Transcripts For SFGTV Health Commission 20240712

Commissioners. Does anyone have an amendment, or moagdz to approve. So moved for approval. Second. President bernal i will do a roll call vote. President bernal yes. Vice president green yes. Commissioner chung yes. Commissioner chow yes. Thank you. Item 3 is general Public Comment and id like to just put this information back on the scroon be r screen, the callin number is. 4084189388. Access code 1465666224. Once you dial, you press the pound twice and to actually get in line to make Public Comment, you then press tries tries 3. Araceli, are there any people with their hands raise forward general Public Comment . There arent any. Okay. Great. Commissioners, lets just wait a few more seconds to make sure no one comes in, and we can possibly move to item 4. Item 4. The annual request to the Health Commission meeting ar approval of potential chapter 21. 42 sole waiver usage in fiscal year 2021. This item was brought at the june 16 meet and the item was deferred because the r we had issues with some commissioners having conflicts and i hadnt done my homework proarnt lee. But today mirks read of the document shows that none of you would have conflicts bu. Let me know if you have issues or questions. President bernal thank you, commissioners. Do you have any questions. Again, this is a presentation that we received last week with a delay of vote. If there are no questions. Secretary morewitz, we can ask for a motion to approve. Secretary yes, actually, commissioner, may i ask first if we have Public Comment. President bernal thank you. Hi, there is no one listening on the line at this time. Secretary morewitz all right. Thank you. We can do a roll call vote. President bernal do we need a motion too, prove first . Secretary morewitz oh. Im sorry. Yes. Of course we do. Move to approve. Second. Secretary morewitz thank you for that. President bernal yes. Vice president green yes. Commissioner chung yes. Commissioner chow inaud ible . For the next item. Item 5 is the zsfg c. E. O. Report. Dr. Ehrlic. I see your name on the line. Welcome. Can you all see me right now . You were seen and heard very l. Okay. Perfect. Thats great. I dont see myself on the screen. But thats great. Im here to present my c. E. O. Report and i just wanted to comment generally, that the accommodation of the narrative and the data gives you a very good overview of the extreme changes that weesk living with g with in our environment. Ive never speaned going like this in my career, and im really glad toft opportunity to be able to talk to you more in detail about what its been like here. We start d talking about this, the last time i was with you and its only been more of the same and every day, is really a different day here. I will also say that i am always impressed by our team here. They are just incredibly resilient, incredibly creative, very perristent in ensuring that our patients are getting the best care possible. So im very grateful for that. Just to start with a narrative, and please feel free to interrupt me at any point if you have a question. One of the ways that our organization has changed completely and in a very new way is with staff screening every day when people come to work here, they must be screened and we have changed the way we have screened our staff and now, we have everyone coming through building 25 for the most part, unless they are going to work in building 80 or 90. You have the option as a team member to either start to complete this screening on line or to do it in person and every one can you come visit the clinical building. Those are the buildings, 255, and 8190 also have a Temperature Check so thats a very good way making sure everyone coming into the environment is safe. So can you see a photograph in my report of what the screening looks like in building 25. We have involved nursing students in that screening recently, which has been working very well. Our clinics have been mostly until recently doing visit byes phone or video. That is slowly starting to change. By virtue of the health order we have had recently, were able to fully build up on our capacity and were work towards 30 capacity for inperson visits at this point. Visitor restrictions has been a major topic for us. This has been managing a balance of ensure being safety of patients, visitors and staff coming into the building while ensuring that our patients have the opportunity to be with their loved ones. We have been restricting visitors since the pandemic began by virtue of health orders. More recently, we have expanded our restriction so that everybody in the hospital now has the ability to have one visitor and in certain circumstances, they have the ability to have two. We also now have convened a Visitation Team that considers exceptions to these rules and this has just been a very difficult process to manage, as im sure can you understand. My team again, weesk very weesky thoughtful in trying to manage safety and the needs of our patients and families and these are some of the details in my report. Communications has really ramped up. I spoke about this the last time i rchtd to you. Reported to you. We continue to have at least one communication from our team to the Larger Community every single day. Those communications, theres a daily digest and there are other communications that come along with that as well and i believe its been very well received by our team. With all of these changes, its essential to make sure that everyone is up on the latest news. And then staff appreciation is something we have also been able to do quite a bit more of. We have received very generous donations from the foundation. A total of about 4. 9 million, not all of which we spent, but a portion of that has been going to staff appreciation with give aways, with events, with meals and that also has been very wellappreciated. Equity obviously, is a major topic for us right now and im very pleased to say, it has been a topic for us, since ive been here in 2016. Our efforts to address equity on campus have evolved, changed and grown over time. That doesnt doesnt mean that we dont have a long ways still to go but we have a lot activity going on, on campus now and we are growing that and changing that as well and ill let you read what were doing on page 5 of my report. We did have a silent vigil for george floyd and can you see photographs, there were hundreds of people outside in our campus at the bank of America Plaza and that was very powerful and moving event. So ill be happy to take questions on any of that, before i move into the data. 92 please raise your hand. Thank you and it was very nicely prepared report also. I do want to ask on your question of the visitor. Are the visit ors under going the same screening, and Temperature Check before going in . Dr. Ehrlich yes. Commissioner chung and on the equity piece, although i read the Different Things youre doing, what will be our means to be able to track this a little better in terms of what, i mean, you have 8 didnt items that youre calling countermeasures and i just wanted to know we were going to follow which once. There must be some priority also in look at those and what type of maybe its a more extensive report at our next jcc or something, in terms of that. I think it would be very nice to keep that kind of on the agenda and have a hear detailed report in terms of how we are addressing equity and more towards our clients and patients. Dr. Ehrlich yes, id be happy to do that. I will point you to the top thf report. We do have a strategic a3 for equity and we have been modifying that over time. The two, the metric that we follow are actually on our dash board for the department as a whole. We havent presented that in a while for obvious reasons but we look at the completeness and we look at how our departments are developing their own equity metrics and in both of those pieces im happy to say, we have met and exceeded our tarnght we can talk about that and the, initiatives. I think that would be very nice for the public to understand, how we are outreaching, in order to respond to certainly, some of the issues that have risen ofter last several weeks. Youre going to talk about the data later. So ill talk about those later. Imhish near green, did you have your hand up. Did you have going . I just want to congratulate you and everyone on your staff for this incredible pivot that youve been able to flish in the context. Extremely difficult and rapidly changing circumstances. One question i did have about screening in general will there ever be a time, especially if we do have an event that rapid covid19 test would be available iin this terms of not only our employees and paicialghts but also visit ors . In other words, do we have, have we got any ability, what is our capacity. Tests tests are great, but they take time. And they take patients and staff into these acute care units should we have a greater case rate. What type of opportunity we might have there. Dr. Ehrlich yes. Well, theres a lot to say on this topic of testing. First ill saker the department and city overall has goals for testing, which we follow pretty closely on the public website. And im very proud to say that as a city, we are testing at a rate that is equal to or exceeds many other places. So thats a great thing. I will also say that testing is generally pretty focused on people, for the most part on people in higher risk groups. For example, we do surveillance testing in Skilled Nursing faculties, and other congregate living sites. Obviously, were testing people who have symptoms. We test every Single Person who comes into the hospital here, whos admitted into the hospital, i mean to say. And we test everyone, as much as we can, who is scheduled to have a procedure or surgery. So all of those folks are being tested and in fact, the where were testing both our patients and employees are getting more and more utilized. In terms of rapid testing, that is one of the resources that is most limited to us and sadly, the rapid test that is most available to us is also the one that is the least sensitive. So we use it because we really need to, for example, for patients who are being admitted to p. E. F. And in other clinical situations but its not ideal. And so testing in general of course, across the country, is just limited. So i dont foresee a time in the near future when we would rapidly test visitors into the hospital. That was kind of a longwinded answer but, you know, it would be great if we tested everybody but thats just not in the cards any time soon. Are. Thank you. Wonderful work. President bernal any other questions, commissioners . All right. Dr. Ehrlic all right. So im going to go on with the data, which as you can see, has changed dramatically in most cases. And commissioner green, thank you for your very thoughtful question. Im going to incorporate the answers to your questions in many of the slides. [phone ringing] sorry. Video conferencing. Dr. Ehrlic lets focus on the Emergency Department. Can you see in that first paragraph, that we have seen a pretty dramatic reduction in the volume each day, as well as the daily admissions. What i do want to point out though is that if you look at january, for example, and you compare the admissions to the volume. Youll see that we admitted about 16 of our patients and just know that for the most part, admissions to the hospital are coming through the mrns department sthrough the emergy department. Anthats 15 . And thats really what was admission rate has been for the Emergency Department all the time ive been here. Fast forward to april when, we saw this dramatic decline and we continue to see a pretty dramatic decline of patients coming to our e. D. And less dramatic decline in the admissions. What that translates to here is 24 admission rate. So the patients who are showing up in the mrnts department are sicker and require more care. So its interesting to compare those two. We have generally a lower volume, a much more reduced volume in the Emergency Department. And that really reflect it is, i think, a general trend in the United States of fewer people coming into healthcare facilities. And i can just tell you, based on my personal experience with patients, even the patients i would want to come in to get care are relocket abet to do soa. Because of the are reluctant to do so. Because of the fear of disease in the hospital and were working on bringing more patients whackback to the hospital. If you look on the next slide. Leave without being scene rate is really a function of the fact that were not really using your rating room in the mrns department anymore. Thats typically why people would leave. That would be met in triage and they would wait. And and now, people are brought right back into the back because we have the capacity to do that. Thats why the leave without being scene rate is so low. Diversion is fascinating so can you see this dramatic and for r forethank you tive drop in diversion that we have had and on many days, we had no diversion at all. So the question is, why is that . In general, we dont know the contribution percentage of each of these factors, but we know its due to two things. One, obviously is the drop in volume. We have fewer patients coming into the mrns department, so its easier to accommodate all the second thing s right along with the covid pandemic was the cavy project. A project we had long anticipated in the Emergency Department well before covid, it just so happened, that project coincided with the covid pandemic caddy is a cafe say project of the emergency basically, they have a physician an emergency medicine physician, ask one of ours, who is receiving calls from paramedics in the field and directing them to the appropriate mrnlts department, depending on what the patients complaint is and what the volume is in the hospital. So it is an active way of level loading the traffic coming into the mrns department so that has also play aid role here. What it has allowed us to avoid is ambulances, which have been, before now, very common and ask causes us to go on diversion. So thats been helpful. Not all paramedics quality physician when they are supposed to. The adherence rate to call ranges its been as high as 80 bu. Its been lore. Were still working on that, but thats also a really important factor in our ability to have such a low ambulance diversion rate, which is great. You can see this average pef counters have gone down to some degree. That is because we have basically tapped senses in pef. Just to digress on this a little bit. As the pandemic has evolved, we have made many different changes to our practices. One of the first things we d is we started testing everybody. We tested on the 7th floor because we wanted to be sure patients werent to test positive in that environment. We lower the pef. We recognize in some circumstances when, we had beyond 18 patients, it would be very hard to maintain social disantsing, especially when some of the patients there wouldnt be masked appropriately. Or would refuse to wear masks. So basic eacialtion the situation is now that all the staff in there are for the most part, wearing n95, especially when theyre near patients. The cap is set to 18. Every, before they go into p. E. S. Is now tested using a rapid test. That means, they are going into the mrns department first. And that speaks to a later slide ill just cover now. Which is that youll see 100 code red for f. E. P. Its kind of an artificial statistic at this point. Right now and since we required all of the p. E. F. Patients to go to the e. D. And be tested before they come over, they are always on code red, and reason for that is because we dont want ambulances coming to p. E. S. Directly when they need to be going to the mrnls department. Does that make sense . What questions do people have about that circumstance . Whats been so great, this is one of the sill veer linings of the pandemic. We have about 50 more patients in the e. D. Now on a daily basis, to eventually head over to p. E. S. So we had about 8 or so. Even before the pandemic because many of them needed to be cleared immediatically before they went to p. E. S. Now, we have about 12 or so. It various from daytoday. But now we have a p. E. S. Physician. So a psychiatrist in the mrns department every day between 7 00 a. M. And 11 00 p. M. And that has been a huge bonus for the e. D. Team and also the psychiatrist, many of them seem to like it as well. So they are actually age to evaluate and discharge patients from the e. D. Who might have otherwise gone to p. E. S. Before this pandemic. So i think the last thing i want to talk about the medical surgical census and the ic icucensus and you can z thats been depressed. You see fewer patients coming to the e. D. And we had that spike in april. So we went from an average of about twesk and a half or so, up to 35 that was all due to covid. What we know in the city in the height of our surge, there were about a hundred patients hospitalized in the city. We are doing 30 or so plus of that volume. We still do about 30 of the total volume today. See whatever questions you may have, comments, suggestions. President bernal observe we get there. Id like to make sure we dont have Public Comment. Araceli, can you let us know if we have anyone on line . We have no one on the line right now. All right. Commissioners, raise your hands if you have any questions. Vice president green thank you for going over the questions. It seemed to me,. Commissioner chung mine was just very small data point butt message was the same. The percent diversion doesnt go out until april, and i was hoping that was because you just didnt put it in. Sounds like you are actually in the process of collecting all of the data. Dr. Ehrlich i look at the diversion rate every day and its 7. 4 in april. Commissioner chow what about may then. Dr. Ehrlic may is similar. We dont have the data for that year, but its similar. Commissioner chow but more importantly, i think, what you are demonstrating is that a number of people who dont come and use the emergency room in less than how someone should be using it. But you have lesser people coming into the urgent care. So assuming there should be Lessons Learned in terms of what are some of the takehomes, for the an experience, which was already, of course in the works and it would be interesting, as you get that budget even more up to speed how the other hospitals are also taking that because i think that was part of your resistance. But that is good to understand that, that is perhaps something that place role in this especially the fact that there would be a position helping to basically triage to the right place. Rather than just leaving it at the hands of the paramedics in that ambulance which is what its been in the past. Dr. Ehrlich we have talked about the caddy project and its learning for everybody, not just for us. So, you know, the ambulances arriving are really a problem for any hospital and everybodys been very happy with cavie. In terms of the paratransit medics calling the physician, i think its really an issue of culture change and weesk working on that over time. My understanding of where the caddy project is going to go eventually, is a paramedic supervisor would take over the roll of the physician. But i think they need enough experience under their belt with a physician to feel confident to be able to do that. Commissioner chow i think i reserve judgment for that and maybe im just a little bias. With the paramedic supervisor, but i think they would feel a lot more comfortable. But well of course, let that play out for that project. The idea of moving or having a site position in the e. R. Might be one that helps. You remember that we had also all the complaints from the e. R. Staff, that they were getting all of these patients prior to screening and that kind of became a cry for some of the staff there and they were being inundwaited and they should have really been over at the psyche unit. Whats the feeling now in terms of the e. R. In terms of trying to integrate this and having sort of the front door of the p. E. S. Being the e. R. . Dr. Ehrlich yeah, i think there is mixed feelings about t. Would the staff rather have patient guess to es. Probably. Its not appropriate to have more than 18 people in p. E. F. Right now. We dont have a good other option for those patients until we have our new p. E. F. Which is still several years away and so what has going to meet the needs of the e. D. Team is having that psychiatrist in the e. D. So as long as were doing this care in this way, were going to continue to have the psychiatrist. The other thing that weve been doing that helps a lot, weesk bringing in more lpts, licensed psyche techs. So not just physician but other people who are trained trained in psychiatric care. And last but not least is the burk team, the behavioral episode response team. bert . Before covid19. To respond to behavioral events. We started other things as well all in the service of Workplace Violence and thats another thing you probably want to hear more about and i think adrian will speak to that as well in his report. Commissioner chow can i ask one final question before we get to that screen. On the cue custodial side gets e decreasing. Dr. Ehrlic l the lower level situation is complicated with covid. In general, i would say overall our lower level number on the med search side are slightly better. On the psyche side, they are not better and i think theres a conflict web of reasons why thats true but right now theres a huge focus, obviously on providing shelter in place options, and providing isolation in quarantine options for people who need them who are either unstable or homeless so that has limited options for parents charging out of the s. F. G. We have also been limited in other ways. For example, laguna honda has not taken any of our patients for months because of their, you know, very strict Infection Control they are patients on thh is just around the corner. We have working out a play, with Troy Phillips and work on out a plan of how they are going to take on our patients. We havent been able to admit patients into 4a because we had a staff member that tested positive there. So there are all kinds of things in the environment that are limit org ability to test patients so its very complex, and were working with our partners in the network and the dnc to get as much flow out as possible. Commissioner chow i want to thank you for this process, and the severity and emergency from covid, it looks like we are making additional progress in how we handle people on the intake side. Particularly at emergency room level and also, even in the face of the pandemic. Thank you. Dr. Ehrlic we have an exemsal team and our department has been exhibiting Exceptional Team work and im very grateful for that. Commissioner green. Vice president green i will echo the compliment, definitely. I wondered if there were any other changes you made that you plan on codifying in the developed response. Can to understand a little bit better, as we do open up and more patients are likely to come into the hospital and the clinics, theres some aspects in your report about the issue of space and social distances and im wondering if you can talk a little more about whether you feel there will be challenges there and how were planning on approaching that, as more people do come for visits and perhaps, you know, come back to prior levels of utilization. Dr. Ehrlic remember, much of what were doing on campus right now is governed by Health Officer orders. So for the foreseeable future and by that, i mean, for the next 18 months, were going to be screening, staff, visitors and pates. We will have some restrictions on staff visit oshes and patients coming into the building. We have made physicianal change in our environment to, ensure that takes place. For example, in our waight room, there are waiting rooms in ppmc, there are physical barriers placed on chairs so people cant sit closer than six feet together. There are limitations, especially in building 5 really make it challenging to bring in the same number of patientings as we did before, even if we wanted to. There are many didnt things that are limiting our ability to bring people into the building. Thankfully, we realized, we can do a lot care over the phone and over video even though were bringing in fewer patients, we are providing a lot of care in that way. Thats something you scrks what would be codified Going Forward. Thats definitely something, not just here, but across america that is really a needed change to our way of doing business. And we are putting a lot of effort in making sure we do that Going Forward. I would say that well, caddy project for sure, that needs to continue, in some shape or form because we have realized what a critical asset that is not just for us but for the city. Were definitely going to need that Going Forward. Another important thing we have realize side we need to have better control of people coming in and out of our campus. We are looking at different ways of being able to do that, without personnel b we theyd to do a better job of making sure that the campus is restricted and safe for our patient staff. Those are the things off the top of my head but there are other things. Any questions, commissioners . President bernal thank you for your presentation, it is very much appreciated. You had mentioned that the general is taking about a third of all of the i. C. U. Covid cases in the city. Is that right . Dr. Ehrlic its actually a third of the Covid Business overall. President bernal okay. In terms of hospitalization. Dr. Ehrlic i think all of the hospitals are finding, well, more at the peak. At the peak at the time when we were caring for these patients in early april or so, you know, as many as a half of the patients we were taking care of were in the i. C. U. That is less true today. I think today we had nine covidpositive patient in the hospital and only one of them was in the icu. President bernal okay. That answers my question. Thank you. Thank you, dr. Ehrlic. We can move on. To the next item. Which is, give me one second item 6. Regulatory affairs report. Good afternoon commissioners. Thank you for giving me time on the agenda to communicate with you about the sst. So we heard at the end of may, that in june, the joint commissioner got a reassumed survey throughout the u. S. The survey is going to look very different. Looking at how technology can help with chart review, by doing that remotely through screen sharing and they are also committing to doing an assessment of each city and it is organization before the severity, to make sure things like hotels and restaurants are open. To find out there are ways in which organizations are operating to see if the survey is achieve ablg. The schedule is very flexible. Well probably get some advance notice when they call to ask questions so weesk doing work to see how we can be ready for that. They are not going tourette row spectorrively look at what we did during the covid emergency reform, they are going to focus on what were doing on the way they arrived and how we changed our processes in line with the best practices, and changes worldwide in the pandemic. The state, all skilled nurse and facilities, 68 weeks beginning in july around their mitigation plan for the restriction of visitation and reduction in the high risk pop laigdz. So will receive a survey every 6 to 8 weeks. The survey was also with the American College of [indiscernible]. [round audio interference . We have two completed surveys. One im pleased to say, there were no anticipated deficienci deficiencies. No investigations of course going on for a while now, and the other was secondary to a fall in the emergency room. There will be some deficientsies. There were some deficiencies on that survey, but we acknowledged we had [indiscernible] where our highest participations were. We have one outstanding plan of correction and based upon the report i submitted a week ago, we have had some change in the Workplace Violence abatement plan. We have the final parts of that plan accepted on monday by the investigator and we have a desk Conference Tomorrow with the district manager to find out if theres any chance that the penalties association citation can be reduced because of the severe abatement plan we submitted. Once we understand that piece, we will reach out to the Sacramento Office and cancel our appeal, based upon the acceptance of our plan. In the ways we were trying to support our staff, being a victim of violence in the workplace. We have seen activity in the last few months. Some of those events, the state surveyors, reached out to us, so they can try and close remotely if we k. So were going through the process on some of those. A patient was unhappy with the care they had received overnight, and made some allegations and we have invest gated that. We have not substantiated that, so we submitted that investigation to this date and we wait for them to reach out to us the root cause analysis for that piece is underway. And combining it with the other wrong side surgery disconnection . Thats cpi training chrks we have scheduled for the beginning of march. Cpi is a fairly handson process, so we had to postpone that training, and throot due to start, later this month or next month. Theres a schedule put together for that so that really gives the staff a lot skills about how to escalate a situation without reaching a point of physical violence. The second piece is documentation. And thats really important, how were doing what, so Risk Management worked really hard with the Workplace Violence committee and put together a ib disdiswhich sounds kind of conkie. But its a comprehensive work book that documents the event, documents the response and then any efficient followup thats needed the next piece is around environmental safety. The various parts of the organization, we may experience, one of the main areas what we see happening is in the emergency room and in psychiatry. So tht emergency room, a big piece is a response where if someones exhibiting violent behavior or behavior thats not easily explainable through kind of trying to reason with some questions, a group of people come together and respond to the patient where the patient is and they do a Rapid Assessment of the reasons that the patient is exhibiting some anxiety thats manifesting itself, its aggression. Once they have an idea how to deal with that patient, then an individualized doing rapidly. So the staff is supporting that. And the last piece is employee resources. There are two pieces to that. First of all, its feedback and were doing that in a staged way on how we present feedback on events to staff we take daily data to the staff so that the staff on duty understand that this is what we did to try to address it, and these are the things that were doing in the future. And then also we formalized how we would refer employees and also, inhouse, drama counseling, resource, so the staff can understand they can access them and manager consist keep track of what they need to follow up with in case, so that no one gets missed. So that upon no one slips through the gaps for the follow up they need. Secretary any other questions, commissioner . All right. Thank you. All right. So everyone, im going to even though theres not anyone on the line, im still going to flash the Public Comment information. Keep it up for about 10 seconds and make sure everyone can see the numbers at the top and the access code with all the instructions. The next item on the agenda is going to be zsfg medical straff report s. Dr. Horton on the line here . Dr. Horton . Does anyone know if dr. Horton, how to reach dr. Horton . no subpoena araceli let me reach out to her. Secretary lets move on. In the meantime to item 8, which is the la gunna honda c. E. O. Report. Mr. Phillips, i believe youre in the room. Can you speak up, cint hear you very well. Mr. Phillips what about now. Can you hear me okay . Secretary thats great. Thank you. Mr. Phillips. Good afternoon, commissioners. Thank you very much for allowing myself and my Leadership Team to present to you this afternoon. I hope everyone is doing well. We at la gunna honda have had a very eventful month since we last present towed, we continue our fight against covid19, of course but we have also been deal wealth affects of the unrest thats been playing out across america so we have had to give our staff a safe space to air their concerns and just have general conversation, ask questions, so we have done a lot of that this past month and we continue to do that. We also had a heart felt farewell to maggie [indiscernible] who we were able to in one of our large conference rooms, have a number of Staff Members come through and really say kind of their last appreciations to maggie, we sent her out appropriately. And we also, i think have had a pretty good transition on to new leadership, can and now, were on our way towards the future. Over all, i think we have had a very successful month, given all the challenges that we have faced. Were currently running at about 97 occupancy so were effectively full, although were not taking admissions. We do have open beds. We have a 15bed neighborhood on south 5 which is our covid unit. So those beds are essentially available for any covidpositive patients we may have. We currently have one positive patient on that unit and hopeful, if were lucky, by tomorrow, that patient may be off if they test negative this even and tomorrow. We also have 13 beds that are available for p. U. I. I would have one bed on each of the 13 units for that purpose. We havent taken admission since the month of march this year but the cause, obviously, this has been related to covid19, once we went on quarantine, but we are anticipating a surge in covidpositive cases and types of patients so we are as mentioned earlier, we are working on developing a plan to have reassume admissions here at la gunna honda hospital and we have had really, a Multi Disciplinary Team working on that effort and really have spent a lot time, in terms of considering all potential issues that might come up. But at the end of the day, really, our mission is to prepare for that potential surge that we anticipate getting over at zzsfg so they can open up more beds for acute patients. In addition, we are also beginning the planning phases for reopening at la gunna honda hospital. Thats going to be probably a longer approach, given our unique situation with our longterm care patients. We dont want to approach opening our facility too quickly with the type of patients that we have and their vulner agent. We want to make sure we have really good processes in place, before we kind of vent down that road. So itll be a phased plan with regard to that and we will watch close 3 adhere to what is in place. And continuous to be in place. Were currently running about a 6. 9 vacancy rate for staff. We were able to hire some rns and other support staff to assist with our continuing efforts with covid. So we were able to get some of those staff on board in the last few weeks in terms of key positions available. We had about 8 candidates that we interviewed about three weeks ago and we determined that really, we wanted to reopt announcement for another couple of months because we wanted to cast a wider net and so were going to be looking at bringing in additional candidates for that purpose. We are also starting for interviews for a chief quality officer. That position has been vacant as well. We have introduce scheduled for july 10 and so hopefully well have really strong candidates and potentially, well be abling to find a particular selection, based on that group. We have also, in the miffed of developing an emergency staffing plan, one of the challenges we have, each time that we have a positive case on one of our units, but of course, we have contact investigation that occurs and in some instances, it require ace number of staff to be quarantine and sent home and not be able to work. So that creates a lot of staffing challenges. So we as a Leadership Team, determine that we really needed to move towards an emergency staffing plan far staff or rns or lv networks, working in administrative capacity but are still able to potentially do Certain Service on the floor, in an emergency situation so were preparing for that contingency in terms of covid19. We are just wrapping up the third round of universal testing so were testing of course, all of our staff and all of our residents so we have conducted thousands of tests during those rounds. We start round 4 on monday and thus far, we have had a total of 45 positive cases of all those cases so i just cant say enough about how our protocols staff has worked very, very hard expurks we have kept cases down to respectable levels. Of the 45 cases. 31 are staff and 14 are residents. And of the staff cases, 23 have already recovered so there are only 8 active staff cases and of the 14 regular cases, 13 have recovered so theres only one remaining and hopefully, that one will be recovered after tomorrow. We have 4 units that are currently on quarantine and so they are in various stages of quarantine, depending on request that last positive case occurred and so depending on where they are, and when the retifting occursretesting occurs, at so, in the near future theyll start to be coming off of quarantine several weeks ago, we had a budget assignment, really, the entire department of Public Health were given instructions to look at our budget and look for opportunities to implement reduction and we were given a target, based on our percentage of the gentlemen of the jury fund and we tried to do this in a way that was not going to be alarming to the staff so we in conjunction with finance, met individually with selected department heads, and based on those meetingsing, we were able to come up w we did a lineby line analysis of the budget and were able to come up with, i think, reasonable reductions that do not impact patient care or resident care is so i mentioned earlier, the world events and how they are impacting la gunna honda la laguna honda hospital. Start wealth killing of george floyd and being so close on the heels of brieona taylors death, and ahmad ash re and rashard brooks. It really had, i would say a devastating impact on the staff. So we really focused on, you know, giving them space, giving them the ability to ask questions. Make time before every meeting to have some quiet time giving them the ability to participate in vigils and being available. We continued down this road. But i think given the fact that we, as a Management Team recognized the impact, we really focused on that and trying to be of support for them. We also have a number of campus activities over the last month. So despite the fact that there was this social unrest that i mentioned, we really did have an opportunity to have some fun together as an organization and there were many opportunities for that. And a couple of them, the supervisor yee and the mayors office, coordinated with four bakeries in the area, and they delivered 1500 pastries to the laguna honda team. Viewper visor yee was here in person, pretty much throughout the exercise and spent some time with the staff and it was just a great opportunity for us to relax and enjoy, and the staff really loved the pastries, of course. On the heels of that, we had a staff celebration. So we had a number of activities. Music, food that, occurred throughout the week and just a real great opportunity to share and have some fun together. I also think one of the highlight that is we were able to, we have received a donation from the conlait general of the netherlands. They gave a donation of 5,000 bouquets of flowers. So essentially, every person on this campus was able to get a bouquet of flowers. The consulate himself was here and spent time with the staff and with the Management Team and it was just a really wonderful opportunity. We also conduct aid town hall meeting. With a large staff, its difficult to get everyone together. Especially with covid19 so we put together a virtual town hall and it was very well attended. Most of the Leadership Team members that are sitting here today, were also in attendance and we were able to provide some updates and information to the team and rules to allow them to ask questions and really respond to, you know, some of their occurrence it was a great town hall and i think it gave us a pathway for how we will conduct business Going Forward as long as we continue in this environment. We were also able to celebrate juneteenth. And juneteenth this year, was really pro found, given all the unrest thats been occurring. I think it brought attention to a lot people, in terms of the meaning and significance of the day itself. And i think in normal times, it probably would not have the impact that it has upon had. So we had a nice event for juneteenth here, and several employees were able to do some entertainment, do some replication and really just spend time together. And i think the employees appreciated quite a bit. Oh. And the last thing, in term terf our team of the month, we went instead of recognizing one person for employee of the month, we want to recognize teams for the month so for this month, we recognize the respiratory therapy department. They have just been really so instrumental in helping us to operationallize the universal testing. They have really been fully involved in that effort and really havent missed a beat, during their normal jobs as well. So they were posted with the greatest of attitudes and time and just really has been so effective in carrying out our universal testing effort ill stop there and see if we can answer any questions we might have. Secretary commissioner, i want to make sure if we have Public Comment on the item. Theres no Public Comment at this time. Secretary thank you, araceli. I have you on screen, commissioner bernal. President bernal thank you. I wanted to thank you much, particularly with the departure of maggie, for your really extraordinary work in hitting the ground running, not just in addressing a number want regulatory matters that are before laguna honed a but also your, you know tremendous leadership as we are dealing with covid epidemic and really, your work to maintain the morale of the staff. Its really a test amount to not just your leadership, but everyone at laguna honda, that youre putting away that stands apart from the experience of so many Skilled Nursing facilities around are having, in terms of out breaks so i want to thank you for that. And for the team of the month. Peab ill just say their names, personally, out loud to be a part of the record from the respiratory therapy department. Gary cosi. Marie bue ncelitto. Gary sikita. And ginning lun yu. We look forward to learning who the july team of the month is and more of a question, of course, but we would like to learn the results of the second round of testing at the end of june, if those can be provided. Give a directors report at the july 7 commission meeting. Wed appreciate that very much. We absolutely will. Thank you. President bernal any other questions, commissioner green and commissioner chow. Vice president green if can you give us an update if how residence are fairing, given this shelter in place. And also, do you have any plans to allow to go out on paths or given the real opening, and the phases were going through, how that will affect the residentss lifestyles and ability to both have visitors and perhaps, go out on passes and so forth is there any plan there . Great question. I have to say, ive been thoroughly impresse impressed ad surprised at how let residents have responded to quarantine i expected they had have some cabin fever after a while. But they have responded extornado not that i recall well in the beginning stages, it was very difficult, until we put into plashings the ability to do face time with their fames. Thats helped tremendous. And the activity therapist, teams of course involved and engaged in keeping them owmed and keeping them, you you know, having things available for them to do. But over all, i think the residents have responded extremely well. Were hesitant to open things up in terms of too quickly so were really mindful of doing a phased approach and so at this point, we dont have any plans to start visitation. We are thinking about it, were talking about it but i think its probably a little further Vice President green clearly , the staff and the leadership and i think its admirable that youve not only been able to avoid a diseased burden, but also the resident vs. Faired so l socially and psychologically in a very restricted environment. It was a shock to everyone. So i think thats another testament to the staffs work. So thank you much. Secretary commissioner chow. Commissioner chow yeah. Thank you. Im sorry we cant quite see you. But we must be having technical issues here. In followup of dr. Greens questions in regards to visitation, i thought we had seen [indiscernible] maybe can you tell us what status that had in terms of permitted visitors to Skilled Nursing facilities and or longterm care. I think mr. Rich afterwards, sent us to documentation that this was occurring and i wanted to know what laguna was doing. We heard what general was doing, in terms of visit oshes, and i just heard what you were saying in terms of being quite cautious about doing this. So what are your plans and is there going from the state that is actuallying us also, in terms of visitation of families . As you know, we are a little different from the normal Skilled Nursing facility in that with 13 units and almost 780, you know, residents here, so you know, were in 10, 12, 13 Skilled Nursing facilities all wrapped into one. And like i said before, we have really spent a lot time and we have continued to kind of think about visitation, think about opening but were just i cant say, were just not at the point now where were comfortable with moving in that direction. I think its going to take us a little more time to develop our plan to consult more with some of the experts to receive guidance from the department of Public Health. Were just a little were not ready to take that step as of yet. Commissioner chow i understand that, of course, as you were saying, it does take time and we are a very extraordinary institution. And i just wanted to be sure that were responding back to the state and whether or not any of the residents families are also asking and certainly at our report when we have our regular laguna honda meeting, i think that would be a goo time to seew your reflection is going and how well you are doing in terms of bringing in new patientings and what you might be doing in terms of allowing some sort of family visitation. One of the nice things about laguna campus, there really isnt enough areas around to feel more comfortable and that of course is a challenge, too. In terms of how you would bring visitation. But its quite possible that you might set up visitation, in different areas, that allow for social distances and meeting of families and would feel a need to be on face time and try to make the visit. So i know youre looking at that. Among all the other challenges, and we look forward to a followup. Mr. Phillips. We will give you specific details about what our next steps are, along those lines. And commissioner chow, if i may, we do want to [indiscernible] currently, we do allow visitors for those who are. Way and cdc. So there are very strict guidelines, but we do actually nobody in our facility is dying alone and [indiscernible] can be here with them. So thats one exemption that we do allow visitors at this time and as mentioned, we are working very diligently on a reopening plan. That is a National Phase approach. But would work with families to allow them to come visit in a controlled environment, as much as we k we continue to keep our resident. Way. I appreciate the fact that those people who are nearing the end of their life, can have an opportunity to have family with them. Yes. Absolutely. Chu thank you very much. Secretary any other questions, commissioner . Commissioner chung. Commissioner chung i keep click the wrong button. Thank you for the presentations and i, too, appreciate hearing those who are in the endstage, you know, of their life, get to spend that with the family. Instead of like dying alone because like this whole covid19 created a very different way for hospital assistance, which also caused many patients, you know in other hospitals, that ended up dying alone. So i think thats really important for tows acknowledge. You mentioned face time and a video visit, which prompted other questions i have. How well have we been utilizing telehealth since some of these like inperson doctor visits, it is not possible. Could you guys hear me . Secretary could you raise your hand, dr. Hathaway. Its very hard to hear her. Theres an echo and we sure do want to hear this. Dr. Hathaway could you hear my better . Yoasm like im yelling. So here at laguna hospital, were not utilizing telehealth, telemedicine, the same way that the community is using. So remember this is a very unique facility and we function very similarly with [indiscernible] as an inpatient hospital. So our providers actually see patients facetoface. We do not utilize any sort of devices that rely on a third party because a nurse or a pca to visualize the patient. We actually still seat patient and assess them as if they were an inpatient facility. Now, there are some instances in which i can do Remote Access for our cubicle or from our offices but its more of a chart review process. Any service situation where a patient needs to be examined, a physician will examine them in person. Does that answer your question . Commissioner chung yes. Thank you much. Dr. Hathaway youre welcome. Secretary any other questions, commissioners. The team is already lit up and on video. We continue on with the laguna honda item and go back to the staff report. Is that okay, commissioner bernal, with you . Okay. Great. So then well move on. Well move on. To 9, which is laguna honda Regulatory Affairs report. Just one minute. I am the [indiscernible] for laguna honda hospital. Im going to share with you the regulatory report for the month of may. For the month of mai. Laguna honda hospital submitted a total of 19 facilityreported incidents to cdc h. You have the break down there on your report. There were also 7 anonymous complaint. To questions that were provided by commissioner green, just some quick follow up. So there was a change in staffing so this has caused a delay in followup in some of the investigation items so this is the roughly 15 investigations that you see have not been started here at the hospital just yet. 7 of which are [indiscernible] cases. Additionally, follow up with over 40 cases during this covid time. So the surveyors are not visit visiting all the facilities. Its a great time for them to catch up on some of their pending cases and theyve been doing that. The Management Team has been extremely busy, providing followup documentation to over 40 cases and over 15 impenlding case that is we an tyes prit documentation comes. There are concerns in term n terms of the penlding cases. I would say, not at this time. Of course, theres an opportunity they might be substantiated, there might be deficiencies. But in terms of other penalties or other deficiencies that the facilities have seerntion that is not a concern, as all those cases of course closed ow. Thank you commissioner green for your thoughtful questions. I hope that addresses some of your thoughts. In addition, i think one thing thra is really something to celebrate. Is that we are back in compliance. I just want to highlight it again. To get the facility back in compliance with participation. This was shared with us on may 7. The so that was very exciting for the team here, as we were in the midst of covid, they accepted our plan of correction with a table review if their office after submitting documentation. Clerk let secretary anyc comment. Theres no Public Comment at this time. Secretary thank you, any questions, commissioner . No comment . All right. Im not i zoo seeing any. We can move on. To the next item. Item 10. Laguna honda wide policies and processer. Thank you very much. Ill continue to present this item for you. Nawzaneen we have three hospital wide policy that is have been revised. These are three of our Infection Control policies. All the revisions are related to the laguna honda hospitals covid19 response and wanting to update our policies in line with the protocols we have put in place with the facilities. There are three departmental policies from nursing. These are related to epic workflows. The department has updated workflows. The rehabilitation has one policy up for revision and this is in terms of their commission to medical. Secretary do we have any Public Comment for this item . We do not. Secretary any questions, commissioners . Okay. President bernal do we have a motion to approve . Vice president green so moved. President bernal is there a second . Second. President bernal yes. Vice president green yes. Commissioner chow yes. Commissioner chung no response . Secretary commissioner chung . President bernal commission. Secretary let me make sure she had no trouble with kexese connections. Im going to give her a call. Please hold, everyone. Please be patient. Thank you. This is a vote on item 10. The other three commissioners have already voted and we need out record. Commissioner chung yes. Secretary thank you, laguna honda team. So as you know, first were going to go to dr. Horton closed session first, so i will email you, and i will also test you dr. To make sure when its time for to you sign it in closed session, i will do that through that communication. In the meantime, please turn your camera off and thank you much for the report. Dr. Horton, are you on the line . Dr. Horton i am and im so sorry for the glitch i had earlier. Secretary okay. Great. Youre o. Dr. Horton im you cant see me on video. This should be fixed next week when i join the dph ranks knead and we have a different Microsoft Teams. But my apologizes about that. First, for my chief of staff report, thanks so much for attending and for your wonderful words of encouragingment of med staff that are virt yom, this year, our virtual med staff dinner, our handle meeting we had a good time, even though actually we could not actually have a dinner. We had a number of interns from the various departments who won a [indiscernible] award, and always a shout out, as that particular award focuses on their dedication and hard work on behalf of our very vulnerable patients and zsfg in particular. The nominating committee for the med staff had met and proposed a new chief of staff, and it was voted on at the dinner we are delighted with anyone who is not familiar with dr. Winston, she is the head of Infection Control, at zsfg and is vice chief the of the internal medicine department, the Largest Department at dsfg, so shes played a Critical Role of operations, mostly on the Inpatient Service but shes very knowledgeable in the out patient services. Were really happy shes been willing to step into the role, and sleel be keeping her Infection Control hat but passing on her chief of medicine hat, sort of getting a lot of bang for your bucks there. As she knows more about than almost anybodyel at the hospital. Im really thrill body that and i leaked a couple of new atlarge members. One is the vice chief of the Pediatric Department and the medical director of pediatric clinic. The other is vice chief of Community Family medicine and also is the Program Associate director for their residency. Really, wonderful people. The other thing we focused oat the dinner, but also at one of our med expect Committee Meetings is of course, the issue of Racial Equity. Theres been a lot of involvement and concern about these issues, not only before the death of george floyd and Brionna Taylor and all the other events that have happened, but really a lot more light being shed on all the advocacy going on in this area, and all of the work that we have put in for Racial Equity. Im very appreciative and prepared a list of resources as well. She is the head of ourstra teenlic planning for equity at the hospital and some of the metrics shes followed and some of the work beef been doing to advance Racial Equity and both she and some of our trainees, who have taken leadership role in the roles for black lives Matter Organization at ucsf, has been carrying a lot of resources about how the med staff will get involved in that and i really appreciate all the work going on there. The final in my chief staff report, we have taken a bit of a break from our division reports because everyones been scrambling around to reconfigure their services but were back to service as usual. And we had a great report and they did some tremendous work at the help. And complexity, chief of services they also do it with very little, they have 1. 8stes for attending time. And someone point d out. Dr. Russell hearses seems to be doing 1. 5 herself so she wears a lot of hats and answers all the econs, does a lot surgery and they have a wonderful residency class and i have three action items can i go through all together. Or call for a vote or we can vote individual lee. But ill let you know what they are first. So the first, we have revision to the standard procedure. Fortified nurse. Midwifes, and it allows them to be first assist for csection. The reason for this is because like all services, there has been the ob gyn service and the residents are not always available we had a discussion about this. And the committee had a discussion and the commit i recommended some revisions. We wanted to make sure that there were actually two surgeons in the room. And so that one of the surgeons could actually be overseeing and teaching and watching the words of the nurse midwifes, so that nursemid wf can learn and be proctored and be signed off on the first assist rule, in order to perform that adequately. Secretary any questions, commissioners. Do we need to take them as individual items. Secretary on mass is what you normally do. President bernal all right. Thank you. Secretary go ahead, dr. Horton. Dr. Horton okay. Great. So the next is an an thesia st. So the reason for this youll r youll see a lot is in there. We have had a pain clinic for a while now, where we have had nurse practitioners, working in the pain clinic. But as you all know the way our system works. You were supposed to have an st. And so we modeled this, or we didnt, but the cipd committee and dr. Wood, who is the medical director of pain clinic, mold thd on our sp, so it follows similar guidelines, in terms of proctoring automatic all of the nurse practical tigdzers, working in pain clinics, are credentialed at the hospital and are covered under some st, they were not specifically working on an st for pain clinic. Prior to this. Any questions about that. We also have an update and that is we are removing the central line placement in the tunnel catheter procedure so this is for the attending nephrology, and the [indiscernible] need to be proct ord or are proct ord from attending other departments who hold those privileges. You have questions about that . I think our questions and Credentials Committee was a little bit of a surprised that our Nephrology Center is not doing procedures but we were reassured, the people who are doing procedures, they are getting adequately proct ord and signed off by those who do have those privileges. Secretary before we go to the commissioners for questions, lets just check and see if theres Public Comment. Being currently done. Just taken out then . Into these circumstances in which the spiftist nephrologist has in fact been doing . I mean, i dont know [overlapping speakers] dr. Horton [indiscernible] [overlapping speakers] but they are not retaining the priviledge . Commissioner chow by eliminating t. Even though they are not doing it right now. Commissioner chung in the future, its potentially possible. They dont have residents. Yeah, i did wonder that myself. Even if no one currently is doing it on the attending level, it is possible someone would want that joined in the future. I do know more are, replaced by i. R. And the attendees do not take overnight call so its really an overnight call to come in and place those. However, im also happy to take this back from the chief of neverseenbefore iology and they dont want retain t but a lout current nephrology. Privilege. Commissioner chung its an optional privilege and its fine if youre going to take it back to them, just for review and we can go on right now if they think it might be good to retain it, they can put that in. Dr. Horton okay. That sounds very reasonable. Secretary commissioner green, do you have a question as well . Vice president green im confused about in many of these situations. In terps of new criteria. There are highvolume things for things that are realliesome and lowvolume needs for those that are complicated. audio distoargses in the background [indiscernible] some kind of consis isies, for how they address the complexity, procedures, compared to highvolume procedures, when factoring, when creating a new procedure but there is some variability in them because they are all created by their own department and i dont so far, i dont think we have of we have plan a comprehensive overhaul of them, but what we have planned is more of a procedure where the entire st has gone over, at least every two years and we are right in the process you of beating the drums for that and trying to get departments to do that. When covid hit. But i think the new chair of the commit severy interested in doing that. Now that things are calming down again with covid they still made sense and you correctly pointed out arks couple of sessions ago, that they had a procedure in there that im sorry, this is for the attending privileges but they had a privilege in there that was no longer done anywhere and i think that goes to under score your point which is all of privileges, really should be reviewed. R rs, at least every with a certain period that we can count oso we have a more comprehensive review. So i dont know if you have a comment about those specific procedures now, in which case im happy to take it back to the Ob Gyn Department and im happy to [indiscernible] to the chief of staff and ann swager and allen gield and the head of the cidc committee [indiscernible] our efforts around regular comp henlsive review of the s. P. s is a good idea. This is dan, so yes, im on the phone. Noted. Inld you dont know the extent to which it applies to multiple specialties as well. I think what happens is, people get kind of stuck in a situation for proct org whether its for an initial a payment or a reappointment. Low volume. Hi complexity procedures are opportunities to view them, but theyre the most title for proke omplet were having this discussion. Pretty often enough, where we need the peed i mean, you really have to know what youre doing and yet, we dont have to int bait that many kids per year. So its hard for everyone to maintain their competency in lowrisk, high volume situations and thats really true we continually discuss that. Secretary before we go to a vote. I miss today, for the nephrology, is that going to be included in this vote or are you going to be take ting back and trying to address commissioner chows question . The way the call is set up and other way the Current Department is set up. I think it would probably be best to vote to approve to remove them but i will take it back to the Nephrology Department, this conception that, you know, if going changes, we will get it back with a special procedure right away. I think thats the best way. I didnt have the direct conversations myself with the Nephrology Department and there may be additional considerations and its not going to leave anybody doing the procedure without a privilege assist at this time. S i understand. So my question is more for [indiscernible] with thindanind. Are the nephrology privileges still on the action items for a vote today . Okay. They are. Okay. Great. The standard procedures in the nephrology procedure list. Do we have a motion to approve. So moved. Sefnlgtd. President bernal yes. Vice president green yes. Commissioner chow yes. Commissioner chung yes. Secretary great. And i believe im sorry. I understand dr. Ehrlic has some things she would like to say. Dr. Ehrlic yes, thank you, commissioners for the time. I want to take this time to recognize dr. Horton for her service as chief of staff. Dr. Horton has just been a tremendous leader in this role. Shes been in the role for an unusually short period of time but shes really packed in a lot action during that year she worked with us on epic and going live and she is Pretty Amazing in her efforts in dreationz faculty and trainees, coming out of that epic go live, she was very involved in the ambluetory demain, in helping them get back on their feet. And no senior we got things semisettled with epic, but we went into a pandemic and dr. Horton has been an incredible leader during that tie. I have so enjoyed havingler on the executive committee. Shes been a great contributor. Shes creative, incredibly intelligent. Shes got a great cents of humor. Sense of humor. I regret shes had to cut short her time as chief of staff. But the good news is, shes going to be the chief medical officer for the network and well all get to keep working with her in a new and enhanced role. So im looking forward to that. Thank you very much, clerc. Youve always been so thoughtful and informative when you come to the commission and we have just really enjoyed having you in this role and wish you the best, knowing that youre not going too far and that well continue to see you. Dr. Horton oh, my gosh. Thats so nice of everyone. Youll probably see more of me than you want to. But i adopt to take a moment i really enjoyed working on your executive team. And its been real pleasure to work with all of you, the commissioner nirs and about mark and this has helped me so much how this commission and the department functions. I am completing my original twoyear term, but it is true, i was planning to stay for a third year and then [speaking away from microphone] secretary before closed session, theres item 11 for other businesses. Just checking other things that have come up. Any Public Comments about the item. Theres no Public Comment. Secretary thank you. So commissioners, consideration for going into closed session. That requires a vote. Is there a motion. So moved. Second. President bernal yes. Vice president green green. Commissioner chung yes. Commissioner chow yes. Secretary okay. Everyone. Please, remember, im going to close this meeting out. You have to go to the next link if youre opening up the email i sent you, or can you go to your Microsoft Teams and click on the closed session link, and that will take you to the meeting. I will see you hopefully, in a minute or two. Wrack brack close [closed session in progress]. . [connection difficulties] i need your voice, sir. You were muted. Yes. Oofnlgt great. Commissioner chung. Commissioner chung yes. Vice president green yes. Commissioner chow yes. And the last thing is consideration for adjournment. Move to adjourn. Second. Okay. Great. Commissioner chung yes. Vice president green yes. President bernal yes. Commissioner chow yes. Secretary thank you all. Thanks for this meeting. Have a lovely meeting. Be safe. Thank you. [arc jowrnment 5 43 p. M. Pt] hi, youre watching coping with covid19. Today im going to the pharmacy. [music playing] now im not a medical professional or a doctor of any kind. Sorry, mom. Im a video guy. And this is my personal story. I have a Family Member whos in the atrisk group so im the one going to the pharmacy. To get the most detailed and uptodate information about the virus, go to sfgov. Org. Theres a really good f. A. Q. There. Ive been taking a plastic bag from the house and putting a sanitizing wipe and for this trip, i feel safer wearing latex gloves. Im taking the smallest number of items with me. My debit card, i. D. , the gloves and the wipes. And that means therell be fewer items to wipe down later if they come into contact with shared services. When i get to the pharmacy, i put on my gloves. My goal while im inside is to not touch any common surfaces and try to keep at least six feet away from anybody else. This is my second visit of the day. The first time i came, there was a huge line so i just left. This time there is no lineup. Im very careful after i use the p. I. N. Pad to pay for my purchases. This is a point of contact that many people have touched, which is why im wearing the gloves today. I thank the pharmacist for her important work and leave. On my short walk home from the pharmacy, im careful not to touch my face. I keep the gloves on and until i get to my recycling and trash containers, where i remove the packaging from the medicines and i put them in the recycling. Now we dont need the instruction for these particular insulin medications because were already very familiar. As soon as i get through the door, i wash my hands for at least 20 seconds. Then ill wipe down my debit card and i. D. And, as an extra precaution, i wipe down the medicines packaging and anywhere where they have touched indoors. Then i wipe down the front doorknob and, finally, i wash my hands again. That is it for this episode. I hope you enjoyed my story. Thank you for watching. My name is Angela Wilson and im an owner of the market i worked at a butcher for about 10 years and became a butcher you i was a restaurant cook started in sxos and went to uc; isnt that so and opened a cafe we have produce from small farms without small butcher shops hard for small farms to survive we have a been a butcher shop since 1901 in the heights floor and the case are about from 1955 and it is only been a butcher shot not a lot of businesses if San Francisco that have only been one thing. Im all for vegetarians if you eat meat eat meat for quality and if we care of were in a losing battle we need to support butcher shops eat less we sell the chickens with the head and feet open somebody has to make money when you pay 25 for a chicken i guarantee if you go to save way half of the chicken goes in the enlarge but we started Affordable Housing depends on it occurred to us this is a male field people said good job even for a girl the interesting thing it is a womens field in most of world just here in United States it is that pay a mans job im an encountered woman and raise a son and teach i am who respect woman i consider all womens who work here to be impoverished and strong in San Francisco labor is high our cost of good ideas we seal the best good ideas the profit margin that low but everything that is a laboring and thats a challenge in the town so many people chasing money and not i can guarantee everybody this is their passion. Im the ive been cooking mile whole life this is a really, really strong presence of women heading up kitchens in the bay area it is really why i moved out here i think that we are really strong in the destroy and really off the pages kind of thing i feel like women befrp helps us to get back up im definitely the only female here i fell in love i love setting up and love knowing were any food comes from i do the lamb and thats how i got here today Something Special to have a female here a male dominated field so i think that it is very special to have women and especially like it is going at it you know im a tiny girl but makes me feel good for sure. The sad thing the building is sold im renegotiating my lease the neighborhood wants us to be here with that said, this is a very difficult business it is a constant struggle to maintain freshness and deal with what we have to everyday it is a very high labor of business but something im proud of if you want to get a job at Affordable Housing done nasal you need a good attitude and the jobs on the bottom you take care of all the produce and the fish and computer Ferry Terminal and work your way up employing people with a passion for this and empowering them to learn the committee will come to order. This is the meeting of the vision zero for thursday, june 25, 2020. I am commissioner yee and i will be chairing todays meeting joined by vice chair commissioner stefani, and commissioner peskin