Transcripts For SFGTV Health Commission 20240712

July 21, 2020. Before we begin with this item on maf o behalf of my fellow commissioners we approved to help equity resolution declari declaringit was based by the Human Rights Commission during their june 25th meeting. Ours had the addition of some resolved statements that were tailored to health and programs. On behalf of my fellow commissioners i want to acknowledge the critical work of the commission and their staff along with members of the Community Group mega black sf. And develop the resolution of the same name that was approved of the commission and all the hard work and energy they put in to creating that resolution. The commission is very proud of the resolution that contains some measurable outcomes to achieve equity and combatant eye black racism. It was apparent that there were some issues with respect to the development of the resolution and the process by which the commission approached the discussion of this item. Last week the secretary and Staff Department of Public Health and Human Rights Commission meant to resolve were committed to developing a process and protocols for our continued Work Together to address anti black racism and other crisis effecting San Francisco and discussion of these critical issues. I speak on behalf of any fellow commissioners saying well continue to address anti black racism and advance other Health Related issues at our meetings and in consideration of future resolutions. During the covid 19 pandemic and were grateful for all the hard work being done to combat the pandemic. Everyone is doing their best to conduct all of the necessary work. We can do better and will work collaboratively on developing a strong process moving forward. Thank you for your attention and commissioners do we have a motion to approve the minutes of july 21 . So moved. Is there a second . Let me check to see if theres Public Comment. Give me one second. If you wanted to make Public Comment on this item, press star three right now. I doapt se dont see any publict on this item. Okay. We do have a motion, is there a second . Second. Please call the roll. roll call . Just a reminder to all the folks who arent speaking, please mute yourself if youre not speaking so theres no background noise. Its a little hard to focus. Good afternoon, commissioners. Director of health. The details where we stand with regard to our covid 19 response and budget. Those follow on agenda items. Im happy to take questions on any additional questions that you see on the directors report. I recommend we go to the covid 19 update in the budget that will answer many of those questions. Its fine to proceed. Folks if you would like to make Public Comment on the directors report, please press star three. I actually had a question on the Behavioral Health dhr. Yes. Please go ahead, commissioner. It was only a question of clarification. The dhr being developed for Behavioral Health would it be compatible or is this also developing a Mental Health ehr. This has been a long standing controversy about whether or not well have merging ehr. I turned this over to dr. Hammer who oversees Behavioral Health. Could you provide answers to the questions. Could you clarify what youre referring to. I dont know what is in the directors report that you are referring to. Ill try to clarify. Its the new dhr thats being developed. The question is whether or not this is consistent, compatible with ethic or would one still need to use two different ehrs to be able to get a complete record . The plan is that we will bring Behavioral Health services onto epicim not sure if its not. Were currently in early wave two. We had our anniversaryim not sure exactly what you are referring to. We will not have any interim new Electronic Health record for Behavioral Health. Well continue to use avatar. I guess perhaps im miss reading the item. It seems Behavioral Health services Electronic Health record is here. Perhaps we can d do this of line in terms of trying to clarify that. Sure. That sounds great. Ill look to see what you are referring to and get back to you on a more comprehensive answer. And congratulations on one year. Were looking forward to many more things with our present pandemic. And i have to say, it has been, i think a lot of us have been feeling so grateful that we have epic and that we passed the immediate post school live period before the pandemic hit and had to put it to the test. We have really benefited from being able to use epic to coordinate care and access testing results. Its been such an important tool in our Covid Response. Great. Thank you. Well move onto item four which is the covid 19 update. Thank you commissioners. Here to provide you with a covid 19 update. Have some data to present updated information and i believe some time for discussion. You see the deeper curve on that right side of the graph. Next slide. In terms of our testing. We have far exceeding our testing goals. Our average is thirty one hundred eighteen tests. I will note that demand for testing has out stripped supply not within city and Health Department sites but we are far exceeding our testing goal. Our positivity rate, our rolling seven day average you can see here running from april to early august is currently nearly four percent and consistent with a high number of cases were currently diagnosing. As the commission is aware, we have inequities within the pandemic particularly in the Latin X Community. Weve been working with key stake holders to address the pan emipandemic in that community. We continue to do well on many aspects of our response compared to other jurisdictions. Our case counts per one thousand is relatively low compared to other jurisdictions with respect to king county. A death rate low, a total of sixty one deaths. Rate of one every ten thousand. Our testing is not meeting the full demand but is certainly a success compared with other jurisdictions. Baltimore is the one jurisdiction thats close to our total. D c is somewhat higher at a rate of four point one three per one thousand. Next slide. This is our rate of hospitalizations and the commission recall that we are in a surge scenario. You can see that in april we peaked at a tole of ninet totale hospitalizations. It declined in mid june to twenty six hospitalizations sm that number saidly cloimed in s. You can see the light blue lines represent the medical surgical beds. A slight decline over the last few days. We are watching these numbers very very carefully. Because it takes about two weeks from someones dates of infection to being hospitalizations, the hospitalization was about two weeks ago. A little bit of hopeful data with regard to the declines you see there. Watching it very carefully. Next slide. Our key Health Indicators, these were updated as of this morning. Our hospitalization rate which exceeded the 20 was level four in red. Just a week or so ago because of that decline and a negative three point six percent rate. We remained at good capacity. Its twenty three percent and twenty seven percent for medical and icu beds. The testing numbers that i described earlier, their one hundred and eighteen. Our Contract Tracing had fallen behind. This is due to a number of fact yores including the increase in keasecases and delay in test re. Locally and nationally the labs have not been able to keep up with the testing numbers. Weve currently experienced delays of seven to ten days as lab corp. And other commercial labs are waiting as long as two weekweeks. City test sf to get results turned around more quickly. Our Public Health lab is catching back up. We expect returned results within 72 hours. With regard to our personal protective equipment were at 8l protective equipment has a thirty day supply in the city. This is our r reproductive rate. These are estimates through about august 1. You remember reproductive rate over the line is more than one person i is infected. We really need that reproductive rate less than one. The veer us had a reproductive rate of eight point five. You see that increase in estimates starting around june 15th. We went above one and went to about as high as one point three. This created a situation where we paused our reopening and took aggressive actions with regard to education around prevention activities that were needed to tract the reproductive rate down. We see some hopeful signs that reproductive rate is tbing down again. Its wu one point five. This is still a high number. Were concerned that were still above one with the reproductive rate. If theres no change in the reproductive rate even at one point one five we would estimate that peak hospitalizations would be three hundred seventy with three hundred ninety deaths in 2020. That is marked by the followup blue line going from the august fall through the end of year. More vair eations in the reproduckive number can cause a difference in estimates in the fought youre. The plausible number that can be in the hospital which is neen tean hundred on ct 30th, 440 deaths. These are models and estimates. This is all about probablity. The shading of leans represents the probability of zero to 95 . Certainly we have a window of opportunity as we hope fle can ten to drive this reproductive rate down dramatically. If were able to reduce by 30 , you can see a dramatic shif in our future. An update on our testing approaches Going Forward. We have set up across the city and this is not just e ph but across the city theres a total of 29 testing sites throughout the city that has performed nearly a quarter of a million tests. We have achieved more testing access than any other surrounding county. We early on tested surrounding city sites and exceeded our testing goals. We expanded our access to anybody who requests to test. We have had to set priorities to challenges we have had locally and state wide and nationwide in regard to steadily supply of testing and unified testing strategy for the nation. We have prioritized san franciscans testing with symptoms of covi covid 19, foret line Disaster Service workers. This is a slide that marks our relative success in addressing concerns about spread of covid 19 in our skill nursing facilities sm these arfacilitie . These are dataits a little hard to read. The numbers of infected Health Care Workers are shown in the blue line. Infected residents with the orange line. Hospitalled patients shown in the gray line. Deaths in Skilled Nursing facilities across the city has been relatively low compared to other Testing Facilities across the state and nation. This is due to the fact that we have a scaled up testing in these facilities. We are testing all patients and all staff every two weeks. This takes about three hundred tests a day. We have issued orders requiring other nursing facilities to do the same. Obviously its not just about testing. Ive said repeatedly were not going to test our way out of this pandemic. Other resolutions have to do with good infection control, mask wearing and good hygiene. Youll see he on the far right an uptick in positivity rates among the Health Care Workers and that is certainly consistent with more Community Spread both in San Francisco in the region. We inspect to see this as theres more Community Spread and that would obviously effect the people working at these facilities sm we also continue to focus on testing with regard to out breaks and Residential Care facilities, shelters, and sros. And being aggressive with our testing in the jail. In collaboration with our dph data teams is with u c sf. We continue to file the data with regard to our testing priorities. These maps of importance. The green and orange map is prevalence of diagnosed covid 19 cases. You can see the darker orange census tracks represent where theres a higher prifl ens of covid 1prevalence ofcovid 19 in. The lighter green or some color between orange awnd green tha ai dont know the name of, those are the wider census tracks. The second map shows where testing is available in the city. Theres a mismatch where testing is available and where covid 19 is being diagnosed. This is not just dph or city test sites this is Health Care Providers across the city providing covid 19 testing. You can see the testing rate per capita is hardly surprising that people are getting tested in the neighborhoods where there is testing availability. Theres a pretty clear match there. Our testing strategy Going Forward will be an adaptive testing strategy that will focus on where cases are being diagnosed and scaling up where those are census tracks. Our new testing goal is five thousand tests a day by Early September of twep 2020. Pushing ourselves beyond that thirty five hundred to five thousand. Really focusing on our neighborhood strategy and concentrating neighborhoods most impacted. I would remind the commission that because of our Health Clinics across the city we impleimplemented multiple test s early on in the pandemic including south east Health Center and also in the parking lot of zuckerberg General Hospital where the Research Building is supposed to go in the future. We did extend testing availability in those neighborhoods. We are also looking to expand capacity and speed of lab process to shorten turn around times. Were looking to ensure that private providers do their part. Ill show you data in response stto that. We have more cases so they can manage up to two hundred cases a day. Were incorporating Emergency Technology into our time line for expanding testing. I dont have the private providers data. Ill provide the commissionwith regard to the private providers and working with them to do their part. Many of our larger Health Care Systems. Actually, if you could pre vied thaprovidethat slide so the comn see the relative number of tests that other health care sif ems s have done. While waiting to bring the data up, ill remind the commission that our Health Officer issued a health order two weeks ago that requires Health Care Providers to test certain people who are at high risk for covid 19 within the 48 hour period of presenting to the system. This is data with regard to other Health Care Providers and their contribution to covid 19 testing. Just to say that our city supported systems and Health Department system has done a total ofrelatively smaller contributions of certain key private providers in the city, seven point six percent, four point six percent, some of our larger Health Care Systems. I would iterate that these systems have been incredible partners during the pandemic. They are very committed to working with us and other key stake holders to ensure more testing is available for their patients and staff. With regard to our neighborhood strategy, the mayor announced also just last week, i believe, that well be expanding our testing options for people. Well be working to scale up two new mobile test sites that will be able to go to various parts of the city. Especially where covid 19 is highly preflen. Highly prevalent. Those are on the dprownd now as wground now aswe speak. There will be a permanent site, were working to select a permanent site in the southeastern part of the city which will have an additional ability to test five hundred people a day and be in addition to the city test sf sites which now have the ability to test approximately two thousand people a day, fifteen hundred at the site. I would also emphasize that in addition to the testing that we are ensure thag right now we all need to behave as though were carrying covid 19. Which is why we advise not to use a test as a way to indicate. You need to use a facial mask and good hygiene. Thats key to flatten the curve and key to getting that reproductive rate closer and hopefully below one. Thats all i have for the commissioners and i will stand by to answer any questions. Im not seeing any Public Comment. If you wish to make Public Comment press star three. Seeing no Public Comment, commissioners. You can continue with your comments. I do have a comment and a question. Going back to the long term hospitalization projection slide with regard to the reproduction number, i want to under score that if youre looking at the four months since the beginning of the pandemic. Weve suffered the loss of 61 lives. Looking forward to november first, that number if we follow the median at the same reproduction number could be six and a half behind that. I know the mayor has spoken out about that and frustration with not wearing masks. This should say more than anything about lowering those numbers. We have six and a half times as many deaths in the next four months as we have had in the last four months. I hope everybody is taking that to heart. In regard to the testing priorities, i know were looking at the prevalence in the Latin X Community a lot of that has to do with members being essential workers working at Grocery Stores or other areas where people need to Access Services or the functions of daily life and also often times the Latin X Community has much higher rates than people who do private work. If people are essential workers, they cant get tests at city test sf. Weve been working very hard with the Latino Task Force on covid 19. Establishing pop up testing availability for people, for instance at the hub in the mission. We takewe dont turn anybody away for testing. That low barrier access to testing is really pivotal to our work. As people do test positive, we ensure there are ku culturally appropriate Case Investigations. Half have been in spanish ensuring social services are made available including food and other wrap around services. If people are not able to isolate in quarantine, we offer free of charge hotel rooms where people can isolate in quarantine. Theres a very robust package offered to people who do test positive. Our goal is to continue and expand testing and no one is turned away in communities that show high prevalence. Well provide testing to anybody who requests it on that day if there is capacity available for testing. Thank you. Next queue, commissioner green. I ask that other commissioners and participants on the phone, please mute your microphone. Thank you for this. Its very rich information and very much appreciated. Along the line of testing Health Care Workers. Man dating the other Health Care Systems and expand testing. I was wondering if you could ewill be rate a little more on not only the mandated across the board. please stand by you and hdiscussed. They provide people to test people with symptoms and close contacts to find if someone who is in contact with someone who is in dying know of for 15 minutes and more and those would be tested within the 48 hour window period. 48 hour period of asking for a test as well as anybody else and we are working with kaiser and starting conversations with other Healthcare Systems to better assist them where they can get expanding testing. They are under limitations as they are across the state and nation with regard to supplies and and Additional Technology that we could potentially use partner to use i dont know together is the right word and in terms of expanding Rapid Testing and using homes and so those home test kits theres not an actual test you can do at home but you can do a simple collection and accepted it in. Those have relatively a short turn on times and we are whether you can pool samples and test its a more owe efficient way if you have prevalences of covid19 in the institution or circumstances in what you are testing. So were looking at working with all of them with regard to those techniques. In terms of testing healthcare workers. And really towards a consistent approach to this but we havent reached that yet. That is certainly something that we would like them to do. We have limited capacity to enforce that. Is my understanding. Thank you. And in extension of what you were paying about home testing, can you elaborate that what the potential is and when, as you look or not and the potential anticipated numbers that the commissioner was talking about and if that and its an option. I appreciate the question commissioner. Rather than my speculated on that it would probably be ok if we have some of the Technology Experts on test coming to the commission and consent what the horizon looks like. We have people working at covid commands including a testing so we can bring them to commissioner to answer more specifics of the question that you are asking. Thank you, development. Very. Yes, thank you. I was curious about who things and i appreciate the data on the swift institutions and it appears that i guess all smiths are following the same guidelines that laguna is. If i recall we were going to suggest and i have not seen the guidelines themselves but if theyre following that it looks like one of the reasons i think that smith beds that we have in San Francisco. So i appreciate that and i also appreciate there are people who are really anxious to really do see their loved ones but i think with the surge going on right now its really difficult to try to bring more people into an institution which seems to have been because of the community spared right now and were really in danger of very vulnerable populations, i understand that. I want to go to test forgeron aa moment. Your data shows that we are trying hard after that one incident that edmonton early in terms of strat guards which is frightening by itself. In testing, i thought it could be helpful to us in terms of looking at how you are doing in the testing of certain areas because while you have tests sites it doesnt mean all the test sites are doing all the cases and also, i do note that apparently in the 29 sites, im not sure if those also include some of your other temporary sites because, i thought we were doing a lot more testing already in the mission and the bayview but it doesnt look like that from your test reports and i would think that its to understand how many tests are being done continue a particular sensuous track or it would may be the better way to do it because there maybe several test sites within those census tracks so we can understand the numbers that are being done in the vulnerable areas. I appreciate that, commissioner. The purple map showed the prevalence of testing percapita by census track and you always said you are right the dots on the map, which showed the testing sites do not reflect the mobile sites so the pop up so if theres an outbreak where owe do a day of testing in a certain local cal that wouldnt be reflected in these testing maps. Its particularly with those resources we need to concentrate on the southeastern part of the city and go where the virus is and test as many people as possible particularly in those high prevalence census tracks and that what we will kobe with these new testing resources that the mayor announced just a couple of weeks ago. And then, im sorry, the other, with regard to the visiting at the nursing homes, we are taking a look at our health order and our policy because five months into the pandemic, the social isolation that unfortunately has developed while we have been working to get people ways to connect we know its not the same so we are looking at that and theres a teamworking on plows able, safer alternatives that could allow for more proximal interactions with Skilled Nursing home residents and their families. Looking at things like outdoor visits and so fourth. I cant speculate beyond that right now but were taking a hard look at that because the Health Consequences of we need to balance it by the risk of what covid can do if and when it gets out of control in one of these facilities. Thank you. I didnt appreciate your righthandpurple map as much. I think we were to look at how well you were doing and increasing the testing we might see a progression of the number of test. This is darker because wore doing a great job and maybe that can match the prevalence. It could be helpful to understand how we are doing in terms of identifying and also i dont know this may be difficult, trying to understand how we have been. I had one more question was really related to contacts. Is there any evidence by delaying our information that is valuable after youve done a test, if it takes seven to 10 days, how many more people we have been impacted which could then drive even more well not more demand because thats the problem. A more urgent need to really get the supplies correct because while weve all talked about these delays, what has it meant which could then help us really push for own a better supply line . The delays are concerning. If you have a seven or even 10 or 14day lag in getting your test results and the relative value for that person of getting a test result is diminishing as well as the close contacts of that person in terms of the isolation there it snow because because of the Contact Trace asking challenging and the return diminish further because of that. So thats why were focusing improving these turn around times at our dph site at city sf and working with providers across the city. These are issues of sings like free agents, right, and primers that are not available and sufficient supplies and this was the case in march, april, may, june, july, now august and its were doing everything we can do this work and ive explored homegrown copses around trying to come up with these supplies. How to process the specimens and its really not efficient or feasible for us to do it because of the way the west works and the cartridges and the materials need today perform those testings. We need a steady supply chain to get at the root cause of these terne around times from the larger labs. Thats unfortunately not something that we have jurisdiction over and we have an ability to be flexible and move is to work with systems that are able to turn the test around and were encouraging private providers to look to those systems. If you get a positive test result, it comes to the Health Department and we are the ones that are needing to reach out to do the Case Investigation and the longer it takes for the test to come back it diminishes our ability to be reflective and the more risk there is to publichealth. Raise your hand if you have a question or comment for the director. If you do not see any currently unless someone would like to speak up. Without any questions or comments, we can move on to the next item, general Public Comment. On the phone, dial star there. Is it. I dont see any hands raised item 6 the dph proposed budget and we have mr. Wagner. Give me 30 second to move you to presenter so you can share your screen, please. And weve got jenn on the phone. You are good to go with your screen. Mikaela, are you still on . Yeah. At the top of your screen where it says display settings, do you see that . In webex. In powerpoint. Do you have two screens sometimes . Let me text you a picture. Everyone is going to be patient and we appreciate you working through this. Id like to take the opportunity to think again for leading us through this new process. At the top of the screen when two monitors are active together it will show the full and different features. So, im going to text it to you. Im going to try this. I just unplugged my monitor so im working off the laptop. Thats a good idea. Nothing shows right now. Of course. You can also send it to me and i can share it for you. And so, um, in the mayors proposed budget, there is significant funding for three of our key priorities and to which no surprise the response to covid19 19 pandemic prior tieing Racial Equity and the allocation or resource and that is riel occasion of dollar from the citys and to initiatives and that are aimed at Racial Equity programs and Mental Health sf and the initiatives that the and it is meetings in june and i believe its a last time we did this and its an increase to our budget. Is there quite a bit of uncertainty arent budget and i will talk a little bit about that but, all of this good news is depending on assumptions and those include the assumption that we have some sense of what is going to occur with covid19 which is questionable. There are a lot of things that can change there. And it is assuming that theres going to be a voterapproval of a Business Tax Reform measures on the november ballet that would free up dollars for Mental Health underlining the Mental Health sf initiatives. And, its also assuming other federal revenues and labor contracts that have not been achieved so theres a lot of good news in this budget for us and i think over all, were in a better place than i certainly expected that we would be but theres a lot of uncertainty and i think that this is going to be a situation where well real evaluating the budget over the course of the year given the fluidity of the situation. So, this slide is a snapshot of the highest level change in the budget you can see in fiscal year 19 and 20, our total budget the year that we just passed was 2. 4 billion. In the mayors proposed budget that goes to 2. 77, and 2. 58 so its an increase of 344 million in the first year of the twoyear budget and 149 in the second year. Down below you can see some of the big items are that make up that change. And ill go through each of these in a little bit more detail. Obviously the covid19 response is the largestmoving piece in our budget and a number of other city departments budgets the Racial Equity initiatives is 36 million and funding in our budget and the Behavior Health is 113 million in the first year and 108 in the second year of new pro appreciations and its not available to us and ill talk a little bit about more about the nuances to that and those are the big moving categories in our budget. First a little bit more detail on the covid19 the entire city wide budget is 446 million for the Covid Response. 205 of that is within d. P. H. And were the single Largest Department in the covid19 response but theyre big programs that are outside of d. P. H. And the two biggest of those are the Hotel Leasing and operational costs born by the Human Services agency and the leases for the shelter in place hotels and the this gives you in the dpr portion of the this program so you can see on the left row labels are categorizing where the expenses are in the budget. The first numerical column is the total effort so you can see weve got a budget of about 299 million worth of total effort so a very major effort is expected to continue and expand over the coming year. The second new measure i canal e intend to satisfy by repurchasing existing resources so the majority of that is Disaster Service work source its taking an existing department worker and repurchasing their job for a new lead under covid19. Theyre also some contracts in that category and that leafs us with a gap about 205 million that is required to english pendture and it will be a new experience. Back for the department of publichealth and the city wide covid budget were making some assumptions and these are out of the Controllers Office and some assumptions about what we will be able toll draw for reimbursement for this program through fema and through the federal legislation that has been passed so far to help with reimbursement for expenses related to covid. You can see on the cot um of the right, how much is leftover after we assumed the seem a reimbursement and ill show you the cares act on the next page but its a large program. Couple of the biggest categories, as you can see, looking at that first new mer i canainumerous numericalcontract. Our Contact Traceing and Case Investigation programs and testing as you have just been discussioning will be a and we also have hospital surgery, support for the hotels and support for our outbreak programs and all of those and grouping categories. So, that is a very high level description of what is in our budget and were happy to talk in more detail about that or take questions on it. I will say that we have been very intentional both dph and city wide as we developed this budget in acknowledge interesting are unknowns and we have to be adaptable to to what the world brings us over the course of the year. So this will have controls around it and were continue to go put those in place but we will, within those parameters have a lot of flexible to move dollars around to respond to changing circumstances in a way that we dont in our normal city budget with our normal city financial rules and constraints. Next slide, so this is going up to the city wide level. This is the city wide covid19 budget. You can see at the bottom of the page the grand total is 446 million. Again, the reason for that sue can see that so many of the dph costs are in the bigline items in this sheet as well testing ppe and operating supports and we have large dollar and the good thanks and programs and pit stops and they are the hand washing and hygiene stations throughout the city and all of that together adds up to 446 million and when you subtract the fema and cares act funding you can see the net general fund bottom line for the city is about 93 million. Ill just lately say on this, we have flexibility and theres an understanding that were making some assumptions about developing this budget. Weve come at this from a perspective of youve seen a lot of the modeling thats been done and command center where were taking up a more pessimistic than median approach but acknowledging that were not going to be able toll plan in the budget for every scenario so we made some assumptions here and i think theres a collective understanding that we got this wrong and the Coroners Office is hold something reserves against the need for a surge and were already obviously starting to see some of that surge happening even sooner so i think this will be changing and evolving for the course of the year. So next big category, on Racial Equity and resources. City wide, the mayors budget redistricts 120 million over two years and from the Public Safety department. So primarily the Police Department and Sheriffs Department and that funding has been allocated into multiple departments with the idea that that those dollars will be repurposed to programs that are being district today repair the legacy of racially disproportionate policies on health, housing and economic outcomes for African Americans. Leading up to the budget, the human rights direction at the direction of the mayor has been taking a leadership role in this process and has been doing a lot of Community Process gathering input and talking to various folks within the community and to get input on what are the best uses of these funds, what are people seeing as a need that can be met with these funds. One the big categories that came up was health and Behavioral Health in particular. Because of that, the mayors budget of that 120 million, 72 million of it is allocated to dph so 36 million a year. Right now its still at that relatively high level, theres not a granular program for how this 36 million is to be spent and that is intentional. The next steps are the Human Rights Commission and its going to continue to lead a process after that commercial round of input and to make decisions and we will be closely involved in that and its a communitydriven process to make decisions about specific allocations and so theres more to come but this is really aligned with a lot of what the Health Commission and the department had been focused on in terms of Racial Equity and its a big step for the city, really trying to make tangible changes in a short timeline where we can have some effect on our Racial Equity. Next up is Mental Health sf. So, could the commissioners know that this was legislation that we worked on and the mayor breed led on and ultimately came to ar ordinance board by the board of supervisors last year and its a big Visionary Program and total estimated cost is 100 million or more per year to implement and were not going to have 100 million or more but in this budget is funding for us to take big steps into the first phases of implementing that Visionary Program. The budget does make the assumption that they will approve a Business Tax Reform ballot measure and its on the ballot in november and what that measure will do, if approved by voters, is you will recall in june of 2018, voters passed proposition c a business tax measure for homelessness and behavioral Healing Health and ts held up due to a lawsuit in the courts and is being litigated in the courts. It will free up a significant portion of those dollars regardless of the outcome of the legal back and fourth. And make it available to dph and the department of homelessness and support of housing to begin spending those dollars. So there are two categories. The first is, the on going revenue from that business tax measure. That would be 28. 1 million in fiscal year 2021. 38. 4 million on going and that is kind of the core basis where we have used to design the programs that is in the budget. In addition that, there are onetime funds and those total about 115 million and its been collect today date thats been held under litigation that would be released and because that is kind of retroactive onetime funding and because theres still quite a bit of legal processed to play out, those funds are going to be held really strictly and they may be used in some circumstances for onetime uses and there are a lot of restrictions around those so those are appropriated in dphs budget but we will to go through the process with the Controllers Office before we program them for specific use and they may be available to be available for capital spacek what decision and other costs associated with the program. In the Mental Health sf program, there are four core pieces to the program that assumed in the budget. The first is establishing the office of coordinated care and this is a piece of the Mental Health sf budget and the past and this is in some ways its really the core of the vision for the Mental Health sf program and this would be the new function where weve heard, in many cases, we have a lot, we have a strong system but its not use working together in a way that is clientcentered it can be hard to navigate and the pieces 2003 have the infrastructure to make sure the pieces of the system are alike. So the office of coordinated care will create that infrastructure to do coordination data analysis, planning for our Case Management and care coordination functions and really the glue that holds the system together. The behavioral investments. You know from previous hearings we have, under the work of dr. Bland, and his team, been doing analysis of our Behavioral Health med supply and demand and trying to make determinations about the gaps in the system that are really creating a do theel neck odobottleneck. That work has been completed and identified a number of needs and they include lock beds, residential Mental Health beds, site beds and the last category and were going to assume that we will meet those recommendations and it will be a process as we go in through future budgets. This is a new streetbased team that would be in partnership with the Fire Departments ems6 group and dph where we would have clinical staff that would be out on the streets responding to calls for 311, 911, other courses and this would be a way to have more appropriate response where we can send out people with medical and Clinical Experience and knowledge to respond to these calls today which are by police due to availability of resources so this is a big improvement in our ability to be responsive in a appropriate way and get people linked into the system of care. And then lastly, as i Mental Health service center, another piece of the legislative vision would be a physician site and have access for people to come in and engage with services. There would be a pharmacy on site so out of these opportunities to connect people who need services to the system of care could occur at that site. They would be expanded hours and services on site. In addition to the legislation tied to the business reform tax theres quite a bit of general fund included for Behavioral Health and a lot of this is tied to programs that are already on the way but need to be funded to continue and for our emerging increases that were adding up and i woke up to all of these in details but you can see a lot of things weve done over the past couple of years, which were adding treatment beds and doing expansions with grant money. The mayors budget is providing general fund to continue the funding for those services so well be able to maintain and pod fie that capacity as we think of a best concern of the clients. Also, we have 5 million for a creation of a psychiatrist class. This is one of the things the city has done to address the issue of difficulty and recrewment and retention of psychiatrists in our system of care this was done with the department of Human Services and our labor partners to really take a deep look at our competitiveness in terms of our compensation and make us more competitive. This is to emphasize a lot of good news in this budget and a lot of opportunity and a lot of uncertainty and they are what is going to happen with the covid19 pandemic, i dont need to spell that out for the commissioners. A lot of things could change including federal response. We have the budget continuing on border approval of the business tax in november and the other city wide assumptions including wage increases. I will lastly note we talked last week about the fact the Mayors Office and the asking us to be prepared with a potential adjustment should they be needed if the city cannot come to agreement on its labor Union Partners on modifications of the of of the contract. There are wage increases scheduled to be in effect over the next two years of the budget and to have asked the labor partners to host home and delay the wage increases but it has not crept yet. Its a very high level look at if we were asked to meet those additional targets what would that mean in terms of kind of the the scope of solutions we see would look at that and it would change the equation for our budget and we would go back to do some additional thinking at that the is case. So, very last august 14th, next week we start our hearings at the boards Budget Committee and then we expect budget will pass out of the board in august and full board approval in september in the mayors signature in late september and early october. So, its a lot of talking. Im happy to take questions. I see that one person has raised their hand if you would like to make Public Comment. Please, press star 3 and i will recognize you by unmuting you. We have one person so give me one second to get this going many of. My name is francisco decosta and ive been paying attention to this subject not only today but it has come up before the different committees of the board. What i see missing is that we havent filled some positions. Leadership positions. And yet we talk in general tees so if you havent filled the leadership in Behavioral Management we cannot talk in generalities, the other thing is that, somehow we are not really having dialogue with the community at large. The welleducated, stellar, citizens of San Francisco. We have a budget of over 2 billion and fundamentally, whatever programs we have we have to have rep around services. So, when we lack empathy and compassion, and we are not going to have results so right now all over San Francisco, we have thousands of people slowly dying. But the most important thing i want to say today is, we cannot allow our infants, our children, and our youth, our elders, those are compromised health, more mentally and physically challenges to slowly die. Your time is up, sir. Im going to move onto the next call. Thank you. Im trying to make sure everyone as a chance. Star 3 if you would like to make a comment. You can condition your discussion. Do you have any questions or comments for mr. Wagner . If you do so, please raise your hand. Press the hand button. Or just speak up as well. Mine is only a comment to say that i am actually very appreciative of mr. Wagners presentation is as he began it is a farber picture in terms of trying to obtain resources to do the work if the department has to and the recognition on the part of the mayor and hopefully well be the boards recognition and its important to be able to continue the work and were not pitting covid against that and not for getting the initiatives that the city has prioritized including Mental Health programs and programs for Racial Equity so i just wanted to compliment mr. Wagner for actually taking that almostsounding impossible sounding task and really being able to show thousand could be done obviously contingent upon many things including the voters in november and i think we recognize that. I just wonder, i guess it would be at the time there are significant changes during the i do a log you might want to bring that back just to keep us updated on what is happening with the bored. Absolutely. Well stay in close touch with mark and at this time of the year, we often have at least a brief check in on each Health Commission agenda. Until the budget is complete. So well certainly keep in touch as things move and change its course. Thank you. We have a commissioner. Thank you, excellent presentation. I submitted a question earlier through a comment. In my concern to the Public Safety funds that will be coming to us and in focusing on Behavior Health with a Racial Equity lens that we are cognizant of the fact that with the Community Input, et cetera, that we really look at youth and elementary and middle and high school since my concern is this group is often not totally focused on it until the kids are in trouble. So, im hoping we can look at formulating some Prevention Strategies within these dollars and within the areas that i think could be very, very helpful. Thank you, commissioner. I received your questions and i meant to touch on it and i also do know if dr. Hammer or anyone from Behavioral Health wants to chime in on that comment and that element of the work. I think its a great question and its a lot of receptive teeo that idea to go in that direction. We have, as probably know, a number of Early Intervention programs for school based and some communitybased organizations and theres a lot of interest in using some of this redistricted money focused on Health Equity and reducing Health Disparities and to this Early Intervention work and they are acting direct to be of Behavioral Health services wasnt able to be on the call but she has expressed to me lots of interest in this sort of work and in really with Community Input figuring out which of our intervention programs are really having an impact and we have a good program at the bayview and working with dcyf and identifying where we can really focus on this work o so it has the biggest and well definitely be working on this. Next also, well, well make sure that we do some thinking as we understand what this process is to make sure that were communicating what all the commissioners and bringing you in on that process as it happens. Commissioner. Thank you, very much, i appreciate it. Any other questions or comments . I want that thank greg and his team for the work. This is the been an unprecedented year in many ways including on the budget. You saw the multiple opportunities and also challenges the budget presented on any sort of normal year any one of those would have been a challenge and talk about having many balls in the air and a tight deadline and i want to thank craig and their team for doing such a remarkable job and coordinating with the Mayors Office, the controller on all of this, it was a effort but this one was for the record books so thank you the team for the work. Thank you. You beat me to it. In addition to the work that goes into putting together the budget every year to have to scrap the whole process and start over again in the midst of a pandemic, greg, for you and your team, for jenny louie, thank you dr. Hammer, i know that dr. Bland had a lot to do with the Mental Health aspects of this as well. So to your entire team thank you for your hard work and we look forward of track particular to the process. Thank you and i will pass it onto the team that has really worked hard on this. So thank you. Thank you. Item 7 is the monthly contracts report. And we have folks inform present furniture across the city. Next commissioner. Good afternoon. This is michelle rugel. Sorry i dont have all of a camera. And so im going to go through the report and we have other staff, i believe, on to line your questions and do my best ok. The first contract my hospice. This is an ongoing contract and we are here today to ask for approval of an amendment and which will be to extend the contract terms by throw years for a total of 6. 6 million. I mean 6. 6 year term and then we have increased the contract amount with con ten again see so its the full amount of the contract to and theres a 71,200 increase which is the inclusion of onetime funding and this is a program that the San Francisco residents living with hiv aids and the end of life hospice or 24 hours killed nursing care and the program has they have met their declarement. Do you have any questions of this contract . It looks like not. Please continue. Ok. The second contract is asian and Pacific Islander Wellness Center doing business of San Francisco community Health Center and its improvement of amendment that would extend the contract by 14 months picking it up to 10 years and that also has rised under the existing contract terms and this is on going and the target population is trans women and trans men, including transgender persons of color and joseph is on the phone and he worked hiv Health Services as the manager to talk about this contract and also to point out, as we bring these contracts back to you, and this one has been at the opened of a longterm, the terminology has been evolving with the contracts and so you received one v. And we have the newer terminology and is joseph on the line . Not joseph but john is. John, im sorry. Yes. [laughter] hiv prevention. Just contract is really an extension of a contract that has begun in 2010 and we had rfp on these services out last year and they were to begin or they should have already started by now but we had to put a hold on everything due to about what were dealing with in terms of covid19 so the original language at that time we were talking about men and women as female to male and male to female and now that we realize its no longer appropriate that really focuses on a procedure rather than the person and so similar to other types of language with people firsttype language where we talk about people experiencing homelessness and rather than the homeless so its really more oust respect to the individual that weve changed that language. Well continue to do so. Any questions on this contract . Thank you. Hi, thank you, john. The last contract on here is called the shanty project. This is on Going Services but we had to move it into a new contract document to update because it was easier to move it into a new contract because the boiler plate has changed so significantly than to document all the changes so that is why it shows us the new contract. Its really the continuation of on Going Services. This is going to be, were asking for approval for this contract and when this contract is over december 31st, 2021, then we would have this would have gone out to bid in a new contract will replace it. This is bridging the gap for that period. This contract provides services for and the and i lost my place. It provides services and support of the margi Breast Cancer program and then services and and San Francisco and the, i think the still on the phone. And she has patients and then i think and im just going to carry on if there are too many questions i cant answer, then t. We can either foal up or bring it back but its an ongoing contract youve seen before and dr. Chow raised a question or brought up a question and he was interested to know how much this is being used and what the volume of usage is so one question was specific to the mammogram. The manovan volume. Ill use 2018. They did 5,305 screens of barbra just emailed and 5,305 screens. 1,637 diagnostic i dont know what the rest of that word is. That is the whole thing. And then im sorry. I dont know what these if the table, lets see. The table says screens, 5,305, dog months tick 1,637 and the mamovan1190 so those are the numbers for that program and followup and then the director of the program provided with the support services, which is a different grand, they had 384 clients had received care navigation, 78 had received survive oership navigan and support Service Ideas servie provided to clients as of july 1st, 2019. Thats the update on the numbers. I dont know if that answers all your questions or if you have other questions that i can stumble through. Commissioners, any questions or comments . Theres Public Comment on this . My name is francisco decosta and ive been involved with Health Issues for the last 40 years and ive especially been involved with the shanty program and and while i want to advise the commissioners is that over the last 25 years, its been difficult to support our most vulnerable population in San Francisco even though our budget is over 2 billion. So we need those in charge to think outside the box. And now this pandemic is going to challenge us. And San Francisco and this is a where to think outside the box and do something. So that the positivity we had to bring to the fold. We cannot allow people to die in the tents. We cannot allow the most vulnerable to die. If you do you can really read the laws that have been brought fourth by the united nations. Thank you, very much. Thank you for your comment. Theres one more caller, commissioners. Caller, welcome. You have two minutes. Caller hello. The caller disappeared. Thats the last Public Comment for this item. This is an act item. Its a rewinder to my fellow commissioners and the public given our abbreviated meeting schedule during the full commission is acting as opposed to the finance and Planning Committee and the publichealth committee to we will be considering for action for a vote which normally would have gone through the finance for Planning Committee before coming to the full commission, however, both those committees that the mentioned, the publichealth committee will resume meeting starting in september and well have that schedule Available Online for people so they chose to view. So, commissioners, do you have any questions or comments . See before we go to a vote. Thank you, commissioner. In the spirit recently passed resolutions, i also want to mention that you know, from what we know, in general, is that African American women tend to have their diagnosis more advanced stage you know like of Breast Cancer so i am very curious, you know, to know more about how a program like the role is shantys providing helps to fill some of those disparities so hopefully in the future, that we won able to invite them to come into the presentation. Thats it. Thank you, commissioner chung. Any other comments or questions before we move to a vote . Seeing none. Mark, would you read the roll, please. We need a motion to approve. Motion and a second. Ill move. Ill second. [ roll call vote ] thank you. Next is a request for approval of a new two Year Contract with brightbart health. Also, Marcus Judy Martin on the line. Ill just introduce it and turn it right over to Judith Martin who is the director of there she is. Substance abuse services. So, just to introduce it this is brightheart health and its upon your approval would be a new contract for dph under behave yearal Health Services in the amount of 232,960 which includes the contingency and that is a two 46 Year Contract and its a sole source contract. This one is a sole source 21. 5 which skates there isnt another provider similar to this and as dr. Martin explains this you will see why this one is a little bit different than a few dialed up and looked in google tele health, opportunities the same. Im going to turn it over. Thank you, michelle. I think this is an unusual contract because its a vendor. Its a telehealth vendor and we started talking about it last august when director coal fax invited us to meet with dr. Di vito from marin who had experience with this agency, with this vendor, telehealth vendor, brighthart health in helping with Behavioral Health services to extend the reach in marin county. Weve been working on San Francisco is a very compact county. We have seven methadone clinics and we have had since 2003 funded and now drug medical covers it and medical pays for it and its a pharmacy benefit. Many of our primary care programs and many of our regular out patients Substance Use programs and some of our residential programs all offer these services and yet, we have an overdose increase every year and so and so, where they provided medication at Harm Reduction sites in other words, theyre approaching people who do not perceived the need for treatment or do not feel they can access our treatment for whatever reason. If they have same day access at methadone clinics its still theres some people who dont reach and of course, those are the people who are highest risk for overdose and so, if someone comes to the Access Center and picking up needles because theyre planning to use heroine and how about morphine instead of heroine and evaluates them and sends them with a prescription to the pharmacy three blocks away. Its equipped to provide and observe dosing and do tox screens and has done this since 2003. Theyre very experienced clinicians in terms of providing medications as their treatment. We designed this use because they have started providing people morphine in response to the Opioid Epidemic and theyre unusual because they have worked with this state to under the spokesmodel that the state used their state of i remember response funds and when they first got them and they have been a hub and spoke to one of our San Francisco clinics and they also provide the Health Services to ucsf and since august, weve met with several and did surveys and met with several of our providers in the city of Harm Reduction and in particular glide and Harm Reduction Therapy Coalition and syringe access San Francisco aids foundation. Were interested in working with us and a lot of their services are located in the tenderloin which is one of the most highly impacted areas for Overdose Deaths and so, we asked them to ask brightheart health to do demos and talk to the Harm Reduction providers just to be sure it was a cultural match that brightheart Health Clinicians who well play a talk with someone who was anxious to get out of there and couldnt stand in line and couldnt fill out forms and maybe didnt have current medical and really didnt, wasnt there for the highest purpose of treatment was there because they were using drugs. And yet it was something they were willing to talk about. So this kind of very low threshold is what street medicine has been doing now for several years and it has been judged to be successful and so this is our way of expanding it. So, we didnt expect to start this in february and then in april and you know what happened. We brought it up because we thought it would help in the sick centers and the doctor wants to use it at the alternative care sites and expand hospital locations and step down from acute care for covid19. So thats what this is about. The structure of it is that Bright Heart Health would provide tablets that are key to them and in other words, they wouldnt be used for playing games or being on the internet, it would click open to their clinic there would put them in a waiting room until the doctor is ready and in the case, they would be interviewed immediately by a nurse and they would take down a lot of the information that is needed to make a decision about treatment. Even if the physician wasnt ready right away the person wouldnt have to wait and this is a response to testing theyve done in other sites and in california. They designed a whole model and had a whole program for low threshold. That is what were proposeing and were looking forward to having it. I apologize for jumping in. No, you are not. My questions or comments . Again, just stating one more time that its the financial and Planning Committee and will be taking action on this item today. Commissioner chow. Yes, there was only thank you dr. Martin for explaining how this works but then how does the recipient not and the tele health get the medicine . So theres several ways that that can happen. This is partly because this organization has response that can cover the medication. So, if the Behavioral Health pharmacy is open and has hours and near walking distance, which typically would be true for those organizations, then the person would be advised to go to the Behavior Health pharmacy and to get their medications and including motivational interviewing techniques and so on and so we would be able to decide and talk to a person about how long and help the clinician decide if they need it was a Street Medicine Program the pharmacy had found is many people didnt come in for a month after the prescription had been given and so it was stale and needed to be reassumed or refilled or reinitiated and the person sometimes came in in a different state of health and looked like they needed to be evaluated so the pharmacy in this case will have a tablet to talk to the heart great people and they can evaluate people on site at 1380 howard. They could call in a prescription and raise funds for it to be billion dollar to the grand they have at Bright Heart Health. Well see how many people go to wall greens and how many people go to Behavioral Health pharmacy. I asked, you led up with a various program that you had pointed out they would have to go to the pharmacy so i was thinking maybe you actually had a way on site and that avoids them going two or throw blocks or over to wall greens but its not true. You still have to go off site in order to get the medicine. Yeah, theres no way that we can figure out the dea would allow us to have a scheduled narcotic and theres no safe storage for medications. Ok. Because in they were trying to get a clinician to match without giving the drug, right, at the same time. And i guess that just isnt possible from what you are saying. So, the program say methadone clinic. They can dispense at the window so theyre a mini pharmacy for specific medications for methadone clinics. Is that what you were referring to . Thats what i was thinking if you were doing this, one of the barriers after the consultation district said whether its live or way way of the tablet is getting them to the next step and by these are difficult and its just another one of those, right, when you get and you convinced them and its just better or perhaps even more effective to be able to say and here it is. The only time it would happen for this effort is and that is why we have office space and they have been there and we snuck out so these are even lower threshold in the office space induction clinic and at hu looked at the experience and you were placed at an uptick that was worth doing this and in order, half the patients moved on and did get the medication or acceptance or higher and in carrying telemedicine for this type of a visits. These are some of the things were going to follow. The street medicine effort was studied and they found that they had treated about 400 people when it was studied and 140 of them were remaining in care in some forms. Thats pretty high. Yes. Very good. I hope our results will be just add good. It sounds like a good program to try. Thank you. Commissioner green. Yes, well, thank you for your presentation and its row marketable to recognize the potential of tele health in this area and i wonder if you would comment on a few things, theres a amazing article foray dex treatment and i dont know if you saw it but one of the pointed it made was entry into a program does not require an inperson visit as the First Encounter and you can also give pain for a month rather than a week. So there are things i would really love to know your vision. One is, do you that i that we have better entry points, this is one of the points in the Entry Barriers we talk about in what were doing and do you think that would lower a significant number beyond what weve just said about not having to be this person and this first go around and whether the ability to read the pharmacy is a big barrier when someone is in the program and also, they talk about the program where they use their mobile them for purpose and wondering how you rethink that whole program and in relationship to whats really becoming i think a much more accessible type of treatment and how we plan on capitalizing on the changes that legislation promoting telehealth have come along as a result of covid19. Snail of all of a sudden our heavy regulations went rational and so, counseling was banned and it was considered the height act with around inperson visit starting medication assisted treatment has a statement related to emergencies and so covid19 was an emergency and allowed initial contact to be by telephone so a lot of the providers from primary care taking advantage of that and using telephone visits to provide medication and this is what happened at the Containment Center as well and people were using opioids and prescribing it and then the containment nurses would pick it up and so, there have been a lot of Creative Things that happened with addressing that the Opioid Epidemic because the pandemic allowed people to declare it an emergency. Thats one of the things we need to look at and maybe collect actual data about to see how much advocacy we should do to keep that going after the emergency isnt an emergency anymore. Is that what you were asking . There was Great Potential here that you never had before. And you are way ahead to reach people and to treat them. Yes, thank you. Im also very impressed with what otap493 has done in the parking lot. I dont know if you heard about that. They have decided to use fresh air as much as they can because to reduce the traffic through their clinic as a way of keeping people safe and methadone maintenance was a initial visit that was not required and so, they came up with very Creative Things that they already had methadone vance in the bayview and they moved a van into the parking lot outside of clinic and the csfg and moved a lot of their stable patients to go to the van. They didnt even have come in the clinic and there was a tents which now i think theyre using a container and one of those modified containers to be the councilor. They have ordered telephone booths with glass doors where theyre installing tablets for Video Conferencing with their councillors so people who walk in can now have tele health which was not so possible. Thank you dr. Martin and commissioner green. Commissioner chung. Im sorry, you are muted, commissioner. I echo the innovation of this program. There are a few things im curious about also. One is you know, im assuming that these tele Health Consultations done in soundproof rooms . The booths are described are soundproof. But the Harm Reduction though therapy is not soundproof but the clinics have chosen spaces where theres a small room where the person can go. Theyre trying to i mean, were allowed, because of the emergency, were allowed to use telephone and tele health and get verbal consent on the phone to explain that this might not be completely meet the standards of complete privacy because were here on the street or in a van but as much as possible, people will be they have a place for the Nurse Practitioner which is pretty private. Thank you, i think theyre clearly important because a couple of things that i could think about immediately is the privacy and also the stigma around being engage in this kind of Behavioral Health services and though like ownership treatment. So i think that you know, San Francisco has always been very owe have a tive and as a and my followup question, does bright heart also prescribe naloxone to these patients if they are do they need to ask for it . They have to the rules like the rest of us to do when you prescribe a ownership and i think its unlikely they would have to do it because Harm Reduction sites are offering naloxone and in fact, that might be why the person was contacted and you need naloxone by the way would you like some. Naloxone provision also happens at the pharmacies. The pharmacies so theyll be multiple chances for the person to get naloxone. And im really impressed and all this innovative searches that were doing to lower the barriers for access, you know, to this much needed services so, thank you so much. And i look forward to hearing what the outcomes are like. Good, thank you. Thank you, commissioner chung. Commissioners, any other questions . Thank you, dr. Martin. Thank you ms. Ruggles. Commissioner green used the word present. I would have to go with her the timing is fortuitous and this is, as you mentioned in your summary, preserved Staff Resources and limits the opportunity for exposure to covid and im hope be suggest cease for this program and it made be a model for the nation and providing these Critical Services in the future. And i support it. Thank you, commissioner. Thank you. Since we have no other questions or comments from commissioners, do we have a motion to approve . So moved. Second. I will do roll call. [ roll call vote ] all right. Move to the next item, commissioners. Item 9 is the sfz medical staff bylaws and medical staff rules and regulations and just to note the zsfg joins the recommended approval of this document at its meeting last week after a thorough discussion and review. Thank you, mark. Lisa is here to present. You are muted. Thank you. Thank you for the opportunity to present the bylaws and rules and regulations today. I believe a written copy was submitted that includes the major changes and as was mentioned, we did have a indepth and at the jcc on jul july 28th, and people might have questions about any of the changes or updates. Public comment on this item, commissioners. Commissioners, do we have any questions . I would really like to know the chair of the zsfg on i dont know conference that within that discussion we did say that there were still considerations theyre not going to await just another one or two year they hae discussion and recommended that the commission accepted it at this point and met be back and im absolutely correct. Thank you, commissioner chow. Public comment. Thank you. Any other questions from commissioners or comments . Seeing none. We can entertain a motion to approve. Move to approve. Second. All right, roll call vote. [ roll call vote vote ] thank you dr. Winston. Thank you dr. Winston. Item 10 is the 2006 publichealth and safety bond update and weve got mark mark o and harry salas. Can you see us . Yes, we k. Ok. Good afternoon, commissioners, dr. Cofax and my name is mark and advise tore the directors office. Well not go through every slide in the interest of time but i dont want to say as of a couple of hours ago, the city and the Negotiation Team just agreed to all the terms and conditions and closed escrow which means we can sign on wednesday or thursday for 99 years and ensure that the Research Building gets built. I want to thank the city team and the Real Estate Department and City Attorneys Office and the ucsf side and their Legal Council office of the president and then the real estate chain as well. This is. 2012 and the second flor in city hall as a discussion and exploration of whether it can be done and it took a while to get this point. The exciting thing the is the building can serve when im in august and then moving in the first or Second Quarter of 2023. Um, in this program of the 2006, we are gearing up to be the last sale of 174 million sometime this november and that will complete the entire funding that is in the 2016 bond. I will just go to slide six which is a little bit more detailed view of the zuckerberg piece which is 222 million. If you noticed, weve added a second column across to the right from the budgeted and its called other funds sources and although, we have not identified any particular sums right now because were working closely with the general foundation and Capital Campaign is underway and well start it as soon as we start seeing commitments come in and supplement with the bond funding and then the other column is pretty much what you are seeing before except now we track the actual money that is spent and in one column and we look at what is inkum berdych for various reasons. We want to make sure were spending actual spending money at a pace that the Controllers Office and we want to see and in slide seven, its identical slide that you saw previously and the other Funding Sources here we start to see supplemental Funding Sources that will come and sustain and the Mayors Office and at the state level and now we start incorporating that into various categories whether construction or project control and were taking advantage of other Funding Sources and not just the sorry obligation model and then the next slide, well jump to slide 18 because i want to show you what weve identified as optical Funding Services and so its from a to i and these are things that we know now and it doesnt mean that this will be the complete list and these are some of the targets that ill go to slide 15 and ill turn it over the director for zuckerberg office. This is what weve been doing accepting document and get the design and team and ready to go on the roadway and as i said, well close on wednesday or thursday and theyll Start Construction and that roadway south and of the hospital in august and a couple of years later they get them into first and Second Quarter of 2023. At this time, im going to turn it over to jerry and. Our contractor has been awarded with eight projects under the belt and so we passed this this proposal and issued it to builders and right now theyre in a phase when theyre reviewing the packages for awards to the trade and hopefully it will be starting construction in early 2021 on those projects. For projects we have going on, we have our seismic retro fit phase 1 which is completed. That did a lot of work to strengthen the building as far as the stoke which was the south side of the building we the fiber wrap and we had concrete columns to strengthen them and also did some strategic to reach the structure and the next activity that the panel will be doing will be validating the sequencing and instruct ability of the proposed work completes too. Our 6h Office Search space is 90 complete and they should be completed by the end of the year in 2020. First, open Office Work Plan that is kind of a wrong time to come out with an open Office Work Plan because it will open area and so were addressing the social distancing issues in this plan by changing some of the higher transitions and afford more social distancing so its interesting to see how it will come out. We have a project coming along and construction continues and walls are in place and we have multiple issues on the project and covid19 is one of the impacts with resources and actually permanent delays and were looking forward to the construction to continue and with a completion in 2020. A family Health Center has been designed and and were looking forward 100 normal reestimate the project and do some reconciliation and our specialty project out of the relocated building 5 is in a design phase and its completed 100 weve done the programming and weve got issued 100 snag design and its reestimated and well be doing some budget wreck salati n and to the inventory chair bold for Health Centers and the Health Center and and the improvements happening there and the structural permits are actually this month and the mission Health Center receives plan approval back in 2019 and the instructions are supposed to start by the end of the year. We were able to secure a has ar Mitigation Grant to support this project as well. And then the south east Health Center project approval and plan approval and construction contract was awarded and it started and right now theyre doing site work and site gradi grading. That completes the 812 as far as had are impacts with all the projects and those surrounded are they involve the supply chain and contractors interpretation of the Health Orders and clarifications basically communication and we seen the impacts to labor and were contractors will not come to this price. Project approvals are hard to get when some of the offers have shut down. The amount of work happening from the homes so that proper design process is impacted because of the work from home. And then we also have campus restrictions which it hard to get around campus and then, it requires social distancing and theres an impact. Were basically evaluating these items and well be available for that at a later date and total impact on these covid related issues. That completes the accomplishments and the inaudible . Are there any questions that we can address . Mark, do we have any Public Comment . We have Public Comment. Commissioners, any questions . I would if it would be can i interrupt you. For anyone else who is not speaking please put it on mute. Mark, you lets go. My question is really mostly on your timing. Understanding all the issues that were facing whether at the next Quarterly Report is what you are intent is in terms of telling us what your making these and what is a dollar consequence of the delays. Terry has been modest. I have been dispatched over here for to help out with various things of from the testing sites to the food activation and to the general foundation to help the doctors and the nurses who are working so hard with this chair and i have been able to and were finding out we need to do those and theyre cost savings but some things are costing more and we should have all that analysis done for the next condition meeting and be for that. Commissioner, any other questions . Seeing none. Thats the presentation. This is not an action item. Thank you. Commissioner, item 11 and other business. Any other business from commissioners . Seeing none. All right. Item 12 is closed session. Do we have a motion to move into closed session . So moved. Second. All right. I will take roll call vote. [ roll call vote ] can everyone who is not in the closed session leave the room. We thank you so much for your hi everyone, thank you for joining us today for the Panel Discussion on the covid recovery. I am your moderator today, megan, the policy share for the San Francisco womens political committee. I would like to welcome our panelists carmen chu, joey jackson morgan, and veronica shepherd. Thank you for being here today. I would like to open up the discussion with a question. Please introduce yourself and tell our audience what you are currently working on the covid issues in your field. We can start with carmen. So good afternoon everybody, so glad to join all of you today for this great panel. I want to thank you megan for helping to host this and making sure this important conversation comes forward. I serve as San Francisco elected assessor. Like many of you, we had to quickly change to a remote work scenario with our office when we had the shelter place be put in place in march. We were able to do that relatively quickly and 98 of our operations is happening off site and not in person. Weve been working hard to make sure we try to continue to do our work, primarily because we know that the revenue impact of our work has been very, very large and disperse impact to the city, from the types of programs were able to support people with us specially during covid19. Were continuing to do that. I think on another note, i think i also serve as the Economic Recovery Task forces cochair, so very much excited to speak to you about the work of the task force coming up in our additional conversations and the last thing ill say in terms of introduction is that im a brand new mother of a 14yearold i mean 14monthold, not year old, but she is growing very quickly and i think more than anything i really am truly seeing and appreciating what it means to be part of a working family, especially during covid19 because there are so many different challenges associated with worklife balance among other things. I want to recognize that i consider myself in a very fortunate place because i have my health, i have a job, and i think that is so much more than a lot of people are facing at this moment. I think we always have to count our blessings in terms of things we do have and recognize that there are many people who need much more in terms of help than where we are. Im happy to be part of this conversation and i look forward to hearing from the co speakers today as well. Thank you. Thank you carmen. Lets go to joy next. Good morning everyone, my name is joy jackson morgan. Im the executive director. Im a unicorn in the city, a San Francisco native. During this time third street has really focused on our young people in addressing the needs that youth have been coming up with, primarily with housing. That has been a huge issue for our young people and food has also been an issue. Weve gone from having our food pantry to having food delivery for our youth and their families. Were currently serving about 50 youth and families per week. Were also trying to keep our young people engaged. This has been a hard time for them adjusting to Distance Learning and not having the certain outlets that theyre accustomed to. So we continued our Youth Development program. We have been keeping our young people engaged, and active, and connected to their peer groups. This is not the norm for any of us. We are use to be being able to go outside and going where we want and now were confined to zoom or many of the platforms we come to be recognized with. Its been difficult for young people, i think, because this is their time in development where theyre suppose to be social and not having these normal things has really taken a toll. So weve been trying to make sure that our Behavioral Health services is available to them, our clinic has been closed since march, and were in the process of trying to get our clinic reopened in the next few weeks so we can start delivering some of our medical services as well. So really trying to stabilize our young people the best way we can and help them through this difficult time, both economically, food, sheltering, heal health. Definitely, thank you joy. Last but not least, veronica. Good morning everyone. Good morning to my panelists. My name is veronica shepherd. Im with the San Francisco department of Public Health. My primary work is around Food Security and Racial Equity. I support primarily the African American faithbased coalition. Its a coalition of 21 plus churches across the city of San Francisco with primarily African American congregants. Covid19 through the population of people were put into a whirlwind. Shelterinplace hit and there were not a lot of city plans on how people would be sustained. The coalition i work with, because of its infrastructure, we developed a partnership and was able to provide meals immediately across the city. As of todays date, they have delivered over 110,000 meals across the city. Theyre feeding almost 1,000 households each week. Its been quite a challenge. For those of you listening that dont know, the African American community, joy kind of spoke to it. We have been suffering precovid and theres been huge disparity issues between racial inequities. So the shelterinplace and the coronavirus had just added another additional issues on top of what was already going on, on top of the heightened Racial Climate. Its like this stew of a lot of issues that people are facing. We have seniors who this isolation is impacting them mentally and emotionally. We have hunger, issues that hit immediately but were addressing that. We have children in households that cant go out as joy was talking about. I have families where there are ten people in a household and only one person is working. I mean there are so many issues that are spiraling all at the same time so part of my work and role is to support people, help them to stay safe, provide resources and information, and continue to just be that light as a beacon for people who were living complex lives precovid and continue to live complex lives in this pandemic. Thank you veronica. Thank you everyone for those good introductions. I also wanted to quickly note that anyone watching from home, you can feel free to leave a question in the chat box or if youre watching on facebook, leave a question there for our panelists and well get to those at the end. So i wanted to shift it over to carmen. If you can talk more about how was the Economic Recovery Task force created and what is the purpose of this task force . Sure, absolutely. So the i think maybe folks may have heard that the task force is a convening of the mayor, as well as the president of the board of supervisors normen yee. I think as we started to learn more about the pandemic, learn more about the disease and how it was spreading, i think the picture has become that much more complicated and i think you see that with the most recent resurgence with covid19 and the Health Indicators coming back to a negative when it comes to hospitalizations, as well as the number of people who are contracting it. So, it is going to be a big challenge in terms of how it is that we deal with it as a city. I think in general, San Francisco has been really trying to take a measured approach on how it is we have been thinking about economic recovery and making sure were grounding how it is that we are approaching both where were directing or services, house were making sure that were providing different support, based on information on the ground. So actual data, statistics, information that helps us understand whats happening from a health perspective. I think as veronica and joy mentioned also, i think there is a really strong recognition that covid19 really is, is even though the disease does not discriminate, what were seeing is some of the underlying inequities that exist are being exacerbated by the disease. We are seeing instances where people who have the least income security, the people who are at least able to take a break from their job, people who are not able to tell commute, people who dont have savings or have poor Chronic Health conditions who are the ones that are the most impacted by covid19. So we see this from the latinx community, where they are 15 of San Franciscos population, but they make up half of the people who are testing positive in terms of covid19. We seen a disproportionate amount of deaths being asian, pacific american, and the impacts to the African American community and were also seeing in the asian community, a rise in terms of xenophobia, a lot of people being blamed for the creation of covid19 and the spread of it, even when we all know that thats untrue. So i think we see some of these disparities. I think one of the partners we have Going Forward in our w challenge and recognizing women is the department. Im not sure if folks have seen but they put out a report that was telling which spoke to how covid19 is exacerbating inequities amongst women. So again, women tend to be concentrated in lower wage jobs and jobs that may not have as much ability to do telecommuting or some of these other options that people currently have. We are also typically people who will be primary caretakers for young children, and our seniors, and our children, and there is a disproportionate impact among women. Were concentrating on what kind of policy decisions can we be pursuing as a city to enable recovery and think of equity while were at it. If we will have scarce resources, we need two different programs to support our workers, families, and san franciscans as a whole, where should we put that understanding there is a disproportionate impact on how covid is miimpacting our city. S there this is such a significant challenge to us. A lot of the work in terms of spre spreading and food securities are some of the other things. We still have to think of intermediate term. Thats what the Economic Recovery Task force is trying to do, putting the on the ground experiences together, coming up with a coherent plan and strategy on how the city may want to approach reopening going into the future. Definitely, very impactful. I want to bring it to veronica and knowing that Health Disparities are tied to systemic racism and this is a Public Health issue that disproportionately effects people of color and black and brown bodies, what can our leaders do and those in power do to change this tide . I dont think we have enough time. [laughter] ill give it my best shot, okay. Its a loaded question. For our community and im specifically talking about African Americans, we as leaders in this city, particularly at the higher level has to be honest about the Structural Racism and violence thats been perpetuated by our people ever since slavery. We have to be honest on how it looks and how it shows up in each of our systems. We have enough data on the black experience to build cities about, but we dont seem to shift on how the racism and its structure is continuing to keep these barriers and these hurdles high so our communities cant thrive unless we change the Program Project mentality. Were not really pulling out the roots of the racism. Were just doing check boxes. Theyre always like a band aid. They never really resolve the problem because were not going deep enough and were not being honest enough to say were putting systems in place that perpetuate the inequity. Until we as leaders all come together at the highest level and have honest conversations that will be very uncomfortable, because t going to reveal how our own biases stand in the game, to be honest. We have to own up to the fact that a lot of the systems in place, were protecting them at the highest level. People who make up 5 of a population, but have the highest Health Disparities, the worse education outcomes, the highest rates of mass incarceration, i mean i can go on and on. Something is intentionally wrong there. Half of the Homeless Population is black and there isnt even that many of us. What structures continue to perpetuate this and how are we protecting it that it keeps going . We got to be honest, otherwise we are going to continue to Fund Programs that are not sustainable because theyre not designed to be. Theyre not going to dig out the deep root of the problem. The entire country has been functioning in systemic Structural Racism and violence against black people. Now we just got to own that. So it comes back to checking ourselves with our own bias i cant say biases, and you cant tell your community were here to help you and you need a heart transplant, but you give me a band aid. How does that help my community . Yet we continue to do this. So somehow until we as leaders at the highest level can sit down and be honest about what were actually doing to black people and particularly right now with the Racial Climate that were living in, its been unleashed and against us and yet were fighting to get basic needs, food, housing, struggling to get testing out here in our community and yet as karmen spoke, the need is huge. Were not being honest. I think weve been so conditioned to operate in our different slices of the pie, we dont see the whole picture. We dont see how the ingredients are combined to create the recipe we want to build. We need to have conversations that dismantle the racism and make sure that everything were doing is connected to some policy or some ordinance that dismantles the barriers against African American. Absolutely, thank you. Joyce speaking on that, i know that you spoke a little bit in your intro about how this effected your organization right now. How has covid affected your ability to provide Behavioral Services to youth . Both carmen and veronica, i dont know how i get to come after both of you. You spoke so well about this. I think Health Starts in community. It is a community response, a neighborhood response, right . When you start to take away some of the things that were accustomed to, to have this sort of response, on top of the social determinants of health we already had, it definitely puts us at a disadvantage. We need to acknowledge the roles and how that relates to the disbursement of resources and the response from the city. As veronica eluded to before, we are scrapping for resources, for testing. We had to do all telehealth for our Behavioral Health services. Thats not a community model, right . We depend on relationships. We depend on each other for our needs. We build a rapport with you and then that gets taken away. They trust us. Its like were a boutique clinic. It was designed and created by the community and youth to be the beacon for their needs. So i think when we talk about policy, i think we need to look at how there is racism in the Decision Making and that we need to look at whos at the table and who has the power at the table to make these decisions and to help Bring Community to the table so theyre at the forefront of the Decision Making, the solution and the progress. How do we hold the city accountable for try to address our needs without the community there . So when we look at these things moving forward, as veronica said and carmen said, we have to put our leadership and the Community Leadership to help with some of these policies and Decision Making Going Forward. Thats the only way were going to crawl ourselves out of this hole were in. Yep, definitely. I hear that and agree. Speaking about policy and good policy, but just often the foundation of good policy. I want to open this question up for all three of you. How have you seen this city or your organizations budget effected by this pandemic . Can i just start by saying i want to appreciate what veronica and joyce said. I truly think that when we talk about economic recovery, i agree with joy in terms of the Community Based approach. Its really important there are community leaders, network, and existing relationships that can only strengthen and either make that work or not work. I think that is really important to acknowledge. I think to veronicas point as well, i really appreciate the comment she said about how we need to be willing to confront those Difficult Conversations because i really feel whenever it comes to the conversation around race, its really, it is very hard to talk about. Its very hard to be vulnerable and talk about what you dont know or to be fearful of saying the wrong thing and then that makes the conversation around race hard. When we start to see the outcomes that we talked about, whether its economic outcomes, health outcomes, so on. Theyre tied to race. So how do you say that its not connected . So i do think that its important for us to begin taking those steps. Its hard to do, but im hopeful that were going to start to have more conversations and the more conversations we have and sustain conversations, not just for this month or next month, that we can actually see progress. I hope thats going to be the case. I know that its going to be the leadership of the city, but also in our community and how we all interact and what kind of personal responsibility we can all take with dismantling the system we have. In terms of budget, you know, budget is incredibly tough for the city right now. You know, i think what were seeing is a 1. 7 billion deficit because a lot of the revenue has been drying up, all these things tied to Economic Activity has pretty much stopped. So i think thats been a big challenge for us from our organizations point of view. Were trying to figure out the best way possible to continue our work because for folks who dont know, the Assessors Office is responsible for property taxes and our operation brings in about 3 billion of funding to the city year after year. That helps to fund our social services. Its the largest source of general fund revenue for the and Public School and education, which is also important. We want to make sure to continue those operations, but its not going to be easy because if were going to defeat this budget deficit, it looks like potentially cuts. I think all of us are looking for areas where we can cut to help make balance and wont impact people and services, but for an organization like mine where 80 of my expenses are people, thats hard to do. I think that youre going to see that to be really true, especially with so many of our nonprofit partners, where it was already hard to begin with in terms of being able to run the operation to recruit, and to keep talent and people in your organization, to pay them something that will help them survive in a high expense city and now that were in this situation, its even harder. So i just want to acknowledge that its true. Its true for the city and its even more true for a nonprofit partner. I will imagine that were going to have a really challenging time. With that being said, in my point of view, were committed to doing everything we can to continue to bring in the revenue that is fairly due to the city and we will see a lot of challenges to that. We are already seeing a lot of commercial properties and others saying covid had an impact. It certainly has an impact, but from a Property Value point of view. We dont think it has an impact for the fiscal year upcoming. So that is just in my mind understanding where were going to have challenges coming forward as a city. Its going to be tough. Thank you. Im going to jump in. For me the answer is twofold because i work for the Health Department and lot of the budgets were redistributed because of covid. Then i work for community and people on the ground, and their budgets were just pretty much destroyed by a lot of this work. So from the citys lens, from the Health Departments lens, the new guidelines, the Mental Health money has been drastically reduced, which impacts our commune huge because there wasnt enough resources for black people and their Mental Health needs before covid. With the reductions i saw from Gavin Newsoms office, its going to have even a harder hit for our community because as i stated earlier, all of this impacts our mental and Emotional Health and wellbeing. We have people who are seniors that are isolated and are just not doing well because of this intersection of us being around people has impacted us all. So from the community lens, its a huge struggle because youre trying you got funded to do certain programs and certain projects that are going to sub support people and yet people are sheltered in and cant come out. Our Community Also doesnt have access to Technology Like a lot of other communities. Those resources arent always available. As black people, many of us live multigenerational. Our programs are for the seniors or for the kids or for the working poor. We arent looking at Household Level responses. Were all impacted. If grandma is getting the grocery bag, all the eight people that live in that house are going to live out of that gross bag, which is probably going to be gone the same day they get it. So the programs have been impacted by the pandemic so the resources arent as great as they want them to be. It has changed the last few months, but its been a huge impact on trying to connect resources. As joy said earlier, we as Community People know each other and try to build upon what we know we all have, but were all still fighting for the same bread crumb. Its not like joys program got an abundance of stuff. Our wonderful baby y here, a great resource to our community yet theyre trying to engage our community, families, seniors, all the people they serve from an extended reach. The question about the budget has to do with the people on the ground compared to the Health Department who are trying to take resources and redistribute them in an equitable way, but the need is so great. Theyre trying to figure it out each new day. Things keep changing. We have federal guidelines that impacted our budget. There are layers upon layers of things that people have to think about daily. Thank you. All right, im going to answer this question wearing two hats. Im going to start with the first hat as being cochair. So this is my third year. Every year we put out these recommendations, trying to be as equitable and Community Focused as possible. As a cochair, i am worried about this plan shrinkage in the city. When i say that, when we think historically when these things come up, black and brown people are always at the tail end of this. This is who is going to get hit the hardest. It will come out of the Police Department or fire department, wherever it is, its in our neighborhood. Trying to make sure in every decision being made around this planned shrinkage that were taking an equitable lens or equitable approach. The director put out a Covid Response not work book, but i cant think of the word. She put out a great report about how we should approach our recovery as a city. I recommend people should read that. Also my other hat as a leader of a nonprofit, im terrified because by this point in the process, nonprofit leaders will know what were working with. This delay is adding another layer of stress. Youre trying to keep your staff calm and make sure you have money to pay for the things you planned for. Now were waiting for your city counterparts to know if this is going to happen. Youre trying to keep your population to conserve calm. Its a whole level of stress for nonprofit leaders because we dont know whats going to happen and all the things that we grown to trust and depend on are all at jeopardy. I just want to say that health is involved in all policies, whether its education, transportation, whatever, intentional or unintentional. So like we really need to focus on how all of these policies and event the way these budget cuts come down and what impact its going to have on communities of color. Yes, definitely. That is so true. Speaking on that, in todays debate, the Public Health recovery and the economic recovery are often times pinned against one another. So, how do each of you envision a community where these two could be integrated to create prosperity . Lets go to carmen. I was going to let someone else take the lead. In terms of tracking this, when you look at the reproduction rate of covid19, in march it was something above 3. That meant for anyone with covid19, they were basically spreading it to 3 other individuals. San francisco in the bay area took Decisive Action to do shelterinplace in midmarch. They were faster than many other places and it helped slow the spread pretty quickly. When you look at the trajectory of reproduction rate, it dropped dramatically after shelterinplace went into order. For a long time it was under 1. Thats a good thing. You want the number to be under 1. Around the beginning of june or so that started to inch up and now were likely above 1. Thats where we are in terms of the reinfection rate. We want to bring the number down or we will see spread in our communities. I tell you that because what happened that drove that number down was two things. We closed a lot of businesses, reck recreation was also shut down. The second thing, i know for myself, psychologically we were seeing what was happening across the country and around the world and new york. We thought we better take precaution because we dont want to see that happen here. We dont want to see lines of ambulances going into the hospital with us having to make decisions on who to treat and who not to treat. Many of us took a lot of precautions and then that flattened the curve when we reopened the economy in midmay or so, i think a few things happened. I think you know, number one more Economic Activity was happening, so more people were coming in contact with one another. I think a lot of people let their guard down. Weve been cooped up and people thought it wouldnt hurt if i just saw so and so. Overtime as you start to be social, you forget you shouldnt have give someone a hug. I think its hard is see what of the resurgence is related to Economic Activity and what is he rated to our social behaviors. I think the one thing ill say is that im still hopeful that we can open up more of the economy so we can get our budgets back online and our support back online and to help people too. There is a cost to shelterinplace. We heard a lot about the cost to business, the cost to losing jobs, which is not small. Those are big things when people lose their incomes. There is social and emotional challenges, Mental Health challenges. Veronica spoke about social isolation amongst our seniors. We are seeing more food insecurity. There is also the typical ability for us to be able to detect things like abuse. Were not seeing kids go back to school. Were not seeing more avenues for some of these things to be daylighted for example. So it is not without other costs associated with it. I just wanted to say that because part of reopening the economy and getting back to as normal as possible is because there are other impacts we have to see. I do think that we can continue to do it, but we really have to double down in terms of our own social behaviors. Thats hard to do because were use to being the social people we are and seeing your own family. I do think thats what needs to happen in terms of the city and other actions that need to occur to make this a not a here or there or win or lose situation. We have to take more personal responsibility. All of us do. We have to remember to buckle back down again right and not try to get back together and do as mump as we can to social distance and wear masks. Those are things we can take on ourselves to do. As a city we need to think harder about how do we support people during this time . So if we want people to not spread, it means we need to support people who get sick, to make sure they have a replacement income, and they are not going to lose their jobs when they do that. I think there are a lot of policies that need to happen that support Economic Activity so people can have good health behavi behaviors. I just want to say we all have work to do on the policy side to help people who get sick and making sure our Public Health has the resources they need to help with Mental Health, with contact tracing, and testing. The last thing i have to say is that we need to think more regional. I think we started off really well in terms of coming together as a region to slow and close things down. When we started to open back up, counties did it all different ways. So there was a lot of confusion on what is open here and what is open there. When things are open in another county, people from our county and rightly so were saying oh, ill meet you over there to have dinner or whatever it was. You know, it just shows you that spread isnt contained within our county, right . People go, they work in other counties. People come here to work. So i think our lack of having a regional approach when it comes to opening really hurt us. I hope we can get back on track with some of these things so we can come together and be more coherent and cohesive on how were moving together. I could talk for hours about this stuff. So for me megan and thanks carmen. That was wonderful. The question has a different turn for me. When i think of economic recovery or Public Health recovery, i have to ask for who . Our health was terrible before covid. Our Economic Life was very poor precovid. So, when were talking about the recovery of these things, if were talking about black people, we have to have a whole different conversation. The Median Income for white people was 101,000 and for black people it was 29,000. Our Health Disparities are the worse across the city for every group. Its a different discussion. Again, everything all the racism that black people and people of color just in general experience is connected to economics, period. So its not just about the pandemic but for my community, it heightened everything that was already in place and occurring. So when we talk about recovery for people who are already oppressed, already impacted by the social determinants of health, the conversation has to take a different nuance. We need honest conversations on what does recovery look like and for what population are we talking about . If youre already twothirds of the food chain and the issue for you is this pandemic, but you still have food, housing, your bills are still being paid, that recovery will have a different outcome for those at the bottom of the barrel. Right now what we see and i know carmen and joy have seen it, its the despair in everyone were seeing. How long will this go on . I have people that i know that dont have jobs and are so afraid because theyre going to end up losing the place theyre renting because they cant pay. I think of recovery for those who are marginalized already and its a different conversation. I agree with carmen. It has to have a regional approach so were not all doing our own thing based on the communities we live in. We do have to think about that. I learned last week because of my exposure to data in the Health Department. I currently live in the census track, in the bay view. Im a native here, born and raised here, that has the highest cases of covid. Oh god, im scared to leave my house even for a basic need. There are people that are Walking Around and theyre not thinking about Public Health recovery. Theyre not thinking about economic recovery. A lot of these people dont even wear masks and theyre not just the black people. It has a different layer added to it in our community. That recovery requires the voices from our community to be leading those conversations. What recovery looks like is not the same as in the bay view. Thank you. I very quickly. Go ahead. And i think that was a perfect segue into one of my points about the community aspect. I was thinking since young people are now one of the fast ers populations to be contracting covid, i have this crazy idea, why not hire them to be our Contact Tracers . They know who are around and who is going to be somewhere and all this other stuff. Have them help us track this for us. Its their population that is now entering into this. We didnt do a great job with our young people in messaging. They have all kinds of messages going on, does the mask really help, i thought we can go here, is this real, all these different things. So now getting them involved, getting them educated on whats really happening and helping them be a part of the solution is going to engage them, is going to help them in economic recovery. Its going to give them experience that hopefully later on you now have your new Public Health team. Even hiring young people to be Community Ambassadors or captains to help with the Data Collection in specific neighborhoods. I think about whats happening in sunny dale. Hire young people to help with that. Even in the shelterinplace hotels, how can young people be part of the stat . I think there are ways that we can include community and im using my youth lens because i run a Youth Organization but community in general. These are ways we can incorporate the community in a way that doesnt make them feel tokenized and you understand what youre going to do and youre going to sit here and this is on the checklist. This is having them feel a part of the solution and helping their community that is also uplifting them economically. Can i add to that too . We have a Seniors Group called network for elders out here. I know the president and she says theyre trying to communicate because so many of them live alone and they dont even have laptops to do that. They used to meet monthly before covid. I asked how many laptops do you need . She said eight. They dont have the money to get it but its a way to stay connected and to be able to engage and feel like they are also part of what they can do to shift the narrative. It could be small but its so critically needed. Yeah, i love what joy had to say about engaging the youth that way. The city has a huge need for Contact Tracers and well have a huge need for a while. I think thats an idea we should be exploring as a city and to veronicas point. The Digital Divide is terrible. Youre seeing thats playing out in terms of education. If you have parents or kids that dont have access to technology or the connection, or dont know how to use it, youre seeing theyre falling further behind. Thats a huge challenge. Yeah, so really quickly, i guess a follow up to this is what are some of the red tapes that can be addressed. Youre shaking your head veronica, theres too much red tape. Thats something to think about and maybe theres Community Building down the road. A question we have from an audience member, denise asks how has the covid crisis effected or complicated the housing prices . Hi denise, thanks for your question. We saw an uptick in young people trying to escape Family Violence just in a weeks time. Before the city was allowing them to use Emergency Hotel vouchers we said were going to use them and ask or forgiveness later. So we tried to get our young people somewhere where they could get safe. It started as a week, then growing into a months time and we thankfully were able to sustain them during this whole shelterinplace time. It ended up being 12 young people we had to do this for outside of trying to house i think during this time we were rapidly trying to house all the youths on our list. In addition to the emergency housing youth, we housed close to 20 young people during this time. It looks like rent is going down but there is still a huge need. There are a ton of young people still in the queue and we had to slow down because of resources. Its been strapped because all the money that had to go into hotels, food, just making sure that everyone has the electronic stuff like laptops, hotspot, all of that. It just put a huge strange on our resources strain on our resources and there are still a lot more people in the kuwaiting to be housed although rent is dropping. This is like we went into this crisis with homelessness being one of our huge issues at the city and weve done a better job of trying to address it, but its only going to like its a deep hole. We need if i can advocate for anything right now the two things would be housing, food, and Mental Health. I can say that as a homeless response system in general, everyone not just youth, everywhere faces this crisis during shelterinplace and even now. Definitely. Does anyone else want to answer that question briefly . I guess just quickly for me, its just thanks denise for asking that question. Its so complex. Our housing, our homelessness shot up. I mean we got hundred times more Homeless People here in the bay view than we had before because resources shifted. Things that use to be available in certain parts of the city werent anymore. We even have people that are in sheltered environments without food and going to the Homeless Services to eat. So its just very complex and i ditto everything that joy said. All these of these intersections have to be addressed because theyre all happening at the same time. Definitely. So i want to open it up to our Closing Remarks and last questions here as were coming to time. How has each of your personal experiences guided your strategy to recovery and what are some resources that you can provide to our audience and try to keep this under 2 minutes. I think well be good. Ill go very fast, which is you know my parents were immigrants here so my parents i grew up most of my life where my parents think racism because they couldnt speak english well and they worked in low income jobs. My mom was a seamstress and my dad worked in a kitchen. It always colored my perspective because when i think of policy and how we respond to economic recovery, i think of the people who cant make it to the table. I think of the people that cant come out and advocate because they have to work or i think of the people that cant or dont feel they can speak up. So, i think that is something that will always be with me. Its always keeping that perspective on who cant come here to say what they need to say and we need to be thinking about them too. I think in terms of this pandemic, its even more clear about how it is that we need to be protecting, especially our most vulnerable communities. Joy, if you want to go. Yeah, ill go. I dont think you come out of Hunters Point without being an activist. One of the most overused but appropriate words to describe our neighborhood is resilient. So i think weve learned how to, you know, make something out of nothing. I think again as i talked about earlier the village model of really making sure that we all were helping each other no matter what, even if we had something little. Let me help you get this. I think thats been sort of the beauty of all this, seeing how San Francisco has come together to make sure that we are at least trying to address our most marginalized. I seen people come out to help our seniors like veronica was talking about with the Faithbased Community and serving all those meals. That came from just conversations, very organic conversations. Seeing that and seeing how the networking has i have really been amazed at how everyone has come together in all different fronts. In terms of resources for the audience, i just really want people to get out here and advocate, right . Weve talked about all the things that need to happen. Get engaged. Look at the next budget meeting. Look at the next Police Commissioner meeting. Look at all these different meetings where we need folks to come out and advocate for the things were talking about. Were going to need your voices to make this happen. This is where the community is at the table. This is where we shift the power in the Decision Making. We need you all to show up and advocate for these things. Ill leave you with that. And im going to end with very little. The resources i bring is food. People know me as you need food, call veronica. I pretty much know where all the food is and how to get it to people. More than that, i bring grace. I bring dignity. I bring values and humanity to peoples lives who are suffering in multiple ways and spaces and places, whether they speak english or not. I think that hope and joy said, the resilience we have helps keep people helps people know that somebody cares and somebody really shows that they care about how were experiencing life each day. I dont care whether youre giving a person a napkin or referral. Do it with dignity. Do it with hope. Do it with grace and remind people that theyre not alone. To me thats the most important. If we dont stand for the values that we say we represent, it doesnt matter what we have to offer. You can treat people very badly for something they really need and theyll walk away from you because you disrespected them. So i think that is critical of how to engage people, specifically in this pandemic. Thank you. Thank you veronica, carmen, and joy. Your comments are much appreciated and i hope the three of you collaborate down the line. I just want to plug for summer in the city is their next event, august 6th. This is a big event for all women to celebrate and i know that carmen also has the w challenge coming up celebrating the 100 Year Anniversary of woman suffrage, both are tied to womens suffrage, keeping it in line with womens rights and of course what that means for women of color especially black women and brown women. Thank you again for everyone that is watching from your homes. A remind to make sure that you are socially distant, wear your mask, and stay informed. Thank you. Chair fewer good morning everyone. This meeting will come to order. This is the july 31, 2020 regular meeting of the San Francisco local Agency Formation commission. Im sandra lee fewer. Im joined by gordon mar and matt haney. Do we have any announcement. Clerk yes, due to the covid19 Health Emergency and to protect commissioners City Employees and the public city hall is closed. However, members will be participating in the meeting remotely. This precaution is taken pursuant to the various local and state federal orders, declarations and directives. Commission members will attend the meeting through Video Conference and participate in the meeting to the same extent as if they were physically present. Public comment will be available on each item on this agenda. Both channel 26 and sfgov tv. Com are streaming the number across the screen. Each speaker will be allowed two minutes to speak. Comments to speak are available via phone by calling 4156550001. Then pound and then pound again. When connected you will hear the meet discussion and in listen mode only. When your item come up, dial star three to be added to the speaker line. Best practice is speak clearly and slowly and turn down your television or radio. You may submit Public Comment in either of the following ways. Email to myself the lafco cle clerk, or by u. S. Mail at one dr. Carlton b. Goodlett place, San Francisco, california 94102. That concludes my announcements. Chair fewer thank you very much. Please call the item number two. Clerk approval of the lafco minutings from the june 19, 2020 regular meeting. Chair fewer any comment or questions. Lets open this up for Public Comment. Clerk members of the public who wish to provide Public Comment on this item should call 4156550001. Please dial star three to line up to speak. A system prompt will indicate that you have raised your hand. Is there anyone on the line . There are no callers in the queue. Chair fewer Public Comment is now closed. I want to make a motion to approve the lafco minutes from june 19, 2020. Do i need a second for that . Clerk yes. Chair fewer second please . Second. Clerk motion to approve the minutes. [roll call vote] you have three ayes. Chair fewer thank you very much. Do we need to excuse missioner pollock from this meeting . Should i make a motion . I like to make pa motion oexcuse commissioner pollock from this meeting. Could i have a second please . Supervisor mar second. Chair fewer roll call vote please. [roll call vote] you have three ayes. Chair fewer thank you very much. Please call item number three. [agenda item read] chair fewer thank you very much. We have our executive director presenting on this. Thank you, good morning commissioners, bryan goebel executive officer. This item will authorize the lafco to enter an construction with banner production to provide Renewable Energy consulting to the lafco. The lafco is mandated to provide oversight of cleanpowersf in august of last year we issued a request for qualifications for Renewable Energy expert in three Service Areas. I outlined all of this in your packets. By the okay deadline, we haved a total of seven responses. They met the minimum qualifications to work with lafco. There was only one response for service area one, which is to support lafcos oversight of cleanpowersf. We gave all of the respondents a Second Chance to apply and by the february deadline received a total of four responses. On march 13th, we convened an r. F. Q. Evaluation panel made up of chelsea from chair fewers office and a legal counsel. Of all four respondents, vanir scored the highest in the supervisor and proposal evaluation. On june 16th of this year, the lafco issued an intent to award a contract to vanir. The panel were impressed with vanirs presentation during the interview and their understanding of the role lafco plays with cleanpowersf. They have done their homework. As well as by the firms documented expertise and proven record in the Renewable Energy field. They are a minority and women owned company. The staff member for the role at vanir will be jenny witson with Extensive Knowledge of Renewable Energy issues. The team who will work with lafco, i outlined this in your packet, includes developing the framework for the c. C. A. Program in los angeles. They have c. C. A. Experience. This would allow us to significantly strength and our oversight role of cleanpowersf by retaining expertise from a firm with experience in this field. Im very excited to work vanir Going Forward. My recommendation is that you approve the contract. Chair fewer thank you very much. Any comments or questions from my colleagues . Seeing none, lets open up for Public Comment please. Clerk members of the public who wish to provide Public Comment on this item should call 4156550001. If you have not already done so, please dial star three to line up to speak. Please wait to indicate the system has unmute you. Are there any members of the public wish to provide Public Comment on this item . Yes, i have one in the queue. Hello commissioners, eric brooks with californian for energy choice, i worked the last 14 years to get cleanpowersf off the ground. Support of this, the diversity and the expertise that this company and team has is both crucial and impressive. Its great to see this Going Forward. Theres one big caution and hopefully vanir is watching this as well so they get this message to both the commissioners and to vanir, the big caution is that all the expertise looks great but the one thing that i dont see from either of the commission or the contractor is the plan and the ability to integrate all that spirit expero plan a Virtual Power Plant for the San Francisco bay area like the sydney, australia renewable plan. Thats what the advocates have been watching for 14 years. Its not coming from the sfpoc. We need this contractor to be expert on power plant and hire contractor to build it. Thats absolutely crucial. Its the one thing i would say to step up your game on both the commission and the contractor. Thank you. This looks great. Its great to see that were moving forward and i look forward to communicating with all of you in the future including vanir. Clerk thank you for your comment. Anyone else on the line . That completes the queue. Chair fewer Public Comment is closed. Mr. Brooks, comments are noted. I think we are now able to make a recommendation to approve the contract with vanir Construction Management as mr. Goebel has recommended to us. Supervisor mar i had a question for mr. Goebel. I wanted to clarify is the contract with vanir going to cover all three Service Areas . I noticed lafco received responses to the r. F. P. From different bidders in the three different Service Areas. Vanir only submitted a response to service area one and Service Area Two but not service area three which identify proposed programs for communities of concerns. I wanted to clarify whether the scope of this contract will cover all three Service Areas . Chair fewer mr. Goebel . Thank you for that question commissioner mar. I want to add that Jenny Whitson from vanir johnson us as well. No, this contract only covers service area one, which is supporting lafcos oversight role of cleanpowersf. I think it could maybe be possible that vanir could help us develop scope of work for service area three, which other service they didnt apply for. This is mostly to support service area one. Chair fewer commissioner mar, would you like to hear from Jenny Whitson from vanir. Shes available for comment to answer questions. Supervisor mar yes, sure. Im curious how whether lafco will be pursuing consultant support for Service Area Two and three . It is my goal that well be able to based on what i heard from commissioners in the past that service area three is a priority, particularly picking up on Winston Parsons work that he did with his report with number of power disconnections in San Francisco and doing work in this area and other work that the commission deems a priority for communities of concern. Im not sure if ms. Whitson would care to say a few words. Mr. Goebel and commissioners, vanir is excited to support the lafco and service area one oversight of cleanpowersf. In termings of the comments that we heard, well work with mr. Goebel and commissioners to consider any advocacy comments be and recommendations and incorporate those accordingly into lafcos recommendations. Were very excited and we look forward to working with lafco and many other stakeholders that are looking at the cleanpowersf implementation plan. Chair fewer thank you very much. Ms. Whitson to reiterate the question from commissioner mar about working in areas two and three. Would you be able to lend any expertise. I know that your contract for Service Area Number one. Im assuming that you have the expertise for two and three should we expand the scope. Is that correct . Yes, we we do have the Technical Support and expertise for Service Area Two. We are willing to help develop the scope for service area three. We can certainly help with developing that as well. Chair fewer commissioner mar, any other questions or comments . Supervisor mar no, thank you so much. Chair fewer thank you very much. I think that seeing no one else in the queue, i like to make a motion to approve this contract. Could i have a second please . Supervisor mar second. Chair fewer roll call vote please. [roll call vote] you have four ayes. Chair fewer thank you very much. Please call item number four. [agenda item read] chair fewer mr. Goebel . Thank you madam chair. Commissioners, this item would allow the lafco to extend its contract with the jobs with Justice Education Fund to conduct another survey of on demand workers in San Francisco. The focus of this survey would be delivery workers. Who are among our front line workers now. Our previous survey, those delivery workers who participated in the survey, mostly in San Francisco, more than 60 of them. I gone into detail on this in your packet but the survey would have two part. The team would recruit for a representative survey of workers on four platforms, two grocery and two food with a target of 200 workers on each platform. They would also conduct a survey of delivery workers are unionized. To understand how the work is performed when the workers are employees with union representation. This will then compare the difference and have some analysis on that. The first step of this next phase will be to do a pilot to develop a methodology that prioritizes Public Health and safety for the team who will be working in the field. A part of that how they will determine whether or not this would be inperson survey using all the safety protocols and or whether it would be a phone survey. I think thats something they hope to work out with the pilot. We do have funds left over from the previous representative survey since it was cut short. That would cover the pilot phase and then conducting the next survey would actually be dependent on additional funding from private foundations to the tune about 360,000. Weve already applied for one big grant and im starting to work now with the team on fundraising strategy moving forward. I feel confident that we can raise those funds. Im looking forward to this next phase of work with the survey team. The contract will be extended for one year and my recommendation is that you approve the contract. With that im happy to answer any questions. Chair fewer thank you. Any comments or questions from my colleagues . Seeing none, lets open up for Public Comment please. Clerk operations checking to see if theres callers in the queue. For members waiting online and wish to speak, please press star three now to be added to the queue. For those on hold, please continue to wait until the similar indicate you have been unmuted. Anyone on the line . I have one caller in the queue. Hello general commissioners. Eric brooks again. This time representing our city of San Francisco, local Grassroots Group and the San Francisco green party. I wanted to really you probably already thinking in this direction, it is vital during the virus crises that we get responsive and data on what front line workers need because of the virus crises. Especially with were just finding out today that congress is totally dropping the ball on support unemployment support maybe a lot lower and that essential workers like this, is vital that were paying them a lot of money. Soothe like doing this. We really need to get data and responses specifically on that. Not just for this industry but this will cover but if we get the right kind of responses it will apply to uber and lyft and maybe even whole foods workers, Grocery Store workers, you name it. So we can get some guidance on giving real relief to front line workers and make sure theyre paid well enough to justify the hard work that were having them do. Those are my comments. Chair fewer thank you very much. Anyone else in the queue . Clerk i dont believe theres anyone else in the queue. Madam chair, that completes the queue. Chair fewer thank you. Any comments or questions from my colleagues . Commissioner mar. Supervisor mar thank you. I wanted to thank executive officer goebel and my former colleague, the academic partner and others for all your work on this groundbreaking study on workers in San Francisco. I fully support extending the contract for jobs for justice, to do a new surveys with the food and grocery delivery workers. Im very interested in following up on recommendations that came out of first round of survey and supervisor haney particularly the recommendation to explore licensing system for food delivery. I think the second phase of the survey of those workers will align well with us and initiatives that can support these workers better. So thank you. Chair fewer thank you commissioner mar. Any other comments . I like to add my ditto to exactly what commissioner mar said and thank mr. Goebel especially for staying with it and being able to fund these really important studies. Thank you very much. Having said that, anyone else in in the queue . I make a motion to approve the reservation authorizing the Second Amendment no, Second Amendment to the agreement between lafco and the jobs for Justice Education Fund for on demand delivery workers. Can i have a second please . Second. Second. Chair fewer roll call vote please. [roll call vote] you have four ayes. Chair fewer thank you very much. Can you please call item number five. [agenda item read] chair fewer i think today we have our counsel inder khalsa to present this item. Good morning madam chair and members of the commission. It is my pleasure to bring to you today an extension to the chair fewer i see no one in the queue. We can open this up for Public Comment. Clerk operations is checking to see if there are any callers in the queue. Please press star three now to be added to the queue. For those on hold, please continue to wait until the system indicates you have been unmuted. Is there anyone on the line . I have one caller. Its eric brooks again. This time representing all four of the groups that i mentioned. Just to give thumb us up to renewing the executive officers contract. Its been very refreshing to work with bryan. Todays meeting is a clear indication that bryan is getting stuff done and his ability to get the supervisors to realize the importance of this commission has been important as well. I would urge you to approve this. Thank you. Clerk i believe that is the only caller in the queue. That is correct. That completes the queue. Chair fewer thank you. Public comment on item number five is closed. I would like to make a motion to approve resolution for bryan goebel executive of office services. Second please. Second. Chair fewer thank you commissioner cink. Singh. [roll call vote]. You have four ayes. Chair fewer please call item number six. Clerk item number six is Public Comment. Members of the public who wish to provide Public Comment should call 4156550001. If you have not already done so, please dial star three now to line up to speak. A system prompt will indicate you have raised your hand. Please wait until the system indicate you have been unmuted. Is there anyone in the line to speak . Yes, i have one caller. Hello again one last time. Commissioners, eric brooks representing all four of the groups that i mentioned before. I cant say this with enough urgency. If you look whats happening in washington d. C. Right now, the trump administrations handling of the Economic Crises that has merged from this virus and other problems with the economy is dismal at best. Even the leadership of the Democratic Party is not stepping up to make sure that things are funded and the people are funded the way they need to be. Housing is producted the way it needs to be. I would urge you to take the public bank off the back burner because were now facing a situation where San Francisco is likely to be under extreme crises, especially for housing even with the protections that weve got in place. Its vital that we make sure and get the public bank on the front burner and moving forward as quickly as possible so we can get people out of harm and get coops funded and things like that. So we can fund things like cleanpowersf that will be much easier to build than saving the planet if we get money from a public bank to build that Virtual Power Plant. Sydney, australia power plant that i was talking about before. I dont think that we can leave public bank to decide at this point. Thank you. Chair fewer thank you. Clerk that is the only caller. Chair fewer okay, Public Comment is now closed. Madam clerk, is there any more business today. Clerk no further business today. Chair fewer thank you very much everyone. We are adjourned. Good morning. The meeting will come to order. Welcome to the thursday, july 30th special meeting of government audit and oversight committee. I am gordon mar and joined by peskin and safai. Thank you to joh john john carrd sfgovtv. Do you have any enouncements . To protect the public during the covid19 Health Emergency with board of Supervisors Committee room are closed pursuant to various local and state and federal directives. Committee members will attend through Video Conference and participate to the samex