Transcripts For SFGTV Government Access Programming 20240713

The department did previously with the review back in 1112, the way the department previously did their annual reports where they were much more extensive, but they also took approximately 1824 months to complete. If you look back in history at the departments annual report, technically included data for 1112. It was much longer. So we are looking out for version we are doing now is to find more of a sweet spot in between that has a series of grass and basic data and information and additional narrative and something that is complete within six months of the fiscal year. But doesnt take a major thesis to do. What is the diffidence between what is the difference between a corner and a medical examiner . I am probably not the best one to answer that question. A coroner is under a sheriff, and other jurisdictions in the country. It could be anybody who runs for office and has absolutely no training. The medical Examiner System is set up to bring a level of professionalism to Death Investigations and how Death Investigation should be properly handled. Our office and many other major jurisdictions in california are set up in the medical Examiner System. Thank you. Supervisor brown . Thank you. I wanted to talk up a little bit about the timing of these reports, because, i know i have talked to mayor mccallie, administrator. This is really tough for families when they are waiting for this report. I went through an experience with the jessica alba family. They were waiting for the death certificate to be um released because they felt it was a homicide and not suicide. Um and, you know, the entire native American Community came out and said this was a coverup. I just filled that, and we have talked about this that the communications has to be a lot better with families um because as we know families are in um there worst times of their lives when they are dealing with this, the death of a loved one. We need to be able to communicate with them what is happening, what the process is, why it is taking as long as it does. Um because, what i have found, the board of supervisors to get that information. We are the in between um. So, i really appreciate that youre looking at this, and even having really skilled, qualified people to help with the families. I think that is so important because um, you know, it is a real issue when we are dealing with those families that are waiting for them. Supervisor, i could not agree you more. Being able to communicate with families at the time of a tragic loss is very key. This is information we are using to help with our recruitment efforts and some of the vacant positions we have. With the jessica alba situation, you know, after talking to you i went back and looked at the timing, and the report came out 52 days after the ten day determination out and then the final report came 52 days later. Had there been better trust and Better Communications the family would not feel this way right now. Especially with a community that does not have trust of this government. Exactly. When you say pending, does that mean there is a draft report that is available for people to review and then later on a final that may or may not be the same . Yes. What doctor hunter did, instead of waiting for everyone, and i think this was right for determination to happen once you have the final report which could be 52 days, 90 days, that is a long time not to know. He waited call quickly and just say pending, pending toxicology reports. Those were available . The toxicology reports were not done yet when we did the pending. Right, but the pending determination was available to the families . Yes. That is why if we build trust a Better Communications we would be in a much better situation. Thank you so much. Thank you supervisor peskin for calling for this hearing. Thank you. Um are there any members of the public that was to comment on this item . Seeing none. Public comment is closed. Can we file this hearing without objection . Great. Mr. Clerk is there any further business . There is no further business. We are adjourned. Thank you. Usf donates 100120 pounds of food a night. For the four semesters we have been running here, usf has donated about 18,000 pounds of food to the Food Recovery Network. Im maggie. Im nick. Were coechairs of the national led organization. What food recovery does is recover and redistribute food that would go wasted and redistributing to people in the community. The moment that i became really engaged in the cause of fighting food waste was when i had just taken the food from the usf cafeteria and i saw four pans full size full of food perfectly fine to be eaten and made the day before and that would have gone into the trash that night if we didnt recover it the next day. I want to fight food waste because it hurts the economy, its one of the largest emitters of Greenhouse Gases in the world. If it was a nation, it would be the Third Largest nation behind china and the United States. America wastes about 40 of the food we create every year, 160 billion worth and thats made up in the higher cost of food for consumers. No matter where you view the line, you should be engaged with the issue of food waste. Access edible food that we have throughout our Lunch Program in our center, i go ahead and collect it and ill cool it down and every night i prep it up and the next day ill heat it and ready for delivery. Its really natural for me, i love it, im passionate about it and its just been great. I believe its such a blessing to have the opportunity to actually feed people every day. No food should go wasted. Theres someone who wants to eat, we have food, its definitely hand in hand and it shouldnt be looked at as work or a task, were feeding people and it really means so much to me. I come to work and theyre like nora do you want this, do you want that . And its so great and everyone is truly involved. Every day, every night after every period of food, breakfast, lunch, dinner, i mean, people just throw it away. They dont even think twice about it and i think as a whole, as a community, as any community, if people just put a little effort, we could really help each other out. Thats how it should be. Thats what food is about basically. An organization that meets is the San Francisco knight ministry we work with tuesday and thursdays. By the power of your name i have faith to move mountains because i believe in jesus. I believe its helpful to offer food to people because as you know, theres so much homelessness in San Francisco and california and the United States. I really believe that food is important as well as our faith. The San Francisco knight ministry has been around for 54 years. The core of the ministry, a group of ordain ministers, we go out in the middle of the night every single night of the year, so for 54 years we have never missed a night. I know its difficult to believe maybe in the United States but a lot of our people will say this is the first meal theyve had in two days. I really believe it is a time between life or death because i mean, we could be here and have church, but, you know, i dont know how much we could feed or how many we could feed and this way over 100 people get fed every single thursday out here. Its not solely the food, i tell you, believe me. Theyre extremely grateful. Its super awesome how welcoming they are. After one or two times theyre like i recognize you. How are you doing, how is school . I have never been in the city, its overwhelming. You get to know people and through the music and the food, you get to know people. We never know what impact were going to have on folks. If you just practice love and kindness, its a labor of love and thats what the Food Recovery Network is and this is a huge i believe they salvage our mission. To me the most important part is its about food waste and feeding people. The Food Recovery Network National Slogan is finding ways to feed people. Its property to bring the scientific and Human Element this noting will come to order. I will call the roll. roll call . President james loyce before we get started i would like to read a statement from the commission. Thank you for attending todays meeting. There have been several articles about the property of Public Health adult residence facility. There is frustration and confusion about the past year. In response to the changes made in areas of homelessness and Behavioral Health issues in San Francisco we request the next three meeting including the following relevant items. Today we will discuss the presentation. Next meeting whole Person Care Initiative to address the needs of the highest utilizers of Public Health services. On the fifth of november a broad update. We are concerned about the health and wellbeing of those in San Francisco. We take our role seriously and we will continue to use our meetings as a public forum to discuss important Public Health issues. Members of the public are always invited to attend and provide input. I am mark. Health commission secretary. If you have Public Comment, please hand a slip to me. If you would consider today, there are a lot of people who feel passionately about what you are here for. As others speak, they may have different opinions than you, try to be respectful. Be silent in your show of your opinion by either doing Something Like this or this. If you like what is being said. If you dont like being said do this. Vocalizes is not respectful to the person at the podium. Please consider that. Item 2. Approval of august 20 and september 17 meetings. In front of you is slightly revised Meeting Minutes for the 17th. I was to add it was adjourned 4 29 p. M. Due to disruption of the meeting. Please consider that version for your approval. The minutes are in the hands of the commission. If you have comments about the first set of minutes on september 17, please do so now. We will follow with the minutes from august 20th. I move approval of the minutes. Second. Those in favor signify by saying aye. Is that both sets . I move september 17th. Second. A. Item three directors report. Good afternoon, commissioners, grant colfax director of health. We have a full agenda this afternoon. I will highlight the key items in the directors report in front of you. One thing that is exciting, the first item. Yesterday mayor breed and the department of health announced a new Overdose Prevention program for the hotels to be carried out. This program is in response to the rising number of Overdose Deaths in San Francisco, approximately which 30 occur in single room occupancy hotels. This program is based on the successful tenant Overdose Response program from vancouver. We will work with the sr operators to develop the prevention programs. It will expand the Overdose Prevention further and support installation of naloxone boxes. That will begin later this year. The Health Department supports Harm Reduction Coalition Drug Overdose Prevention project which provides 15,000 doses of naloxone to thousands of those witnessing overdose in 2018 alone. The drug Overdose Prevention product reported 1658 overdose reversals that year and is on track to double that in 2019. We are concerned about overdose death in San Francisco. We are doing everything we can to minimize that terrible situation, and this project is a major step forward to help people most at risk for overdose. I want to emphasize that on september 24th, the mayor and the director of Mental Health reform announced plans to launch an online inventory of dph Substance Abuse and Mental Health treatment beds, we want to be sure there is increased transparency in terms of bed availability in the city within the system. We expect this public web page will improve the timely access to treatment and Health Providers make the best use of beds in the programs. The first space in november will have withdrawal management and 90 day programs. In the second phase the short term beds will be added. In addition to transparency this will help data driven decisions where we need to target new investments and bottle mecks in the bottlenecks in the healthcare. We are going to spend time on the Behavioral Health system today. The department has chosen to pause changes while the mayor and board of supervisorses have a conversation how to have expanded access to services. You will be hearing about that today directly from the dph in terms of history and Public Comment. I look forward to that part of the agenda. Just to emphasize with regard to vaping, the California Department of Public Health urges everyone to refrain from vaping given the current status of vaping risk. Since june of 2019 the California Department has received reports of 90 people in california who were hospitalized for severe breathing problems and lung damage. San francisco does not have any suspect cases we will be diligent in that regard. Nationally the epidemic associated with pulmonary injury grew 52 compared to the prior week. There are 805 from 46 states with 12 deaths reported. We continue to be vigilant on both the regulatory and the policy fronts. With regard to the recent heat wave on september 24 and 25, the National Weather service issued a heat advisory in San Francisco with temperatures in the 80s and 90s. They worked together with the department of Emergency Management and joint Information Center for city agencies to coordinate efforts and share messages to stay cool, hydrated and connected. City officials remind the people about the importance of window, water and pet safety. I think as we see the effects of Climate Change continuing, dph will ensure that we are resilient in the city with regard to our adaptation to Climate Change, including potential health risk for residents. That is a final note. I am excited to announce tomorrow the mayor celebrates the groundbreaking for the maxine hall remodel. She will celebrate the remodel, to improve safety during an earthquake. Locate primary Care Services and for the construction maxine hall will move to a temporary clinic on golden gate avenue. We want the community to be informed of that. As a provider i recently visited. The staff is committed and clients are receiving great care. It is time for refresh. I am excited that is happening tomorrow. Thank you very much. I will take any further questions on the directors report. Commissioners. I thank you for the report in regards to especially the coordination during the heat advisory, and because we were in chinatown just several months ago. I am wondering what type of coordination actually occurred in chinatown for that because it would be a very good example of what we are trying to do down there. I believe that doctor aragon has an update with regard to the specifics there. Thank you. Good afternoon. I am sorry i dont have an update. Doctor baba does. Thank you, doctor chou. There are a couple places impacted with heat. We checked in with the chinatown community. Chinatown has a library with airconditioning, which is great. The messages really went to the community. As with all of these incidents we debrief to see what we can improve in our communication. We will keep our eye on how we are able to respond to that community during these heat advisories. We did the same thing with bayview because that has a lot of heat as well. Thank you. Other questions . Thank you, doctor. No Public Comment for that request. Item 5 report back from the finance and Planning Committee from today. Thank you. I am sure commissioner chung would have been pleased today in our reports on the monthly contracts we were able to get some outcomes. The outcomes were quite satisfactory. On the block of the monthly contracts that included the Fountain Institute that is actually a Diversion Program and then several programs that actually were looking at improving employment from the university of california and the positive Resource Center. We spoke somewhat at the positive Resource Center if that information was getting back to primary providers in a way that they may find it useful to understand how their clients were assisted beyond the medical illness. We heard request for a retroactive contract with the San Francisco Community Health authority, San Francisco health plan, administering the San Francisco covered mri program. It is a contract that goes back four years. Because of the changes of funding in which the Services Rendered by the San Francisco health plan on behalf of the mra program and changes in the mra program, there have been some delay, therefore, being able to actually pay for all of the services which the San Francisco plan continued to render. The retro activity will include also an additional two or three months to the end of 2019, at which time all the San Francisco health plan tpa type contracts for the covered mra and other tpas would be brought fort to the finance and the commission. At that time we will be able to understand better the allocation of the types of services being rendered for those people in the various programs. Barring that, then we also have one more contract which relates to an outside vendor to perform mixtures of different compounds and types of medications that we know longer do, and it is a certified contractor from the fda and will giv give us a Super Service at the general for those types of medications. At the consent calendar we will ask for consent on all of these contracts. Questions from the commissioner . I apologize. I made a mistake as we went forward i skipped general Public Comment. Hold any questions on the report back and go to item 4, general Public Comment. I apologize. It wasnt intentional. I hold an egg timer. Everyone gets two minutes. When the buzzer buzzes, finish your sentence so the next person can come forward. For general Public Comment, mike hill, crystal duran and heather roninger. I am one of the nurses in the er. Our concerns are about General Hospital Emergency Department staffing issues, transparency, lack of, promises made to us at the joint commission that were supposed to be built into our contract. For instance, the ratio change in the er. We havent had any information funneled down to us how that will be accomplished. We assume they will hire temporary staff for the changes. That is not the safest way to care for our patients. If that is the plan, but we dont know the plan. There has been multiple issues. Care start is another implementation that didnt respond to any of the input from the nurses that have to work the care start program. It is not safe to our patients. There are so many different issues the other nurses with me will speak about. I wanted to introduce those problems in the er. Would you identify yourself for the record . Mike hill, nurse in the er. Thank you. Good afternoon, commissioners. I am actually going to read a letter on behalf of one of my colleagues. One of my colleagues felt fear in speaking out because of retaliation. I will read this. I am crystal. I am a nurse in the Emergency Department at San Francisco general. For nearly half my life i worked as a nurse in the Emergency Department at San Francisco general and for the department of Public Health. Our department is pushed to unsustainable point. The ed is a disaster scene almost daily. As safety net of the city we reflect the picture of the community. The department of Public Health and city are not well. Our population is more complicated and desperate. Imagine unhoused with cancer, diabetes. It is cruel and heart beating. We are a special group. We are drawn like special forces to this department. We have the knowledge and the skills to bring back people from the dead, literally or care for an 85yearold fractured hip fall patient, 7yearold hit by a car. Kisdisaster is taking a toll. One colleague tried to decrease antidepressants and cried and had to go on it. A group of p103s are on a six month leave of absent for stress and Mental Health reasons. We have contract rns making 30 of total staff. I have never been in such a hostile stressful environment not only from the management but from the patients with complicated desperate needs. They are promised by leadership, dont worry, we will take care of everybody. Do you think the zuckerberg building with hundreds of millions on lobbies, balconies and hallways is providing effective quality Public Healthcare . Really . What percentage of our patients would agree with you . We see the multitudes it is failing. The sad suicidal teenager doubles up in a room with a person in a severe combattic episode or the 90yearold with dementia next to the psychperson who cant get in the group hope. They are on the street. Finish up, please. Thank you. It is time for the painful honesty, the abuse scandal, people jumping out of the windows and the admitted patients in the ed getting bills for care impossible to provide. Please finish. The hundreds of care patients are waiting in the triage area and getting a full ed visit. The goal of numbers and ignoring front line staff has costs which may include juror death or detriment of patient as is and staff we want to care for mom, dad, sisters and brothers. Please help us. Ladies and gentlemen, please respect the people be anhind you. There are a number of people to speak. We are giving you two minutes. Please respect those folks and give them the opportunity to speak. We want to hear from all of you. Thank you. I am krista durand, er nurse. Contract bargains is over. Now there is no reason to think we are asking for raises. We are here because we said we would return. The leadership style at San Francisco general has a culture of intimidation is so severe we fear interaction with management. Our rn director pushed 50 of the best leaders out in less than four months. Why wasnt this a red flag to the administration . This is having detrimental effects of the Mental Health of the staff and distracting them from providing staffing care. Adding an additional layer of leadership not transparent to maintain control is having direct effect on patient outcomes. Front line staff are being dictated to risk licenses. They are aware of it and has done nothing about the administration poor implementation of programs. I became a nurse to provide compassionate and competent care. It is my duty to advocate for the patients. The petition we sent to you guys shows a lot of violations. If you turn a blind eye now you are going to be part of the problem. We sent multiple letter goes with the same outcome. You let Administration Lie with numbers and charts. Now we have submitted the explanation of the crisis. What are you going to do . Are you going to do something what people diane Staff Members are injured or commit suicide . I am heather a nurse in the er12 years. I have been here before. I thought about how to convey the severity of the situation to you. We tried emotional pleas that havent worked. San francisco general is about compassion, not quality care, data. These are data points to consider. 25 to 30 of the emergency beds are housed with admitted patients every day. We get zero nurses to help support their care. 50 of our most trusted respected and experienced leadership staff are forced out of positions in the last four month. 50 . Our department houses from eight to 12 behavioral 12 Health Patients in acute psychiatric bases in space designed for four. Resuscitation area exceeds level of 15 to 17 patients. It is designed for six. We discharge 700 patients each month out of the waiting room. That is where they receive all of their care, in our uncomfortable perfectly public waiting room. 63, that is the number of nurses who have signed the petition sitting in front of you today asking for your help. Asking you to engage. You dont need lean workshops and Software Programs to understand what is going on with our patients. You need to talk to the staff. You need to listen to what they have to say. Thank you for your time. Thank you. Those are all the slips i had for public testimony. Does anyone else want to speak on general Public Comment . Call the next item. Thank you everyone who chose to make Public Comment. The petitions are in your packet for item 7. It is altogether. I want you to know it is there. Item 5. We have gone through with commissioner chow, review of the finance and Planning Committee meeting. I would like to know before the concept calendar the dph staff asked to change the amount on the second contract. They had incorrectly figured out the contingency. 4,431,259. As you vote i want you to have the right amount. That is for the San Francisco Community Health authority contract. That is correct, thank you, mark. That reduction was with a recalculation of the approximate 12 for the 2019 fiscal year. Since the other years had closed. The new amount is actually in the San Francisco health plan contract. The commission would like to move those items on to the consent for your approval on the consent calendar. There is one other item on the calendar which i assume ultaup separately. It is the resolution on alice chen. I will defer to you on alice chen. Why dont we do this first then. Thank you. All those in favor of accepting the finance committee report. Opposed. Hearing none it is adopted. Now we go to consent calendar. The resolution for alice chen. Correct. The consent calendar for resolution 1913, honoring doctor alice chen requested by the Health Commission and a draft had been presented to doctor chen at a reception at the San Francisco general for her. I would like to move that consent. All those in favor signify by saying aye. Aye. Next item. No Public Comment for 6. Item 7 the San Francisco Behavioral Health adult residential facility. Mr. Pickens do you need help pulling up the presentation . Good afternoon, commissioners, roland pickens, director of San Francisco health network. I will be joined by my colleague Kelly Hiramoto former director of transitions for the San Francisco health network. I am here today to share with you some of the background and circumstances pertaining to the adult residential facility located at 88 88 7 00 p. M. At 8 7 00 p. M. Atrero. I hope it informs you about the current set of circumstances. So in todays presentation i will start with Background Information on the bhc which is the building in which it is located. Next i will provide an overview of the program. Then i will present the facts and circumstances that led to the current plan and, finally, i will review where things stand now in the proposed next steps. Currently, the Behavioral Health Center Provides both locked, subacute and patient treatment and unlocked delayed egress Residential Care for adults and seniors who have Behavioral Health needs. However, the bhc didnt start that way. It has a long history that has evolved over time to meet the changing circumstances based by those in need of Behavioral Health services. A brief review of the history includes that the facility first opened in 1996 as the Mental Health rehabilitation facility called the merf. It was then a 147 bed psychiatric Skilled Nursing facility. Then in the early 2000s as the environment in San Francisco began to shift toward the need for more lower level residential beds, in 2003 the mayor of San Francisco established a Blue Ribbon Committee for a new design for the services provided. That process resulted in 2004, thmerf moving to a three program mixed use facility consisting of a 47 bed secure and locked Mental Health Rehabilitation Center on the third floor. A 59 bed psychiatric on the second. 41 bed residential facility. In 2005 the adult residential facility was licensed by the state Community Care licensing and began receiving first admissions. That leads us to what we have today, which is again on the third floor a 47 bed merk also called institute for mental disease, locked subacute Mental Health unit. On the second floor a 59 bed Residential Care facility for the elderly, also considered a board and care facility. On the first floor a 41 bed residential facility. In 2017, we added an Additional Program to the first floor of the Behavioral Health center. That is a hummingbird psychiatric respite center. To familiarize ourselves, the merk is locked subacute of care to elderly houses individuals 60 years of age and over. Again, hummingbird which is a psychiatric respite on the first floor. What you dont see is the arf. I am going to devote the next severals to talk more about its program. The operation of the arf. It is 24 hours each day, nonmedical care but supervised facility for adults 18 to 59 with severe Mental Illness that are stable but still need care, assistance and supervision. Some of the services to the residents are housekeeping of their rooms. Some require assistance with personal care and as they administer medications prescribed by their providers. Where do patients come from who wind up on the arf . They receive referrals from acute care hospitals, locked subacute units like the america and other board and care facilities. It is a licensed residential facility licensed by state Community Care licensing, which is part of the department of social services. I am going to slow down a little more because there is a lot of information that we want to share to make sure you understand. It is important to step back and revisit the circumstances that bring us here today. For many years from 2005 up until 2013, operations a at arf were proceeding. In may of 2014 we submitted a request to the state to expand the number of licensed beds from 41 to 55. However, in december of that year, just 7 months after getting approval to expand to 55 beds we received citations for medication issues that required development of corrective action plan. This was approved by the state and implemented in december of 2014. The plan of correction involved numerous staff straining and education sessions about resident safety, Workplace Safety and medication assistance oversight. Some staff to make these errors in the same areas from this they received the retraining. Some of the results of this process was that it led to disciplinary process for some staff which included employee termination. During that time we also saw the unfortunate circumstance of staff beginning to file complaints against one another and reporting each other to regulatory agencies. During december 2014 through september 2018 despite implementing the performance improve meant plan. They were unable to go more than five months without incident or Community Care licensing coming on site to investigate the facility. In september 2018 we were notified the arf was being placed in noncompliance and mandated to attend the conference. We were advised by state Community Care licensing that it was their expectation a facility would need to go one to two years without any additional citations to be removed from noncompliant status. Furthermore it could have resulted in us going to add enough review to result in the loss of the facility license to operate. On december 2018, two months after the nomcompliance concerts we received two level a citations. They are the most serious types of violation. These were in the areas of medication use and the same types of citations which put us into noncompliance. At that time they informed us because these were repeat we were at prior risk of going to the possibility of using losing our license for the arf facility putting our clients at risk at having to be moved out of the Behavioral Health center. It is important to note in the midses of these changes we were never able to an receive the 55 at the arf. What did management staff do about what was going on at the arf . Since the initiation of the corrective action plan, additional plans have been developed and approved by state regulators. Some of the letter corrective action plans im movement im poos improvements different. In terms of staff complaints we partnered with the department of Public Health to provide assistance with disciplinary actions. In addition to addressing Staff Shortages and vacancies we meet weekly with Human Resources to focus on filling vacancies in the arb. We were three staff away frommenning mullly someplace. We had workplace and regulatory citations. Consequently, our ability to maintain care and not put our license in jeopardy was a real concern for us. It is important for me to note and sum up the situation of citation. Sept 2015 and 18. They received 10 citations, the highless level that can be offered by Community Care licensing. In terms of the decision to suspend beds there is much confusion and misinformation why we chose to temporarily suspend to license to operate some of the beds at the arf. I will share some of the facts. Due to the ongoing unresolved regulatory staff behavior and staff hiring issues at the arf, we determined since there were vacant unstaffed beds on the facility upstairs, Residential Care for the elderly, it made sense to move some of the arf residents upstairs, particularly those 60 years of age. They had 22 empty beds at that time. In addition to moving the residents up tears we were moving staff upstairs. We felt this was appropriate for three reasons. First, to allow all 59 beds on the Residential Care facility for the elderly to be fully staffed and occupied, second it allows those reassigned from the arf. It was an environment not experiencing the high level of complaints and citations so they could experience firsthand what it is like to work in a higher functioning board and care facilities. It would permit the bed on the first floor the opportunity to focus on getting to the corrective actions they needed to improve its operation. Is the status of the arf beds license temporary suspension in may of this year we requested the state and they approved to put 27 of those arf beds in suspension. This is not getting rid of the license but putting it in suspense for another year. This resulted in 41 of the 55 licensed beds being insistent. 14 of the beds would continue and are continuing to be operated on the first police officer. The plan was to have the residents upstairs to the care facility for elderly or other placements if they so chose. Now, i will talk about the circumstances at the arf affecting residents and staff. As a result of our plan, we thought long and hard to make sure we would do something to help our residents and also make sure we were honoring our staff. In this proposed plan no residents would be evicted. No staff would lose employment to ascertain the leading causes of