My name is doctor ellen moffett, i am an assistant medical examiner for the city and county of San Francisco. I perform autopsy, review medical records and write reports. Also integrate other sorts of testing data to determine cause and manner of death. I have been here at this facility since i moved here in november, and previous to that at the old facility. I was worried when we moved here that because this building is so much larger that i wouldnt see people every day. I would miss my personal interactions with the other employees, but that hasnt been the case. This building is very nice. We have lovely autopsy tables and i do get to go upstairs and down stairs several times a day to see everyone else i work with. We have a bond like any other group of employees that work for a specific agency in San Francisco. We work closely on each case to determine the best cause of death, and we also interact with family members of the diseased. That brings us closer together also. I am an investigator two at the office of the chief until examiner in San Francisco. As an investigator here i investigate all manners of death that come through our jurisdiction. I go to the field Interview Police officers, detectives, family members, physicians, anyone who might be involved with the death. Additionally i take any property with the deceased individual and take care and custody of that. I maintain the chain and custody for court purposes if that becomes an issue later and notify next of kin and make any additional follow up phone callsness with that particular death. I am dealing with people at the worst possible time in their lives delivering the worst news they could get. I work with the family to help them through the grieving process. I am ricky moore, a clerk at the San Francisco medical examiners office. I assist the pathology and toxicology and Investigative Team around work close with the families, loved ones and funeral establishment. I started at the old facility. The building was old, vintage. We had issues with plumbing and things like that. I had a tiny desk. I feet very happy to be here in the new digs where i actually have room to do my work. I am sue pairing, the toxicologist supervisor. We test for alcohol, drugs and poisons and biological substances. I oversee all of the lab operations. The forensic operation here we perform the toxicology testing for the Human Performance and the case in the city of San Francisco. We collect evidence at the scene. A woman was killed after a robbery homicide, and the dna collected from the zip ties she was bound with ended up being a cold hit to the suspect. That was the only investigative link collecting the scene to the suspect. It is nice to get the feedback. We do a lot of work and you dont hear the result. Once in a while you heard it had an impact on somebody. You can bring justice to what happened. We are able to take what we due to the next level. Many of our counterparts in other states, cities or countries dont have the resources and dont have the beautiful building and the equipmentness to really advance what we are doing. Sometimes we go to court. Whoever is on call may be called out of the office to go to various portions of the city to investigate suspicious deaths. We do whatever we can to get our job done. When we think that a case has a natural cause of death and it turns out to be another natural cause of death. Unexpected findings are fun. I have a prior background in law enforcement. I was a Police Officer for 8 years. I handled homicides and suicides. I had been around Death Investigation type scenes. As a Police Officer we only handled minimal components then it was turned over to the coroner or the detective division. I am intrigued with those types of calls. I wondered why someone died. I have an extremely supportive family. Older children say, mom, how was your day. I can give minor details and i have an amazing spouse always willing to listen to any and all details of my day. Without that it would be really hard to deal with the negative components of this job. Being i am a native of San Francisco and grew up in the community. I come across that a lot where i may know a loved one coming from the back way or a loved one seeking answers for their deceased. There are a lot of cases where i may feel affected by it. If from is a child involved or things like that. I try to not bring it home and not let it affect me. When i tell people i work at the medical examiners office. Whawhat do you do . The autopsy . I deal with the a with the enou with the administrative and the families. Most of the time work here is very enjoyable. After i started working with dead people, i had just gotten married and one night i woke up in a cold sweat. I thought there was somebody dead . My bed. I rolled over and poked the body. Sure enough, it was my husband who grumbled and went back to sleep. This job does have lingering effects. In terms of why did you want to go into this . I loved science growing up but i didnt want to be a doctor and didnt want to be a pharmacist. The more i learned about forensics how interested i was of the perfect combination between Applied Science and criminal justice. If you are interested in finding out the facts and truth seeking to find out what happened, anybody interested in that has a place in this field. Being a woman we just need to go for it and dont let anyone fail you, you cant be. With regard to this position in comparison to crime dramas out there, i would say there might be some minor correlations. Lets face it, we arent hollywood, we are real world. Yes we collect evidence. We want to preserve that. We are not scanning fingerprints in the field like a Hollywood Television show. Families say thank you for what you do, for me that is extremely fulfilling. Somebody has to do my job. If i can make a situation that is really negative for someone more positive, then i feel like i am doing the right thing for the city of San Francisco. Everything is done inhouse. I think it is done. I have always been passionate about gelato. Every single slaver has its own recipe. We have our own we move on from there. So you have every time a unique experience because that slaver is the flavored we want to make. Union street is unique because of the neighbors and the location itself. The people that live around here i love to see when the street is full of people. It is a little bit of italy that is happening around you can walk around and enjoy shopping with gelato in your hand. This is the move we are happy to provide to the people. I always love union street because its not like another commercial street where you have big chains. Here you have the neighbors. There is a lot of stories and the neighborhoods are essential. People have they enjoy having their daily or weekly gelato. I love this street itself. We created a move of an area where we will be visiting. We want to make sure that the area has the gelato that you like. What we give back as a shop owner is creating an ambient lifestyle. If you do it in your area and if you like it, then you can do it for the first time in nearly two decades fishers have been granted the legal right to sell fish directly to the package right off their boat to the public right off their boats in San Francisco. Its not only helping local fishers to stay afloat but its evoking the spirit of the wharf by resurfacing the traditional methods of selling fish. But how is it regulated . And what does it take for a boat to be transported into a Floating Fish market . Find out as we hop on board on this episode of whats next sf. Were here with the owner and the captain of the vessel pioneer. Its no coincidence that your boat is called the pioneer because its doing just that. Its the first boat in San Francisco to sell fish directly from the boat. How did you establish your boat into such a Floating Fish market . Well, you know, i always thought that it would be nice to be able to provide fresh fish to the locals because most of the fish markets, you would have to do a large amount of volume in order to bring in enough fish to cover the overhead. When you start selling to the public that volume is much less so it makes it hard to make enough money. So being able to do this is really its a big positive thing i think for the entire community. A very positive thing. As a thirdgeneration fisherman joe as his friends call him has been trawling the california waters for sustainably caught seafood since an early age. Since obtaining a permit to sell fish directly to the public he is able to serve fish at an affordable price. Right now were just selling what a lot of the markets like, flat fish and rock fish and what the public likes. So we have been working for many, many years and putting cameras in them. Theres the ability to short fish and we have panels that we open and close so we target the different species of fish by adjusting the net. And then not only that but then the net sort out the sizes which is really important. Joe brings in a lot of fish, around 20,000 pounds per fishing trip to be exact. We had one day one time that we sold almost 18,000 pounds. Its incredible. I know, its hard to imagine. But this wasnt always the case for joe. The markets that we have left in california, theyre few and far between, and they really are restrictive. Theyll let you fish for a couple months and shut you down. A lot of times its rough weather and if you cant make your delivery you will lose your rotation. Thats why theres hardly any boats left in california because of the market challenges. My boat was often sitting over here at the dock for years and i couldnt do anything with it because we had no market. The ability to go catch fish is fine, i had the permits, but you couldnt take them off your boat. That was until the Port Commission of San Francisco rallied behind them and voted unanimously to approve a Pilot Program to allow the fish to be sold directly to consumers right off their boats. The purpose of the program is to allow commercial fishers to sell their fish directly from their boats to the end consumer in a safe and orderly manner for the benefit of the overall Fishing Community at the port of San Francisco. We have limited the program to certain types of fish such as salmon, halibut, tuna and rock fish. Crab is restricted from this program because we did not want to interfere with the existing crab sales on Taylor Street and jefferson street. So this is not meant to favor one aspect of the fishing industry more than another. Its to basically to lift up the whole industry together. And if joe the program has been doing just that. It was almost breathtaking whenever i woke up one morning and i got my federal receiver, my first receivers license in the mail. And that gave me permission to actually take fish off my boat. Once we started to be able to sell, it opened things up a bit. Because now that we have that federal permit and i was able to ppetition the city council and getting permission from San Francisco to actually use the dock and to sell fish here, it was a big turning point. Because we really didnt think or know that wed get such a positive response from the public. And so were getting thousands of people coming down here buying fish every week and so thats pretty cool. They like the fish so much that they take pictures of it when they cook it and they send us all of these pictures and then they ask us, you know, constantly for certain types of fish now. And when they come down here the one thing that they say is that theyre so amazed that the fish is so fresh they could eat a little bit during the week and its still fresh all week in the refrigerator. So thats really cool. The fish is very fresh and the price is super. I dont think that you can get it anywhere in the bay area. I can see it, and i can stir fry it, wow, you can do anything you want. I just can say this is a good place to shop and you have a good experience. This Program Supports the Strategic Plan in terms of engagement, people being connected to the waterfront, and also economic vitality. Because its helping the fishermen to make ends meet. They have no guarantees in their businesses, not like some people, and we want to do everything that we can to help them to have a good and thriving business. How does it feel to be able to sell your fish locally kind of in the traditional way, like your grandfather probably did . When i was a kid and i used to work in my dads fish market, a lot of the markets that we sell to now are second and third and fourth generation markets. So i remember as a kid putting their tags on the boxes of fish that we shipped out of monterey and ship down to l. A. So its kind of cool that were still dealing with the same families. And this is probably about the only way that anyone can really survive in california is to sell your own fish. One of the advantages of this program is the Department People that pull in the fish, they can find out where they caught it and find out more about the fisherman and that adds to their experience. The feedback from the fishers has been very good and the feedback from the customers have very good. And theres a lot of people coming to the wharf now that might not have done so. In fact, theres people that go through the neighboring restaurants that are going to eat fish inside but before they go in they see the action on the dock and they want to kind of look at whats happening on the boat before they go in and they have a meal. So its generated some conversation down at the wharf and thats a good thing. As you can see by the line forming behind me getting ready to buy fish, the Pilot Program has been a huge success. For more information visit sfsport. Com. Hi, everybody. Welcome to laguna honda. [cheering] and before we get started, my grandmother spent almost 14 years here at laguna honda, and so many of you took incredible care of miss camelia brown. I want to give a special shout out to denise and so many people here who day in and day out take care of some of our most vulnerable folks that rely on us to care for them every day. We are so grateful to be here with our governor, gavin newsom. [cheers and applause] he has already hit the ground running, and we know from experience of being a former mayor of San Francisco, he understands intimately all the challenges that we as a city face, which really is going to be so incredible for our city and cities across the state of california for all the things we know we need to do to change california for the better. Laguna honda is a key part of San Franciscos Health Network, which cares for one in eight san franciscans. Primarily people who are uninsured, low income, or for from our immigrant communities. And includes not only laguna honda, but San Francisco general , and smaller clinics across our city, and Health Services in our county jail. Here at laguna honda, more than 1,000 patients each year receive care for complex conditions like h. I. V. And alzheimers and dementia, and other Mental Illnesses and disorders, and we have, for patients who are suffering from strokes or brain injuries, or spinal injuries, or other trauma. These treatments require longterm and specialized care, as so many of you here know, and they commonly include medications as part of the treatment plan. However, it is a wellknown fact that these medications are expensive, and can drive up the cost of healthcare for millions of people who need these drugs to survive. The San Francisco Health Network is constantly working to find ways to save money on drug costs for uninsured patients. We work with federal programs like the 340 b. Program that provides drugs at a discounted rate for some of our facilities, but facilities like laguna honda , or our county jail, our Behavioral Health clinic, they dont qualify for those federal discounts. Not to mention the medications used in treatment plans at these facilities are some of the most expensive medications. The Health Network purchases more than 3,000 drugs for patients who dont qualify for 340 b. Discounts, and just the 25 most expensive drugs, of those costs, it because our city more than 17 million each year. When we have people struggling on the streets of San Francisco, with Mental Health challenges and Substance Use disorders, or people spending thousands of dollars on lifesaving medication for h. I. V. And aids, or people fighting a battle with cancer, we need to be focused on helping them recover and heal, not whether or not they can afford to pay for the medication this is the same case at many healthcare facilities, not only in San Francisco, but across the entire state of california and the nation, and this is why i am so thrilled to be joining governor gavin newsom here today to announce a San Francisco will be joining the efforts to bring down medication costs in our city. [applause] we will work hard to bring down the cost of those medications. We have worked hard over the years, but we know there is so much more that we can do, and by joining forces with other counties across the state, we know that we can make a difference in the lives of millions of patients. We are joined here today by two other bay area counties in making this commitment, alameda and Santa Clara County, and please join me in acknowledging our new department of Public Health director, dr. Grant koufax who is here with us today [applause] at this time, i would like to call to the podium colleen who has spent about 13 years working for the department of Public Health in San Francisco. She is an Incredible Health care advocate, now heading up Alameda County department of Public Health. [applause] good morning, everyone. It makes me so happy to see so many familiar faces here, and to be able to bring my new county in partnership with my old city and county in this really exciting endeavor. Alameda county is pleased to stand with Governor Newsom to leverage the collective garb Bargaining Power as a state in its counties to lower the cost of Prescription Drugs for all californians. I would like to thank the governor for his leadership on this important issue. Alameda countys vision 2026 is in alignment with the Health Forward agenda. Vision 2026 is our comprehensive effort to set a course for a decade that anticipates Community Challenges and maximizes our ability to meet residentss needs in this rapidly changing world. Vision 2026 foresees a thriving and resilient population where individuals and communities are empowered to overcome adversity and be supported so they can grow, flourish and be selfsufficient. Essential to achieving this vision is our ten goal of healthcare for all, which seeks to ensure that every person in Alameda County has access to the care and services they need to live their healthiest lives. Governor newsoms collaborative approach to obtaining Prescription Drug costs will put us closer to a comprehensive solution for affordable and accessible healthcare for all. Collectively, Public Healthcare providers and other safety net providers in Alameda County, spends tens of millions of dollars each year on Prescription Drugs for our countys most vulnerable residents. While many of these drugs are acquired through the federal 343 b. Program which may or breed referenced, drugs purchased for individuals accessing our behavioral Health Services or our inmates and our jails do not this means that we are surely paying more than we need to for these medications, diverting valuable resources from other safety net programs and services this presents an important opportunity for our county and others to partner with the governors Healthcare Team to explore how we can make drugs more affordable in our safety net Healthcare System. Additionally, this approach will foster regional collaboration through the sharing of information and protocols and best practices. Alameda county is looking forward to partnering with the governors office, and our county colleagues to explore the promise of this timely endeavor. At this point, i would like to welcome miguel marques, marquez, the chief operating officer for the county of santa clara. [applause] thank you, colleen, and thank you Governor Newsom for inviting slight Santa Clara County to participate in this event and in this work, and thank you mayor breed for hosting this event today. Over the years, Santa Clara County has implement it programs to expand coverage and affordable options that move us closer to providing healthcare for all. Indeed, our board of supervisors has officially supported a single payer Healthcare System. And Santa Clara County, we are proud to operate three hospitals , and a dozen clinics located throughout the county. Each of which provides highquality, integrated healthcare to the 2 million members of our community. Like the governor, we know that innovation through the Healthcare System, including a path to single payer systems will help us reach our shared vision of Better Health for all. That is why we are excited by the opportunity to work with the governor and with so many other partners throughout the state to take on the high cost of Prescription Drugs. Year after year, pharmaceutical Companies Continue to increase the price of brandname drugs. We all need to ask the question, do Prescription Drugs really have to be that expensive . Wild drug purchasing practices are complex, we must look for and implement Innovative Solutions to reduce these costs. Federal policies have not done enough to control drug prices. In the absence of federal leadership, local and State Government need to partner and need to think creatively about how to leverage our collective buying power to negotiate better prices for our residents. Last year, Santa Clara County Valley Medical Center spent more than 120 million on pharmaceuticals. Giving the extrude nearly high cost of Prescription Drugs, we have been looking for opportunities for savings. We welcome the chance to work with the state and with other partners to explore options to reduce these costs. As you know, public helps it Health Systems play an especially important and unique role in delivering care, services, and treatment to the patients in the communities we serve, especially the uninsured and the underinsured. We are a safety net Healthcare System that is proud to offer topnotch care to all who need it, but to do that, we need to explore all opportunities to reduce costs whenever possible so that our limited resources can better be spent to help the homeless, the mentally ill, and other vulnerable members of our community. A number of years ago, the county of santa clara was the first county in the nation to ensure that every child, regardless of immigration status , could get healthcare services. We are especially proud to support the governors efforts to become the first state in the country to provide coverage to young, undocumented adults. Thank you, governor for leading the way for these young adults. Santa clara county and the state of california have aggressively implemented the Affordable Care act. It has been a huge success. Just a couple of numbers. In Santa Clara County alone, more than 100,000 140,000 residents gained coverage through this expansion. Another 45,000 plus have subsidized coverage through coverage california, that is just in Santa Clara County. And most important, the bottom line number, the uninsured rate in Santa Clara County has dropped by 50 3 . So the time is now to take the next step. We are fortunate to have a governor who is a champion for these important issues. We look forward to working with the governor to make Better Health for all, californias highest priority. Thank you very much. [applause] thank you, miguel. I also would like to take this opportunity to introduce someone who has been a champion for laguna honda, our supervisor for district two, Catherine Stefani is joining us here today. Thank you so much. [applause] and now i would like to introduce our governor, who we all know was a former mayor of San Francisco, someone who led innovative programs, pushed to really change San Francisco and california for the better, samesex marriage, he was the one who put forth the idea and opened the doors for so many people to get married at city hall, when so many people attacked them on this issue, and now it is gone global and has been recognized throughout the United States, 311 was just his brainchild, this innovative resource that we use to call to deal with a number of challenges in the city, so many incredible resources that we use today, and now, is a governor in his budget , he will continue to provide the support and the resources that we need to address many of the challenges that exist in San Francisco. We also should know that he really led the charge on the rebuild on the hospital to the new facility that we see today. The governor of the state of california, gavin newsom. [applause] thank you, thank you. This is fun coming back. The couple of you were showing me photos ten years ago, pregrey hair, and this is remarkable that this place opened. I remember standing here during the ribboncutting, and i think i used a line, which i am now reminded of, at the time we were doing something with a Skilled Nursing facility. Also ten years ago, that was novel and no one was investing in this place. People so the county couldnt afford it and we had to move in a different direction. We get it when it comes to Skilled Nursing facilities and keeping people in place. We are on the leading and cutting edge and doing something no one else is willing to do. I remember saying that the mayor of athens said, he says, we do not imitate, for we are a model to others. I say that then, nine plus years ago, i will say it again today in the context in the spirit that brings us here together around the issue of Prescription Drugs. We do not imitate because we are a model to others what we are advancing here today is new, what we are advancing here today matters what were doing today is what i expect others to be doing tomorrow, not just other counties joining californias purchasing pole, but other states joining californias purchasing pool. Leveraging our resources, big buyers mean lower costs. The fact is, in the state of california, 13 plus billion dollars a year, your tax dollars are currently being spent on Prescription Drugs. I will repeat that, 13 plus billion dollars a year. The problem is, we were isolating the purchasing. We had jails doing their purchasing, we had the state hospitals doing their purchasing , we had our retirement system doing their purchasing, we had the va doing their purchasing, we had our medical system, which is 13 million strong, we were only leveraging 2 million of those 13 million in our purchasing pool. Just combining the medical system alone, taking the 2 billion and leveraging the purchasing now with 13 billion is going to drive hundreds of millions of dollars of savings on an annual basis. We project in our budget that we just submitted a few weeks back, or a week or so ago, that we will save conservatively 393 million because of this purchasing effort. Thats just on an annual basis, 400 million of money that we otherwise would spend that would allow us to provide discounts, to provide additional subsidies to reduce those costs each to each and every one of you. If we are not curious about these drugs, we are not curious about addressing the cost as it relates to the issue of healthcare inflation. This is one of the principal drivers. We have seen close to doubling of our costs in the state, doubling of our cost in the state, just in the last nine years. This cannot continue. With all due respect to big pharma, i have no problem, no gripe with people being successful, i dont begrudge success, i appreciate competition, i appreciate research, i appreciate the kind of innovation that we pride ourselves on, but i dont like people taking advantage of other people. I dont like gouging, i dont like windfalls, i dont like folks, you know, getting massive bonuses and, you know, at the expense of folks that are struggling on the streets and the sidewalks. This is a foundational principle , it is a value i know laguna Honda Community shares. It is a value that san franciscans share, it is of value the mayor shares, it is shared broadly throughout this state and substantial of lee, around this region in santa clara, in alameda, that value now is being brought to the forward in terms of counties joining the state purchasing pool. We had hoped this would happen in a year or two, maybe three, but here we are, just weeks after announcing l. A. County joining our purchasing pool, no three additional counties are joining the purchasing pool. This is remarkable. The momentum is real, and this is exciting because we are actually making progress in realtime. This is not just platitudes, this is not just a tweet, this is not just a promotion, it is not just a promise, we are seeing things happen in realtime , so i just want to thank the enlightened leadership that you heard from today. They didnt need to do this, it was wise to do it, but they didnt need to do it, but the fact that they are doing it, and they are doing it on the front end, is an extraordinary testament to mayor breeds commitment not passing interest to bring down the cost of Prescription Drugs and the cost of healthcare in this county. Colleens commitment and miguel s commitment to do the same is a big deal, so i dont want to undersell this moment. I want to appropriately sell it. I want to overhyped i dont want to overhyped it, but this is significant. We have governors calling this state wanting to join our efforts. We believe this is the beginning of a different frame of momentum not topdown, god bless watching congress, pretzels trying to deal with big pharma, this is bottom up. It is a new frame. I will tell you, a california, we just reached at 3 trillion year mar. We punch above our rate, and there are only four nations on planet earth that carry more wait then the state of california. We are truly a nationstate, the fifth largest economy in the world, the United States is one of those economies ahead of us, only a few others that have the capacity to do what we are doing as a state. Now the second largest purchaser outside the v. A. And the United States itself in the country. This is important. I want to express and acknowledge the hard work of our team in sacramento that is working overtime to get this right, to make sure we do it right. I want to thank the counties for building that momentum, and i want you all to know that we are inviting the private sector to join our purchasing pools. We want to see Companies Large and small also join in and take advantage of our ability to leverage and to sit at that table as one purchaser, not just aggregated as thousands of purchasers. We are formed where pharma has the power, now we are taking back that power and we are leveraging that power over the table. Hugh merrow costs 96 more in the United States than it does in the u. K. Some medications are 100 more then the folks in the u. K. Give me a break. With all due respect, it is not just about well, we do the research on the development, we have to pay for that, the people who do the most research and the development are people like you. Through our grants, through our tax dollars. They leverage those, they supplement those, and we are proud of that research. But give me a break. They do it because they can. They do it because no one is pushing back. They do it because they leverage influence of the people like me. They come in with a lot of money and they come into leverage their point of view and they usually scare folks instead of doing the right thing, but they cant scare the leaders assembled behind me, and the cannot change the trajectory of a state that says, we have had enough. We are better than this. We will do more and we are going to leverage our voice in a way that respects the people of this state that we represent, so thank you all for coming out. Thank you for being part of this announcement and all this extraordinary momentum and know this, in closing, this is just one of many things the state of california is doing to expand healthcare in this state. Our budget, briefly, is going to expand coverage regardless of your immigration status. Our budget will double substantially and increase by doubling our annual contribution and our medical system through proposition 56. Forgive me for boring you on that, but we will increase our reimbursement rates, more trauma screenings, more early screenings to address issues before they manifest, we are going to deepen subsidies for low income families on the health exchange, and expand subsidies into the middle class. The only state in america that is expanding subsidies for families earning up to 150,000 a year. We are very proud of these efforts. Our goal is universal. Our goal is to get this done through a single parent financing system, but until we advance those ideals, we will build pragmatic steps, make progress each and every week until we ultimately get to those goals. Thank you, San Francisco, thank you to Mother Nature for adding a little energy, thank you mayor breed for hosting us here today. [applause]. Thank you. I dont know if there are questions, how do you want to do this . I will let the electives go, and supervisor, very wonderful you are here as well. Any questions, we will do it out here. We will let you all go. Thank you, guys, very much. [applause]
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