Transcripts For SFGTV Government Access Programming 20240713

Added to the parks analyzed for fire risked due to the large number of eucalyptus trees. I would urge the board to look at shortterm Solutions Beyond hose tenders and currently only north basin has been retrofitted and that would be an if south basin ruptures, that would be a loss of Drinking Water to the city. I would urge beyond house hoe tenders, i would urge others well. This includes the replacement of water is sewer lines, thank you. Next speaker. Hello, supervisors. Im albert chow. Im the president of people parkside sunset on taravel street. Since 1906 earthquake and the rebirth of San Francisco, our forefathers thought it was to build a firefighting system, not in case but when. Our city has expandedded to south didnt west and the awss has not kept pace with the growth. Were not projected to be a city of 1. 5 million in the year 200 whic2050. We need more schools, s and open spaces. The fact that we have grown does not mean that the big one is going to ignore us. I own a harbour store on taravel street. There was a big fire and my entire supply of dusk masks were sold out in three years. As a result of that, i keep about 1,000 masks on hand in my store. The new reality this year is that pg e is shutting off power grids and because it was the lesser of two evils. Either shut down the power grid or let the forest fires conflagerate. Im preparing and doing my small part. You would like to see the city do their part. Thank you. Im the president of the Pine Lake Park neighborhood, representing stern grove and Pine Lake Park on the west side. As mentioned in 1908, there was a response to the single worse fire in u. S. History and the people of San Francisco voted to construct a High Pressure auxillary water system to ensure the city never burned again. It was operational within five years. However, at that time, much of San Francisco as we know today was undeveloped. Carcarl nolte wrote that in thoe days the city was compromised of only the northeastern section of San Francisco and there was a county which was everything else. In the last 100 years, although its populated with established neighborhoods, the county still does not have a High Pressure water system for firefighting. And as a result, its a very dangerous place today. For example, earlier this year, there was a gas main fire at parker and gerry in the richmond district. This fire, taking hours to extinguish, required host lines to be connect the to low hydrants blocks away. Every street in San Francisco has a gas main, just like the one on gerry boulevard and every house has a gas connection. In the next big earthquake that we all know is coming, it is estimated that it could be as many as 20 simultaneous fires in unprotected areas. Each fire requiring multiple units to fight it and only a handful of 18 trucks are in use today. This would not be adequate to deal with the inch of that magnitude. Therefore, our urgent need is to equipment the San Francisco Fire Department with host tenders to deliver water to the south side of the districts and longterm need. Im joe lighthiser, a resident of district 11, one of the districts that need this. I was on the survey Advisory Committee under senator Diane Feinstein and chairman of the earthquake preparedness project looking at mutual aid projects for the ninecounty bay area. So letmy giv let me give you soy lesson looking longer terms. The pacific plate is moving that way, were staying here. Its going to move two inches or so a year for millions of years and, in fact, there will be a suburb of los angelos in 50 million years. But you dont have to worry about that. The 72 likelihood of an earthquake in the next 30 years that supervisor marr mentioned is going to be quibbled about, maybe, a little bit, but the earthquake will eventually happen. That said in the sense of gloom and doom and i think, really, the sense you should take and i think you are taking it in as a call to action. Earthquakes are not really damaging until you build something over your head to fall down on you. If youre in the mul middle of n open field, you get up and go about your business. Structural code takes care of that. Fire suppression is another matter and one that has not found its way into all parts of the city and this aims to fix. So just let me conclude by saying fire following an earthquake, losses in San Francisco and a large earthquake can run into tens of billions of dollars. Thank you, next speaker. Im allen long speaks as an individual to share my hat as a national guardsman. During the last three years, theres been a number of fireses ifiresin california that has std cities like santa rosa causing a number of lives and homes. Last week my soldiers and i are activated to the kincaide fires. We have made enormous sacrifice. Some have had to Cancel School and job opportunities. During the last few years, guardsmen have seen destruction and entire cities burn to the ground. Imagine walking through a city burnt to ash with warped and melted cars and a dark sky b blotting out the sun. We must be ready. Thats why this legislation is of paramount importance to me and all of the neighborhoods protected by the emws. We must protect all of our city. Thank you. Next speaker. Supervisors, commissioners, im david hooper and i serve as the president of the new Mission Terrace Improvement Association and Mission Terrace is the one portion of district 11 that is protected by the High Pressure efws system. The other neighborhoods, the ocean view are not. The only reason were here today is because the civil grand jury took the bull by the horns. We wouldnt be here if they hadnt decided to raise their hands and say that the issue needs to be addressed. At present, our system is inadequate. Everybody agrees to that. Were talking about host tenders because we dont have a system adequate now. What we have in districts 1, 4, 7, 9, 10, 11 is fuel that people live in. So today, were here at this commission to hear a presentation by the puc and the Fire Department about how theyll address the issue by the year 2034. And its really not enough. And if we talk about how were going to fight it with water to raise the temperatures to bring the temperature employee tempere making about Golden Gate Park being fuel. If we try to figure out where were going to get the water from and if the water system for the efws is so much better than it needs to be extended sooner than 2034. And an in effort to do this, the source of water that is most apparent is the Pacific Ocean and the bay. Thats limitless. We might lose a few fish trying to take care of this and we have to have fish experts to advice us but thats better than losing thousands of homes. Thank you. Thank you. Are there any other members of the public who want to speak on this item before i close Public Comment . Seeing none, Public Comment is now closed. Supervisor marr . Thank you. Actually, i wanted to thank all Community Members that spoke out today during Public Comment. please stand by . Of course, if money were not an object and we werent having a discussion about taxing people s homes, we would certainly make the bond a lot bigger, but the idea of having 154 milliondollar bond for 2020 in the spring is a good first step. I know a good portion of the city will be targeted in that bond. I want to say that on the record i think that what i would like to see is the second phase of that to target some of the areas that arent necessarily targeted in the first round and for that to be accelerated and have that conversation accelerated. Having hundred 54 million for the spring of 2020, to make a good first step to continue to add Emergency Water systems and targeting the areas that have absolutely zero coverage is the first step. I appreciate those who have put the time and effort into having that conversation. Thank you. Supervisor walton . Thank you. I want to thank supervisor mark for bringing supervisor mar for bringing the alternate supply system to my attention a while ago when we first got elected and where the inequities existed across the city. I want to be added as a cosponsor and i want to thank the San Francisco Fire Department, sfpuc, and all our Emergency Responders for sitting down with my office and sitting down with us and talking through what things will look like in the future and what is on the way, and how important this is that we move on this. So you are correct that 15 years is a long time, but it is under our radar now and we are going to be working and pushing to make sure our city is safe so that when we have a disaster we can adequately respond. Thank you. Thank you, supervisor walton. Thank you supervisor mar for bringing this resolution to us and to all the folks that came out. There is clearly a need, particularly in a growing city, where we are adding density in areas that have not had density before or as much density before , to make sure that we can can can contend with all the challenges that will be coming with that. One of the speakers said that we figured out how to handle the seawall and the potential infrastructure challenges on the eastern side of the city and i think thats pretty much not true, but, you know, looking forward over the next decades, we will have extraordinary infrastructure challenges everywhere in the city, but i want to thank you, supervisor mar. I will make a motion to forward this to the full board with a positive recommendation. We can take that without objection. Great. Mr. Clerk, please call the next item. Number six is an ordinance amending the health code by amending the sugar sweetened beverage morning ordinance and revise the definition of advertiser, reduce the required warning size, modified their warning text and revise the enforcement provisions. Supervisor walton . Thank you. I just want to Say Something about item six before we move forward. This ordinance will require advertisements for sugar sweetened beverages to contain a warning level label and telling information and Health Effects of these beverages. The ordinance was originally introduced by supervisor scott weiner in you know and unanimously passed by the board of supervisors in 2015. Since that time, a lawsuit was brought against the city and county of San Francisco on this ordinance in the ninth circuit and to the ninth circuit ruled against the city holding the ordinance from taking effect we have reintroduced an amended version of the 2015 ordinance. Legal battle or not, we will not stop fighting for the health and safety of our community. There have been countless studies connecting these beverages to weight gain, obesity, type two but diabetes, and tooth decay. These are large Beverage Companies that are often specifically targeting and advertising to communities of color, creating Health Disparities across our city. We know that warning labels are an effective way of providing ever community with information like this. They deserve to be informed before deciding to consume one of these beverages and we owe it to our communities to provide them that transparency. This ordinance is Community Driven and Community Focused and because of that, our office is committed to gathering input from everyone. A number of Community Members have been in touch with our office. Recently on ways this ordinance can be as effective as impulsive as possible and improved. For that reason, i will be moving to continue this item to the call of the chair so we can hear from everyone in our community before moving forward on this incredibly important piece of legislation. Thank you for the time, chair madelyn. Thank you. Lets open this up for Public Comment. I have a few members of the public who have indicated they are interested in speaking. If there any other members of the public want to speak, line up on your right, our left. Hello. Good afternoon, supervisors. I am here representing the American Heart Association as their Community Advocacy directive. We want to say thank you to supervisor walton and other supervisors for supporting this very important piece of policy. We do know the effectiveness of Consumer Education and believe the public have a right to know the risk of these beverages. It is proven by science at this point. The aj is available as a Technical Assistance provider. We do have a lot of expertise in this area and my colleague worked on the state level bill back when that was going on a few years ago, and was first on this issue and able to provide support. Thank you for continuing to be open with conversation and we want the most effective policy pause possible. Thank you. Thank you. Next speaker, please. Good afternoon, supervisors. My name is john and im the past president of the San Francisco medical society in here on behalf of our organization to speak in support of the concept of a warning label. In 2014, a ucsf medical student first proposed the idea of a sugary drink warning label as part of the California Medical Association contest. He won first place for this novel innovation to address the twin epidemics of obesity and type two diabetes. It served as the inspiration to supervisor then supervisor weiner and senator bill morning s efforts to champion this forward. The medical society endorsed senator weiners legislation when he was a supervisor and i have a letter from our president in support of the current conceptualization. This really highlights the importance of raising awareness. I would draw to your attention a recent paper in internal medicine which highlighted which after the Medical Center had restricted sugary drinks sales, they followed 214 employees were about 10 months and they showed a decrease consumption, decrease waistlines, and a decreased insulin resistance that resulted we would like to thank supervisor walton and supervisor brown for their leadership in championing this effort. We would like to be available as this is discussed further. Thank you. Thank you. Next speaker, please. Quite a number of years ago, the economic agreement with brazil was made with the intention that the latter would increase Sugarcane Production for the ethanol market. If you visit brazil today, you will notice a huge volume of soda dominating Grocery Store floorspace and a middleaged population that is experiencing record rates of obesity and diabetes. While here in the united states, with a population of 330 million , there is an estimated 37 million individuals with kidney disease, greater than a tenth of the population. And hundreds of billions of dollars are expended annually on directly related healthcare costs for this very reason. President trump signed an executive order last july to say more individuals might receive hemodialysis at home. And so that the government can better regulate actors in the organ transplant industry in the hope of doubling the annual reno translate renal translate renal transplant rate to prospective transplant patients. Sugarcane is actually a species of gigantic grass, so i dont know how much of this grass someone would have to consume in order to become obese. Probably more than is humanly possible if it werent refined and reduced into a pure chemical state. I believe that soda is in a category of its own when it comes to the production of fatty tissue in the body and i encourage you to tax it accordingly or to increase existing tax on sweetened beverages, particularly if you cannot compile a printed warning thank you. Are there any other members of the public would like to speak before i close Public Comment . Seeing then, Public Comment is now closed. Supervisor walton, your desire is to leave this to the call of the chair. Correct. So moved. We can take that without objection. Great. Thank you. Mr. Clerk, please call the next item. Agenda item number seven is the hearing on the 2019 budget and legislative Analyst Report on short conservatorship his and requesting the department of Public Health and the office of the public and servitor to report. Great. Thank you. We are having this hearing on our conservatorship analysis prepared by the budget and legislative analyst back in july time flies when you are having fun. We have spent a great deal of time over the last year or two talking about conservatorship in the city, but it has been mostly or much of that conversation has been in the context of s. B. 1045 and s. B. 40. And although i believe that those that that legislation was important at the state level under decision to opt into it locally was important, that is, of course, even at its maximum capacity, a program that is going to affect a handful of people at a small proportion of the folks who are participating in Conservatorship Programs overall. Of course, lettermanpetrus sure it has been the law of land for many decades. So as we have been going through this conversation about s. B. 1045 and s. B. 40, i wanted to have our b. L. A. Take a look at what we were doing and have been doing over the past number of years with the more traditional conservatorship his. There is, it seems to me, apparent to the broader public, a pressing need for the city and county of San Francisco to be doing more to care for people who cannot care for themselves. And it has been my understanding that conservatorship his are the principal mechanism for either family members or the county to take care of people who cannot take care of themselves, and yet plainly there is a mismatch somewhere where we are not actually doing that. I do think the conversation about conservatorship over the past couple of years has created an expectation in the public that is not merited by recent history that conservatorship his are somehow going to be the solution to all of the problems that we have. I was at a castro merchants meeting yesterday and the district the interim District Attorney was asked whether she could request that conservators, the folks that are being brought in on misdemeanours, the condition of their not being jailed be put into conservatorship. And of course, that is not the way this works. The report, for which im very, very grateful, identified some interesting trends. Partly, you know, i am hoping that we will spend some time today clarifying some of the information that was in that report. One of the statistics that caught a lot of folks attention about the statistic or about the report was a chart that showed that San Franciscos rate of conservatorship was significantly lower than surrounding counties and significantly lower than the states. There is, my understanding is disagreement about whether this is in fact, the case. But there were other elements of the report that i dont think are contested and do raise interesting or perhaps troubling issues such as the decline in conservatorship his between 2012 , 13, in 2017 and 2018. A pretty significant decline in referrals for conservatorship over that time. And so i am hoping, in part at least, that we will be able to use this hearing to discuss issues that need to be clarified and to better understand some of the decline that everybody agrees own. I do think the conversation about conservatorship over the last couple of years may have led to a renewed focus on this potential tool and i do notice that conservatorship his and referrals are up over the last couple of years and i take that to be a positive thing, but even with that increased number of conservatorship his, i do think there remains a real mismatch between what laypeople, neighbors, my constituents would expect for how conservatorship his would be used, and how we are a cabbie using them in the city. I see in my office in here in my office and i know other supervisors do the care of the neighborhood characters who have been on the streets for years, were frequently coming through psychiatric emergency services, may or may not be struggling with Substance Use disorders, but certainly have a Mental Illness or chronic inebriation often and i really want us to dig in on why we are having so much trouble using conservatorship as a tool for some of those folks. We need to understand why. No one in City Government should be shrugging their shoulders or trying to make the best of a bad situation. We are in a crisis and we should be doing everything we can at the local level and advocating for changes in state law, if necessary, to address that crisis. Thank you, colleagues for being here and for participating in this conversation. I really want to thank the b. L. A. For their hard work on the report and i want to really think the public and servitors office for working closely with the b. L. A. On the report and some of the aftermath of that report. First up, well be hearing from the b. L. A. And then we will hear from the director Deputy Director of programs for over at the department of aging and adult services, and then we will hear from the director of forensic and justice and Behavioral Health services. We also have the department of Public Health here for more on the s. F. General side if we want to take it to some of the issues around what is happening around referrals or what may have happened around referrals of the last several years. I think that is it. Lets start with mr. Campbell miss campbell. Good morning, members of the committee. Im with the b. L. A. Let me get the slideshow for you here. Can you help me . Okay. Yes, supervisor mandelman did ask our office to look at the conservatorship in San Francisco as they currently exist. This is looking at the current state. We presented a report in july. Just a brief overview, the act was passed in 1967. The concept of the act was created for uniform civil process for involuntary detention. So that they would be some standards across the state for when people were involuntarily detained. This requires a superior Court Determination of grave disability, grave disability means a person cannot care for themselves because of illness or alcoholism. Significantly, it does not cover Substance Use disorders. If the court does determine that somebody meets the definition of grave disability, in the county can appoint a public conservator who then becomes responsible for decisionmaking on that individuals behalf. His two components to the conservatorship. Theres the first which is a temporary 30 day conservatorship this is the period a period in which the public and servitor can i would like to go back a step. All these referrals come from a Mental Health provider from a psychiatrist. Once referred to the public conservator to the courts, the public conservator then has 30 days to investigate the case. Someone can then refer to a permanent conservatorship after they have been through the 30 day conservatorship at some point. However, when we say permanent, it is one year. It has to be reestablished by the courts every year. So to go back to what supervisor mandelman was talking about, our report looked at state department of Health Care Services data shows the number of o. P. S. Conservatorship his by each county each year. The most recent year that was reported by the state at the time of the report was for 2016 and 2017. What we took from that data was that San Francisco was below the state average. After the report came out, and in our discussions with the public conservator, we understood that there was a misreporting by the county. So what this state said is the county he his report all the new conservatorship his. So those who are newly referred and all those who are reestablished. Because the court has to reestablish everybody every year , then the entire conservatorships caseload should be counted. In fact, San Franciscos only counting the new referrals. So it is significantly understated. So the state data still under reflects and understates the San Francisco numbers. We ask ourselves we asked for data from the 50 largest counties in the state. We got responses from 13 counties. What it showed is and then we went to San Francisco and said what is your conservatorship data . How many are new . Hominy are reestablished each year . Said taking the data we got in this from the superior court, we got to finding witches San Francisco has, among those counties, a high rate. They are equivalent to the county of san mateo. They were higher than the other counties and just to clarify, we are reasonably short and this is now apples to apples. We are not. So the other counties might be might have been under reporting their conservatorship his . Potentially. I think four counties reported to us on what was new and what was reestablished. We felt, at this point, we didnt validate the data individually. We know the state is not validating the data. We think there could be some incident uncertainty in it. What we are certain of throughout the report as we are confident in San Franciscos data. But they reported to the state it is a Nonprofit Agency contract with the state that reports it. That data wasnt correct. And throughout our reporting period, we believe that the other San Francisco data is accurate. The one other piece i would like to say is the state auditor is now looking at the Conservatorship Program statewide. They have begun this audit. That audit work plan for los angeles goes through two other counties and San Francisco. It does give different results. We are confident of San Franciscos numbers unless confident of everybody else at this point. At this point, comparing us to other counties is a really hard thing to do. It doesnt tell us a lot. We did have conversations with other bay area counties, and anecdotally, some of their experiences were very similar to San Francisco in terms of the program itself, but we werent asking numbers in those conversations, we were asking for experiences and trends. In terms of actual San Francisco data, we started looking from fiscal year 2012 and 2013. The reason for that is that was the year which we felt the data was most reliable. So if you look at the seven year period here, in terms of the total number of conservatorship his, and these unduplicated clients, you will see there is a 13 decline over the seven year period. In the first five years, that decline was driven a lot by the new referrals that were significantly less than the number of individuals discharged from the program. I want to step back again a little bit to say the way the act is written, the ideas that should people should ask to grow out of the program. They should become stabilized with treatment and no longer have to be conserved. And you will see the data here. That is actually stated in the act, i believe. And then the second two, the more recent, you will see the new referrals are exceeding the discharges. That is in the next slide. And accounts were slightly up in the most recent year. If you look at actual referrals, there was actually, in the sixth year period from 2012 to 2013 and 17 and 18, a 50 decline in total referrals for the program. You will see here, a lot of the significance you will see it in both sets of numbers, both the permed and the temporary, but certainly in the temporary you will see a 56 decline in referrals to the 30 day temporary program. The impact is also that you then had fewer being referred into permanent conservatorship and 17 and 18, the totals were 141. It went up to 149 and 18 and 19, but it was too early to determine what was permanent and what was temporary. So we kind of looked at this. We dont have good reasons for understanding this, but we did do some looking at exactly why the referrals were going down. In terms of thinking of the temporary, one of the things that happened during this time period is the state legislature amended the welfare and Institution Code to add section 50 to 70 that allows for a 30 day hold without going through the superior court conservatorship process. We dont have data on the impact of that hold, with the timing of that hold and reduction in referrals, there is some correlation there. Also in discussions, especially with people who have been working with the conservatorship and Public Health for a number of years, there is an issue of Budget Constraints, especially after 2008. Theres also an issue of during this period, sort of a policy change. It is hard to get at that information, but a preference to move people into the community and that takes treatment away. That is more of an anecdotal discussion. If you look at what happened, the number of acute beds in San Francisco decreased by half. From 88 and 2008 to 44 in 2011. I think they are still at 44 beds in the current year, but more significantly, because this maybe where a lot of the need is , the number of subacute beds decreased. At the same time you are seeing wait times for subacute beds being 51 days. That is locked and unlocked subacute beds. I think that is locked. And so, this would be consistent with the Conservatorship Program so i think that funding and bed placement is a big issue in this we dont have a direct data, but certainly the two are aligned. What i would also say is in 1920 and the 21 oh, the 21 budget, the city is beginning to fund more longterm subacute beds, which may have an impact. The other thing that happened in 19 and 20 is there were resources added to the public conservator budget, which may have an impact. The growth is at st. Marys . That is the increase in subacute beds . Yeah. Supervisor stefani . Thank you. Just a question on the reduction in beds. The acute beds, 88 to 44 and 2011 and subacute 359 in 2012 to 241 in 2018. I am wondering if you went back through the budget and hearings to understand the rationale behind that and why such reductions were made when the need is so great. For acute beds, and this is in an interview, so it is anecdotal, our understanding is some of it had to do with budget cuts in 2008. I know that dr. Gary is here and he maybe able to speak to that. And then, what our report says in terms of the number of subacute beds, and this comes from interviews and being able to understand it, our assumption is this is a combination of a book Budget Constraints and policy changes. What we learned through interviews that is the best we can say about it. I would say that those policy debates continue to simmer under the surface because even in this last years budget, the increase in subacute beds, i mean i think it was 14, an additional 14 at st. Marys and that was an item of some underlying controversy about whether we wanted to be investing more in a locked subacute beds as opposed to communitybased placements. Supervisor stefani . Definitely that is still a debate, but i think that we have to analyse whether or not somebody actually needs a locked bed. I mean those people who can do better in a Community Setting and people who cannot and those are determinations that can be made by our psychiatrists and that is dated that i think should be out there for us so we can make those decisions. It shouldnt just be anecdotal. It should be based whether or not someone absolutely needs a locked facility, and quite frankly, some people do. And so i think we need to be able to look at that objectively and decide from there how many should we have and then, of course, how many we should have in a unity as well. That is just my opinion. [please stand by] i think part of the problem is gravely disabled. And thats not a constant condition. A person can be gravely disabled because theyre not taking their medications, because theyre facing a trauma and because they face the treatment and no longer meet the definition and this is reestablishing the conservativeship and people move in is out of gravely disable. So we looked at all of the individuals referred in fiscal year 2017 and twothird left the conservativeship and theres a caseload long material. Term. 50 was for five years or morph. More. We werent able to find population needs and we did draw from this because there had been an increase in referrals in 1718 and 181, i 1, 1e was a greater need. We spokthe response was outreaco providers, system improvements, to improve referrals. This was consistent in our discussions with other counties, where they felt that they expected to get referrals from priorproviders and didnt and ft there was not always good communication in terms of the need of being referred. So it wasnt specific to San Francisco. You could hold up for one second. Vice chair stephanie has a question. I understand youre having difficulty getting the information. I wonder in you would glean any information from our coordinated entry system with hsh. Were you able to look at any of the information that they are imputting about the individuals that are living on the streets with conditions that might need a conservatorship in any way . We looked at overall population numbers but not individual numbers. Is that the question youre asking . Or individual cases . Im just trying to understand when you were talking about the population in need, it sounds like theres difficulty getting there in terms of the numbers and im trying to understand why and im wondering if theres any information out there that might have that information or some of that information. I mean that might be something an angelica could address. I dont know hsh would gather deep information about peoples Mental Health needs as a part of the coordinated entry assessment. I do want to say we talk later in policy options with working with the wholeperson care team and high user population, doing more evaluation of that. What we were saying, conservatorship is a definition in terms of gravely disabled and because its not a constant definition, its hard to identify the population. So in terms of a couple of other questions, one is simply cooperation between city agencies and thats really the Public Health and public conservator. At the point of time we were looking at this, there was no memorandum of understanding between Public Health and conservconservator but theyre providing the treatment so theyre an important player. So essentially, weve considered there to be a need for mou, a formal mou, establishing the clinical standards and accountability metrics and another component would be how clients are served in the least restrictive setting because that is a part of the program as the city has set it up. We looked at the Performance Measures and there we thought that the measures were a lot were sort of about how the program worked administratively but not how individuals were served and what their outcomes were. In the most recent fiscal year 1819, there was a near measure added, looking at the number of individuals that were discharged from conservatorship referred in a year and well talk about that later in terms of policy options. The number, and this goes back to what you were asking, and we talked about it in the report, is who are the high users . And how are they being looked at in terms of population need . One number from the most recent information from the whole person care team was that of 400 and some individuals identified as the top 1 of high users, 14, i believe, currently conserved but 39 were conserved but were still a high user of emergency and urgentcare services, indicating there was still some need and we have that in the report. And in terms of policy options, i think the most obvious one, in the lbs conserv conservatorshipt needs to be part of the services. The mayor appointed a director of Mental Health reform and thats to identify gaps and improve substantive Abuse Services and we considered this Program Needs to be a part of that. And we also looked at how resources are added to the public conservators office and we looked at staffing and caseload over time and i think that continues to be looked at where that fits into the overall program. And then, of course, the discussion we had been funding for subacute beds. So this goes back to, i think, a little bit, too, what was being asked. There needs to be a formal evaluations and thats what we did not have as we were going through this report. And there was we think there was a big impact on 30day people moved to 5270 where they were able to be held for 30 days didnt not referred to conservatorship and we dont know what that is, if people stabilize after 30 days because theyre on medication and off of alcohol and there needs to be a better understanding of that. And then going back to this performance measure about the number of individuals who are discharged from conservatorship and we refer this one year. In 1718, it was referred and in 18, that dropped to 15 and we think thats an important number to understand but we dont know why that happened. And then going back to the communitybased placement, there are communitybase placements and what are those outcomes. But i think its important for there to be an evaluation of the outcomes. And then, of course, we talked previously about there needs to be a normal mou between Public Health and the public conservator and a big piece of that is data sharing. And formal datasharing agreements. Again, it goes back to whats the population in need . And this again goes back to the high user population and who is that population and what those needs are . And it needs to be also a protocol on how the citys agency Public Health, human services, public conservator response to that high needs publication. That summarizes our report and if you have any questions. Looks like were ready for joel neilson, i think. Hold on. Underquick question, since the original report had different information that made us think the number of conserve conservatorships were declining. I dont want misinformation out there. We can update the numbers with what weve got from our veer. I think that would be good, thank you. Good afternoon, i will be doing a join presentation, lots of teamwork happening between our two departments these days. So thank you for the opportunities to provide feedback on the report and i want to express my appreciation for comprehensive report and for correcting some of the significant errors that was a major concern for our departments. So i will able to abbreviate or presentation because the vlas report was comprehensive and i think we can skip over that slide. I know that youre all well educated on the lps act. Improve do think that its worth highlights that the original act is composed of shortterm holess and based on Mental Illness is treatable and individuals can recover. The shortterm holds provide opportunities for individuals with serious Mental Illness to either accept treatment on a voluntary basis or to recover and to be released from the involuntary hold and thats a critical part to the lps process and it does inform some data points that were looking at here today. And i did also just want to highlight that the although a referral for conservatorship could be submitted after the 5150 hold, the majority of the referrals that we receive are smutted to our office during the 30day 5270 hold. Can i ask a quick question with that slide. You have on the 5250, on the two week, it says clientassigned public defender. But not for the 30day hold, just for the two week . The representations with the public defender continues on. I didnt understand the chart. During an involuntary hold and throughout the duration of a conservconservatorship, the indl has representation from the public defender. So i wanted to clarify that in the bla report, the Community Independence Participation Program as appropriately known and the post acute conserv conservatorships, those are not separate but we operate under the same authorities that we have for traditional lps. Murphy conservconservetorships e separate and we will have three separate Mental Health conserve torships in San Francisco. We think they exceptbly few our citexemplify weprovide within tl framework of the least restrictive setting, our legal and ethical obligation. Youve heard that the primary driver of referral reduction is related to the implementation of this institutions code, 5270 provision and that occurred in 20142015 through approval from the San Franciscos board of supervisors and really, the intent at the time was to do exactly what was the outcome. The tenan intent was to reduce e theconservativeships and more enteinterinterventions and withe implementation, individuals can receive care in an acute setting for up to 47 days. When you look at the length of stay, we have two large groups. Within a malte matter of monthsy engage with treatment priors ans and to we have another cohort of individuals that may need conservativeship for fiveyears plus and may be a lifelong relationship and those are individuals who have very serious Mental Illnesses and they may thrive in their structured environments, in licensedcare settings, typical lip, butypically, but they may e care for their protection, for extended periods of time. And so this slide is a little different than the one you saw because we added in the numbers, our permanent conservativeship and temporary conservativeship and referral numbers for the past fiscal year which the bla did not have when they prepared their report. What this slide really highlights is that although the temporary conservativeships have declined and the overall numbers of referrals have declined when we start looking back to 20122013, what i see is that the number of permanent oneyear conservativeships that we are completing has actually more than doubled in the past five years. And i do believe that the efforts that have happened over the past three years, that i know very closely because theyve been a top priority for me, for my office, is really working in close collaboration with the providers at zuckerburg hospital to make sure that we are communicating about what is an appropriate referral and how best to get that referral to us. I think that we have excellent communication at this time and were seeing a difference there. Good afternoon, supervisors. So ill do the next couple of slides and well switch back and forth but one of the things we wanted to talk about as weve previously discussed, that we have both a legal and ethical responsibility to treat individuals in the least restrictive setting. And over the years have made a number of investments in less are restrictive interventions and where these investments are ebb and flow depending on the te needs of the population but it provides urgent care, the Healing Center beds, and straight medicine. We completely agree with the conservativeship offices that the primary reduction in conservativeships is related to the implementation of 5270, but some secondary reasons why this might be the case is the implementation of other innovative programs in our community, including outpatient treatment which launched