Is the minutes and approval of minutes of october 172,017th. Motion is in order for the approval of the minutes. Second. So moved. Its been a motion second are there any corrections to the minutes . If not all those in favor of the minutes please a aye. All opposed the minutes have been approved. Thank you. Next item. 3 the directors report. Good afternoon commissioners i want to welcome the ucsf pharmacist students, lift your hands so we can wave at you. Also our members of our drug usage union are here today to testify so i want to acknowledge all of you. And many advocates from the community so well have a very Great Commission meeting today. And just on that note, well let you know President Trump announced he is helping Human Services agency to declare a Opioid Crisis a publichealth emergency. This does not provide us new dollars. There are a couple of things i think are worth noting, one is that there may be flexibility about the regulations of certain medications considering being able to pay for tele medicine for many Rural Communities who do do not have access, this would be a real important part. Also naloxone, trying to reduce cost to that and also there is some concern from h. I. V. Advocates in the way theyve allowed for thinking about flexibility to shift resources from h. I. V. And a. I. D. S. To this issue but i think over all, knowing that its a publichealth emergency i think is from a symbolic message i think is very important. As you know, we have been discussing this for the last month or so. We have had a epidemic, i mean an outbreak in hepatitis a in san diego and santa cruz. Its in san diego and in santa cruz, not in San Francisco. But we are doing a lot of preventative vaccinations and to date weve already vaccinated 3,000 individuals at risk and those include Homeless Individuals and drug users. And we believe were trying to do this in a preventative way and we believe we have enough ak vaccines in stock and this is a really important part of the work that were doing in terms of prevention and theres over 500 individuals in san diego that had hepatitis with almost 30 people that have passed because of it. So, a lot of this is being part of ensuring that people have access to water and being able to use rest rooms and wash their hands so as you know, weve had many pit stops in the community and weve done a lot of that infrastructure that many of those cities are now having to look at as part of this. So im proud of the staff, weve opened up our Disaster Operations Center to do this and i want to particularly note that our Emergency Preparedness staff have been involved, all of our clinical staff and many of the groups from our executive staff have also been involved. Also, during the d. P. H. Has responded to north bay fire victims over 115d. P. H. Staff and contractor staff have answered the call to go to the many shelters up north. Many of these individuals were spanishspeaking and theyve done i think an incredible job of responding, we were the largest Response Group in the area that provided support helping many of the neighbors in the north bay. I will end my report there unless there are questions to the report. Thank you, commissioners. Thank you, commissioner. Any questions . I dont think your microphone is on. I thought we might try to have a report on the reduction subsidiaries as they now affect us. Before we ask our Deputy Director to come up, let me make an announcement i think is one that is really great and another that is a big loss for us and that is Colleen Chala will be the Alameda Health director in the next couple months. Were proud of her and also of course its a big loss for the department so you may want to take advantage of her in the next meeting so she can report on the policy issues. In alameda shes done a lot more than policy and i want to acknowledge that shes done a lot of work around many of the things you will hear today on your agenda and its a great honor to work with colleen so we want her to come up and we can give her a hand of applause as well. Right, congratulations. [applause] we wish you well but hopefully you can give us a good report. Interview thank you, i appreciate those kind comments and its really a difficult decision to leave. Ive been here for nearly 13 years and ive learned a lot since ive been here and i really love my job and its prepared me well for the one in Alameda County so im looking forward to that. Im sorry that i wont be here to talk you through all of these interesting policy issues like safe injection and other things and the future but ill still be watching from across bay. But i can answer your question about costsharing reductions, the cost sharing subsidiaries, california anticipated that the costsharing subsidiaries for people 138 and 2 50 of the federal pottery level might go away and they enacted law that essentially allowed insureers to instead get their subsidiaries from another pot of federal money so it shifts from the cost sharing subsidiaries to the tax credits and it will have little impact on policy holders through covered california, not zero impact but minimal impact. So were fortunate to be in a state that thought ahead for that policy issue. Very good. Do you know if recovery california is making it wellknown to the public . Interview they are, they are mostly the reason that its effecting a particular plan so people who fall within certain income brackets are being navigateed towards that level plan so that the impact is least felt. Interview very good, thank you. And i guess you do have an update in regards to the new bell that is going through, i mean, what is the staff us righf the bipartiasan bill . Has it changed in the last two days or three days . Are you talking about the budget bill . The congressional budget on the bipartiasan retention of the subsidiaries . Interview i havent heard anything different than what is reported there. Ok. Thank you. Commissioners any further questions . Yes. Im sorry,ers first. Thank you for all your good service and we will miss you. I hope things workout and you will decide to come back at some point later on too. With regards to the aca and the lack of advertising, that has been supported nationally as the city and county had to fill in with any incrows advertising for a. C. A. Enrollment and or has the state been picking up that. The state cover california has invested in more advertising and in fact californias open enrollment is longer than the federal open enrollment so the state has invested more in advertising and its open enrollment is longer so we wont see same challenges faced in other states that rely on the federal exchange. Do you know if well take any measures locally just to monitor or make sure that the communities that need to be reached are being reached . I believe that the San Francisco health plan is working on that as well as a lot of the c. B. O. S we work with. Thank you, very much. Commissioner sanchez. Hi, i would just like to first of all, again, with comments just even an exception al colleague staff executive officer chief, whatever, and alameda is up there and were glad you will assume the helm there and you will make an exceptional chief over there. But one question i want to ask with all of our, the work we know and the work we do both here and Alameda County together , about immunizations and these problems coming in san diego area, you know, i still am still so frustrated over the fact that i talked to some colleagues today that there are still major, major areas in puerto rico that are still not even in communication even with the ship out there and even with others, you know, and theyre going to need all of these supplies and i hoped with you across the bay we have old navy basis with the port of San Francisco is the port of oakland the fourth largest port until the world, hopefully we can think of some ways where Publichealth Department can provide new path ways so when our u. S. Citizens in puerto rico and these areas have been begging and asking and still dont have the supplies, perhaps we can find a new pathway, thats all im saying, think creatively. What im trying to say is as we look at within our own areas, you know, weve always been listen to go other parts of the world, especially where they are u. S. Citizens and they are its just a little frustrating, thats all im saying so hopefully we can keep those areas on the radar and hopefully we can get some answers. I share your frustration and ive been in touch with Nancy Pelosis office as well and some International Disaster relief groups so we arent looking at its going to be working with commissioner banel and pelosi and it might be a way to get our foot in the door. We have staff from puerto rico who are from many different areas and were exploreing the idea of can we send a medical team to one of their homes and use that as a base and maybe get a creditability and im kind of waiting to see and make sure theyre not a burden on on the local community and so we may have tried Veterans Administration first and then look at some other opportunities but there are many disaster groups that are trying to work with a couple of National Disaster groups through the National Hispanic alliance and working one of them is the next mayor in puerto rico so its a very big frustration and i understand your frustration and as soon as we can we will respond just wondering if maybe commissioner banel has comments to that as well . Thank you. So currently the Veterans Administration theyre accepting volunteers deployed within their own resources and clinics and other places so i dont know that they are really capability to bring in outside groups that would operate outside of the v. A. System but we can make another inquiry with them and if i can add, colleen youve been a tremendous resource to San Francisco and a fantastic partner to your counterparts of the state and the federal level and weve enjoyed looking with you and our loss is alamedas gain and thank you very much and well miss you. Thank you. A com days coming from you in december so we dont have it today but we will cap a special one for her next month. Let me add my voice too, others who have spoken up, ive known colleen, she worked for me in los angeles and i watched her come here and watched her growth and development as a professional and you know we often times talk about the students exceeding the teachers skill set, colleen has done that in relationship to me and i appreciate the work shes done here but at the los angeles state and federal level so you will be missed but i still have lunch with you. Thank you. [laughter] thank you. Colleen, thank you. I cant believe its been 13 years. Weve been working together and it will be a pleasure that we can access you and alameda. Any time . Thank you. Item 4 general Public Comment and we have two requests. Yes. Its from the ucsf pharmacy and it has noname so the issue of roll back Birth Control. Yes, please. You are invited up to the podium so your comments are Public Comments so they need to be made to the public. Just for everyone my name is mark and im the executive secretary to the commission and theres a lot of Public Comment thats going to happen today and each you is going to have two minutes and i have a timeer with two minutes and when the beep goes off it means time for you to finish your sentence and walk away from the podium and the commissioners will likely not engage with you in conversation because their job right now is to hear your comment and if they have something to offer they may direct comments to the director next to me to followup so were all on the same page about that. Ill start the timeer. Thank you. Proceed please. Ok, hi, my name is shirley and i am from ucsf school of pharmacy and if it is about roll back for Birth Control its i mean i think we just wanted to know what your current standpoint is and if there are proposed actions against women in San Francisco or on a federal level for the people that can no longer afford Birth Control because of this. Thank you. Thank you. That is a question and well move that over to our director of health. And you can actually get that answer back from the director or colleen that can tell you the departments position at this point. Ok. Thank you. We have one more Public Comment. I can say 30 seconds. Thank you. Hello, my name is michael pet relis and im a longtime person with aids and accountability activist and im here today because im very concerned that there was no public discussion as far as i was aware of a pointing Nancy Pelosis chiefofstaff to this public body. Specifically, im talking about dan personal. My concern about the appointment of dan bernal to this board needs a lot more scrutiny. Specifically we need to know why dan bernal has never held a town hall meeting. He has so much time on his hands as Nancy Pelosis chiefofstaff he can serve on this panel. He has also served as a board member of the San Francisco aids foundation. He is also currently serving on the board of the National Aids memorial. Annually, he goes on the aids ride. Clearly this chiefofstaff has a lot of time on his hands but not for weekly town hall business. We cannot accept business as usual from the former speaker of the house. Our congressional representative is quite busy but her chiefofstaff needs to Start Holding town Hall Meetings now. Thank you very much. We need town town Hall Meetings so that dan bernal hearse from us and conveys our concerns to his boss. One big concern that mrs. Pelosi does not represent me or my husband on is she is against singlepayer health. You have appointed the chiefofstaff for the congressional representative from San Francisco who does not support singlepayer health for all. That is one of the issues we need to address when dan starts Holding Town Hall meetings, thank you. Thank you. And just for everyone to note thats how this works. Public comments. [laughter] well proceed onto the next item please. Item 5 is a report back from the finance and Planning Committee from today. Commission. Good afternoon, commissioners the finance and Timing Committee met before this Commission Meetings and we have focused on mainly two items, one is the contract report which you will see on the consent calender which for contract under the report for your approval and the other discussions that we have is on the draft annual report which will also come in front of the commissions in january for final adoption and we actually also have a followup conversation about the format of the contract reports and i think thats going to be like a continuing conversations that we have because like for a long time you know, weve been trying to bring how to reflect outcomes and impacts on the dollars that we invest and as the department of publichealth and we have to look at how we format the contract report so we know what were comparing that to when it comes in front of our desk and so that is it so i hope that you all have a chance to look at the four contracts in the contract reports. Thank you. No questions and well move onto the next item. Item 6 is the consent calender and its noted on your agenda theres only one contract , the contracts report. So the contracts report was also afforded to you in the packet and has been moved by the committee. Are there any extractions from the contracts report the commissioners wish. Its not what well proceed to the vote on the contracts report . All those in favor of the report please say aye. Aye. All those opposed recommendations have ban proved. Thank you. Item 7 is the safe injection Facility Task force recommendation. Hello commissioners, i am really excited to be here today and have the opportunity to present the task force recommendations. Introduce yourself. My name is irene lockrin and i work with the Community Health equity and promotion brands of the department of publichealth and i was fortunate enough to partner and work on the Safe Injection Task force with colleen, patrick chang, israeli and 15 Task Force Members and the direction of the director garcia. Before i start presenting, i want to just acknowledge supervise or london breed who really supported this and for her leadership for convening the task force and to explore just innovative and Creative Interventions to address the issues that is happening on our streets and i also want to acknowledge board of supervisor s Public Safety committee which was really in full support of us . Ok, sorry. It was in full support of the recommendations and so moving forward, im going to present the recommendations and if theres any questions we can ask them at the end. I also before i began want to acknowledge the Task Force Members we had 15 Task Force Members that gave their time and commitment and just a lot of enthusiasm and thoughtful discussion for us to be able to come up with the document to share today and most importantly , the direction of director garcia in sharing the task force. We know that there are an estimated 22,500 injection drug users in San Francisco what is happening on our streets is the same thing happening nationally theres an Opioid Epidemic and out on our streets, people are injecting primarily people who inject drugs are in the tender loin south of market the mission and bay view Hunters Point and injection drug users are often male 41 to 60 years of age and often have multiple health shoes and theyre at risk for h. I. V. And hepatitis c and as well as Chronic Health conditions. As well as overdoses. So we are continually seeing im sorry, im spacing out. I apologize if i get nervous or ahead of myself. Im very enthusiastic about this topic. So were continually seeing overdoses on our streets and from heroine and methamphetamine and also with the drug supply just being poisoned contaminated with fentanyl and we do a really great job in San Francisco with getting naloxone in to the hands of people who use drugs or Syringe Programs have been ahead of the curve in that and thats why weve been pretty stable with our overdose since 2006 and theres a range of 160 to 200 overdoses per year fortunately we have not seen the spikes in deaths that are happening nationally and again thats because wore getting naloxone in to the hands of drug users and the communities its most important they have. So prime reduction is the philosophy our publichealth programs and basically Harm Reduction is a philosophy that we meet people where theyre at and recognize everyone is an the the same place and its important for us to recognize we have to work with people until theyre at a place to make changes and that includes meeting people with respect and dignity and kindness and helping people move along and that might mean abstinence for some people it might not but we know its a really difficult Challenging Group to work with for many reasons people challenges and relationships with the Healthcare System and its really important that we step back and meet people where theyre at and in San Francisco weve been doing this for a decade and the way that we would see Safe Injection Services its just another piece of our Harm Reduction model in our system of care and in San Francisco, we have a very comprehensive Harm Reduction program right which includes our syringe access and disposal programs and naloxone distribution and medicateed Addiction Treatment and such adds methadone, our Sobering Center and the task force really sees this as kind of another tool in our continuum of services and our spectrum of care. So Safe Injection Services is nothing new and its evidence based intervention and they are theres none in the u. S. There are Programs National ly, internationally in over 100 countries and the wave that Safe Injection Services work that people go to the service with their pre obtained drugs and they go and are able to inject in a clean safe space where other services are available and theres opportunities to link and connect people to services such as Substance Use and treatments, Mental Health services, et cetera. So theres several different types, theres the ingrateed model which is basically its looked at just another piece of the comprehensive Services Available and specialized something more of a stand alone sort of sight and then there would be linkages available to services and what we do now is that Safe Injection Services promotes safer injection practices and are an opportunity to pull people to get people connected to services. People who who are hard is reach and have challenging relationships with the Healthcare System. One of the things of Safe Injection Services is we know that this would probably reduce the number of outdoor injection that is happening on our streets and well also just create a cleaner and safer environment by perhaps reducing the syringe litter that we see on the streets. The next few slides are pictures of different types of Safe Injection Services that are international and we felt it would be a good idea to show these the community because theres already that trust. Theres already that and were moving people along. The next recommendation was just the task force felt strongly there had to be a strong engagement and education component to a Safe Injection Services. And that includes engaging several levels. The public which includes residents and Business Owners and neighbourhood groups, Law Enforcement because if the services are going to set up in neighbourhoods we need the strong relationship and partnership to ensure theres sustainability and that were all on the same page of what were doing and how this is operating as a partnership and city agencies and Community Organizations that may already be providing services or already dealing with the same issues out on the streets. We recognize this is not a stand alone issue that falls within one department or one organization. It has to be a collaboration to be really effective. The education has to happen and the one thing thats not up here is the importance of it also engaging people who use drugs into the conversation. Thats just a given to have a strong effective programme is there needs to be that level of dialogue as we move forward. Finally the last recommendation is to identify populations that are at risk for Health Disparities and just to ensure a place is welcoming to everyone and it came up, well, will i be comfortable there and people of colour, women, lgbtqi we have to consider en our programming and thats important. And we need to continue the legal analysis exploring the laws. Having conversation with the city attorney. Advocating for ab186 which will reappear in january of 2018. Investigating potential partnerships and Service Sites and thinking through very thoughtfully how we can do this. The importance of having a very comprehensive work plan is so that we can do this right and just really meet the needs of the community. Thats an overview of the task force recommendations. Again, i wanted to acknowledge the great work of the task force, the leadership, the director garcia in chairing the group and happy to answer any questions you may have. We have public testimony and well accept that first before asking staff questions. If not well proceed to public testimony. As commissioner chow called calls your name ill have two minutes on the timer and when the buzzer goes off please know your time is up. I will call approximately five or six names as a time. You do not have to stay in the same order but this is to allow you to prepare to be in the centre aisle so we can all receive your testimony and not have gaps between. Also, following the twominute timer you are allowed to complete your sentence and then please exit. The first five will be holly jess, johnny sevin. Police. Please. I understood some of you would like to be in a certain order and thats perfectly fine. For this is holly first, jeff, johnny and sevin. Thank you. Im holly bradford. I work at the San FranciscoDrug Users Union. First i want to thank you for being here and for listening to us today. I want to beg you to please let this happen in San Francisco. A supervised injection facility is so needed. Theres such a streetbased using population. Ive traveled all offer the world and lived in cambodia. Ive never seen close to what we have in america like we have in San Francisco. It benefits the drug users and the population that lives in San Francisco. The population doesnt want to see people in the street injecting drugs and needles and the drug users wont want to be seen injecting in the streets and it saves the city money because we get them health care. What i want to say is behind me for the first time i know had are injection drug users from the streets of San Francisco here to tell you why they feel sup supervised Injection Services are important and it takes a lot of guts. Youre a hidden population and to come out and put themselves in front of you guys, i ask you listen to them with open hearts and please pass this on to the mayor. Thank you for listening to us today. Thank you. Hi, my name is jeff. Every day i pick up needles if the streets because i feel, first, they have to get picked up some way. I feel if we have a facility then there would be less in the street, obviously. [inaudible] i feel we need these facilities and definitely need more than one. I mean, its going to save lives. Its going to save my life. Im putting myself at more risk by picking up these needles in the streets and keeping them off the streets and by people using the facilities. Its a winwin. I had it all planned out and as soon as i got up here i lost everything. Thank you. Commissioner chow thank you. You did great. Next, please. My name is kevin. When i use drugs in public im afraid i will be seen by children who have enough things to deal with todays day and able with you name it. Its the last thing kids need to worry about being distracted as far as what they need to be focussed on the things they must be focussed on a daily basis like their school work. Just being a kid, you know. cause i remember growing up in louisiana and georgia theres fog nothing like what we have here in San Francisco. I think i speak for most of us when if it was a socially acceptable thing, yeah, but its obviously not. We dont want to be the bad guys here. With this kind of facility i think it will allow all of us to do that. Thank you. Commissioner chow following the testimony is kyle, tommy and ian and nona. My names johnny. Id also like to speak i dont like using it in public. I dont like to offend other people. I think it benefits children so they dont have to get stuck by needles and stuff if the street. I think it would help to have these sites. It would help a lot. Thank you. Commissioner chow thank you. Next, please. Good afternoon. My name is sevin. Id like to thank you for letting us speak and the work youre doing and from a personal standpoint its important when i inject in public its stressful. I see the faces of judgment and the looks of disgust and comments as people walk i. By. I live outside. I had a home and would go in my room and do my thing. Eve everything i do is in public. Injecting drugs is one of them. Given this opportunity, a place, a Clean Environment in which so inject would benefit the community at large in general because San Franciscos always been ahead of the curve. You were ahead of the curve on needle access and didnt obey the rules on a federal level you figured out a way to get it done because its necessary. This is necessary. This is an epidemic. We have lots of people injecting. In the eight years ive been using ive noticed it more and more. Piles and piles of needles. Its unacceptable. This will eliminate some of. Some of that. Well still be the pariahs but we dont have to be the visible pariahs. Its bad enough being homeless but to be an injector as well its not necessary when we can inject cleanly. Were rushing our shots because were afraid of police or people seeing us. Its for everyones benefit and i really strongly recommend you vote for it. Commissioner chow thank you very much. Next speaker. Hello, my name is kyle. Id like to all very much. Its near and dear to me. I was born and raised in indiana. Its still a felony to be caught with a needle and nine month in prison for it. When i came here and i was blown away by as they said theres still a lot of problems and injection facilities helps so many things. First off, i find it with great disgust when i see piles of needles and the blood and objects around the street. With safe injection facilities it allows San Francisco to put rules back in place where Law Enforcement can give tickets back to those caught loitering because if youre not doing it where youre supposed to you can get ticketed and puts responsibility to the actions and responsibility for our own waste. I never leave my stuff. I have a 10yearold driver. Unfortunately my drug addiction cost me but i still see the other ones. I dont want to be the one that sees somebody inject drugs. It rips me apart in side. Why should you guys have to deal with this. My demons are mine. Not yours. You dont want you to deal with it but i also dont want to be judge or the vicious cycle of judgment. It continues inside of me. Its not good. These things would give me access to the resources to get clean, to get healthy to all the things i dont see any more. If someone says hey, man, we have something for boxing maybe id be more likely to go towards it because id feel more comfortable talking to that person. This say winwin for everybody in my opinion. And like the guy before me said, you guys do the best thing that needed to happen for San Francisco. Ive always loved that about this place but its beginning to take a lot people across the country and you have the chance to set the bar for it and a hope you do. Thank you for your time. Commissioner chow thank you very much. Next speaker, please. My names tom. I worry about when i shoot up in the street the children will see me and ill be judged by others. I believe a safe injection facility will do good for all of us. I have brain cancer and im dying and the reason im using these drugs. I believe a safe clean place would be a great thing for San Francisco. Thank you. Commissioner chow thank you. Next speaker. Hello. I work at the San FranciscoDrug Users Union and work with holly and these lovely people you just met. I just want to make two quick points. I guess three, the first is its also tommys birthday. But i echo the point that everyones making about syringe letter. Our job is considered frontline work and theres not a day that goes by where i dont hear all my participants abhor the amount of syringes they see if the street. We at the union and other organizations, a lot of the people in the audience today are out almost every day of the week picking up syringes and its still not enough because you hear lots of complaints. And for reasons you heard about today is why people leave syringes out in the street. I wanted to echo the point a site would diminish the amount we see in the street. Two, the thing i see all the time is wound care. I see so many abscesses that get really infected and sometimes cripplingly so because theyve had horrible experiences getting help at clinics and hospitals. As much as theyll wait as long as possible to the point where they cant even walk before they experience that situation again. And im not saying all clinics and doctors are horrible people. It only takes one nurse or slip up or i can tell you inject face to not want to do that again. I think this would end that and have humane treatment for my people that would be stigma free and that would be amazing. Commissioner chow thank you very much. Following the last speaker is aly and michael, one anonymous from ucsf that wishes to discuss the availability of nanoxone. Yeah, shooting up is a highrisk activity the one id want my kids, my friends, the people i care about id want whatever evidencebased practices we can put into play to make this a survivable condition or moment in someones life. Whatever we can do to make that possible. Whatever we do lets bring that into play. Commissioner chow thank you very much. Hi, im in the street Harm Reduction centre and i have been an injection drug user in my life. Im here to beg you to go through with this. As someone who moved between both of those worlds, drug use, street drug use and now im sitting here talking to a bunch of important people. Theres a lot of tale of two cities. I think a safe injection space sends a message theyre not forgotten and we dont just assume. So many people assume. Im struck by how many people talked about not wanting to shoot up in front of kids and the shame. This is our most sensitive population. Commissioner chow thank you. Next, please. Good afternoon. My name is michael seaver. Many have heard me testify many times and im a psychologist whose specialty who is working with people with additions and im a drug user. I want to talk about the importance of supervised injection facilities or consumption services. It gets called several things. Primarily its about the health and wellness of the people who inject drugs. Thats the most important part. This will go to having supervised injection facilities and services will do a lot of for particularly homeless people. The streets are not sterile environments to do anything. Its very hard and a lot of the reasons people get sick is because they dont have a sterile place to inject their drugs. Having supervised