Transcripts For SFGTV Health Commission 20240712

Commissioner chow is supposed to be here. I thought he was on but he is not. Mikaela, can you share that slide right now . Im going to pop up the Public Comments slide so that everyone on can see how to make Public Comment. Theres a few people on and i want to make sure everyone knows. Give me one second and ill pass you to ball. So, the phone number for Public Comment is 415 6550003. The access code is 133 1902636 and press pound twice to get on the line. When you are on, if you would like to raise your hand for a specific item, please press star 3. When you get on the line, you press pound twice and then star 3 if you would like to raise your hand for an item and well talk about the comments for each item. Commissioner bernal, would you like to move forward with the approval of the minutes or wait for commissioner chow . Commissioner ball do we have a quorum . We do. Is he dialing in now . I will call. And i apologize. No problem. Well give him 30 more seconds. Thank you to dph staff and everyone making this meeting possible by webex. Commissioner bernal thank you. Before we move onto the approval of of the minutes, i want to share with the commission, with dph staff and all those watching as members of the public, that as you know, we are under an excess i have heat advisory and there may be rolling blackouts in San Francisco, the beginning as early as now 4 00 p. M. In San Francisco with an anticipated restoration of power around 7 00 p. M. We dont know exactly when this will happen or if it will happen or what areas of San Francisco will be affected, we do know about 103,000 customers accounts will be impacted by this. I know director colfax will talk about dphs response to the heat advisory during his remarks and i want to assure the commission and members of the public the Health Department will be monitoring the heat situation and take all appropriate actions to prevent and protect vulnerable populations. So, hopefully well make it through the whole meeting but if we do suddenly go dark, we know why. Apologies in advance if that happens. Lets move on to the next item. Approval of the minutes. The commissioners, you have the minutes before you if you have had a chance to review them. If would you like to make Public Comment on this item press star 3. This is for the minutes, item 2. And commissioner, i think we can move forward. O. Do we have a motion to approve the minutes . So moved. Is there a second. All those mark, call the roll. [roll call] yes. Thank you. All right, well move it to the covid19 update. From director colfax. And actually sir, im sorry, its the directors report first. Item 3. I jumped ahead. Directors report first. So, we will go into the directors report, thank you, mark. Hello dr. Colfax. Thank you secretary morewitz. Just a few things to highlight in the directors report, what you have before you. Mayor breed presented her covid19 budget for the next fiscal year, which is over 400 million, 446. 1 million to be exact with significant portions allocated to help operations, including of course most of that to the department of publichealth and focusing also on housing and shelter programs and Food Security and Human Services in Emergency Communications and operations. This budget is being presented in various components by different departments to the board of supervisors. We presented the covid19 dph portion of the budget to the board last week and there were a few questions and well go before the board for our fourth hearing on the budget on friday. I will give an update on covid19 in more detail in the next agenda item. Just to say that as some of you may have been reading in the paper, there were reporting delays and charges with regards to the state cal ready system that impacted our ability to better to optimize our understanding of the status of the deposi epidemic in san frano and partner notification. The state is telling us that those data are fixed and we are improving our ability to monitor the epidemic as a result and as we look at the data coming in, there may be some adjustments with regard to the data that has been posted on our website. Weve received a large bonus of thousands of tests, reports that were previously not calculated into our Positivity Rates. The good news is those were for the most part negative results so we were counting for the positive and of course, even with, not of course but just to highlight that with the cal ready system challenges people were still getting their positive test results from their provider. In terms of the few pieces on the Behavioral Health side, the mayor announced last week that a collaboration between the Health Department and the Fire Department ems6 in terms of creating a Street Crisis Response Team that will pair First Responders with Behavioral Health workers on the streets and ensuring that people get the Behavioral Health services that they need in real time when they are engaging with First Responders and this is a Pilot Program and we expect to have it up and running in the fall and lastly per president bern allies discussion around the heat, we have been working with our communitybased organizations and with our team to make sure that people understand the precautions necessary if given the heat advisory, and combining that messaging with covid19 prevention messages, so drink water and stay cool, wear face recovering, avoid strenuous activity and wear light clothing and weve been coordinating with office of Emergency Management to consideration of opening cooling centers if and when we meet the criteria to open them in this age of covid19. That completes my directors report and im happy to take questions. And so, if the commissioners have any questions about those articles or what i went through im happy to answer them. Thank you. Im sorry you are muted. Commissioner bernal sorry about that. Before we hear from commissioners, mark, do we have any Public Comment. Anyone would like to make Public Comment press star 3 and im not seeing hands right now. Lets check. Star 3. Looks like we can move forward. Commissioner grown. Commissioner green. Unmute yourself. Sorry, i didnt have the question. Im sorry. If i raised my hand it was in error. You are just waving at me. We dont see questions from commissioners. If we dont have any questions or comments, from commissioners or someone is having difficulty raising their hands in the system if you would like to just speak up. Commissioner giraudo. My question is when do you think the state crisis team, which is wonderful, will be able to launch . Some time in the fall and im happy to provide updates as we get a sense of the capacity to resource the project and also to hire people. This is claire. I just wanted to say that we were working pulling together and a team to just really delve down as the next step for everything we need to do for that project to make sure that were in close communication with hr and the existing stakeholders to move forward with that. Im looking forward to it and i think its going to be great. Im hoping so as well. Its a department of the department and commissioner. Any other questions or comments, commissioners. If not, well move on to the covid19 update. I was just going to ask i was going to ask when it does start, if we can be notified and then get an update because this is an Exciting Program and one that we would like to track and im sure the public will too. We would be happy to coordinate with the commission and provide an update on that. Absolutely. If there are no further questions well move onto the covid19 update. Director colfax. Can you hear me . We cannot hear you. Now we can. You are good. You can hear me . Now we can. Sorry about that. Well, again, commissioners, director of Health Providing you with an update on covid19. I have a series of data points to review with you and then of course happy to answer any additional questions. As you can see, were at 842,700 cases of covid19 diagnosed in San Francisco. Approximately in the last two weeks and under cal ready system has created challenges and we have estimated about 1,400 people who have been diagnosed in the last two weeks of this would be considered active infection and we have a total unfortunately of 70 total deaths among San Francisco residents. Next slide. This is our test team numbers and we far exceeded our goal of 1,800 tests today and were now almost at 3,900 tests on a seven day rolling average and you recall that we set a new goal for september of doing 5,000 tests a day across the city and were making Good Progress towards that goal and demonstrated by the seven day rolling average on the curve. Our over all seven day Positivity Rate is 2. 97 and we have started our adaptive testing strategy that i talked to you two weeks ago with mobile teams providing testing particularly in the southeastern part of the city and where we have high Positivity Rates and we currently have two test sf mobile sites going into neighborhoods with highest prevalence rate with a capacity to do a total of 500 additional test as i day compared to where we were just a couple of weeks ago. With regard to cases of Race Ethnicity and continuing to see high preportion in the Latin X Community and we are working with key stakeholders, Community Leaders and providing the supports services and the cultural Economy Services and with regards to addressing the covid epidemic in the last inex population. With Sexual Identity data i did want to share this data with the commission looking at cases, cases diagnosed and you can see here that we have under Sexual Orientation, and this is again, a data that doesnt include all our cases. You can see this was for cases interviewed and after april 27th of 2020 you can see the distribution by Sexual Orientation and by gender and next slide. I also wanted provide covid19 case and deaths by age group just to emphasize to the commission that we have, in terms of distribution of cases, this is a pandemic people who are under 50 over all and we have seen a shift as we seen across the nation to a younger population that weve had an increase in cases among people younger than 18 and particularly in the last few months and you can see our distribution here as currently stands and then that is by age group. You can see that we continue to reflect with over half of our case, our debt screen among people over the age of 81 and you can see 3 of our cases where people over 81 or over with regard to the deaths 90 of deaths that weve had in San Francisco of the 70 deaths, 90 have a known whoa more bid condition about the disease and being particularly deadly among older adults and the people with comorbid conditions. So a quick county cove covid comparison. Our case rate is low compared to similar jurisdictions across the country. Death rate significantly lower than other communities and our testing rate is higher with the exception of the testing rate in baltimore and you can see where data are available and we are in excessive including new york city which has done a lot of work to stale of testing were at 3. 61 and theyre at 2. 59 per 1,000 residents. So this is our current hospitalization rate its the farright is our current hospitalization rate and this is our hospitalization rate through the pandemic that peak that we saw in april and may going down to a low of 26 hoppizations in late june and we see the city climb to 111. You can see that weve had some variation in august where were currently most recent data shows a total of 84 hospitalizations and the dark blue lines are the number of people in the icu and the light blue lines are people in our medicine surge that is so were watching it carefully and it is to note the peak and the decline is quite similar and so far to what we saw in april and may with a 94 hoppization and another increase and in late april and early may so were wait to go see if we see a similar pattern here so far it looks like it may be marrying that. We dont have conclusive evidence why theres this by model distribution but its something that were observing and determining why we get this distribution again. Next slide, please. These are data on our key health caters and we have the slope of covid19 hospitalization thats rate of increase shown here at the 1 level is now green and that is alert just a few weeks ago commence rat with that indication we are in a surge. Our hospitalization Capacity Remains in the green with 25 and of our acute care bed facilities and our icu bed capacity is in green and we are high levels of case positivity and this is going on for a number of weeks now and were at 11 and for 11 cases, per 1,000 over seven day rolling average and we, again, to stay at that high level. The testing numbers are ability to succeed our goals and now going to that goal 5,000 in september and our Contact Tracing and partner notifications those numbers are in the orange and lower than we would our goals and again, part of this we attribute to that backlog of testing that happened a couple of weeks ago that was very challenging for our team and we hope coming in, we will correct that and we caught up with our test teams window in terms of turn around times we hope the Contract Tracing numbers will improve. Weve made expansions in our Contact Tracing capacity and are staffing and anticipating the potential for 200 new cases a day. Expect those numbers to improve. Over the next few weeks and then our ppe within n. D. P. H are good and were in a 30 day ply of dpe. This is update on our reproductive rate of the virus again is how quickly or slowly the virus is reading through the population and its less than one and the virus is slowing down because fewer than one person is getting infected and its basically neutral and one person infected infects one new person and a reproductive rate means for each person infected more than one person gets infected and you will see the solid blueline demonstrates the estimate the row productive rate based on models and this is not a number that we can precisely measure and this model at uc and uc berkeley is something weve been using on from early on in the epidemic. We were at a rate as low as. 8 in may and june and it was 1. 34 a number of weeks ago and were down to. 93 on the farright of the curve. Confidence are still wide so we could still be above one but over all the trend is the favorable direction but i would just add we want to continue to see that number go down so that completes my covid update for the commissioners. It doesnt complete it because i did want to add one other component to this which is we were added to the state watch list because of our covid19 hospitalizations. We remain on the state watch list due to our high case rate which means for now we are on pause on our reopening and we are working with the state to determine what the next steps would be when we are off the watch list and the state is we are hoping the state will issue more detailed guidelines about what accounting the may be able to reopen after coming off a watch list and i asked our Health Officer to create a detailed plan in terms of when our reopening face may look like Going Forward given weve been on pause for most of the summer and we are in this pandemic and he will be in a serious situation for a number of months so he is now working on that in terms of what gates we may use to consider reopening and business and other entities Going Forward as we enter the fall into flu season and other challenge thats may lie ahead so thats my update for the commission. Do we have my Public Comment. I dont see hands. If you would like to make Public Comment on this item, press star 3. Lets give it a moment to make sure we dont miss anyone. Star three we have one caller. Give me one second. Just for you to know, i have a timer and everyone can speak for two minutes per item and i will start in the order i see raised hands. We have several. All right, caller, you are on. Caller hello. Hi. My name is know he will and im a hairstylist in San Francisco. The salon i work at has been closed for five months and that is seeing salons reopen safely. Its baffling we are unable to work in San Francisco. We have been waiting watching neighbors and close theres door permanently and were still unable to pay our rent as you know employment insurance have run out and the situation is dire. Hair salons are controlled environment we we practice safely since we are licensed and regulated by the state and we focus on disinfection and client protection. I firmly believe and as evidence shows that by allowing salons to reopen will not spread the covid. Please let us reopen. Hi my name is sha ray a and im the ex tough cultural district and one of the questions that i have was about the rates and ethnicity and how its tracked on the presentation that you presented. Specifically does that. 4 include those who indicated both native american and other ethnicity . And also, on those Health Funding related to the mayors most recent budget announcement, im curious if theres still proposed cuts to major native American Health programs. Thank you. Just a reminder and that the commission will not answer questions thaw may ask but they are hearing you and noting them and passing them on so you are being heard. Lets see, next caller. You are on, caller. Hello, caller. All right, theres no one there. There we go, im sorry. Caller you have me now. Go ahead. I apologize, i have so many mute buttons i had to find the right one. I want to thank the commission for its time first of all, my name is craig and my wife owns a hair salon in San Francisco and i want to join with the womens voice who said you know, theyve been closed for so long now and its absolutely brutal and i would urge that these hair salons should be open and to ask the commission to do whatever it can to row think the policy of the city and county and urge the state to move that way and the main point id like to make quickly is that i think the instinct sof these salons and maybe come from a sense that this is close Contact Business they must be vectors of spread and that is based on proving to be an empirical mistake nation wide. You have the small study out of this cdc which was reported in the times of colorado governor tuesday talking about where you have two symptomatic hairstylist. They treated about 140 people not a case was report and they trusted 67 of the clients and none came back positive. On august 6th ut doctor and saying he wasnt on board with even the states cutting people outdoor policy because he had seen quote no evidence end quote, that salons were spreading this as fast as other businesses were in allowed to remain or reopen and to have them lumped in with bars and restaurants is always seemed just misguided. One salon and perhaps this person will be on the phone but one salon in San Francisco, who also owns a shop in austin, texas that has been open, reports over, this is maybe two weeks ago, a week ago, about 3100 clients in zero reported cases. I know my time suppose. Fair enough. Thank you. Great. Commissioners, i believe that is all. Let me go. Theres another hand but i believe give me one second to try. I believe thats all. Press the button to raise your hand. I do not see any. I will raise two questions. On your last slide its encouraging news we see our reproduction number below one at 9. 3. Recognizing that our early success in containing the pandemic involved close coordination with the other bay area counties and with work that you and our Health Officer had done with them. Do we know or do we believe the reproduction number is also following the trend in surrounding counties and it may be below zero in those countries . Thank you, commissioners. So, when is interesting in looking at the rate around the surrounding counties is theyre leg than San Francisco right now and we dont know exactly y one thing that happened is their rate increase before our reproductive rate did and so we may be behind. In other words, they went up faster and we were behind them in the increase so hopefully our decrease is lagging so were watching that. The other cause for concern is that we are a much denser injuries diction than most of the other surrounding counties so, it is plows able because of our sense tee and because of the high level of virus that without greater adherence to the social distancing, the masking and good high queen we will continue to see a relatively higher rate than the other surrounding counties and thats my response, thank you. San francisco is the second densest jurisdiction in the country. I believe. My second question goes back to case demographics you mentioned we were putting into place our adaptive testing strategy with mobile teams that are sent into neighborhoods in the city with higher prevalence and do we expect that result in a higher percentage positive number in our testing because were being more work would community and let people foe there is Testing Available so were in the process of on what day and well look at the data evaluating whether we are in deed going where the virus is and based on those Positivity Rates and before we can draw conclusions about what the data are showing us in terms of how we may need to adjust. It may be the report and to understand and if we do see an increased Positivity Rate and it could be a better targeting our testing events that are most infacted. There are reason and if were being more more precise about where we need to test, that would mean we could have at least initially a higher testing rate. If our prevention interventions and our testing sat rates, we would expect to see that Positivity Rate to go down unless the numbers continue to go up and we continue to focus on basically the increasing cases going up as a result and reproductive rate so theres a combination of factors that could influence the Positivity Rate Going Forward and our goal is to basically look at our Positivity Rate our Testing Programs and the Positivity Rate at the mobile sights in conjunction with the reproductive rate as well as our Contact Tracing Positivity Rate and that Positivity Rate has been from two to three times above average of our over all Positivity Rate so that starts to go down its a good sign that were basically saturating the groups with the highest risk for covid19. One more question. You mentioned that we are doing a much better job in our resulting time for testing. What are we looking at for our resulting testing and is there a difference between the time for getting results between our publichealth labs and private labs or private providers . The most recent data i have is that our large scale testing labs and lab course so i have lab core turn around time is 2. 2 days now dramatically better than it was. And its a huge advances there and with our city test sf site and oir publichealth lab results are available within 24 to 48 hours with a possible outside window of 72 hours. Thank you director colfax. Commissioner giraudo. My question is about the increase in the rate of children that was up rather significantly it seemed and if you have any information on the root of the increase in this population of camps . So there are a number of consideration thats have been taken into with regard to that rate of increase. The most basic one is the outbreaks are more widespread and occurring in multi generational households and adults who are essential workers and working are essentially infected bringing it home to the households and kids are becoming infected as a result. The other plausible explanation is were six months into shelter in place and the kids are just getting out more and interacting more with other kids and perhaps other families and there may be increased transmission there as well. Thank you. You dont see an increase in the Daycare Centers . Specifically. I will check. Were not seeing a sustained increase in the centers that im aware of but i can report back to you on that. Thank you. Oh, yes. Thank you. I had about throw questions. One was first in terms of the data coming in i thought i had understood previously that because the reports also came directly to the department along to the state that we werent going to be impacted to a great extent so is that still true or do we feel that actually a number of things slipped through and they never got to us and they got to the state and when do you then expect that the data would be aligned correctly within the week or give us an estimate if you can. Yes, commissioner, thank you. So we do get some data directly locally but a significant preportion was set up through the system and sent back locally so we do expect some disruptions as a result. For instance, this weekend we got 45,000 test results that were backlogged and not reported into our system. So were now repopulating those test results based on when they were drawn and resulted so that will probably influence our Positivity Rate on some dates. Almost all those test results were negative. So if anything our Positivity Rates should go down. Rather than go up. And im being told by our data team we expect provided the state is accurate saying they fixed everything that they that was malfunctioning at the state level, we should have a pretty we expect to have this resolved over the next few days and certainly by next week. We would be able to see what was there before versus once the state has repopulated the state data has gone out so that we can see the difference the two. Ive asked the team to track that. Yeah. That would be helpful in terms of understanding the impact and as you said, if these were negative it would lower our rate. If i could just clarify. Our reproductive rate wont change because its based on hospitalizations and those hospitalizations are local data so the fall function did not effect our hospitalization numbers and the reproductive model would still hold. I see, thank you. That is a very good clarification. Second good evening i have and theres a publicity at this point in regards to flu vaccine and does the department have been put out advisory about when people should be getting. Theres some data that says thas people should get it earlier and versus the usual period of time where additional device is said because here in california we normally see it in december and january you should be closer to october or november but others are now saying it would be useful to get it earlier so it doesnt confound the symptom apology that may occur with a potential covid surge. I dont know if the department is looking that in terms of it offering officers our residents. Thank you for the question. Dr. Horton, we have been working on killing our flu and ensuring that gets out and people are aware of the importance and i dont know if you can share with the commissioner some Additional Details or certainly we can provide those at the next meeting if necessary. I can speak to that. This is how good afternoon commissioners. We have had our commercial meeting can you hear me ok . Yes. Weve had our initial meetings with ucsf and commune i canal disease putting together a strategy for the flu season for immunizing as many people as possible. Dr. Chow, i cant speak exactly to how it will workout the timing. Its still part of the discussions but i will say that our approach is going to be a one of removing as many barriers as possible to immunizing the public. We expect well have a good supply of flu vaccine this year and were interested in speaking outside the box and really getting as many people as possible in vulnerable populations and immunized as possible so we can prevent what everybody is concerned about which is the double pandemic. We have a team now from the dph that is working with folks in the public command center, across the network and with other systems including ucsf on our approaches here and taking it very, very seriously and if you would like, we can have that team come report or send you a written report after this meeting. This is claire and im sorry i had trouble unmuting but just wanted to echo this is a top priority and its a top datadriven and well track throughout our system as well to make sure that our stable Patient Population as well as the other patients and people we are treating throughout our system get the flu shot this year. Im thankful for the response and i think because its urgent, when you do come to a conclusion about how to roll out the campaign, some of us are being asked about this even though personally and professionally and it would be helpful for all of us if that information is available its also passed on and it would be helpful. I have one more question, which was more trying to understand because as i understand that you know were in a city in which schools are not going to be inperson was were on the watch list i think. Can we get an understanding as to what is our position on schools . I know that there have been some orders and issued but theyre not really quite clear and that would be in regards to the primary and secondary and then what are we doing about universities . I mean, are they just on their own and its up to city college and sf state or usf or are we also giving advice at this point . There are two types of questions, the schools and advice and what happens with the upper Higher Education . So were in a situation where the state will not permit inperson learning until were off the watch list for two days and the exception of that would be any waivers with the Health Officer so our Health Officer is in the process of drafting a letter to School Administrators detailing the process that would be required and the criteria required to be even considered for a potential waiver. So, the plan is for us to ensure that the environment in which schools are open is safe and we adhere at a minimum to state guidelines with regard to social distancing and good hygiene and to keep children and staff as safe as possible and as you know, i think commissioners San Francisco Unified School District has dedded not to open inperson a learning until next spring at the earliest and so right now, our focus is on schools that many wish to be grant aid waiver to reopen and welcome to the state for further guidance when were off the wait list in terms of what the criteria would be from the state level and this is something that dr. Aragone, along with our pediatricians and other experts including collaboration with ucsf are looking at the National Situation and looking at cases where School Offerings have been detected and what are our criteria going to need to be Going Forward so that schools can open as safely as possible and we have the authority with regard to hire education and learning and dr. Aragone is working with institutions of ire learning as well to ensure that if they do meet criteria and the guidelines are as concerned by the Health Officer. Thank you. Thank you. Im doing my best to take commissioner comments and questions in the order that hands were raised. I see commissioner green and after that commissioner christian. Thank you for all this excellent information. I was wondering if you had anymore detail on some of our hoppization lengths of stay and whether that is trending in anyway and also, the demographic of the patients who happen to be hospitalized as we see the case percentages in younger populations increasing. Are we also seeing changes in the demographic of hospitalizations and how we have data that are the ethnic backgrounds of our tested patients along with began you lar that patients that passed away but do we have the subset of people who are hospitalized and another thing that have we got any plans to offer flu shots at our testing sites, especially our mobile testing sites . So thank you for the question. Our length of stay of hospitalization appeared to be going down in may and june which may have been evidence of less disease severity and the latest information that length of stay has gone back up again so i can provide more details about that length of stay in a update to the commissioner earlier and drr advance planning officer, has a lot of details on the hospitalization data and we can certainly share that before at the next update as you request. Weve also been able to work with hospital zoos that the detailed data on patient demographics is going to be made available across the system before now weve only had in sight into the hospitalizations at sucker burg San Francisco general so that data system is on its way to being developed and we can report that to you on a timeline in terms of when we can report the demographics of the hospitalizations over all. Its been a lot of high work on part of the hospitals across the city and i want to thank them for their collaboration and cooperation and this is ensuring data across our systems and including systems that dont have our systems so theres a lot of work and a lot of good collaboration and it will help us better plan Going Forward in terms of our Hospital Capacity and the needs of the communities of people who are being hospitalized. I just wanted to answer part 2 which is the here now group is that has come up an as idea is going ahead and vaccinating as we swab them. Many of many ideas that is no yonge door to the flu vaccine. Great. Thank you. Commissioner christian. Just adding onto the questions weve had about the flu. I was wondering whether one of the things that will be considered in expanding access will be pushing out the termination date for the flu vaccine. Dr. Chow mentioned theres been information that, here in the bay area it doesnt peak until december. And so, i also know that in the past, it is difficult toward the winter to get a vaccine so i wonder if that also might be a part of what changes to make it more fatigued against us. And so, no need to answer that now obviously. My other question touched on one of my other questions touched on what commissioner giraudo asked about the demographics in kids and dr. Colfax you said one of the hypothesis was related to essential workers and People Living in larger households and bringing the virus home so are we seeing the same disproportionate rate of infection rising among children in people of color and the black population and lean tino. I dont know whether its accurate or whether or not you can see that yet but do you have any information about that. We have the information i can share with the commissioner. That is my understanding. Yes. Ok. And, obviously whatever strategies were looking at will address that attempt to at lea least . What information can you give bus what were seeing happening in the Residential Care facilities for the elderly, the rcfb versus places like laguna honda, the Nursing Homes . Is there anything that the city has control over given it may be, i dont know a lot about these facilities but i imagine some of them are private and not city run. So we do have a team thats been working with the rcfce since early on in the ep dem spick we support them with resources, guidelines, inform and guidance and information about where people can get tested and certainly if people are symptomatic and they need tested we support it and so we n report back in detail but its a focus of ours since the beginning of the pandemic. Is it voluntary to adhere to the guidelines you suggest . We provide the guidelines. Weve not required its much les. The over all risk to the population is lower. Certainly, we have the inform and guidance that can provide more details to the commission and to you by the followup. Thank you. That would be appreciated. Thank you so much. Thank you, commissioners, before we move on, i know i did that commissioner chung did have a question and shes not able to be with us today but related to soji data and the end of july i believe. But looking at data [please stand by] [please stand by] we can move on to general Public Comment. Please press star three and ill give it about ten seconds and everyone please know that were someone knew at webex. Speaker i feel like were kind of abandoned here and my main concern is theres a big inconsistency between the rule for opening churches and restaurants. I dont know why because were under a much more serious height restrictions and i havent gotten a clear answer from anybody about that. And its quite frustrating, especially we got rained on yesterday and as the winter comes in were very worried youll shut us down again and we cant go indoors to have our worship services. Weve been waiting months and months and months and we can safely go inside and we wear masks and wipe everything down. Speaker i just want to echo some of the things a couple other people said and one of the things i would like to request, i guess, is that you consider taking us off the highrisk list because its keeping us from opening any time soon. Were trained anyone Infectious Diseases and we take courses in bloodborne pathogens and our clients are wearing mansions andmasks and alot of the peoplen francisco are small and sometimes its one client, which seems very minimal risk and as the earlier caller said, theres data showing that we are not the place that is the vector of spread with unemployment highly inaccessible, theres an entire industry that could go back to work that could help with that and San Francisco and california is having less benefits to take care of and i think that the risk is very low as a cosmetologist, i wanted to throw that out there and be another caller to say, please, consider childrewhen youre looking at te businesses that are risky and cosmetologists, we dont gather in huge numbers. So, anyway, thats just what i wanted to say and hopefully you will consider that. Grocery stores are far more dangerous to go in and thank you for your consideration. So to discuss the proposed updates to the patient rates for the department of Public Health, for background, especially for those who are not on the commission over the past couple of years, we charge, we have a charge master that is our patient rates for services that we provide in our hospitals and clinics and we periodically propose updates to those rates an. In ago decision to not coverg the cost, the remainder of the cost to the patient, to the insured individual. We have about six of our patients who are commercially insured and within that six , about onethird of the six was covered by health plans that were potentially in this category of legally being allowed to do this balance billing where theyll cover a portion of the charge and the balance will go in a bill to the patient. And this is a practise that is widespread and kind of known through press coverage and that sort of thing, but it became increasingly clear that a lot of our patients were negatively effected by that practise. That was out of character with our mission and how we want to approach our relationship with our patients and it was in 2019, april of 2019, we brought a package of proposed changes to the Health Commission which the Health Commission approved and designed to limit that practise. Were creating a new policy if youre commercially insured you will only pay what you would at an innetwork hospital. We will simply say, tell us what your Insurance Plan is and charge the coinsurance or whatever it is under your insurance but not that additional cost for being out of network. Secondly, we established out of pocket maximum payment at all income levels and it does vary by income level and that ranges from zero for those who are below 138 of the federal Poverty Level up to a maximum of 4,800 who are at a thousand percent or more of the federal Poverty Level and those out of pocket caps are available to all patients and in addition to that, we put into place a lot of changes in our administrative policies about how we communicate about Financial Issues and how w and significans to the patients at our department work. And im describing all of this history, particularly because at that time, another one of the pieces that we exite committed o doing was to benchmark or charges and our patient rates against peer hospitals. We wanted do that just to assure ourselves and assure the commission and other interested parties that our charges were within the realm of what other hospitals and consistent with the industry. And so weve done that and, ill talk a little bit about what we found. I do want to emphasize, though, because of these protects that e put in place, the out of pocket maximum is the case that theres very little remaining relationship from the perspective of the patient between our rates and what theyll pay for care. Its primarily becomes an issue between the department and commercial insurance which is one of our cares, particularly at the zuckerburg General Hospital. So we did go through this process to analyze our rates much more rigorously than we have in the past several years before bringing them to the commission and we hired delight consulting to do a peer benchmarking study. They did that, selected a number of hospitals, compared our rates to those. And made recommendations on how we ought to adjust our rates to be more aligned with the industry standards in california, Northern California in particular. And so, they evaluated 15 peer hospitals, made recommendations for areas where we are above the norm and below the norm and we applied a threshold where we are adjusting our rate so that well be within the 75 percentile of that peer group. Thats higher than the median but that reflects the fact that San Francisco is a higher cost in our study group and it keeps us it takes that into account while keeping us in mind with the industry. And so weve proposed some adjustments in the rates here and there are some areas where the rates are proposed to go up and some proposed to go down accordingly and you can see that in the memo attached to your Commission Packet in a table at the end of the memo. And there are two areas where weve proposed to phase in those rate changes over time and those would be in the Emergency Department charges and trauma activation charges. Ed charges would have gone down according to the trauma down. What were proposing to do because of the financial situation around covid is to hold those rates flat and allow them to catch up as industrycost inflation occurs and that we would then be within that benchmark period over a period of three to five years as a opposed to making that change immediately in a single year. And so those are the modifications. Taken together, these proposed rates would increase our revenue by about 2. 63 million versus the last approved rates ordinance and thats an increase but a lower rate of increase that we had then we have proposed over the last handful of patient rates ordinances. And as i discussed, it would be variation and whats going up and whats going down in those categories. And so that was a lot of talking, but i wanted to make sure to remind and connect this patient rates ordinance with the previous discussion that we had at the commission and how we followed through on our promise to do this analysis and this study prior to bringing you a new set of rates to approve. Im happy to take questions and we have the team from our outpatient Financial Services and reimbursement groups here, as well. Folks, if you would like to make a Public Comment, please press star three. I dont see any hands raised commissioners, i dont see any hands, so you can move on with any questions or comments you have. Commissioner chow. Yes, thank you, mr. Wagner. It was a very good explain expln as to the events over the last 18 or so months. I am only looking at i think technically, on your page two of the ordinance, i think its a typo that since well be passing this, i just thought that we should at least take note that in your column or medical, surgical 2021, you actually have it has 9796 and i think you meant 9769 because the next year, it is 9769 and that would go along with your thought that you werent raising rates. You put an extra 30 there and you can let me know why. I believe that you are correct, dr. Chow and thank you for catching that. I think that has two reverse numbers and intended to be 9769 and we will clean that up. And right, that was all that i wanted to comment on so that we can have an odd rate going through. Thank you, thank you for that catch. Thank you. Otherwise, i saw your explanations to commission grange and she may have some questions but im fine, thank you. Now. Thank you. I just wanted to thank you for the extensive answers to the questions, they were clarifying and i congratulate you with the things that were troublesome to the public and very much appreciated the work, yes. Thank you, commissioner and im sorry that i got the ann answero you last minute. Perfect, thank you. I would like to move to approve if were at that point. One second. Do i have a second . Second. I will do a role call . Actually, im noting to amendment needs to be made for the correction commissioner chow has made and well make sure that is taken care of. Role call, commissioner chow while youre on the screen. Yes. Chair car role call . The item passes, thank you. Thank you, mr. Wagner, and your team. Well move on to the next item, the laguna honda hospital and the gift fund budget for fiscal year 20202021. Hello, commissioners and good afternoon, commissioners and dr. Im william frasier. Currently im a dsw worker in outbreak management, and so thank you for having me on your Meeting Agenda today and thank you, mark, for your excellent work in facilitating this meeting. Laguna honda hospital seeks your approval of the 2021 fund budget. We are putting our budget together in the spring before the fiscal year and this year we faced a bill challenge determining what life was going to look like at the laguna honda and how best to meet the needs of the residents through our gift fund budget. Our approach was to go at it with the hope that things would return to normal sooner than later. Of course, that doesnt seem to be the case, but were hoping that well be able to pivot and adjust. And an example of this is early on in the Public Health emergency, we use gift fund monies to purchase 20 ipads im sorry, 50 ipads, to facilitate video messages between the residents and the families and friends. The gift fund remains a a wonderful resource to help us meet the needs of the residents. And so, im going to take you through the budget and just point out any variables that you may be interested in and i will let you know that theres been some reorganization and you will see for the first time we have an item called discharge support previously undermiscellaneous and were ramping up to prove the success of the discharges to the community and were using the gift fund to provide residents with items like toiletries, clothing, luggage, and things like that that would help them be successful in their discharge. And some other variables that you should be aware of that there are some expend tour expee related to purchase orders in the Previous Fiscal Year and there will be well, actually on the 14th, those charges reverted back, but i had to have this information in on the 13th and so, i would say that the total expenditures for the gift fund budget, you can see at the very bottom as of the 30th i would probably would estimate theres another 15 to 20,000 that will be reverted back to the Previous Fiscal Year. But just going through the different line items and the variables you may be interested in on. First on Behavioral Health, i want to explain the increase. Increase. Our Behavioral Health program, specifically what we call our laguna premiere club acquired a special computer system, especially designed to meet the needs of the ederly and disabled residents. We got that through the wish list and that comes with a 3,000ayear subscription for the content and its a great, great resource for that particular items going up. And you can see that weve also added covidrelated support. Of course, well need to address those needs, but we received 13,000 of donations, specifically to benefit the residents. And that is our practise, is to acknowledge and to try to meet the intent of the donors. Then theres discharge support and i do want to explain the friends of laguna honda wish list. Weve been working with the friends to kind of line up our fiscal our years. They work in a calendar year and we work in the fiscal year and weve been working to kind of align those so that theyll Work Together, but you may remember i came to see you maybe well, i came to see you in 2019, asking you for an increase in that particular budget and we have to go through a process of having their donation accepted through you and the board of supervisors and a number of issues, including covid19, prevented us getting that through the board of supervisors before the end of the fiscal year so we were unable to spend that. So we were carrying that over and the 90,000 reflects what laguna honda committed to donating this year. The only other item that looks variable is the memory care program. Theres about 5,000 worth of expenditures that will be reverted back to the previous budget and will be eventually reflected there, but that also represents plans on the part of our memory care programs to up the acquisition of century stimulation equipment. And if there are any other items there that you would like an explanation for, i would be glad to give them to you and i would glad to answer any questions that you may have. Before we move on to commissioner comments and questions, secretary, do we have any Public Comment on this item . We do have at least one. I will remind the public if you would like to make a comment, press star three now and ill unmute the one call theyre i see. And i will put two minutes on the timer. Are you there . I see commissioner green. Is that a leftover han raise from the previous item . I think thats a lefton the other hand hand. Thank you, commissioner green and do we have any other comments or questions from commissioners . Can i just express my appreciation to mr. Frasier for the completion in the work that laguna honda are down as representing by mr. Frasier and in the overall Covid Response . This is an intersection and i just wanted to add that laguna honda, weve had a total of 82 total covid cases, 60 among staff and 20 among residents and so far, right now, weve had no dennings among the residents due to covid19. And we have no active cases among residents. We have ten active cases among staff, which we attribute to the increasing community spread. But just to reinforce that this is supported by the gift fund are more important than ever given the covid19 pandemic. As the commission knows, laguna honda has been severely restricted because of the covid19 pandemic and just i want to reinforce how important it is that the residents get the support that they need, especially during this extremely difficult time. Thank you. Thank you, director. And i also want to add to directors word, thank you, mr. Frasier for your work and the work from all of your colleagues and laguna honda and your adaptability in your personal work and everybody there. Laguna honda is a model for the nation in responding to potential covid outbreaks and its work on the ground, as well as cooperation with it federal government, the cdc and i know there are many Lessons Learned that dph has applied with other longterm care facilities in San Francisco. And so that is directly attributable to the excellent work thats being done at laguna honda and thank you for that. If we do not have any other questions or comments from commissioners, we can entertain a mission to approve. please stand by . Im not hearing him. Ok. Well, i guess what we can do is he is in the next office over. We can mask up and carry an with our presentation. Thank you very much, this is just a special report from our Covid Response dr. Brown is on our office right now. Good afternoon, commissioners. This is a special report of our projects that we have been doing with the covid19 response. Weve been activated since day one towards the end of january and been very busy both with Covid Response and also running the 911 system. Weve been wearing multiple hats and i just have to do a big shout out to our staff theyve been working tremendously hard on creating innovative projects and not complaining and just doing a fantastic job. Is without them we wouldnt be in the place we are right now as far as our projects that were doing and also the 911 system. So, just to give you an update of our presentation summary were going over some of the projects that weve been working on. And i think the commissioners did receive a dictionary of were start with the mow chalk dr. Brown will go ahead and give his presentation on this. Can you hear me ok, commissioners . Yes, we can. One of the major functioning is acting as this medical operation coordinator or mohawk and we are a link between the San Francisco as a city and county which is called Operational Area so were looked for coun tease in our region which is region two of the state the bay area going up to the oregon border and and through that region to the state, so when theres a need that we cant fulfill within San Francisco, either by the normal functions such as a hospital purchasing to their supply chain or obtaining through their hr process personnel, then we go to the region with the request and if it can be filled by our coun tease in the bay area, that will be done and if not it will be brought up to the state level. So, some examples of the functions that were doing coordinating disaster medical Health Resource and patients distribution and medical evaluation and inpatients Emergency Care provider around clarifying regulations, getting a scope to practice established that type of thing and then, assist ing the establishment of field Treatment Facilities and these are examples what weve been involved with so far. Were now up to 64 resour request examples of these range for large items like a federal medical station which is the basis for the sites up in the practice seed yo to cleaning supplies such as wipes disinfect apartment rapes and it depends what we are unable to we have helped out other communities in the drug during a phase of their illness. Its closely allocated by the state to the difference county and the different cities and counties by their hospitals Covid Patients burdens. We saw dr. Colfaxs presentation its dynamic. By the time the allocation is received by the hospital, they no longer need it or they need more. When we tried to exchange within the city we do it through our Hospital Unit here at the covid19 command center however when we dont have that ability we need some and well go outside the county and so we have helped out slano county that needed an emergency transfer. Thats an example that came through the mohawk. Coming in and out of the county most recently you are aware from Imperial County and the surge they had down there and from the difficult outbreak at san quinton, San Francisco is still receiving some patienc patientsk when this started in february or so we had the grand princess cruise liner that came in with several patients that had to be distribute today the bay area counties and participated in the distribution of those patients determination of where they went to. Weve been helping with plans on the dph side and board and care facilities utilizing a blended ems providers and emergency providers from hospitals and from the field care clinic. We have responded to request mainly for information from the state office of Emergency Services and then weve been working with dr. Luke john day and the group of chief medical officers from all of our hospitals on the distribution of the medication. Were now getting weekly allocations and theyve been increasing in size. When this first started, we were getting them every two weeks and it was a much smaller number. Were trying to respond quickly and pivot quickly as our needs change when we dont need the medication we try to make sure it goes to other counties that need it and when we need it we get exactly what we do need. Next slide. Thank you, dr. Brown. The mohawk program is something that is on going. Its not necessarily due to disasters but its a program that is constantly in the background and so early on, were test come up with a based on very Little Information knowing that there was a pandemic pending and it looks like historically there was a big push on the 911 system and those patients would end up in the hospital and we looked at it and we came up with our ems search plan for the system and we followed the same color coating and it means the Different Levels of search weve had. Our expectation is we would surge just like the hospitals were but what we found out, up until a week ago is the 911 system actually dropped about 25 in call volume so for the last five months, the call volume, the 911 call volume has been down about 25 and up until about two weeks ago, were back to normal levels. Our ems surge plan is based on a lot of different factors or triggers and each one of those triggers represents a response that this system will automatically kick in from green to austere care out in the community when things the system overwhelmed and we had this in place and its our working document for when or if a surge happens in the 911 system that its pushed over to the hospital system. Along with that, we developed a transportation and communication hub. We started out with one dispatcher and in our Conference Room at 90 van ness into a fully functioning interactive dispatch center at bill graham. We have multiple people 24 hours a day running a, basically a Transportation Service and part of that service is we do the inter facility transports from the shelters to the hospitals. We do street to shelters, greet to hospitals and we also support the 911 system. We provide support to the publichealth Services Field testing unit on top of that and we have partnered with a lot of different people the publichealth nurse and nor cal ambulance and amr ambulance and theyve been very, very beneficial and the success of this program as you can see our volume is has up and down and theyve been steady and increasing and the need and transportations and we have about 15 paratransit bands on a daily basis and five ambulances for supporting ambulances and theyre there basically from 7 00 in the morning until running those calls and we have another based out of there which is the program which dr. Brown will talk about in a few minutes and its a very Robust Program and its been very successful and weve also just started a new program from a Health Officer order to test in the communities and we have a unit that will either go out on site and test someone that has passed away or we will go to the funeral establishments and test and take this gust and to the publichealth and finding out about that did have a cove and and up to date, along with that, we felt with all the shelter sites and place and we decided that one of the things is a safety of the individuals that are at the shelters, we developed a aed and external and and Training Program so we purchased the defibrillators and were currently scheduling training to train the staff at all the sites and the use of the its been a year and a half in the Development Process originally envisioned starting last doing a better level loading or matching of capacity for the system with their new hospitals coming online and for San Francisco central begun for helping with the diversion. We realize quickly in the development of this program we have a lot of input and thanks to our partners commercially and who went through three test of concepts and assimilation, pretty large scale and helped us to define the Program Parameters so were getting some data and looking at some specific outcomes that im about to discuss and should we experience levels of surge in the system and we have not, were very fortunate and being done on the preventative side and should we have that we will be able to absolutely maximize the ability of the ambulance fleet to find every single area of capacity in this system and have utilized every capacity with available rather than overload some areas and under utilize others. So this program is operating 24 7. It operates out of the health that you have just seen. Its staffing models its either a paramedic supervisor plus a emergency physician with base hospital training and base hospital means that physicians, Emergency Physicians that workout of San Francisco General Hospital who are trained in contacting and working with ambulance crews on a regular basis so every day there are calls to the base hospital from the ambulance crews or advice and for certain protocol items so theyre working with the county supervisors and when not available we have two paramedic supervisors that are again looking at the over all system and the hospital and and theyre able to factor in such items as icu capacity if that is limited and its been the biggest change that weve seen in issue weve seen around Covid Patients. Look at number that is 11,600 calls in three months and in our system to give you a sense of perspective, we have 50 to 60,000 destination calls in a years time and these calls they are the code two calls and redirect patients that are critical because its important they go to the nearest facility regardless of the capacity issues and then were also not trying to direct Specialty Center patients that theyre not directed by the caddy pilots and individuals who are on duty at the caddy system. Briefly listed are the goals of the system and in the first slide in the center daily transport average daily transport to static Emergency Department capacity. What this means is, if hospital has a 20 Emergency Department bids, then they are getting 20 ambulances over the course of the day. If they have more than that number of ambulances the ratio is getting to be greater than one and if theyre getting less than that, they are getting a ratio and the same 20 beds they were getting and 30 ambulances a day a 1. 5 ratio and five ambulances a day, so were trying to get this ratio this is all data post cove because its important to remember Emergency Department volumes have dropped by 35 city wide since the shelter in place order and ems has dropped 25 . Were not taking data before the pandemic, that would not be a good comparison. Were taking pandemic data before the Program Start and after. Were seeing improvement are goal being to get one the large number you see in the lower is the compliance rate of the crews with the programs are targeted here with 80 comply bans because from are exceptions and the crews cant communicate very well with caddy due to technical issues or other extenuating circumstances you might not call in and its present in hospital. We are finding that some things have been improving and other things staying the same and other things have not been improving. Theres been a total decrease in diversion which is part of our goals but were trying to analyze is that do you to the decrease volume in Emergency Departments and due to both. Were also seeing a little bit of a trend in off load time which is the delay that patients might have when theyre in Emergency Department getting were following up with hospitals with higher levels of diversion and longer turnover times and seeing where those might be cause be and whether or not theyre causing problems for the system. Thank you, doctor. One of the things that we have really looked at is the pre load of the hospitals or the front end of the hospitals. Were also with the communication hub. West ambulances there to help on the off load of the hospitals so for patients that are needing to be discharged to free up room for patients that are sitting in Emergency Departments waiting from a bed to free up. These ambulances and units can be used to move those patients out to sit by the sites or where they can do for a step down error. The other program that i talked about earlier is the testing unit. Just to give you an idea of where we are. We started out in june, late june, when we looked at our data in july, we only were at the 55 test and as of today, were at 230 tests. So fairly busy operations in coordination with the communication hub. One of the other things that we looked at in our surge plan is cardiac arrest. The potential of the exposure to the providers and doing cpr because were doing cpr you are pushing down on someones chest to compress the heart but you are also pushing the lungs which then air comes out which could be droplets so what we tried to do is create some programs its an assist program and if its a mechanical compressor so it simulates or does mechanical chest compressions we have less chances for exposure. We have 12 devices and four on the rescue with the Fire Department on 24 7 and one each on the amc supervisor and one on the marine union exit we have a few back ups. We did a lot of training and we did train the trainer and along with all of the Covid Responses, we had to stay on top of our policies and procedures and being thinking more towards what is coming next and preparing for it. We have the new protocols on mechanical cpr devices, the lucas device. We had to redefine our protocol on respiratory pandemic so we dont use certain drugs for ar solation of medicine and increase providers in an enclosed space in the back of an ambulance taking care of a patient. We looked at assess and refer things where we respond and 911 searches where someone might not need to go to the hospital so a 911 unit will go out there and assess the patients and refer that to another source of care. And we also looked at Airway Management policies and other than a designated and emergency room and i work with the state to allow us to take those patients as needed through other sites through the field care sites at southeast and we can take them to a couple of other sites and pick them up and and we used the basic lifesupport ambulances in the 911 system through the communication hub or or well do a memo that allows other providers to provide els ambulances in the system when it becomes very busy. We have changed our local optional scope of practice that allows ems providers to do testing and also weve allowed our ems providers to work in static healthily facilities like the field Care Treatment Centers or Skilled Nursing facilities in they run into staffing issues. We have looked at ems providers to assist in giving injections and and to make sure the crews have that information and they can proceed with monitoring their own health and falling over there occupation we have cooperation from systems and we have some holes in the system and were working and weve had about 316 positive notifications for ems contact patients than weve contacted up to 10 or 12 individuals because it depends if its a ill patient and there was multiple ems providers on site doing resuscitation and we want to be sure they have that information followed up with their providers. One of the last slides that we have is not only are we really deeply involved in the covid at multiple levels, so the Covid Response, we have our regular ems business that we have to attend to and running the 911 and they went out on july 1st. We have all the providers signed and were still waiting on one. Hopefully its coming soon. Weve instituted a new ambulance audit tool which helps us evaluate new Ambulance Service thats would like to come in and work in the city so that is up and running and we have one in the process currently and we have to do emt certification and accreditations and both emt and paramedic and we also had to move like i said earlier and the program, weve moved from 90 van ness to 25 van yes and this is a temporary location and well be moving again and probable february of 2021. I just want to give another shout out to the staff, they have been in absolutely an incredible humbling experience working with some fine, dedicated individuals and we would not be as successful as we are currently without their dedication and involvement and i just want to say thank you again and that is the end of our presentation and we will answer any questions that you might have. Do we have any Public Comment on this item . Do i not see any but if you would like to make comment on this, press star 3. Well give it a few seconds to make sure we catch anyone who raises their hand. Thank you dr. Brown for your detailed presentation even outside of a pandemic and services requires a great deal of precision and planning so thank you for bringing this presentation to us and for all the fantastic work you and your colleagues have done. We have a comment from commissioner chow. Thank you. I certainly echo president s comments and concerning this division and agency and im a very impressed with the caddy project. After so many years of looking at ways of trying to help the different adjust and and, i think that as we look at the future, and its not and under which if its someone elses work we would look at some of the previous benchmarks that had been established in terms of response and where we are now in regards to that and either in a local and comparison to either region or a national levels. In a couple of areas, we are continuing to monitor the situation and i think we have not seen any deterioration and improvements so two examples are, weve participated in the cares response and survival data base and National Project and 20 to 30 of the ems systems in the country, including all of california, and they provide over a two hospital discharge with good neurological outcome are in the high 30s range and that is good in the sense got continuing however, its not our goal. Our goal is to get into the 50 range its been a longterm coal so were not satisfied that were not sliding backwards. We need to continue to improve there and so aed project you heard about is one small component and we hope when we get into phase 3 of this pandemic well redeploy those devices to areas of the community that are under populated since the whole southeast corner of the city has very few aeds per person as opposed to the Financial Systems in north beach. We want to try and apply that and to get more survival because its clear rapid cpr and defibrillation are very important part of life saving even more so than the response times and its what we measure. Our response intervals are still not where we need them to be. Were trying to reconfigure how we evaluate them and to be careful were applying a National Standard that were taking the same times everyone else in the country and another area which is our lifesupport therapies that the paramedics are refield we are trying to adjust our protocols that follow what is the best practice that the paramedics are providing so for instance, we made a change where were favoring the over and the because its more successful in the field and we want the most successful therapy to be applied that were using in the community and we want our rate improve and we want to get them off the National Standard theyre in the 60 frame so the Fire Department has a program and to implement video learn which is the type of technique to improve that and therapy and working with dr. Crayon that well be leave evolved in the training and the roll out so that we get up to the National Standard in that area. While we are not backsliding we moved from one emphasis of one therapy to another and we want to get up to exceed and on our website and the commission devise and i think in the past sense either quarterly and metrics and i think we would be happy to continue to do so. Thank you. Well be introducing new dashboards january 1 to reflect the standard. The other thing that were doing as far as cardiac arrest, we have developed a very Innovative Program that looks at com operation rate and a quality of chest com persions and its nowhere else in the world that theyre actually looking at it and at the level we are according to a lot of Industry Experts and they have a keen eye on the work that our staff is doing and creating that program where we can actually analyze the quality of a single com operation. With rate and release with the hopes of increasing cardiac arrest outcomes with quality chest compressions. I thank you very much for actually getting offer to bring black information and i know how busy its been during the transition with the department and all the challenges at covid we dont want to interfere with the great work you are doing and you were able to create the caddy project which had been something that was dadly needed as we looked at our different institutions and the issues of diversion or rightly getting patients to where they building. So i suggest working with the Commission Secretary and president to find the right time to begin again a reporting back our success as we tried to move our own numbers back in terms of response and the goals that you are saying so we can appreciate the work that you are going to be continuing along that line and i would leave that with our officers to find the right time to do that. Thank you. Do we have any questions or comments . If not we can move on to our next item. Can i just want to acknowledge and thank Patrick Brown and the incredible work during covid and the epidemic they were engage and involved and i think that the work theyve presented speaks for itself and just to say that the pandemic has brought the best forward in our ems system and the work that theyve, the foundation that theyve laid for the last few years in terms of the ems roles and responsibilities really shined brightly during the Pandemic Response so just acknowledgment of their leadership across the department and the city as a whole. Thank you dr. Brown and jim. Thank you director colfax and we associate ourselves with your remarks. Moving onto the next item for action. Resolution honoring Maria X Martinez. She passed on july 15th. She was highly respected both within the department and large and we all mourn her passing and were grateful to have dr. Hale hammer before the commission acts on it and i would like to hand it over to secretary mor morewitz and dr. Hammer. Thank you very much commissioners, dr. Colfax and secretary morewitz. Its a honor to introduce this resolution recognizing maria x. Maria x, as many of us knew her was a trusted colleague, mentor and friends she served as our director of whole person care so this resolution before you is well primed with our hope and care act which will follow. When i think of my dear friend and colleague, maria, the four words i think of are commission, wisdom, vibrant, and ex h again. She left a mark on the department of publichealth in San Francisco in the programs that she helped develop which served people experiencing homelessness and think the latest of these programs but its really a tremendous honor again to radio introduce this spirit and the work she did for us over her 23 years. Im going to turn it over to mark. So you all can hear and the public can hear, honoring Maria X Martinez. Whereas, she served the city and county of San Francisco as a devoted San Francisco department of publichealth and staff member and leader for 23 years and whereas, during mrs. Teen he is tenure, she served in the following leadership roles. Deputy director of community programs, senior staff, director of health, chief integrity officer and and whereas the highlight of her career at the dph was her role and extra care and aims to improve outcomes for adults and experiencing homelessness and San Francisco and to enhance care coordination and they solidified among dph the department of homelessness and Supportive Housing and bringing them together to wrack in ways they had been under her leadership envision San Francisco adopted a Population Based approach providing housing and Human Services to adults experiencing homeless. It highlighted care coordination and inner agency data share to identify and problem soft and street to home plan with whatever it takes approach. She helped build initiatives and Public Policy and for the past 15 years she was an active board member of the Chicana Latina Foundation where she developed the Leadership Institute for relationship recipients and she died on july 15th, 2020 surrounded by a loving circle of close family and friends now be it resolved that that San Francisco Health Commission honours maria x martine he is for her lifelong commitment and dedication to improving the lives of others through her service and thoughtful leadership. The San Francisco Health Commission conveys its heartfelt condolences to ms. Martinezs daughter and other family and colleagues and friends. Thank you dr. Harmer and thank you for mark i would like to say and in addition to the remarks offered by dr. Hammer in reading true this resolution there are so many words that just pop out that remind us of her fantastic work, partnership, vision, problem solving and its all things we knew to be closely sewated with maria x and her work. We would approve this resolution and its though we can take this on whole person care both as a tribute to maria x and her leadership and our contributions because this is such a deep and strong legacy that shes left not only within the department but serving the entire community in San Francisco. I dont see any Public Comment before you all move forward. Thank you, mark. Commissioners, do we have a motion. Comments or motion to approve. So moved and i would echo your comments, so. Thank you. We all inaudible and she was always wonderful. Everyone she touched was someone that seems so personal to her. It was just amazing. Thank you. Thank you. Second. Great. Yes. Commissioner ger add owe. Yes. Commissioner christian. Yes, commission gren. Thank you, the item has passed. Thank you and i know i wish we would be seeing maria x for this next item which we will now bring up the whole person care update. Ive given you permission to present and im not sure if you are the person that will share your screen i need to do a special it looks like you are, great, thanks. Can you see my screen . Yes. Great. Thank you very much and i did want to add that well have another chance to celebrate her life on september 3rd. Well send out an announcement about the event we are planning. The whole person care team is working with the family and looking forward to a beautiful event to celebrate maria. Ok, so, i have the pleasure today of producing amber reed who is the acting director of whole person care and our medical director for whole person integrated share and edge under care and amber will present the update on whole person care and the last time we presented this update was maria and me presenting to the Health Commission and there were some followup items we were asked to come back and share and thats what were doing today and i just want to let commissioner green know that we received your questions and they should be addressed in the talking points and if not well be happy to address them after the presentation. So, with that, i will hand it over to amber. Hello, everyone. Can you hear me . Good afternoon commissioners, im pleased to be here giving you an up update this afternoon and thank you for your kind remarks about maria. Today, we are going to be level setting on our program goals, providing an update for our data sharing solution and Care Coordination Services and discussing sustainability for whole person care beyond the 2020 waiver. So as a reminder, San Francisco whole person care is focused on people experiencing homelessness and we have a twopronged approach. First is innovation and technology and second innovations in service and we talk about a datasharing platform that will allow us to share comprehensive, integrated Health Hazard and benefits data for shared clients. The innovations and service, care coordination and structure to care for the highest risk and utilizing clients across the citys echo system and services and its unique its an inner Agency Partnership also. Weve taken a humancentered design approach to identifying and understanding opportunities for improving the homeless system of care. This is a map of our discovery work and theres a lot of detail here and we dont expect you to read through it. Its an example of a whole person care client and theyre run by different departments and different locations. What this highlights is the opportunities we have for improving coordination and communication between these programs. Its during these times of transition between and wore optimistic our inner agency data sharing will facilitate Better Communications between providers and staff. Next slide, please. Are you able to go to the next slide. Through whole person care were implementing the inner agency data sharing solution and ill walk you introduce the component. Were care coordination functionality to the current installed and this means and shared cool set and care coordination and working together and we will make the data in information more accessible to providers. This will also help us to identify people experiencing homelessness who enter the system of care through any door and so if they come in through hsh, the shelter system or dph or through hsa well be able to identify them and locate them more easily. Were expanding access to non dph teams to epic and were excited about this because this means that teams like ems6 who provide Critical Services to people experiencing homelessness who will also have access to that shared care coordination tool set, and this will facilitate better coordination and this is possible because of the groundwork that weve been putting in place for the last several years is data sharing agreements and implementing protocols to allow this information to be shared. Next slide, please. Our work is positioned us to be a key source of data and specifically attempt to mitigate the impact of the pandemic on people experiencing homelessness and our Data Infrastructure is built on longstanding relationships and partners between agencies and because we have this data and understand how were able to use it, we were able to quickly develop a Risk Assessment methodology based on cdc guidelines enabling us to locate and identify individuals rapidly and individuals who are at highrisk for complications analysis of this has helped inform policy and Planning Decisions as well as were able to provide a daily census report for people in the shelter in place hotels and isolation and quarantine sites and provide that to providers which facilitates targeted outreach and linkages to Necessary Services and then finally, because we have this Data Infrastructure in place well be able to more effectively evaluate our interventions in the future. Next, please. So, i want to give you an update on the shared priority project which you all heard about in october. Just to remind you, last summer an inner agency group of stakeholders came together and through this project dph, hsa and hsh came together to take a populationbased approach to provide in the health, housing and benefits. The goal of the project was to create street to home plans and then to identify and problem solve system barriers that arose throughout the process and those system barriers that we were able to identify and problem solve for and not just the 237. So an interim evaluation of the or progress update for the project was conducted with take stakeholders in february and the evaluation of the process is on going. Some of the things that we heard from providers during that initial check in was the shared priority label is effective and Opening Doors that wont be open. That shared Party Project is helping teams to be creative and flexible and carrying for vulnerable clients and individuals are getting help that wouldnt be if it werent for this project. So the shared priority project Team Continues to meet weekly and we report on on going progress through by by weekly dashboard. Can you go to the next slide. So this is an example of our by weekly dashboard from august 11th and the dashboard exclusively follows the original 237 and it highlights our progress and the difficulty of the work. Since we kicked off in october of 2019, from the 237 clients, 126 are currently housed and 35 are ready and awaiting and ununits and they have all the document this is place just waiting for the unit to open up and 117 are connected to dph Case Management and 184 is received Housing Navigation or Case Management services through hsh. Sadly, 13 are deceased, which confirms that this is a very Vulnerable Group of people. This is a living situation overtime since october. You can see along the bottom is the green is the placement into a permanent Supportive Housing. Our goal is to provide services to all 237 of these individuals in the cohort and support their Journey Towards recovery wellness and housing and we are continuing to work on that project. I want to turn it over to the doctor for the next couple of slides. Thank you. Thank you, everyone. Thank you commission for the honoring maria x. It is very strange to be giving this presentation and very hard to be giving this presentation without maria here and her work is absolutely inter woven into all the work weve done. I want to talk about a few things. This is the clinical arm of whole person care. At the onset of the covid pandemic, we had quite a lot of knowledge and monday evidently quite a lot of anxiety about what the effect on people experiencing homelessness would be knowing that much of the Homeless Population was in categories that were highrisk for acquisition and categories that highrisk for complications and death from covid19. We also understand that outside of the effects of the virus the Homeless Population historically is our high users of Emergency Departments and high users of acute hospitalizations and we wanted to do everything we could could be ready for the surge and cope these people kept out of the hospital out of the hospital. And we were aware that the interventions meant to prevent spread of covid would have great disruptions on resources for people experiencing homelessness and related to sheltering and dropin centers and all the other services. The goal was to design a response to mitigate these risks and the work that was done through whole person care through our experienced with the shared priority project and made this i think i can say, made what would have seemed to be impossible a couple years ago feel like it was in the realm of possibility. Because we have data that we had never had before and we had relationships between departments and among divisions that we never had before. And that was an incredible gift, really, to be prepared that way and prior to cove. When cove started and the smelter in place were ramped up we were able to quickly work with Human Services Agency Department of homelessness and Supportive Housing and on having a mold of care that would work and didnt require hours and hours of plan tag it would have required had we not done this Work Together previously, im very aware that looking at dashboards is, they look very good and in the real world and this has really made it a big difference for us in being able to develop these systems quickly and provide care. Next slide, please. I also want to talk about our response to unsheltered people experiencing homelessness and during the covid period of time. We started this spring and late last winter planning for an expansion of a high intensity care team related to shared priority. We took the existing ems6 model and said what do we need to add to it to be able to be the outreach arm 20 hours a day for the shared priority project. And we were well way with planning that although not particularly implementing it when covid hit. We were able to say, we need this team to be up and running. We need to be working closely with ems6 and with sf hot and we were able to reach out both to the shared priority population, to the ambulance and 911 system high user population which were the original populations but we were able to expand to unshelter people at highrisk of highrisk of harm and develop a daily model in which we have street medicine staff working with ems6 and nsf hut on a seven day a week basis. Planning that would have taken many months that was compressed into a period of time of days and it was greatly helped by the work we had done before. Among people experiencing homelessness weve had a few cases of cove diagnosed and very few deaths. One death recorded of a person experiencing and although we believe that persons death was related to an oohed medical condition that were identified as also covid positive. Weve seen a big increase in homeless deaths during this period of shelter in place and we have no way of knowing, its certainly seems to me that increasingly in homeless deaths would be much greater had we not implemented these interventions and work with what we had built on with home person care. I wish that we had the epic care coordination module implemented already and its very easy to see how that module is going to be very helpful to the on the groundwork that were doing when it is developed and goes live. Back to amber on the next slide. Thank you. I want to wrapup with talking about the sustainability and the whole person care work. Over the next year well focus on sustaining that work. The whole person care team will be integrated into the clinical arm of whole person incompetent greated care which well talk about on the next slide. Well continue with the optimization of the care coordination tool set through our work with inner Agency Partners and well foam us on new homeless Health Resource center on track to open in november 2021. Next slide, please. In the future the whole person care team will sit back in the whole person integrated Care Organization and this is a simplified chart of that. As a reminder, whole person integrated care is and weve identified Behavioral Health Service Leaders that will bridge between and and inner agency and collaboration. And i am very please today introduce our new director of whole person integrate care dara and its coming to up from the Supportive Housing and shes here with us today. She will start in august and august 22nd in her new role but shes been a member of our team for the past three years so were very excited that shell be taking on this new and important role. Thank you, dara. I want to wrapup with an image from the project Design Workshop late last spring and you can see Maria X Martinez and to her right, and Maria X Martinezs vision and commitment to the vulnerable population and on our project the department approach to serving vulnerable populations and our team is so proud to be here today and thankful for everyones support bringing this important work to fruition. Thank you. Next slide, please. Before we move forward, do we have any Public Comments. I dont see any hands raised. Ill give it a second. Do you want to make Public Comment on this item, press star 3. All right, no comments, commissioners. Welcome to your new and very important role. Thank you dr. Hammer and dr. Zevin and ms. Reed for this presentation. Before we go to commissioner comments or questions, id like to recognize director colfax. Thank you, commissioner bernal and i just wanted to thank dr. Hammer and the commission for dr. Hammer for her introduction of the resolution honoring Maria X Martinez and just to reinforce that maria was a beloved colleague in the department and a mentor to so many of us. I was able to work with her very closely during my prior tenure at department and was just incredibly i am so grateful for being able to have done that and be training as a department and seeing what she was building and what she developed and with all the kindness and guidance and commitments that is shown through in everything she did so just acknowledging that and supporting the words that have already been spoken and her spirit and we all feel her spirit with us here today. Thank you. Thank you, dr. Colfax. Commissioners, any questions or comments . Not seeing any questions or comments, thank you again for your presentation and for giving us an update on this critical work. I just personally i particularly appreciate the slides showing the journey of someone who is receiving care and their experience and how we can provide services to them. It helps visualize and understand what the experiences from sort of a client perspective so thank you for that as well. Commissioner christian raised her hand after you began speaking. Thank you president bernal and thank you mark. I just want to say thank you and how grateful i am as a person who lives in San Francisco and someone who works in the criminaljustice system and has spent a number of years working with the population that people who need and and seeing up close and firsthand what a difference it makes to have these great emphasis on providing the care that the person needs and a coordinated way in a way that is collaborative with who do work closely with some people in the population and i wanted to know, i know there would be written 237 in the i dont know if you call it a pilot originning thor theinitiative what about bg in more people and how do you know what the capacity is that you are going to aim for . Im just curious to see what work goes through there. Amber, do you want to take that . Sure, i guess i consider this was a Pilot Program to better understand what it will take toktoeffectively serve this population and we heard to be successful, we need to ensure we have adequate staffing to support inner agency care coordination its a high touch work and we also need a shared tool set and so were really excited about the implication of the ethic care cor din module because its all od and better identify and cohort and groups in the future should the department chose to carry on this work in this way. Thank you, i cant imagine the circumstances we would not want to expand this work. For only people outside of the publichealth system and you know, ela person to the system and you talked about it being high touch work and seeing how high touch it is and seeing it does give result and it can work and its not a trajectory or always up and always down its up and down and its the way of life for human beings and please note your work is experienced by those of us who see it in another realm as experiencing working thank you. Thank you very much for your important words. We really appreciate it. Its great to hear that. She will keep in that mind as a model for this work. Thank you. Thank you, commissioner christian. Thank you. Commissioner chow. Yes, thank you. And i want to thank everybody for their wonderful presentations. Im looking at the future chart and im trying to understand because youve already developed an entire system that seems to be working so well and does it mean that whole person incompetent greateintegrated cae people. How much better can you get and what does the full person emigrated care have to what you are already doing with the 200 238 or some odd people. Are we meaning to add more people or Additional Services or just trying to understand our next steps that you are talking about. So ill address that. So, whole person integrated care is a constellation of Clinical Programs and youll of which serve primarily serve people experiencing homelessness so these are programs interested in the Health Department and in different areas and until we hold them together, and started to integrate the program they did not all work in a coordinated way with each other. By having one organizational structure a director to a medical director and really coordination through the ccm module and ep dick and case conferencing and cross Training Staff and we hope that we can do a much better job of taking care of this essentially a larger than the 237 who are in the shared Priority Group and its really all people experiencing homelessness who touch our systems and provide these services and the Health Department. So, none of these is a new program and the Newest Program is actually in care so thats the data design and quality increasement program that came about because of the current medical waiver and now its a waiver that is ending and wore bringing it into whole person integrated care as the data and design team for these Clinical Programs. So, i hope that answers your question. Im really excited to have them all come together and i think we addressed, it was really signed of fast tracked this work of coordination and synchronizing our work with covid because we had to come together and say how does cheap medicine and how do we work with the Care Coordination Team for transition and our Respite Group in terms of comment how can we elaborate our work is much more integrated and coordinated and the epic work wore doing right now is the culmination of that. If i may just try to understand the followup, our current whole person care is a wonderful example to try to draw these agencies together as you depicted here to try to work on everybody that needs this beyond the 237 and will the 237 stay in this pilot then and a group or is that going to really transition so that the 237 might be 500 or 600 within the whole person integrated system . Amber was correct in how she addressed that the commissioner and its a pilot and we really learned a lot from it how much you can came by coming to the table together and across agencies with Human Services agencies and the department of homelessness and Supportive Housing with services and focus on the population that we can find as being highest needs and where we can really make some progress focus on a defined group of people. The boundaries around that group will fade away as we implement this module and epic as we figure out how we continue those cross agency work after the end of the waiver which was ending at the end of next year as we continue to see the benefits of cross Agency Collaboration, in our care of these complicated population. Not just 237 but but really the whole the with complex Behavioral Health medical, and psycho social needs. In terms of sustainability, our new homeless Health Resource centers that you heard of referred to that would be opening in november of 2021, that will be a sustainability plan for this because well be co located and staff will be co located with hsa and hsa team and well have a place for people to come to access housing benefits and healthcare as weve envisioned in our homeless and care work. Thank you for helping to amplify further and we can all look forward to the build out of this future. A great legacy for maria x. This is definitely her vision and this Agency Collaboration and data sharing was her vision. Thank you. Any other questions or comments . Thank you for the great presentation and we look forward to hearing back the next time. Thank you. Well move on to the next item which is other business. Commissioners have any other business . I believe we can move on to the next item. Which is closed session. Did we have a motion to enter into a closed session . Moved to enter. So moved. Ill do a roll call vote. [ roll call vote ] all right. So thank you to everyone who is not going in the closed session. Ill turn a function to cut you off and thank you to the public who joined us. You also will be cut off from this portion but you can stay on if you like and join later. To see what happens. Commissioners, give me 30 seconds please to turn on the extra. Commissioner chow [roll call] thank you for a great meeting. Thank you all, great to see you. Thank you. Great to see everybody. Good night. You. What do you think about working at an airport and i love it is busy all the time. We want it to be an those away was this is a venture if i didnt love it ill be an accountant. We want the experience that is a nonairport experience the negative stigma were trying to erase that. Everything is in a bad food to excite them about the food and they have time to learn about us. People are imitated by traveling and the last thing to do is come to a place fill of chaos. Telling me how the extent of napa a farms came about. It was a vision of the airport director he had a suspicion of a really cool gourmet speciality market locally friendly products this market local flavors this is the best. Can we get a little tour. Absolutely laughter so first on our tour. We have the clock we like to call it. This is coordinating it is made in San Francisco. What about the customer presence. We like to get the permanent farther i love the cappuccino and you have to go to multiple places for the cupcakes the cup a cakes from karis people want to live here theyre longing phone call for one thing in one spot in you know anything about San Francisco the cheese the most popular cheesy think a lot of the people from the west coast say so this the real San Francisco sour dough and theyre curious. You find people respond to the idea of organic and absolutely. This is autumn. Thank you, thank you and theres a lot of personal touch. I see San Francisco. Its very hands on. Whats the most popular items. This is quite surprising our fresh jotting this is the chronicle special a bowl of warm oats and coconut thats mites farther. And speaking of drinks tell me again the cocktail scenes is that one, the things your known for. The cocktails are fantastic. Really. Fresh ingredients we dont have a mixture it to order this is our marcus bloody mayor. Farmers market bloody mary the bloody marys in the airport are great shikz it up. And then were going to garnish it with olives. And some lime and a fresh stalk of selly. Right on. We like the San Francisco playgrounds hitsvery dates back to 1927 when the area where the present playground and center is today was purchased by the city for 27,000. In the 1950s, the sen consider was expanded by then mayor robinson and the old gym was built. Thanks to the passage of the 2008 clean and safe Neighborhood Parks bond, the Sunset Playground has undergone extensive renovation to its four acres of fields, courts, play grounds, community rooms, and historic gymnasium. Here we are. 60 years and 14 million later, and we have got this beautiful, brandnew rec center completely accessible to the entire neighborhood. The new rec center houses multipurpose rooms for all kinds of activities including basketball, line dancing, playing pingpong and arts can crafts. You can use it for whatever you want to do, you can do it here. On friday, november 16, the dedication and Ribbon Cutting took place at the Sunset Playground and recreation center, celebrating its renovation. It was raining, but the rain clearly did not dampen the spirits of the dignitaries, Community Members and children in attendance. [cheering and applauding] the meeting will come to order. We welcome to the thursday, august 20 meeting of the government audit and oversight committee. Im gordon mar, the chairman of this committee. Joining me is supervisor aaron peskin and matt haney. Mr. Clerk, do you hae