[roll call] thank you. The second item on the agenda is the approval of the minutes of august 20th, 2019. Commissioners, the minutes are in your hands. After that review, i would like to call a motion to adopt. I think there is one spelling clipped correction. Okay. Page four, paragraph three, there was [indiscernible] thank you for that. I apologize. Any other comments from the commission . Seeing none, motion to adopt the minutes. So moved. Is there a correction . Second. All those in favor signify by saying aye. Aye. Great. There is no Public Comment for that item. Item three is the directors report. Good afternoon, commissioners im the director of health. You have the directors of the commission in front of you. I just wanted to highlight a few things including some things that i feel that you have done well but were not written here there are number of articles focused on ensuring that whatever beds are available in the system, maybe are available for people who are living on the streets, and just to reiterate, it is part of that work at zuckerberg General Hospital. There have been a number of unoccupied board and care beds for a number of years and those are being converted into hummingbird type model beds. 207 beds Going Forward. I want to emphasize that no clients are losing housing as a result. No one is losing a job, and these beds will revert back to longterm care beds in 2021 as we look to potentially be able to establish those longterm care beds. As an interim measure, well be using that Available Space for the urgent need to get people off the streets through converting 207 beds to hummingbird beds in the next iteration. The other page, i wanted to give you an update on some concern around the current requirements around permitting massage parlours and just to remind the commission that we filed the board of supervisors requirements that we are charged with permitting massage parlours for a number of reasons, including concerns that the board of supervisors had at the time around sex trafficking. We are following the boards intent and giving the legislation that they have passed. It is understanding that it is my understanding that some Board Members are taking another look at this legislation and made any modifications. We will of course, follow the boards orders as required by law Going Forward on that. The other key issues to highlight, i have been updating you in regards to the title two federal changes in the requirements around title x funding, which will now prohibit recipient of title x funds from stopping women from comprehensive production per reproductive services. Related also do some of the federal actions that are taking place, i am proud that the Health Department stood with the City Attorney and is seeking for luminary injunctions to stop the current public charge rule. This revised public charge rule would actually have an assessment of whether people who are benefiting from legal public benefits, that that would negatively affect their ability to get this status. Something we can have a shining effect on their individuals and the families. We are watching that very carefully. I am also really proud that one of our Staff Members was recently featured on our front page of mindful magazine. She has been a real leader in helping us move forward our trauma informed system of care. They have been a pivotal part of that work and remains a local and National Leader in helping us develop a more Trauma Informed Care system. Internally within the department for our communities. I also wanted to highlight that we are working with the Safe Community in the bayview neighborhood, including specifically the africanamerican faithbased coalition, which was started by supervisor walton to provide support and dignity to clients, and our Community Health and equity Promotion Branch is continuing to support Food Security to through that coalition and with Community Members in that regard. Finally, with regard to the neighborhood Emergency Response team, we worked with a group to assure the medical corps, in collaboration with the California Department of health and the San Francisco fire department, were trained with regards to pointofcare dispensing sites and including looking at mass distention of antibiotics in the community with the response to Public Health emergencies, and that this training is foundational to successfully deliver medical countermeasures in the event of a mass population emergency that would require us to be more responsive to protect Community Health. That is my directors report. If you would all i will stand by for additional questions or verifications. Are there any questions from the commission . Yes, thank you for the report this is in regards to the psych unit that we have or the psych units. And i see the difference between them so that this seems to be described that the patients are currently placed on [indiscernible] they are for younger patients who require board and care, and the other is for older patients. What has happened is in our arf unit, some of the patients are qualifying for certain funds pick those. Those patients would be moved up , but on the second floor, we would also maintain some a. R. F. Beds. The second floor would open up some beds on the second floor of the unit for the hummingbird beds. 207 more of those beds would be converted into hummingbird sized beds. Those beds could return. We are putting in our licensure for those beds into suspense, but they could be converted back in mid2021. Does that answer your question . So the a. R. F. Patients are being put into the others . Some would be converted. Their designation is being converted, but there are also some younger patients who have been moving up to that floor that would maintain as an a. R. F. Meanwhile, we will reduce the number of beds that we are keeping open. Those beds have never been occupied, so we are not moving patients from those beds into the community or into other places. This is simply and i may have more detail. Inc. You. Good afternoon, commissioners im the director of the Health Network. There will be 14 patients remaining on the a. R. F. So they will still continue to operate 14 beds that are currently occupied. Okay. And is there some reason that certain beds were not occupied in the past . Yes. We had vacancies and the facility continues to be on a corrective plan of action. I see. They were being held in vacancy because of the corrective action plan that needed to be carried out before we could actually activate the beds. Is that right . That is part of the equation. Making sure that the safety mechanisms are in place so we can safely operate those beds. I see. Okay. They were vacant not necessarily because there wasnt a demand, but we werent able, until we fulfilled our corrective action plan to take or add additional patients. Right. Until we felt comfortable we had corrected those deficiencies in the corrective action plan. We werent able to add additional patients. At the moment, one of the reasons that we would be reducing a. R. F. Beds temporarily , not, of course, taking away from the current residence, because everybody is trying to apply, because we are still working on this corrective action plan. We are currently working. That is correct. The beauty of this plan is that because we have those vacancies on the a. R. F. , we will take some of the staff and move them up because they also have vacancies and being able to actually occupy and put the patients into those beds because we will have access staff that will go up. So that would allow us to fill the needs . Exactly. Okay. Thank you. So when the corrective actions are completed in 2021, is that when you need the flexibility . Right. We want to have that flexibility the beauty of putting those licenses and suspense as we dont put them up. As situations and circumstances change, we can more easily go back to those beds as needed. And how will that decision be made . Is that an administrative decision within the department . We will be making it in conjunction with all of our City Partners with h. S. H. And others who are dealing with the Current Mental Health crisis. Well be looking from a holistic point of view in terms of what makes more sense for the system and the city as a whole. Thank you. Thank you. I think exactly what was stated, and i do think we need to look in 2021 at what our other alternatives to having people out on the street, including more hummingbird based models in the community. I will also add this is a bigger issue in terms of board and care , not only specific to the site at the hospital, but as you know, mayor breed has invested a substantial amount of dollars to help keep the remaining board and care beds sustainable because there will be ongoing issues Going Forward in terms of the model of care. It is something we are taking a hard look at. Strategically, it is more then those 207 beds. Every bed is important, but looking at the longterm strategy as a department, as a city, and as a community to help ensure wherever possible there is longterm care available for people. Yes, i was wondering if you might have any followup on the vague issue. It looks like people are continuing to have difficulty. I am wondering if our county has seen anything or does it seem that the word out there is i have been in close contact with our officer about this and the doctor can give a quick update on where things stand. Across the country theres been more than 200 cases that are being investigated right now San Francisco has zero suspect cases of the Vaping Associated pulmonary injury. Thank you. Anything else from the commission . Call the next item, please. Item four is general Public Comment. If i may, to those of you are making comment, in case you havent been to our meeting before, you will each have two minutes. You will be called by name. I have a little egg timer here. When the buzzer goes off, it means your time is up. Please finish your statement and let the next person come up. Everyone here is here for a reason. Most of you are very passionate about what youre talking about but no, we have to make room for everyone. Before i call names, let me inform the public that the commission will not be responding to your comments. You will make your comments, if the commission does have questions, then we will refer them directly to you. I apologize in advance if i mispronounce anyones name. Let me call three speakers right now. [calling names] hello, commissioners. I am a primary care provider a San Francisco general and the department of Public Health interpersonal violence prevention coordinator. Im here to ask you for your support of the department and the commission on behalf of brandon lee. Brandon lee is a u. S. Citizen who was a graduate of San Francisco state. He his the son of a 40 year employee, louise lee, who works at seven cisco general at San Francisco general. Brandon was working with indigenous kenyan communities in the philippines on Environmental Justice issues, deeply understanding the relationship between the health of the planet and the health of people. He survived an assassination attempt. He was shot multiple times on august 6th. He is in stable condition, paralyzed from the chest down in the philippines. He is his doctors think he will be ready to be transported back to the u. S. Within the next couple of weeks, and we are here to ask for your support. One, that the department of Public Health will help coordinate his transfer from the philippines to San Francisco General Hospital because he will definitely need to care care there. Two, that the department will try and help us locate funds to pay for the medical evacuation of brandon. Three, that his mother would be supported in whatever way she needs in order to deal with this family crisis, and four, that you would issue a statement of support for the family in condemnation of violence against someone who was trying to work on behalf of Environmental Justice and Indigenous Community rights. Thank you. Good afternoon, commissioners i am brandons anti and this is his other anti. Im brandons on tea and this his other auntie. I dont know if this is the right form to speak about this, but im desperate. My family needs help. My sister has worked for the department of Public Health of her 40 of her 60 years. She started as a student assistant in laguna honda hospital, and in 1979, she became a medical record clerk. Two years later she was promoted to technician and later she was promoted to medical record technician supervisor. She gave her life to laguna honda. She was quite dedicated and spent long hours at the hospital during her 305 years at the hospital, she voluntarily served as acting director of Health Information services multiple times. The last time in 2010 to 2013. In 1987, she received a special award from dianne feinstein, the mayor of San Francisco for dependability. At zuckerberg San Francisco General Hospital, she designed special projects and provided support when the new hospital was reopened again, when moche when d. B. H. Went alive. Went alive. [indiscernible] this is only a small list of her accomplishments. She ensures that operating engines as well oiled behind the scenes. If you wonder how brandon is a way he is and how he speaks for those who cannot speak up for themselves, look no further as his mother. She demands a lot but she is fair across the board, and would not allow her people to be mistreated. My sister has been in contact with the u. S. Embassy. You are only supposed to have one person come up back the commissioner, i asked you how we should proceed. You may have one more minute. Thank you. I am here out of desperation. Unlike my courageous nephew, i never speak out. My only concern was that i am not as young as i once was. Now my world is turned upside down. I am ordering Adult Diapers on the internet, ordering body cleansers for bedridden people, addled wipes for incontinence, oral swabs to clean the mouth, glycerin swab sticks, and im speaking out because my sister and i need help. God willing brandon will return. When he returns, he will need several operations to remove the bullet in his mouth, spine, back and the bullet in his elbow and he will need longterm care and rehabilitation. Im here to ask the department for health. For help. We need help transporting him from the philippines. We need help getting him medical care. Is there anything you can do for a very dedicated 30 year employee of this department of Public Health and her son, a local boy who found his calling as a human rights activist in the philippines, and now he needs to return home to recover. Thank you for your time. Thank you for your time. Thank you. The next three speakers are. [calling names] good afternoon, commissioners my name is racquel and im a friend of brandon lee and im here in support of his family, as well. I just returned from the philippines with supervisor matt haney and some others from San Francisco to visit brandon lee at the hospital. We are happy to report that brandon lee is miraculously improving despite surviving a cardiac arrest and still having an unknown number of bullets lodged in him. When i last saw him, he was breathing on his own and he has regained feeling and movement of his upper body, but brandon is a strong fighter, but more recently, he got pneumonia and so he is back on his respirator, but from all accounts, he is getting stronger every day and the doctors are hopeful that within a couple of weeks he would be well enough to be medically evacuated. So we are here to update the commission and we would love to get your support for his family. Right now his mother and brother are providing 24 7 bedside and security for brandon. Between that and they are researching how to do medical evacuations, how to, you know, find somebody who can bring back here to look for government loans to pay for it. We asked the commission if there is anything they can do to extend support to the family, even just assigning a social worker that would help them through the process of figuring out how to ensure that one brandon does arrive, he is properly cared for in the best medical facility. Thank you. Thank you. Hello. My name is kim, i am a massage therapist in San Francisco. I formally was located at the active space building in the mission and several of my colleagues refuse the cease and desist, i cant talk in front of a bunch of people. They were forced by the department of Public Health to leave the building because it was built incorrectly. Thanks to hillary ronan, the building was given a grandfather zoning, but a lot of us massage therapists still cannot afford the establishment permit that is required of us as sole proprietors. I gave of myspace on may 1st and have not been able to find a legitimate place to work in San Francisco as a massage therapist i have been offered seven locations with acupuncturists and chiropractors where i am allowed to work without this permit, off the record, and im not comfortable with that. I have been trying to sell my truck and my furniture. I cannot afford this very expensive permitting process. I understand that it is in place to prevent sex trafficking, which i am not, but anyways supportive of, but i am not participating in it, either. I work with and of life folks, pregnant women, people in pain, i serve a community. I have been doing this for 15 years. At the end of last year, i stopped taking new clients because i was at capacity with my business and im very proud of the work that i do. I would like to keep doing it and i would like to keep doing it on the record, legally, but i cannot afford a multiple thousand dollar cost living in the city as a working workingclass, Small Business will proprietor sole proprietor. I heard the inspection process thank you. Hello. I am Jonathan Jordan and i am also a massage therapist and a personable personal trainer and Nutrition Court coach. I have four jobs. I do a lot of things to make ends meet. I am a Small Business owner, and l. L. C. , i am a rule follower and a goodygoody. I am not here to dispute the good intentions of the law and the commissions duties to execute the law. What i do want to point out, as someone so i am not an active space, i am in a building that is zoned for massage and i was just not aware of all the permitting requirements. It is very convoluted and complicated. What i want to draw attention to is someone like me, you know, i am a taxpayer. I do every bit of my income. I am a great massage therapist. I have an exemplary record. I also am against human sex trafficking, you know, illegitimate sex work, all of those things. I just im trying to do the right thing. There are 200 plus of us that got a cease and desist letter. The second i got the letter i did everything on the steps in the letter, and i just want to draw attention to the errors and misinformation within the governments office. I am a smart guy, you know, i am a Business Owner, i am in charge of peoples bodies. The instructions were unclear, they are wrought with errors. The application in and of itself has unnecessary things in it. It tells me i need a license. If you call them they do not do licensing. Theres no such thing. The boards need to be clear and the steps need to be clear. I was told i need to call this phone number to find out if my building was owned, im assuming that if you were sending me a letter, like the government could determine whether or not my building is zoned, but the head in the hands are not speaking to each other and they putting the onus on the Business Owner to navigate this process which is just a mess. Thank you. Thank you. [calling names]. Good afternoon, commissioners i am also a massage practitioner in San Francisco. Im here today because i am greatly concerned with the Health Permits and zoning page requirement required in the city massage and bodywork are part of healthcare and wellness in San Francisco, and the department should recognize us as such. We Small Businesses and sole practitioners do not make a lot of money in the field. We try to keep our fees affordable for the working class , and common folk of the town. To aid them in their health and mental wellbeing. As a Small Business in the city, it is already hard to make ends meet, and now this huge overhead from the city just to prove we are legitimate. Having a background check for certification Means Nothing to the city of San Francisco. Why was i not notified of this required Health Permit when i signed up for my business permit with the city . Now i am blindsided with fees and notice of cease to desist. Why should we live jim it legitimate businesses in the industry suffer so much because of a few sex partners . Surely there is a better and more productive way to crack down on Human Trafficking and sex parlours then to have such high fees and regulations on an industry that offers healthcare to its community. Massage should be changed. It is eradicating massage business here and we will have to it will have ripple effects to the wellbeing of the citizens. Massage should be change for the health and wellbeing of San Francisco. Thank you. Thank you. Good afternoon, commissioners my name is david clark. Im a Small Business here in the city. I am a certified massage therapist in the state of california. I am one of 100,000 people who have received the ceaseanddesist letter about the Health Permit. Like my colleagues, i was really taken back by this letter, i was very blindsided by the information that we and my fellow friends, hundreds of other legitimate, certified massage therapist providing Wonderful Service in San Francisco have to dig into some savings accounts that we may or may not have for thousands of dollars of fees to pay for a Health Permit that we had no idea was necessary, number one, and number two, i kind of want to have a reeducation about who we are. This may be an issue for the city and for the nation as a whole, but why is the Health Department going after california certified massage therapists who have Business Licenses and who are doing business in the city. I am my only breadwinner, this is my business, this is my livelihood. I am asking for knowledge about that and maybe for the commissioners reflection on what it would feel like to get a letter to say dont come to work tomorrow, no paycheque, thousands of dollars of fees for you to pay before you can go back to work, if you can go back to work. And the most expensive city in the united states. Thank you. Good afternoon. My name is christine and i am a Board Certified massage therapist as well as a boardcertified structural intervention practitioner. I am a Small Business owner. I have 2,000 hours of training. I only work with people who are in pain, injured, postoperative and this is really hard for our community and my business. I signed up they make 40,000 a year and six and hundred dollars is a lot to be 10,000 for a conditional use permit if you want one employee is a lot. I understand the reasons for this against Human Trafficking and a fully support that, but to try and regulate something that is in a legitimate industry is not fair. I signed a lease in the building that is a Medical Arts Building and i had six years in sports injury and rehab and the first the fulltime of 20 hours a week because our hands give out after 20 years. Im working 305 hours a week to make it work and i was burning out. I only opted to go into private practice so i can save my body and i couldnt have my practice there because of the zoning. I was told i went i try to go above board and i go with my a. D. A. Compliant people for people who are disabled, my stroke patients, all of these people who might need that accessibility and we are division two human arts professional in the state of california. We should be regulated as such, so i am also doing structural integration, which is i hope i would like to educate you about what that is. We have our own board certification and we are recognized in 11 states and for our own licensing, but i have done both. Time. Okay. Thank you. Commissioners, do you have any comments or questions . I will just reiterate what i said in my directors report earlier, my oral comments which is the we are following the instructions of our board of supervisors. My understanding is this issue is being reconsidered by that body and obviously we would follow any new rules and regulations that the board would see fit in adopting the current policy. Thank you. Item five is report back from the finance and planning committee. Good afternoon, commissioners we met before the commission meeting. It was a very short meeting because we only have one new contract to consider. What it basically does is to incentivize to connect [indiscernible] if they leave a certain threshold, there is a monetary incentive for the health system. If if they dont meet the quota, they dont get the commission. I think that is how i understand it. It is a contract for the amount is 468,000. It is on the consent calendar for you. Commissioners . There are no Public Comment . Request for this item. This has been submitted. We will take a vote. Thank you. Item six, consent calendar. Item seven is the laguna honda hospital reform plan. Mr. Pickens . Good afternoon, commissioners im director of the San Francisco Health Network i am here today to share with you the results of an initial and ongoing investigatory process and its subsequent plans for remediation and improvement that stem a forum june 28th 19th, with patient abuse of laguna honda hospital. My goal is to share with you as much information as possible, but i while still safeguarding the integrity of ongoing investigations by multiple agencies. During todays presentation, i will cover the following areas. Our promise to San Francisco, ensuring Regulatory Compliance, reorganizing leadership with an emphasis on quality and safety, and where do we go from here, preparing for the future. First, that is our promise. I purposely use the word promise for two reasons. First and foremost, because of laguna honda, is and has been over 100 years our citys collective resource that has taken care of generations of san franciscans with dignity and respect. Secondly, i use the word our because information seared shared affects the lives of thousands of hours of investigation, interviews, and problem solving by numerous city and county staff, other local, state, and federal agencies and regulatory bodies. Many of those individuals are here in the audience today and i would like for them to stand so we can see who they are. Thank you. On june 28th of this year, maryland and breed and the president of the board and the Health Director reported directly to the community about the february 2019 discovery of the abuse issues involving patients at laguna honda. During that report, the director announced that a reform plan for laguna honda would be developed and presented within 60 days. Today, we are making good on that promise. In the reform Plan Document that was provided, with its appendix that summarizes our California Department of Public Health plan of corrections, you can see an overview of findings of deficiency and the cornerstone and action items and plans for improvement. Many of which deal with employee misconduct and gaps in patient care, quality, and safety. While our plan has a correction and the reform plan outlined the work that needs to be done at laguna, in the near, intermediate, and long term, we at the health work Health Network and the department tend to make good and our promise to restore the public space and the facility of laguna honda to deliver highquality, safe, and abuse free care to the next generations of san franciscans. It is important to note that we will continue to take employee misconduct seriously and hold individuals accountable for their actions. Next, we will discuss Regulatory Compliance. It is important to note that upon discovery of the patient abuse in february of this year, it became evident that we needed to bring into laguna honda Additional Resources in the areas of quality, Patient Safety , and Regulatory Compliance. Accordingly, we redeployed staff in these areas from zuckerberg San Francisco general to assist laguna honda in this effort. As we previously shared with the commission, the California Department of Public Health issued its statement of deficiencies, also known as a 2567. Outlining specific areas will be out of compliance with state and federal compliance. Prior to the receipt of the statement of deficiencies, laguna honda has remediated certain steps. Quality management, leadership, and Human Resource Workplace Experience functions. Next we will discuss leadership. These processes will be taken as part of the d. P. H. Plan of corrections in the reform plan and identify deficits and executive management operations as primary contributing factors to the authorization of culture that will allow the cases of abuse and efficient regulatory practices to boast both occur , perpetuate and go unrecorded, where or or can be properly investigated under experience consequently, we have made changes in executive leadership at the hospital and we will continue to make more as needed to support maintaining a safe, high functioning institution that meets our Regulatory Compliance requirements. So what is in store for the future of laguna honda hospital . The initial discovery of the circumstances of patient abuse, quality, and safety deficiencies and the lack of Regulatory Compliance, we both solicited and received offerings of consultation, guidance, and expertise and recommendations from local and National Experts and longterm care whose influence is reflected in the reform plan and from whom we intend to continue to involve in our ongoing operations. Finally, as with the network and the d. P. H. Leadership have spent time at laguna honda hospital, meeting with, listening to and talking with staff on all three work shifts, we recognize fully that we are still in a period of mourning, of some feeling shame and embarrassment, disbelief and acceptance of the fact that collectively we allow some of our most vulnerable patients in our care to be abused in silence Going Forward, we must and we will all pledge to rededicate ourselves and to hold each other accountable to creating a new east those at laguna honda. One that values safety, quality, transparency, leadership, and above all, dignity and respect. And further, we fully expect to you, the Health Commission to hold us accountable for ensuring that san franciscans will once again receive the best care possible at laguna and that we create a new environment at laguna honda that is grounded in the commitment to continue this organizational improvement and transparency in operations and reporting of themselves. We will continue to keep the Health Commission, the mayor, and the board of supervisors apprised of our deliberations. Im happy to answer any questions you may have at this point. Is there any Public Comment . I have not received any Public Comment requests for this item. [indiscernible] i would just like to emphasize what he stated with regards to i take this very seriously. I think that the situation with the patient abuses were horrific , unacceptable, and i have also explained how my time at the hospital has been impressed with the interim leadership and the focus on shifting our culture, moving from a culture of silence to a culture of safety. I think we have taken some key steps in moving that forward already. But there is still a lot of work to do in these and these are things that i am confident that we are taking the necessary steps to prevent and ensure that patients are safe. We have a lot of work to do Going Forward to shift the culture, to ensure the standards at laguna honda meet our standards, meet your standards as a commission. I look forward to your guidance on this draft document. I also really want to acknowledge pickens and the team they have done an incredible amount of work to ensure that all the information is coming out and to prepare a comprehensive plan Going Forward thank you for your work on this. I will return it to the hands of the commission. Were here to answer any questions. Commissioners . Thank you, roland, and thank you dr. Colfax for your presentation of the plan and for your commitment to a new laguna honda, as well as the staff there at laguna honda, and bringing in very decisive leadership in the interim until the investigation is over and whatever processes are put in place to ensure all of the changes have taken hold and the new leadership is in place. I do want to note that it will be important if all of these changes are being put into place that all of the people who have dedicated themselves to the wellbeing of the patients that are there at the hospital, and those that have, in fact, worked for many, many years on behalf of those patients, also feel supported throughout these changes. There has been a lot that has been happening throughout the network. I would want to make sure that we continue to do whatever we can as we make these improvements to support the staff, all up and down the line to do this and to support each other, and to know that the commission and the department is doing this for the wellbeing of the patients, but also not to [indiscernible]. Thank you, commissioner. Thank you for the presentation. The one question i have is [indiscernible] how would that be implemented in addition to these improvement plans that you are putting in place . Thank you for asking that question. Laguna was one of the first places were reintroduced trauma informed systems in the department. Almost all of the staff have actually been through the trauma informed class, and as we move forward, we will make sure that we continue to utilize those principles of trauma informed to both inform what we put into place, and also how we then ruled roll it out in a most respectful manner that respects that we all come from situations of trauma, and how do we support that in the workplace. Thank you for taking your part on this very serious issue. In looking at the progress in the very corrective actions that have been completed, is there a timeline for the remaining ones that was set by the state or otherwise for completing those, as well . There arent necessarily time frames other than what we put in place, but we are dividing those remaining items into both shortterm, intermediate, and long term. For example, a shortterm would be to solidify the Job Description for the new laguna honda c. E. O. We have been working with the department of Human Resources to actually do a recruitment process. More longterm things are the r. F. P. Listed in the plan where we will actually put out a request for proposal for an expert to actually come in, do an assessment of laguna and help inform in terms of its current state, and perhaps where it needs to go in terms of being a worldclass, longterm care and rehab facility. In focusing on both short and intermediate and longterm, and we actually internally have documents that break out what those things are. They are just not in what you received today. Thank you. Yes, thank you for your report and thank you for the draft. It was a very good summary of the findings, and the work that you have thus far done. That credit goes to the quality team for putting that summary together. You could see it is in a format that you are familiar with. I think it shows that you have summed up the issues that we are all facing. I do think that the draft needs more of a timeline, and i think that the issue that we have before us is just as important as when we were building the building, where we followed carefully what the corrective action, in that case, the buildings, and how well we followed it. I would suggest then that one of the reporting criteria should be not just in quarterly to the board of supervisors, but that it comes to the Health Commission. Certainly the j. C. C. , on a monthly basis, appropriate he follows your everyday progress, and that in order to do that, it really requires that there be a more explicit timeline for each of the items that you are talking about, because clearly then we wouldnt be able to follow if we didnt have a timeline to see if we are going to be on target and that the timeline needs to consider not only the regulatory part, but the part in which we are able to take the opportunity to work with our staff and the in the thousand plus employees that we have almost all of who have done a good job, and this is an issue of which a few have blemish the work that so many of us have done in such a fine institution for all of these years. I think in addition to trauma informed, this is a Good Opportunity to look at our application of cultural humility at the hospital, you know, there have been a lot of discussions about how we are actually looking at culture. I think it is not near merely a culture of reporting, but one of truly cultural humility and that may be one of the course of the problems that we saw in the small opportunities of our ability to understand what is happening there. I would ask that as we move forward, that this is a good start, but that we need some timelines, we need some regular reporting done so that we are sure that we are on target, that if there are needs that we all become aware of it and we worked together with this city to ensure that we are able to respond. We may find some things that we really need some greater opportunity to actually take advantage of. Although you spoke of the proposal for partnering with consultants, that that be actually something potentially a lot sooner than the longrange plan because just merely catching back together where we were is probably not the answer, and perhaps one of the ways we want to do it, and it is up to the administration, is to also get expertise from other experiences that allow us to then put in place the right measures that we need in order to understand that our facility is performing and is giving our san franciscan his the best, best, as you say. Thank you for those suggestions and recommendations. We will definitely take those to heart. We will go back and look at the rebuild timeline. I know we worked to really refine that for a way the commission could see progress and look to see how we can adapt that to this reform plan. I think there was a chart that really shows what we do and where we are in terms of being on track. Is that what you had in mind . Something like that. Where we actually are able to understand at what levels you are. You have obviously got one already in which there are regulatory things that have to be done within a certain period of time. With some of the others including doing your hiring where you are with their Community Programs and so forth. If we know where you are going, we will know what to hold you accountable for. In terms of the r. F. P. , i probably misspoke when i said it was more longterm. It is actually in the shortterm the in the developed of the r. F. P. , is knowing how long it takes a put it on the street from this proposal, reviewing the proposal, and awarding the contract. It will be a little while before that happens, but we are beginning on working developing the r. F. P. Right now. Sure. I really do think that that could be really helpful to the department if there is a way to even expedite that and get that so that you all have that expertise and advice that you can all work together. I think that will make more corrective action for us. Agreed. [indiscernible] have there been any activities to promote [indiscernible] especially with the patients . Yes. If i miss anything, i will ask the acting c. E. O. To help fill in, but there have been all of that care teams and all of the neighborhoods at laguna have actually had dedicated time working with patients on those units and some of the surrogate decisionmaking to really talk about what happened. We have also had resources from City Health Services to come in and work with staff both in Group Settings and individual sessions who are having difficulties as a result of this entire experience, and we have an openended commitment to supply that type of support for as long as we need it. Thank you. I want to add my voice to my colleagues on the commission to indicate that what has been described in the report regarding that behavior is not reflective of the institution with its history and staff who have been dedicated to san franciscans and our most vulnerable populations. We need to recognize that is very true, as well as the support for line staff and patients, i have said it before, the administrative staff, the executive team, they need that support because they were traumatized just like everybody else who was acknowledged that this has occurred. I want to make sure that there are people in the honda family who get access to that very important support, and i encourage and are encouraged to take it. It is not an order, but you should be encouraged to take some leave to address the issues that have emerged as a result of this. And some of it will be later on. It will be ptsd, kind of, so we need to be on board and aware that that is possible. Thank you for your very thorough report. Next item. Thank you. Item h. As other business. You