible care to the citizens of San Francisco and the visitors. And then improve data reporting and Quality Assurance. That was my 15 slides. And six weeks. I havent received any Public Comment request, commissioners, just so you know i want to tell the commissioners that one of the story that is jim gave us is that he managed 31 Fire Departments in king county so i told him he was well prepared for one. So, we look forward to your leadership and i think its been a big challenge for our transition, so this these two steps are going to be very important and were going to be challenge ined the next year to figure out how to provide that infrastructure considering some of our challenges within our budgetary issues but we will be looking at help to continue to support this division. I think its really important for our paramedics and our ambulances to be well trained and i think thats a major focus that i know that our new director has and its been an ongoing focus for dr. Brown. Commissioner loyce . Welcome to San Francisco. Thank you. And i hope you enjoy your long stay here. Yeah. I want to thank you for the report, both you and dr. Brown for the report and i also wanted to acknowledge your priorities because i think theyre important and i would like to hear a year from now where you are along that path and what data points youre use tog validate the work that youre doing, i think that would be critical to our discussions here at the health commission, so again, welcome and thank you very much, and thank you, dr. Brown, for this report as well. Thank you. Thank you, commissioner sanchez . I too want the welcome you aboard. Im glad you respond today the challenge, i think its a unique challenge and a unique opportunity, this system has gone through changes and whatever, there were times when you would have certain commissions and directors and mayors looking at the corner waiting for how long is it going to take to respond from one unit versus another, well, nobody really cares, oh, lets do this, lets do that, and then at one point, there was a great crisis, lets what are we doing and do they really belong here, should they go to the Fire Department and the Fire Department wasnt welcome, like the navy welcomed the marines, i cant say that, were all part of the same team, ill cut to the chase, and i think you really articulated both why you came and more importantly some of the parameters of what you feel are important that we, the departments, could Work Together and the support youve gotten and the fact that we have unique people who have been doing fantastic things above and beyond and many have but have been in marginal positions or positions of what are you folks doing here, why are you responding, all of a sudden why do you have five different respond units in one simple call, all of these things have been very frustrating so it gives us a unique opportunity to revisit and to sort of take like a week or two of offtaout and take a look at where we are and what as you said, best practices and lets look not internally but lets also listen to what some of our other units and other areas have been doing given the uniqueness of San Francisco and the focus is on the patient which is exactly what you stress or what it used to be and were glad youre aboard and we all look forward dr. Brown i know has been putting 50 hours a day many, many times because its a frustrating, challenging effort and were now back were back in where youre based and we look forward to some really positive outcomes over time, so thank you for coming aboard. Thank you. Thank you, we do some of us remember when ems was here, so were the paramedics, so it was the entire responsibility for not only regulating and managing ourself for critiquing ourselves whether we did well or not, so we appreciate that. As the city grew and as the city developed more criteria that it wanted for its emergency services, the move of our ems at that time as dr. Brown said seemed logical, but as their responsibilities increased, it appears that we didnt these services didnt get quite the attention that this commission has been asking for also in the last year and a half, so were really pleased that weve been able to make this transition back and which then we believe also as you do that the Public Health department would be the right place to be able to look for the measures that youre so much speaking to in order to develop the best system we can for our public. Certainly kings county is an outstanding system, if not the outstanding system in the country, and we would like San Francisco to outdo kings county. For years, we have been watching the kings county data in terms of our responses and then when it moved over to dem, we didnt have the opportunity to watch it but we were aware and our public paper of course disclosure indicated things were not as good as they should be, that doesnt mean that come tog the department, we can fix them but were hoping to be able to have the department coordinate a lot better with our Health Providers and with our various Ambulance Services and all and with the Fire Department to really make this stellar and if we cant quite get to kings, maybe we can at least be equal to kings county. With that then, i would say that im not willing to say that we wouldnt want to see this in sooner than a a year. I would be interested in your critique of the 2013 master plan that you all developed. I am sure that there are areas of update as youve quietly indicated that would be appropriate on these measures but ill bet thats true also of the master plan, so would it be appropriate to have a report back in about 6 months as to where we are . I think at the level of the interest of this commission, that we will want to hear it at the commission level. Great. And ill be happy to be here and share with you what we have done and its going to be a lot. Well, we look forward to that. I think that as you come back, i think dr. Brown knows we like to also look at data. We dont merely want to hear a process but of course as youre beginning, we understand process is very important but wed like to know what you think when you come back next that the data that we have and where we expect to go, so that we could help measure and also be able to advocate for the resources that you will need so the city get it is care that they deserve. Thank you very much. Thank you very much. Commissioners, any other questions . Otherwise, we look forward to seeing you back in six months, not six weeks. Okay, thank you. Thank you. Commissioners, next item is other business. Do we have any other business at this point . No. Okay, we can move on to item 10 which is the joint Conference Committee report back and commissioner sanchez can give the brief report back from the october 10, 2017 lagune da honda meeting which was just a closed session. This would be the last la gunda honda jaount Conference Committee was held october 10th, everybody moves in, it was a closed session review of reports and medical credentialing and we reported out and the vote was not taken and therefore we approved items. Thank you. Good. The next item we dont have Committee Agenda setting any more than you had at the last meeting. I would like the get us to the closed session so that we could complete the business of the closed session. Is there a motion to enter into closed session . So moved. All those in favor, please say aye. Aye. Thank you, we will enter into closed session, we thank the kub u public for their attendance at this point and the commission will go into closed session for about two minutes hopefully. meeting is closed session, a motion whether to disclose or not disclose the discussions of closed session is in order. A motion not to disclose. Not to disclose is the motion, a second is at hand, all those if favor of not disclosing, please say aye. Aye. All those opposed, we shall not disclose. Motion for adjournment is in order. So moved. Er sxfrjt a second . Second. Er all those in favor, please say aye. Aye. This meeting is now adjourned. Thank you. meeting is adjourned . Tenderloin is unique neighborhood where geographically place in downtown San Francisco and on every Street Corner have liquor store in the corner it stores pretty much every single block has a liquor store but there are impoverishes Grocery Stores im the cocoordinated of the Healthy Corner store collaboration close to 35 hundred residents 4 thousand are children the medium is about 23,000 a year so a low Income Neighborhood many new immigrants and many people on fixed incomes residents have it travel outside of their neighborhood to assess fruits and vegetables it can be come senator for seniors and hard to travel get on a bus to get an apple or a pear or like tomatoes to fit into their meals my my name is ryan the cocoordinate for the tenderloin healthy store he coalition we work in the neighborhood trying to support Small Businesses and improving access to healthy produce in the tenderloin that is one of the most neighborhoods that didnt have access to a full Service Grocery store and we california together out of the meeting held in 2012 through the Major Development center the survey with the corners stores many stores do have access and some are bad quality and an overwhelming support from Community Members wanting to utilities the service spas we decided to work with the Small Businesses as their role within the community and bringing more Fresh Produce produce cerebrothe neighborhood their compassionate about creating a healthy environment when we get into the work they rise up to leadership. The Different Stores and assessment and trying to get them to understand the value of having Healthy Foods at a reasonable price you can offer people fruits and vegetables and healthy produce they cant afford it not going to be able to allow it so thats why i want to get involved and we just make sure that there are alternatives to people can come into a store and not just see cookies and candies and potting chips and that kind of thing hi, im cindy the director of the a preif you believe program it is so important about Healthy Retail in the low Income Community is how it brings that health and hope to the communities i worked in the tenderloin for 20 years the difference you walk out the door and there is a bright new list of fresh fruits and vegetables some place you know is safe and welcoming it makes. Huge difference to the whole environment of the community what so important about retail environments in those neighborhoods it that sense of dignity and Community Safe way. This is why it is important for the neighborhood we have families that needs healthy have a lot of families that live up here most of them fruits and vegetables so thats good as far been doing good. Now that i had this this is really great for me, i, go and get fresh fruits and vegetables it is healthy being a diabetic youre not supposed to get carbons but getting extra food a all carbons not eating a lot of vegetables was bringing up my whether or not pressure once i got on the program everybody o everything i lost weight and my Blood Pressure came down helped in so many different ways the most important piece to me when we start seeing the Business Owners engagement and their participation in the program but how proud to speak that is the most moving piece of this program yes economic and social benefits and so forth but the personal pride Business Owners talk about in the program is interesting and regarding starting to understand how theyre part of the larger fabric of the community and this is just not the corner store they have influence over their community. It is an owner of this in the department of interior i see the great impact usually that is like people having especially with a small family think liquor store sells alcohol traditional alcohol but when they see this their vision is changed it is a small Grocery Store for them so they more options not just beer and wine but Healthy Options good for the business and good for the community i wish to have good morning, everybody. Were here for the antibiotics and meet signing ceremony. Thank you, mayor lee. In the simplest of terms, this asks Large Grocery chains to disclose the antibiotics in the meat and poultry products that are sold. Families and consumers should have the right to know about how their meat is produced. Prior to joining the board of supervisors i worked in health care at ussf. It was there that i spend time studying Health Trends and antibiotic resistance. Antibiotic resistance infections are a Public Health emergency, as they kill thousands of americans each year. And most troublesome is that, in a recent report by the world hem organization, they found out that the world is running out of antibiotics to fight antiresistant infections. This ordinance will help stem the tide of antiresistant infections antibioticresistant infections about meat sold in the San Francisco stores. The response at the federal and state levels is inadequate. In San Francisco when we see a Public Health challenge or problem, we seek to respond to it. This ordinance is about doing what we can as a city to respond to a growing issue and keep more san franciscans safe and healthy. Families and consumers should have the right to know about how the meat they are producing that they are purchasing was produced. With this legislation, we are doing our part to reduce antibioticresistant infections here in San Francisco and protect Public Health. I want to share my sincere gratitude to individuals, City Departments, and individuals who have helped in this legislative effort. Particularly, i want to thank the National ResourcesDefense Council for all of their work in tracking this issue and bringing it to the attention of the city, especially avi karr. Special thanks to the department of environment, the department of Public Health for their collaboration on this ordinance and recognizing not only the Environmental Health issues, but the Public Health implications as well, especially for those with immune deficiency. I would also like to thank and introduce someone who has provided enormous support for environmental and Public Health issues. Mayor ed lee consistently works to protect the health of san franciscans and have been great in the fight for antibioticresistant infections. Please join me in welcoming mayor lee. Thank you, supervisor first of all, i like to eat. What am i eating these days . I think that is interesting. Certainly, supervisor sheehy has done his homework if not becoming the resident expert on our board of supervisors, i want to thank supervisor sheehy safai for being here as well and the other Board Members who joined in jeffs leadership to focus on a growing problem that hes identified. There are literally thousands of people who are consuming meats and poultry in the Food Products in the growing inspections that we uncover that are having antibiotics through their evolution grow through misuse and through overuse. And so this is a modest first step, jeff, until we have more information. It is a proven approach. It is a righttoknow approach. It is i approach that the board, the mayor, we all agree we simply need more information to really find out with a the evolution of this bacteria is doing in the market, in the supply chain, and when our kids and our families and ourselves eat these products what is happening with this bacteria . So if we have that information, if we know where it is coming from, we can then hook it up to abuse and misuse that might be happening in the market. We dont know. But we are asking the Grocery Store to comply with this ordinance and is formed by our medical doctors, our department of Public Health, our environmental department, Natural Resources and deep fence council has been working very closely. But it wouldnt come to this point unless we had people doing the research. I want to thank the opportunity to thank supervisor sheehy but his own staff that has worked hard on it. Because im sure you had to answer a lot of questions before we begin imposing a lot more responsibilities on our on our businesses. But we are doing it for good purpose. And this purpose is a serious one. Its a healthrelated one we dont mess with our health. We have to have Better Health outcomes for our people, and if we find data that suggests to us 23,000 people a year in this country are dying and hundreds of thousands are infected by these antibioticresistant infections or things that are evolving by overuse and misuse, we have to do something about it. But it begins with informing ourselves. And i know supervisor sheehy has done this before when it came to h. I. V. And aids. He informed us. He informed the public. He informed his friends. And then we became that much martyr about our legislation and the about the things we had to do. Then came the resources in order to do something on that disease. On this one, we have to do the same thing. We have to be as preventive as possible so it doesnt pro live rate. And thats the work of all of these agencies coming together. So its my privilege to, again, sign legislation that strikes at the beginning of something before it really happens in epidemic proportions. But when it comes to Health Challenges to be smart about it and to do it early. So thank you, jeff, for your leadership. Appreciate it. [ applause ] thank you, mayor lee. Next i would like to introduce Barbara Garcia from the department of Public Health and a natural leader in Public Health, both our department and director garcia. Thank you. Thank you, mr. Lee, mayor lee and supervisor sheehy. The department of Public Health is responsible for consumer and food safety in the city. So this hard finance really supports our ability to protect the food that people eat. The right to know if your food has antibiotics is really part of an essential consumer right. Overuse of antibiotics we know causes emto stay in the hospital longer. It also impacts their ability to heal from diseases. So our ability to really manage the amount of antibiotics that people use really helps them. There are many medications that they cant use because of that and they have to have the ability to heal and get better from the diseases. So what is in our food, theyre food is a protection we can provide to the people of the city of San Francisco. I want to thank our director, Deborah Rafael who is not here today. Shes been one of the leaders in San Francisco with this, so i want to thank her, and all of the leaders here and those that are here today. Thank you, mayor lee, for signing this ordinance. The city of San Francisco and its residents will benefit from this ordinance, so thank you very much. Thank you. Did you want to say . No. We wouldnt have gotten this through. Its unanimous. I want to thank my colleagues and my friend, supervisor safai and thank you, barbara. Lastly, we have jonathan kapplan from the resources council, which has been a great partner. There you are. Thank you, supervisor sheehy. Hi. I think this is switched off. Can you hear me all right . There you go. So every once in a while a local government stands up and provides leadership for the entire nation. This is one of those moments. The City Ordinance that is being signed today would turn a light on in the darkness that has shrouded the industrial livestock industry. For the first time, san san san francisl have access to those Companies Using meat safely and responsibly and move away from those who dont. The ordinance, i want to point out, is unique in the nation. Theres really no other federal law today that requires livestock producers to disclose this information. Theres a new state law in california thats going to require some data of reporting but its not expected to require individual companies to disclose their own individual antibiotic use. Until today, there has been no reporting of antibiotic use by individual companies anywhere in the country. For decades, that that use has been operated in secrecy and that stops here. I want to point out that this need for legislation is more urgent than ever. Rising rates of antibiotic resistant bacteria has threadenned people as we know it. When antibiotics are used again and again, some antibioticresistant comes and we have to curb the unnecessary use of antibiotics wherever we can. Thats our best hope for preserving modern medicine. The legislation being passed today or signed today will give consumers an important new tool for leverages marketplace forces to drive change in the industry. And, you know, the bottom line, this is a really big deal. So we are really proud to be here. We really appreciate the leadership from the people standing behind me. I want to thank mayor lee, supervisor she, and the directors and staff of the departments of environment and Public Health. Congratulations to all of us. [ applause ] thank you, jonathan, and i think were ready to do the signing. Okay. There you go. [ applause ] thank you. Thank you. Please stand by