Transcripts For SFGTV SFDPH Health Commission 20240712

Is the minutes. Yes. Thank you, commissioner. Item 2 is the approval of the minutes of august 18, 2020, and i can check to see if anyone thats in Public Comment, please press star, three to raise your hands. I have a change to the minutes. The minutes show me as present, and i dont believe i was present at that meeting. Thank you. Commissioner, and i apologize for that mistake. That was me. And there was actually somebody with their hand raised, so im going to let me get my timer. Caller, im going to unmute you, and youve got, then, two minutes. All right. Caller, youve got two minutes on the clock. Hi. Im a little mixed up. Is this the time for general comment . Hi, dr. Palmer. No, this is not. This is the general comment on the minutes. Okay. I want to get back in line for general comment. Okay. No problem. I will take your hand down. I will explain to everyone, heres the deal. When youre making comment, when the item is called that youre making Public Comment on, you put your hand up, and you do that by pressing star, three, and you can do that for every item on the agenda, and youve got two minutes to talk. Commissioners, any other corrections on the minutes. With the exception of the correction that commissioner guillermo brought up, is there a motion to approve the minutes. Approved. Second. Clerk i will do the roll call. [roll call] clerk great. Item 3 is the directors report. Good afternoon, commissioners. Grant colfax, director of Public Health. In my report, i have a number of covid items, and we will be going over those in more detail in the covid update. But we have some important issues, and perhaps the most important issues, the d. P. H. Budget. After a number of rounds of conversations with the commission and the board of supervisors, the board and Budget Committee amended and passed the budget for the Health Department, and im pleased to say that our for the most part, our budget was was passed consistent with what you saw and very much consistent with the mayors priorities. Our budget remains at 2. 8 billion for 2021 and 2. 9 billion for 2122, with very mine i dont remembor cha budget itself. Id like to thank everyone who worked so hard on the budget in this unprecedented year in general, but it was an unprecedented year with many challenges. In addition to the pandemic response, weve had to deal with inclement weather and air quality, and we are taking appropriate action with the department of Emergency Management and other partners to ensure that people remain as informed about the air quality and take steps to mitigate potential impacts from the air. You will see a number of highlights with regard to the d. P. H. Work, and unless you have questions on the two items i just highlighted, we can cover the covid19 updates in the next item. We have updates even from just about two hours ago, so were very much on the cutting edge here. Myself, dr. Aragon are here to answer questions about that. And then, we do have a presentation specifically on some of the educational activity reopenings were doing. Clerk and commissioners, if i may, before we move to any other comments or questions, i see a hand up. Any member of the public, if you would like to make comment, press star, three. All right. Commissioners, it looks like theres no Public Comment, and with your help, commissioner green, ill help you with your Public Comment. Commissioner chow, it looks like your hand is up. Go ahead. Thank you. This is in reference to the air quality issue, and it is appropriate that the Health Department has put out advisories, and even on your website had marked out, if you go into the covid website right away, theres the whole issue of the air quality. However, im just wondering if we could make it easier for people because this air quality issue may certainly surface again over the next several weeks, if not months, that rather than having it would appear that in the first page, it references going to sf72. Org, but it doesnt work. It doesnt get you there. You have to hit the air quality reference in order to get to the air quality. But im wondering if we could actually show that more easily so you dont have to go point too many places to find out that that air quality for that day is such so that people would be able to understand that. But im not sure what the technical issues are, but certainly know that sf72. Org, ive tried it on two or three different computers, and it does not work, and thats what youve got to reference to get to the air quality. The air quality reference does, and its a very good website, but if we could make things easier where you dont have to have an additional click, it might make things easier for the public. But thats just my suggestion. Clerk so noted, commissioner, and well fix any of those noted issues. Thank you. Commissioners, i dont see anyone elses hand up. With your permission, commissioner green, can i move to the next item . Okay. So next item, number 4, is the covid19 update. Thank you. Grant colfax, director of health. We actually have three buckets of updates for you with regard to our covid19 response, and i know theres a full agenda, so i want to be respectful of your time. But i would i was going to review a few slides that that the standard slides that youre, at this point, familiar with seeing where we stand just in the epidemiology, and give you an update with reference to the state announcement on friday, and we do have an update, i believe, per the commissions request with regard to reopenings and our thinking around that. And [inaudible] is available to provide that information. So ill just go through these slides relatively quickly. Could we have the next slide, please. So were up to over 9300 cases of covid19 diagnosed in the city. You can see that our case count does continue to increase. Our deaths are unfortunately at 83 total deaths from covid19 in San Francisco. In terms of our testing, we continue to far exceed our testing goal which we set at 1800 tests a day. Our rolling tests a day are 3300 tests, and our sevenday rolling average is 2. 6 . You can see we continue to have the inequities in the covid19 response, particularly for the Latino Community who continue to account for over half of cases. And i just want to emphasize that we are strategically evaluating our efforts specifically in the Latino Community. Im happy to come back to the commission to report back on those efforts. Weve done a lot, and its clear that we need to continue to do more. This inequity has been with us since the beginning of the pandemic. We are focusing more testing and more testing resources and working more with the Latino Community providing lowbarrier testing. Our Contact Tracing and Case Investigation teams have expanded dramatically, and including providing culturally appropriate services and also providing Wraparound Services in Broader Health care needs and Behavioral Health needs, and youll be happy to know that we continue to offer isolation and quarantine options for people who are not able to safely quarantine at home. But theres certainly more to invest there, and im happy to return to the commission to report specifically on our efforts in the Latino Community going forward. Next slide, please. In terms of age distribution, you can see that we have a relatively young our cases are concentrated in a cohort of basically young adults, with nearly half of our cases between the ages of 18 and 40, and you can see that is very different in terms of mortality, where nearly threequarters of our cases are in people who have been diagnosed with covid19 over 70, and over half have been 81 years or older age. Next slide. So these are data compared to the other jurisdictions. Again, youre familiar with this information, but thankfully, our death per 1,000 is much lower compared to other jurisdictions, and weve been fortunate in that regard. Our testing rate is quite high, exceeded only by a few other jurisdictions across the county across the country, excuse me, and our case rate is also relatively low compared to other jurisdictions. And again, i think this is in a city that is seven by seven i believe that San Francisco is the second densest city in the country, after new york city. And we know that in denser settings and more crowded, where theres more opportunity for more crowded conditions, unfortunately, covid19 does spread more easily. Next slide. So this is our hospitalization rate, and we have been in a surgery since july, where we started to see that increase in hospitalizations. Were down to 26 total cases in the hospital. At the end of june, we started to see that incline. Were now down to a slight decline, down to 72 total hospitalizations in San Francisco. You can see the i. C. U. Bed the people in i. C. U. Beds, the white lines represent the patients in the medical surgery beds. So in this slide, it shows that things are moving in a more positive direction i believe than the last time i reported back to the commission. So in terms of our key Health Indicators, this is the these are the indicators where were assessing the status of covid19 across the city. Our hospitalization our Health Care System indicators, which are really indicators of our hospitals, are in the green zone. Growth of covid19 cases are in the negative zone, so thats good. You can see here that acute hospital bed capacity and our i. C. U. Bed capacity here across San Francisco remains in relatively good shape with 27 and 35 respectively. Whats been up for sometime now and is concerning is our case rate. The running sevenday average at this time is 8. 5. That has come down substantially over the past few weeks, but we are still at the high rate, indicating a relatively high burden of disease in the city. Our testing numbers i referred to, over 3500 a day. Progress has been made on Case Investigation and Contact Tracing, these numbers became particularly concerns as there was a lag in our testing and followup time. Just want to acknowledge the Contact Tracing and Case Investigation team expanding capacity, doing this work every day in a culturally appropriate manner, meeting people where they are. Were now at 87 of cases reached, and making progress. Mean goal, in yellow, and moving toward our goal of 89 . And p. P. E. , 30 , 100day supply for our health care staff. We require next slide. [inaudible] every one person infected new person infected is less than one. For every new person, less than one gets infected. Greater than one, more than one person gets infected at baseline. Youll recall that in july, we started to see an increase in june, we started to see an increase, and we our reproductive rate got up to as high as 1. 35, as you can see by that solid blue line, after being about. 85 in the spring. Im happy to say thanks to the great efforts of San Francisco, we are down to 0. 91 and trending down. We are have been moving in the right direction for a number of weeks now, and hopefully with the em if a seu emphasizing, social distancing, limiting crowds and interactions with large numbers of people, we will, as a city, will continue our success in slowing the spread of covid19. So im going to stop there and turn it over to dr. Tomas aragon who will now talk a little bit around the states announcement of reopening and the steps that we are taking to gradually reopen lowrisk activities over the next couple of weeks. Dr. Aragon . Good afternoon. So last friday, the state came out with a new framework for how theyre going to both measure the disease and also to categorize different counties. Prior, they used to have what was called the watch list, and it was basically two categories. And theres several ways you can get on the watch list. Case rates, hospitalization, as well as some other metrics, and if you got on the watch list, you were on it for a period of time. You had to close down activities and thats what happened to us in late june, where we had to close down nonessential offices, malls, and we had to postpone our openings of personal services. So the new framework now is only using two metrics. Theyre using the case rate, and then, theyre using the test person positivity. And based on those two metrics, theyre classifying people into counties into four tiers. Tier one, or the purple the purple tier, is is the highest, and whatever whatever number is worse, you end up in that you end up in that category. The second tier is called red, and the word theyre using to describe that is substantial. The third tier is orange, and the last tier is yellow, minimal. So if youre in purple, its very similar to have been on the old watch list. If you end up in one of the lower tiers, as you move into the different tiers, you can open up more. One of the things the other things they did was they wanted to discourage counties from undertesting, and so counties that were doing more testing had their case rate downweighted. So for San Francisco, because we do a significant amount of testing, they downweighted our case rate, and so we were classified into the red category. And so basically, that means that we had more things available for us to open, and that was really the basis of a of the plan that was announced today by the mayor and dr. Colfax. And there was between friday and today, there was a tremendous amount of work. People really working like crazy to get all of this in time to be able to move forward. And ill give you just the general themes. Im not going to go into the details or specifics unless you have some questions. And basically, what were doing we sort of approaches it this way. We looked at our Health Indicators. Can we move forward . Are hospitalizations flat or moving down . Are our case rates flot or going down, and is our testing in the appropriate range . And dr. Colfax indicated that were moving in the right direction. And the next question is what does the state permit us to do, and then, we apply a riskbased framework, and we move forward in those areas that we feel is going to be safe. And the other thing thats right around the corner, youre going to be hearing about them, and thats going to be schools. So the first body of activity really focuses on allowing activities to happen outdoors. So personal Services Like hair salons, outdoor gyms. Other Recreational Activities to happen outdoors, one, thats safer, but it also allows a business to adapt to serving outdoors. Just to give you an example, so today, my wife, the first thing she did was she washed her hair, and she went and got her haircut outdoors. She was very happy that she got her first haircut since the pandemic started. She did it outdoors not too far from our house, and the person who cut it was very excited to cut her hair, so that was outdoors. Just a couple of things that were going to be addressing. Outdoor worshipping, increasing the amount of outdoor worship and some other categories. The other big area is this next body of activity which is really schools and education. Its very big. Anas going to talk to you shortly about it. Shell give you an update in this area and how important it is that we succeed in this area. And the other area is lowerrisk indoor activities, and thats looking at those activities that really involve oneonone services, where if somebody were to be infected, the risk of a lot of people being infected were much lower. These services are going to be primarily personal services, and well be looking at other areas, but thatll be the primary focus. So im going to go ahead and stop there because youre going to get a lot from ana, because youre going to get schools, which is going to be a big category. That said, do you have any questions . Are there any questions from commissioners or should we continue . It looks like commissioner dorado has a question. I do have one question. When you had mentioned noncontact outside activities, i thought you were referring to sports activities. Can you maybe explain that. Does that mean that the kids cant have practices, no competitive games . Ive been asked this question multiple times. Yeah. They they yeah. Theres two ways of thinking about it. What can be asked it how can be done with is what can be done with schools opening up, and then no contact. When you think of activities that we dont want people to do, you can just think theres close physical contact between people is what we dont want. If theres nonphysical contact, shared equipment, thats okay, as well as people really are careful, but we kept that category nonspecific because theres activities such as pickle ball i did not know about pickle ball but adults let us know about all these activities, so theres guidance for all these activities, i should say. Welthank you. Its just that i get soccer practice, can we have, you know, hockey . Its just these sort of things, and thats where we need eventually probably clear guidelines so that we dont have, you know, confused people would be yeah. It is a little complex. Ill tell you, so soccer is a contact sport, and it really depends on how its designed. So and ana will go into this. One of the ways we try to minimize risks is to have cohorts. So if you have kids that stay in that cohort for an extended period of time, then, we allow riskier activities because theyre in the cohort. But what we dont want is people from all parts of the city coming together to play Something Like soccer because they can get it and bring it back to the households and affect Community Transmission. Thats part of the challenge, and thats part of the complexity. When you get to the schools, its going to be highly regulated to the extent we can because we can design it to lower the risk. Okay. Thank you. Any other questions, commissioners . Yes. I had two questions about the presentation and also about the information that the Mayors Office released. One was in regards to the outdoor activities, playgrounds were not listed, and the second question is theres no mention about [inaudible]. Im sorry, what . [inaudible] in other words maybe im missing it. Indoor dining or Outdoor Dining well, Outdoor Dining is permitted now. Correct. But theres no mention of your goals here of Indoor Dining in restaurants. And i guess my other question, which is much more broad, as were declining numbers of people that can get around into any of these, whether they be in pods or at schools or churches, are we then using the states guidelines or each county seems to decide whether or not at the moment up to this point can be [inaudible] and i think thats whats confusing to people, too, is whats the science of a pod being 10, 12, or 15 . Whos writing these numbers that we abide by . Yeah, let me take them in order. The first one is Indoor Dining. And we know so much more now about how the virus is transmitted than we knew even a few weeks ago. And a big issue with this coronavirus is going to be the aerosolization of the virus. Just raising your voice or singing raises the a aerosolization of the virus. In terms of our trace rate, we are in we have whats called widespread transmission, so we have quite a bit of Community Transmissions, as dr. Colfax pointed out. So the probability of somebody walking into your dining, into your restaurant, is incredibly high. Its probably youre going to have an infected person eating in that restaurant, its going to be a high possibility. If you sort of multiply that probability in the city. So highrisk activity is something were going to look at as the numbers of infection go down. The other thing you mentioned is pod size, and the general rule is the smaller the pod size, the better. Its a general rule, and its like a household. This is one of the challenges that we have in the latino household, the number of people that will live in a household can get very large, so when the infection gets into their household, a good proportion of them become infected. So the smaller is better. The state has given us guidelines. Theyre only allowing 14, so thats the number that were focusing on around the children activities. And then playgrounds, playgrounds is always a tough one. The problem is you can have multiple households, younger households, multiple kids, and then, they can transmit to each other. Kids in general have mild symptoms or no symptoms, but then, they can go back and infect their entire household. So were trying to mitigate that risk while the Community Transmission rate is high, especially at the time were trying to open up schools. So were focusing on how do we keep transmission rates low when were trying to open up schools . So were keeping an eye on certain things, and playgrounds is one of the things that were keeping close. Dr. Aragon, i know its tremendous effort, as you see, for you and the city to have put out a whole list within two or three days after the new state guidelines i think is tremendous. And i appreciate personally, and i think the public does, the explanation that youve given in order for us to understand why certain things dont open yet. I think its an explanation that we continue to try to get out there so that its not just the rule but the rationale behind it for these controversial subjects, and i really appreciate your response today. It was really very helpful. Thank you. Thank you so much. I would echo that. Any other comments or questions from the commissioners . I guess i have just one, dr. Aragon. Is there a place on our website where members of the public can find the information youve articulated, especially as youre updating these things. I know we can find it in the news media, but is there a website thats easy to read that details some of the what youve presented but also some of the details of the Health Orders because sometimes it can be so complex, and i wonder if you can make a reference for people that they can check from time to time. Yeah. So youre bringing up a gap area thats been identified, and i know the city is going to be focusing on improving their communication strategy. So including updating the website. The website is out of daofdad we need to make it more friendly, in addition to the air quality update, as was mentioned, to make it more friendly. So thats an update that we can hopefully bring back to you in the near future. Well, youve informed us greatly. I guess we still just have another part of the presentation. Yes. If i can introduce ana [inaudible], she is going to update our approach on the schools and education, and i just want to say, while we while the departments been working incredibly hard for so many months now, but one of the things that i think is a positive for the department is were working more collaboratively than i think ever before, and there are key leaders who have emerged in this covid19 pandemic, and ana has been one of them. Shes been leading the team just with regard to education and schools, and just collecting information [inaudible] as part of our covid19 response. Thank you so much, and thank you for the opportunity to present all the work that were moving forward in the Education Field and in schools, and i must admit, i am having a bit of a hard timesharing my slides, so mark, if you could talk me through how im able to do that. Sure. And i also want to let everyone know those on the Public Comment line, i see you, and when this is over, well get to you. Ana, at the bottom of the screen, take your cursor down, and theres seven buttons. Two buttons from the left, theres a scroll and an arrow. I do not see any buttons at all. Do you see any buttons . No. Taking your cursor down to the bottom of the screen . No. [inaudible]. You have to click first on the screen and then you see the buttons. Oh, thank you. Oh, thats helpful. Thank you. And then i see so sorry to put everybody through this. I i see i have the screen view, where i see everybody, and i have the tool bar, but i do not see any buttons per se in order to share my slides. Okay. Let me see if i can give me one second. I can talk through them if thats necessary. Ill try to share on my end so we can get this going. Give me one second. Sorry. Okay. I wasnt prepared, so give me mark . Yes. Can you make me host, and ill share my screen . Oh, that would be fantastic. Thank you, michaela. Thank you, michaela. See, we are a team, and these are things that we have to Work Together with during covid. So there we go. There we go. Thank you, michaela, thank you, everyone. So again, my name is ana [inaudible], and i have been working with this amazing team to prepare for school safer reopening while and prevention and mitigation for covid19 for the coal year 2021. If we can move onto the next slide, please. For the school year 2021. If we can move onto the next slide. So i will admit there are some things that are outdated since i submitted these slides to mark on friday, and i will talk through them as we get to those slides. But of course we want to meet minimum standards of safety when we are reopening schools as safely as possible. We want to be grounded in science and make sure that we open schools when there are lower rates of Community Transmission. For school criteria, we need evidence of low Community Transmission, and up until last friday, that was the state watch list status, which has now changed, and certain key Health Indicators. I we received a question from one of the commissioners about how things have changed with the with respect to the state, and i think i can answer that now. But since we have switched from the watch list to the tiered system, as dr. Aragon had referenced earlier. Now that we are in the red tier, any county that is in the red tier or below for at least 14 consecutive days can consider reopening schools, and we are placed in the red tier on friday, and that allows us to consider, in two weeks from last friday, to move forward with full School Reopening as long as we stay in the red tier. In the meantime, we have started our waiver process for elementary schools, and we received letters of interest from 53 schools and have sent out the full waiver Application Form to those who submitted letters of intent. We did that because we determined through criteria as our three Health Indicators as our evidence of races with low rates of Community Transmission, which we needed rates that were stable and declining, hospitalizations that are stable and declining, and community tracing rate was stable or low, and we have been doing that, so we are moving through that waiver process. We are going to be taking that waiver process and turn it into a full School Reopening process as we move forward, and if we remain on the red tier or below for 14 days. So as the mayor had announced earlier today, the tense the goal is to work with the schools that submitted waivers and have them reopen in september, work with middle schools to reopen in a safe manner in october, and a possibility of working with high schools to for a safer reopening in november. And there is a whole process that we are developing to ensure there is compliance with all of our presentation measures, which i will outline in the next slide, please. Thank you, michaela. So there are specific guidelines for k through 12 school to prevent and mitigate the spread of covid19, some of which are very specific to a School Setting, and some of which are universal to all sectors of the city. The ones that are specific to schools is the construct of a small, stable cohort. This is grouping students together so that they become, ineffect, their own households at a school, and the smaller the cohort, the better, and this will help reduce the opportunity for transmission and also enable any effort for Contact Tracing and Case Investigation. The other mitigation efforts are considering the movement within the school, including the entrance, the exits, moving around in the hallways, and making sure that is done as safely as possible and actually minimizing the amount of movement . So, for example, having teachers push into a classroom rather than having the students push out and go visit a classroom is an example of what we are suggesting. Also pretty rigorous symptoms screening for staff and students to make sure that we minimize the opportunity for illness to be introduced into the site and triggers that we would that the school needs to establish to switch to Distance Learning, and also specific trainings for staff and communication plans specific to school. Of course, some of the universal factors are things like cleaning and disinfecting, face coverings as much as possible, healthy hygiene habits, making sure theres enough hand washing stations and soap and water, hand sanitizers onsite, Contact Tracing, and, of course, physical distancing. This is a copy of our guidance that we released earlier this month or actually technically last month on specifically k through 12 schools. Next slide, please. We are recognizing that school is not open at this moment in time to accommodate for Distance Learning support. We produced a guidance for outofschool times, and this is impacting Community Learning hubs, both public and private. And to the commissioners earlier question, there is recommendations in this particular guidance related to youth sports, and its basically limited to small, stable cohorts of physical activity that is conducted only outside and with limited amount of sharing of equipment. And youre more than welcome i will share the website later, but this is the full guidance you can access the full guidance in order to help people answer their questions. We also maintain an active list of over 600 people and schools and providers that we send all of our updated guidance out to, and we push this out to all of the stakeholders that are interested not only this guide, but all of the things that we publish. And then moving onto the next slide, please, we also want to make sure that we include institutions of Higher Education and any Adult Education programs, so we have guidance and directives as permitted by the health officer, which permits outdoor classes, depending on the weather. If it requires specialized equipment that cannot be provided by Distance Learning, and there are very special recommendations related to athletics. For both the outofschool time and the institutions of higher ed, we actually just published updates today to both of the guidance and documents, including also the child care guidance and directives that we have issued. And of course, this was a recent update that was not reflected in this slide. The California State Department of Public Health updated their guidelines, standardizing the number of students in each cohort to 14 students per cohort, so we have updated our guidelines to reflect that respectfully, and that was published today. Next slide, please. So this is a list of all of our recent local guidance and information that we have published to support our partners in education. The website, all of this, can be found in that white box on the bottom of the slide, and im happy to share the link with you all later . But again, we have published guidance for institutions of Higher Education and issued a directive related to that. We also have issued a directive and guidance for outofschool time providers. We have issued a tip sheet for families that are organizing their own learning pods in their homes . We do recognize the challenges that Distance Learning provides, and even though having multiple households, multiple families in an indoor setting presents a higher risk, we know that these families are moving forward with these learning pods, and weve offered them safety tips for these families to do this as safe as possible. Again, weve also issued guidance related to reopening of schools. Weve also published Additional Guidance specific for youth settings, so what a health check for children would look like at a site, what any program serving youth, including schools, should screen for, any symptoms, whether a child or a Family Member thats in close contact, etc. , thats all in this health check guidance. And then, these last two pieces, we received some questions that these pieces of guidance can address specifically, so at the bottom here, there is an f. A. Q. That we published specific to Contact Tracing at schools, child cares, and any other programs. So that we provide specific instructions and also how to contact our schools and child care hubs . And also, just to note that our hub has been working with child care and summer camp settings since march and has had quite a bit of experience working with all these sites that serve youth and feel like we are ready to support a School Reopening as we move forward with Contact Tracing and Case Investigation. And lastly, we have a quick guide for schools and child cares and programs for youth where we run through all the scenarios of what to do, whether theres been someone that is exhibiting some symptoms versus someone who has been exposed versus someone who is a confirmed case, and what are the actions that a setting needs to do, and also some communication templates that we can provide to all of these settings, and its being translated, and all of this is available on this website listed below. Next slide, please. Questions related to testing, we are encouraging everyone to contact their primary care provider to get tested. Just as a note, the California Department of care has just passed emergency regulations that classifies teachers and staff as essential workers, and they are eligible to receive testing as frequently as they request and have the their Health Insurance cover this . So we are encouraging everyone to contact their primary care provider first to address this issue. And then but there are also testing Resources Available for in the city, which is available at this website. And we are also, of course, encouraging everyone to get their flu vaccinations and other vaccinations as we consider reopening schools as safely as possible to bring everyones immunization records up to date. Moving onto the next slide, please. And that is the that is the end of the presentation, and thank you for having me, and im, along with dr. Colfax and dr. Aragon, happy to answer any questions. Thank you for this comprehensive work. And it struck me, as i looked at your guidelines, how much work you have done in the month of august alone with all of the changing thinking and input and data, and its really remarkable that you and this team have been able to put this type of extensive advice and guidance together in such a short period of time with, really, such elaborate information, so its greatly appreciated. I believe its time for Public Comment, is that right, mark . Yes. I see five hands, so again, if youd like to make Public Comment, you can press star, three, and your hand will be raised. I have a timer set for two minutes for each of you, and ill unmute you one by one, and i will start the timer. I will start with the first person. You are unmuted, and youve got two minutes on the clock. Hi. This is dr. Teresa palmer. Can you hear me . Yes. Okay. One, i would like dr. Colfax and dr. Aragon to address the ongoing isolation of nursing home patients and why health order c1903 has not been revised. As you know, health order c1903 does not allow any visitation on the premises of nursing homes, even if theres a physical set up that would allow safe outdoor or distanced visitation. And in addition, the Nursing Home Administration is on power to refuse oneonone visitors that have that are essentially medically essential nurses homes have been refusing to allow Family Support people to visit unless people are literally within a day or two of dying, and this is the state has much more liberal guidelines, and the state actually guidelines say that there should be outdoor visitation. I got a call from dr. Aragon in early june, promising this would change. The City Attorney told my colleague at california advocates for nursing home reform the system would change a month ago. This is not happening. Nursing home cases have now been locked down, isolated from their families for over five months. It was never intended to last this long. Their quality of life is being impugned. People are having to unsafely take their parents home. Its a violation of human rights, and its an example of ageism and enablism, and when is this going to change . Thank you, dr. Palmer, for your comments. Next caller, youre unmuted, and you have two minutes on the clock. Caller, are you there . Hello . Hi there. Can you hear me okay . Yes, i will start the clock. Thank you. My name is Glen Thornton close. I am the owner of [inaudible]. Sir, if youre moving around, its hard to hear you. [inaudible] with almost minimal to no and how we can plan to come back from this closure. Thats despite the work of the San Francisco [inaudible] independent Coalition Work with the office of economic and Workforce Development to submit plans with no concerns submitted back to us. We it has been incredibly frustrating to not be able to plan to come back from a closure like this. We have put plans in place that have considered every possibly sna scenario that weve been able to glean. Reservation systems, the ability to contact trace, masks required at all times, social distancing or aerosolization concerns, and its awful. Whats amounted to my lifes work is now gone. We have no option but to close. The options that were given to us for outdoor operations, we dont have the ability to work on the sidewalk, we dont have a sidewalk at our business. Other [inaudible] the air quality is horrible, and the fact that sfpd gyms are allowed to open, and the fact that my business is not, and the fact that my family and i are forced to leave because we can no longer afford to live here is a travesty. You must do better. You cannot let an entire sector like this down. Thank you for your time. Thank you, sir, for your comments. Okay. Caller, im unmuting you. Can you hear me . Hello . Yes, you are on, and i will start the two minutes on the clock. My name is dean ericson, and im the owner of [inaudible] and im also a member of the San Francisco fitness coalition, and the first restaurants and bars were allowed to reopen amid the spike in the last reopening effort, and theaters and museums are given a higher priority than gyms and Fitness Centers. [inaudible] onsite schools, which is a mix [inaudible] basically another surge and halt reopening. There are a number of multiple safety and Health Issues related to outdoor fitness. Indoor fitness can be controlled and can be safe. For the last two months, the city has hidden behind the state watch list now that we are in the state red tier, rated in the 10 indoor occupancy for gyms and Fitness Centers, you are deviating from state guidelines with no indication that gyms or Fitness Centers are a danger as long as guidelines are in place minimizing contact. [inaudible] Small Business and the health of San Francisco residents who you serve are impacted. Start applying some common sense to these strategies. Please start looking at San Franciscos Small Businesses as being a priority. Things can be done safely. We have reached out to oewd, department of Public Health, the Mayors Office, our board of supervisors. We continue to run into ro roadblocks and walls with these efforts to bring you up to speed in how we can control this and how we can provide Health Solutions to the residents of San Francisco. Thank you. Thank you for your comments, caller. Next caller, ive unmuted you. Can you hear me . Yes, this is michael ryan. Im calling in support of the testimony of Teresa Palmer concerning nursing home visits and visiting nursing home patients. Senior disability action and [inaudible] are both very upset at properly equipped visitors are not being allowed to visit patients inside nursing homes, especially when the stay is possible. Nursing homes frequently have such problems with understaffing and not being able to take care of everything and take care of nursing precautions, so its offenten presence of visitors which which fills in for things that that the staff simply dont have the time to do because of understaffing. So family visits are extremely important, to say nothing about the morale of both distraught patients and families. So San Franciscos policy about no nursing home visits has to change. Thank you. Thank you for your comments. The next caller, ive unmuted you. Can you hear me . Hi, yes, i can hear you. Okay. Great. Youve got two minutes. Thank you. So my name is [inaudible]. My name is shala, and i am a parent and Fitness Studio owner of ubalance. I wanted to say thank you for letting us open. As a parent and business owner, its honestly, like, a really happy day. We got word that we can reopen, we can go back to school to some extent. What i wanted to say is i feel like the public really needs to hear from the mayor and supervisors and Health Officials that were not just reopening because theres been pressure from a federal level, from trump, from newsom or some protests at city hall. A lot of people think this is political, and theres a lot of internet trolls, saying the mayor is just giving into political pressure. I think we need to spread the word how much work youve put in, how much work Small Businesses have been in preparing for this, and that its safe to go back to work and Small Businesses, and theres a plan, that were not just going to shutdown immediately. If theres one outbreak in one institution, that were going to work with that one institution under the plan for every single museum and school and Small Business. The public really just needs to be educated on this right now. Theres just a lot of people are very skeptical still and find this to be political for a number of different reasons, so if all of our politicians can let people know that its safe to return and months of planning have been put into this, and its not just random, it would be really helpful to Small Businesses. Thank you. Thank you very much for your comments. All right. The next caller, can you hear me . Ive unmuted you, caller. Hello . Yes, youre on. Youve got hi, sorry. Okay. Im calling about personal services. San francisco county, its in the red, while all the surrounding counties are in the purple, yet us and Alameda County are the only ones not offering indoor personal services. Honestly, i really hope this is an oversight or were going to change this soon because there seems to be really bad reasons to allow botox and [inaudible] tucks indoors but not salon services. The only thing i can find, some of these professions that are allowed, they tend to demand a fouryear or longer degree, and salons, barber shops, and personal services do not. I have to question, is there an educational bias going on here . Add weather and smoke and pedestrians, and it is impossible for many businesses to open under the current guidelines. So many of these businesses are failing right now and are so close to closing there are doors, yet it sometimes feels like San Francisco doesnt care or has prioritized other things instead of Small Business. You say youre trying to limit risk during this as much as possible, yet with other county offering these services and us not doing so, youre offering you were suggesting youre allowing people to travel for these services and up the risk that people will be infected because theyre going and exposing themselves to more people. Its just sad to watch whats happening to Small Business right now, specifically, the salon industry, where you move the goal posts over and over and over again. Weve almost opened three times okay. Thank you very much for your comments. All right. Caller, ive unmuted you. Can you hear me . Yes, you there . Yes. Youve got two minutes. Hi. My name is evan, and my wife and i own custom fit personal training and marketing company. Two days ago, the c. D. C. Has said the u. S. Has been badly affected due to covid from a lack of Good Nutrition and personal fitness. So my question is why are we not prioritized . How have you never provided any information to the public on how to eat healthy and examiner advertise to combat covid . There has been zero Scientific Evidence that Fitness Studios spread covid any more than open Retail Stores such as 2kgucci. Why are gucci determined to be essential but not us . Why are you okay with people Standing Shoulder to shoulder on municipal o or sharing an um 20 feet away . You say that is scientific, but that is suspect. You have not presented one site that justifies keeping our entire industry closed, even to the end of the coming month, as the mayor disclosed. Its my understanding the mission of the Health Department is to advise, promote, and protect the health of the public. If that is true, i must ask again, why are we still closed . We should be essential, and you should be doing all you can to help us open immediately to help people in need. Further, we can mitigate any sanitation issues better than any businesses than currently open. We have fans, hvacs, we can clean everything, and we can double the social distancing recommendations. Please use a riskbased decision effort and stop playing favorites. Thank you, the end. Hello. Caller, youve been unmuted. Hello. Can you hear me . Yes. I will stop the clock now. Hi. My name is rianna, and i own a pilates studio. We focus on teaching pilates to underserved and poor communities. I feel like my business is a un unicorn . Unicorn in San Francisco. I hold a ph. D. In kinesiology, and i have a masters in public research. I heard the comments about the gap that workers in physical therapy can open, and Fitness Studios cannot. I have clients who exited the physical therapy space and are trying to get healthier, but now im seeing them back slide because i cant personally train them. I cant take a 100, 200 pound cadillac outside on the street. For me, thats not a good solution, nor can i train or work out in bad weather. I urge you to rethink the methodology in which youre using to determine who can reopen. I believe that private studios can see students oneonone. I can be in a different room while teaching someone and looking at them from cameras. Give resources to someone. As a black women, its heartbreaking to see my other African American Business Owners closing, and with no Financial Aid whatsoever, and its hard to [inaudible]. Thank you very much for your comments. Hi. The next caller, i unmuted you. Can you hear me . Yes. My name is dave care, and im a board member of the Castro Merchant Association and a member of [inaudible] fitness. Were definitely grateful that our first mention of any reopening date for indoor fitness since april. However, noticeably absent from that announcement was Group Fitness like yoga, pilates, boot camps, spin, and cross fit, a huge section of San Franciscos Small Business community. Dr. Colfax and dr. Aragon are so concerned about sterilization and household commingling, how is it okay for worship . Nowhere on the site is indoor fitness mentioned at all, leaving more questions than answers. Nowhere does it say what capacity we will be allowed to reopen or what guidelines we need to follow. We have guidelines for pickle ball but not for businesses that are dying. The mayor said they are working with the Fitness Industry in reopening plans. In fact, our last meeting with dr. Aragon was in may, so it has provided d. P. H. With reopening guidelines, and we have heard nothing back from d. P. H. But crickets. We need d. P. H. To work collaboratively longterm with us so Business Owners can decide to stick it out or pack it up and leave the state. San franciscos dying Fitness Industry cannot depend on Daily Press Conference announcements. Thank you. Thank you for your comments. Caller, i just unmuted you. Can you hear me . Yes, i can. Thank you. Okay. Great. My name is deedee [inaudible] and im the owner of San Francisco institute of fitne fitness and cosmetology. We fall under the department of consumer affairs, and our main goal is to prevent the disease of spreading diseases or causing harm to our guests and also ourselves. So it is outlandish and really offensive, actually, that with our hundreds of hours of health and Safety Training which includes anatomy, physiology, disinfection measures, that you think we should be standing on the curb. Theres no way i could put my students in front of my school. Also, it doesnt make sense that you could go to the dentist, Plastic Surgeon and have your lipps plumped, but i can have no students in a School Setting practicing on a mannequin head. I appreciate the efforts, and that everyone is working so hard, but this solution for Adult Education and this solution for salons, bars, barber shops, is unacceptable. Were going to see maybe 20 people max in a day. Thats extreme if were doing 15minute haircuts. We can find more people walking into a starbucks, target, or Something Like that. We need to be considered low risk, we need better guidelines. We want to follow health and safety guidelines, and we want to protect ourselves, as well. Thank you. Thank you. All right. Commissioners, there have been a few more hands that have been raised, so give me a second to find them. Okay. So caller, youre unmuted. Hi. My name is tracey sylvester. I am the owner of e. H. S. Pilates in San Francisco. We are a legacy business and have been operating in the Mission District for 28 years. Many of our clients come to us for rehabilitative therapeutic conditions. We like many businesses want to reopen and under the safety of doing so in phases. We have been closed since march 13. Pilates is a form of low impact exercise that aim to see strengthen muscles while improving posture sand flexibility. The city has applied a onesizefitsall model to our operating sector. We now have clear understandings how to model our services to match physical therapy offices and request consideration to have our rablth tiff offices to fall within these d. P. H. Reopening rehabilitative offices to fall within these d. P. H. Reopening guidelines. Weve worked with Johns Hopkins Risk Mitigation protocols to make necessary changes to our facilities and operations to make our environment low risk. We have adopted a four pillar Stage Program to increase Public Awareness and internal operations. We have upgraded our facility with an updated ventilation systems, avoiding automatic stations to eliminate touch points and automatic fixtures in bathrooms and washing stations. Please do not [inaudible] shared space transmission your times up. Sorry. Thank you very much. Looks like weve got two more speakers. Hi. Can you hear me . Yes. Weve got you on the phone. Id like just to reiterate what ive heard so far. Gyms are local. Were neighborhood based, and we can run just as safe as the businesses that are currently open while at the same time we help people improve their health. The state has allowed us to reopen at 10 capacity, yet our city officials are choosing to destroy this essential industry along with the livelihoods of the fitness professionals who have dedicated their lives to the health of our members. Our citys Small Business is dying under your watch, and we havent received any assistance. Its time to correct this misstep immediately. Thank you for your consideration. Thank you for your comments. And i believe we have one more. Lets see. Where is it . Yes. All right. You are unmuted. Hello, sir. Hi. Yes, i can hear you. Please begin. Hi. My name is sean shaw, a resident of an apartment complex with hundreds of market units. Im calling to address Resident Safety during ongoing construction. Specifically, id like to state that department of building infections hasnt enforced any guidelines. The residents have been exposed to multiple safety risks. Weve had multiple renovations occurring without permits and without the watch of a department of building inspect officer. Id like to request that more attention be given to empowering the department of building enforce enforce covid safety compliance, and if thats not possible, create capacity for the department of Public Health to step in and enforce safety orders. Thank you. Thank you very much. That is all the Public Comment that i see. Thank you all for for your comments. Commissioner green, i think you might have yeah. I just want to thank the members of the public for your comments and remind you that were not able to respond at the moment, but that we truly appreciate your input and perspectives and certainly take them seriously. We certainly appreciate your time and your commitment. I believe its now time for the commissioners to make comments or ask questions. Yes. It looks like commissioner girado has a question. Yes, i do have a question now on this excellent School Reopening presentation, and i would like to echo commissioner greenes comments on the enormous amount of work and detail that you have so thoughtfully put into this. My question is with the waivers that you have put in i think it was 53 waivers, im assuming those are private or Charter Schools that are requesting the waivers. What is the your thought with the coordination of the San Francisco Unified School District for their reopening . Thank you for that question. Thats an excellent question. The letter of intent and the Application Form is for all schools, including San Francisco unified. The San Francisco Unified School District, which we meet with weekly and have open lines of communication with met frequently over the summer and had a series of town halls and then also presented at their own board of ed and has decided to do Distance Learning. Im not clear on their decisions on when that would change, and that really is a decision for the San Francisco Unified School District and their board of education, but we meet with them weekly and we are in frequent communication, and they know of all of the health and safety guidance that we have offered and are extremely appreciative of that and included it in all of the protocols that they have in place. They are still offering quite a few services, such as Distribution Sites for those in need. They have got Technology Pick up and dropoff, and so they do have enough interaction with the public where theyve had to employ a number of our health and safety protocols, and thats but its its really up to the board of ed to move forward with that decision. Okay. I appreciate it. So its basically out of your hands, what you can do in educating and partnering with the school district. Our prophecies are open to all schools, including San Francisco unified. Okay. Thank you. I just get the questions multiple times, and the concern, again, the haves and the have nots, and its an ongoing concern. I think again for all of your hard work. Thank you. Other questions or comments . It looks like [inaudible] had a comment or question, commissioners. I didnt mean to cut you off, commissioner green. No, i didnt see commissioner guillermos hand up. Oh, okay. Lets start with commissioner guillermo, since you saw her hand up first. I apologize. Thank you. I dont have a question, but i just wanted to reinforce the need for Community Information to the public and to all of the stakeholders that are affected, that all of those affected, as well. It seems as if we have not had an opportunity to focus on the kind of communication with the different stakeholders not just as to whats changed and whats studied, the rationale and the education thats requested to understand why guidelines are such as they are, why some guidelines affect some groups and not others. And i know things change very quickly, but language and communication is absolutely important for the public to be able to understand and to work with city leaders to keep San Francisco safe and San Franciscos residents safe from the impacts of covid19. I just want to enforce to the department that we have an ability to oversee and to really emphasize that the kin of communication panels and methods that need to be put in place as a priority. Thank you, commissioners. Other questions or comments . Al has his hand up. Who does . Commissioner chow. Okay. Thank you. Yes, thank you. I think all the comments made today have been very helpful, and i know staff and dr. Aragon particularly has also emphasized the fact that theyre aware that increasingly theres a need for improvement in the communications. Everyones been very busy putting this out, but the logic doesnt come out as clearly, as commissioner guillermo said. It gives thoughts and pause to people, and given the fact that were now moving towards opening things, and it would appear that even if we were talking about some of the indoor personal services, it would appear that that is really moving we can understand for making sure that the first block doesnt create another problem before moving into the next block because thats sort of a lesson that we learned earlier this year. I wanted to just change the topic just for a moment in terms of also theyre looking at and another aspect of our pandemic, and that is to be sure that were heard a report and have seen the reports on, of course, the latino population, and the offer that we hear all the work going on and the success if we are moving in that direction hopefully in order to try to assist the latino population to be able to control the endemic the pandemic. Weve heard earlier about how weve been working with the homeless populations and how weve gone there, and weve also been quite concerned about the nursing home problem. Were well aware that the success of laguna, for example, with its very large population, certainly, its a lesson about solitude on the Residents Health has been very positive, and i know that the Health Department is working on trying to find solutions that would not jeopardize what is currently a very high risk population. So i understand, and i think that its a matter of additional communication to try to work out how that can be done. I think another area that i would like to hear about and i was talking about before is how well we are doing with the s. R. O. S. I think that was a big achilles heel in singapore, and they had something similar to s. R. O. S, and they might be more congregate. That became sort of the undoing of the success in singapore. I wouldnt like to see that happening here with this population. It appears that we are having very appropriate protocols to work with it, and i think it would be very nice to be able to hear how well were doing in that other very high risk population as a presentation of some sort, so that would be a request that id like to make. Commissioner, ive noted that. Thank you very much. Commissioner green, youre muted. Im sorry. Yes, sorry about that. Any other comments or questions from the commission . So on director colfax, would you like to say a few words on what the commissioners had to say . Well, thank you, commissioner green. So thank you, commission, for your comments and very much appreciate the Public Comments, and just to reiterate, we are continuing to focus on slowing the spread of the virus while we balance the need for multiple reasons to gradually reopen San Francisco. We know that there are key Health Aspects to the pandemic that certainly go beyond the direct effects of covid19 itself, which is one reason we prioritized education as a component today. I also wanted to comment with regard to the information in this rapidly changing environment. I hear the need for clarity, and when it is available, we will do everything we can to communicate it as effectively as possible. Youll recall dr. Bennetts presentation at the last Health Department meeting, this work is being done at the Health Department, but theres a broader approach across covid commands, which is multiple departments working together, and we do have a joint Information Command Center there, and we will continue to coordinate and work with them to get as much information as youve asked for as quickly as possible, and then to address the concerns raised in commissioners comments, i can certainly work with the Commission President and Vice President and secretary to ensure that we bring back presentations per your request. Thank you. Thank you so much, director colfax, and again, thanks to everyone for your thoughtful and eloquent comments. Theyre very much appreciated. I think, mark, is the next item general Public Comment now . Yes. Is there any general Public Comment . So i im not seeing any, but folks, if youd like to make general Public Comment, you can press star, three to raise your hands. Theres a few. Were postponing item number 10. Were trying to make sure this meeting doesnt go too late, so i apologize for the inconvenience for that. Weve got one hand. Give me one second. Paul, ive unmuted you. Can you hear me . Yes, hello. Yes, please begin. Youve got two minutes. Yeah. Id just like to raise some concerns to the Health Commission about the importance of taking you know, not just focusing on covid19. While certainly, you know, covid19 is important, and it does need to be addressed, i think the General Health of san franciscans need to be taken into account, and so there are other issues that need to be considered, Like Mental Health and housing, and then a lot of these restrictions that are being imposed due to covid19 [inaudible] many people are difficulty for a long time accessing their physicians, and certainly now, in Mental Health is a major concern. So i would encourage the Health Commission to also take into account other factors that are important to the general San Francisco population, not just covid19 and address these other issues, too. Give me a second to unmute you. Hi, caller, you are unmuted. Hi. Can you hear me . Yes. Youve got two minutes. [inaudible]. Yes. Yes. So given that the facilities have not been open and wont be open [inaudible] until at least next year, the rent doesnt go down. Its not like it costs a lot of money to maintain the pools, the hot spas, the gyms. You dont spend any money to maintain these things, but the rent doesnt go down. Hi. I dont know if your Public Comment is over. Okay. That is the end of general Public Comment. General Public Comment . Yes, we are. So the next item is the finance and Planning Committee update. Just a quick update from commissioner chung on the updates. Yes. The finance and Planning Committee meet briefly, and we have three items that we are requesting the commission to approve. Actually, you mentioned that earlier already about the impact of covid on the latinx community, and one of caescontracts is when you see the consent one of the case contracts is when you see [inaudible] very timely. And in addition, we have a short discussion about, like, what what we like to see in terms of the finance and Planning Committee, and and we were saying that one of the things that, you know, we wonder sometimes is that whats whats do these investments what kind of, like, Health Outcomes do these investments need . And so we are going to try to also get, like, some of these moderations from staff so we can at least have a fuller story to tell, you know, about the work that were doing. And with that, thi move that w move onto the consent calendar for us to approve. Commissioners, this is item 7 on your calendar. [inaudible] you can discuss it individually, otherwise, you can approve the consent calendar all at once. Do we need to review everything right now or has everyone reviewed it in advance . Hopefully, theyve reviewed it in advance. Are there any comments or questions about the action item . So move to adopt the consent calendar. Is there a second . Ill second. [inaudible]. Okay. It looks like you should have it no garrett, maggie, were not hearing you if youre speaking now. It looks like youre muted. Ive unmuted you. Hopefully can you hear me now . Yes, we can hear you. Okay. Thank you. Maggie rykowski, and im here with our deputy director, garrett chadfield. Garrett served as the acting director on ocpa while i was on assignment at laguna honda, so hes with me here today, and hell be able to assist me with answering any questions that you may have. So our executive summary, want to start, you know, with also the privacy and affairs, we go by ocpa, had to adjust to [inaudible] while simultaneously addressing the covid19 emergency. In response, ocpa adopted the operations of d. P. H. While continuing to protect the integrity of the department. [inaudible] to cover all Service Areas and to establish an operating procedure. We established a dedicated [inaudible] in december 2019. This committee provides compliance activities to the d. P. H. Executive staff. The other two areas are revised audit protocol and increased privacy monitoring, well cover a little bit later in the presentation. Just want to show you our organizational chart, and as you can see where on the far right, that is where ocph fits on the organizational chart, and next, this is the ocph organizational chart. So im going to start with the compliance program. Compliance program conducts operations and activities ethically and with the highest level of integrity. The goal of the program is to practice and promote good favor and avoid conduct that may cause financial or reputational harm to d. P. H. Our program deals with fraud, waste, and abuse, and it should not be confused with compliance from quality that deals with compliance from regulations or standards of care. Were dealing with fraud, waste, and abuse. We have not paid any compliance regulated fines to regulators in fiscal year 1920, however, we did have some paybacks, and these were due to complaints with errors. We have seen a year to year decline in the amount of money that d. P. H. Has returned to payers for disallowed complaints. We are hoping to continue this trend by our active monitoring of claims, documentation to prevent the submission of claims with errors, so we have gone down quite a bit in the last three years. At the beginning of the fiscal year, we do provide or conduct a Risk Assessment and then develop a work plan so we know what areas were going to focus on for the year. For fiscal year 1920, for the three main definitions, vsfq, laguna honda, and population health. These are the areas that we had m monitored and now that were into the second month of our new third month of our new fiscal year, we have completed the work assessments for 2021 and these are the areas that were currently monitoring for compliance. For Behavioral Health, our complains program is tasked with ensuring the Mental Health plan integrity with our contracted and Civil Service providers. We perform we perform scheduled provider audits to make sure they meet plan requirements related to documentation and claims. Im going to have garrett is going to tell a little bit about our revised audit protocol because we did have quite a bit in our disallowed public claims because we did revise our allowed protocol. As maggie said [inaudible] because we are the Mental Health plan, so our job is to make sure that our providers are entitled to the claims that they present and get paid for. So because there was somewhat of an increase or we saw that trending, were going to focus on the audit and fraud elements, and were working with the department of Public Health to move that over to the quality side. We hope to be able to do more audits that we had, although covid did interrupt us this year. Because of the streamlined tool, well be able to identifiidentify claims that are invalid or disallowed. We are providing a corrective measure based on a percentage basis to the providers who will then have to report their activities to the Compliance Committee and then well go back and rereview them in three or sixmonth with intervals, we sixmonth intervals, depending on how they did, which is a change. The idea is to have a closer eye on those providers to make sure that the claims they submit are theyre entitled. Right. And then just to note that the audits were suspended in march of 2020 through the end of the fiscal year due to Covid Health Emergency because these are audite audits that you do onsite, so these were suspended, but they have since resumed. For privacy, we work with all Service Lines to prevent any risks or hazard to security in the confirmation of personal data. In fiscal year 1920, we did not pay any fines or penalties related to privacy breaches. So this this slide shows our number of privacy incidents, our nonreportable breaches and recordable breaches. We take all public incidents very seriously but its still a privacy breach. So we take all of these very seriously. As you can look at the the location, it has brokendown to all our areas where the privacy breach has occurred, and these are report for those that are reported, its either going to be reported to the California Department of Public Health, the department of health care services, and the office of civil rights. It depends where that breach occurred. This slide here shows you the type of breaches that we had, and the three top were the unauthorized verbal disclosure of Health Information, Health Information given to the another patient or wrong person, and then unauthorized photos and videos. The unauthorized photos and videos, that was due to the laguna honda incident. This is a yeartoyear comparison, and just show you this slide because the number of reportable breaches increased from fiscal year 1819 to 1920 while the number of total incidents remained approximately the same, so were taking a very close look at the what we can do to mitigate our privacy breaches. One of the areas that we monitor really closely is appropriate access to the medical record. We have deployed an epic tool called break the glass, which is is a record can be identified as confidential or sensitive. Once thats marked as such, employers who are not identified as part of the Health Care Team must break the glass by identifying who they are and the reason for accessing the record. As you can see, weve done an enormous amount of reviews, and im very happy to report from all of our reviews and investigations, there were no reportable breaches discovered on the break the glass reviews. Data sharing is another area of our privacy program. Our data shares agreements allow for d. Data sharing agreements allow d. P. H. To share information with data vendors and partners as well as relevant city agencies to coordinate care and services. We work very closely with contracts, i. T. Security, and the City Attorneys office to protect d. P. H. S interest and define the use and scope of our protected Health Information. And i do want to address or point out, for the if you look at the chart of the spec deviation, that is specification deviation request. We had 91, and that has to do with requests for maybe Certain Software or encryption bypass, thirdparty email, things of that nature. Were continuing to monitor our data sharing very, very closely. Our Whistleblower Program, o. C. D. Reviewed complaints from whistleblowers as well as received directly. We conduct investigation and provide a report that either substantiates the report with the corrective action or does not substantiate the allegation. Findings of both the complaint and the fiendings are confidential. We investigation all allegations, and we as you can have a complaint that has several allegations, so thats why the number of allegations are actually higher than the number of complaints that we received. I know there was a question as to how did does d. P. H. Compare to other city departments, and the you know, we do have more whistle blow blower complaints than any other city department, however, we are the largest city department, and we also have a very skilled workforce. Our workforce is very accustomed to looking at guidelines, policies, procedures, regulations, so they can identify when something just doesnt look right. Weve done a lot of outreach and training to tell staff, if you see something that looks different, tell someone, and that works. They do tell someone. The Controllers Office will be completing their annual report within the next couple weeks within and that will compare all city departments, so ill make sure that get a copy of that to mark so that can be distributed to the commissioners. And that slide shows the year yea yeartoyear comparisons of the allegations and the types of complaints that we received. And so educational outreach, we really try to be a resource for our staff. All of our staff and partners need to complete the annual training for their compliance and privacy. They complete their confidentiality statement on an annual basis, and they signed that they read and understand the code of conduct. During the fiscal year 1920, they revised our website and replaced it with a more friendly, user friendly site because this really is a staff and a resource and tool for staff. And our code of conduct. You know, our code of conduct, we have worked very hard on the code of conduct. I started as the director in 2017, and our code of conduct was two pages. Its now 21. Its a very comprehensive document and really a guide for employees on appropriate conduct. During the fiscal year, we worked with the office of health the office of Health Equity to add respectful behavior into the code of conduct. And since thats one of our core values, the code of conduct was a very appropriate document for that to be added. So we now have a very comprehensive document, and it includes respectful behavior. So looking ahead, since d. P. H. s inceptid. P. H. S inception in 2015, we have strived to be better every year. As we move to fiscal year 2021, well continue to work to assist d. P. H. As it responds to the unprecedented demands of covid19 Public Health emergency and to continue to reach all of d. P. H. Service areas. And with that, commissioners, that ends my presentation, and we can take any questions that you might have. Thank you for the report. Its really incredible progress in the five years since youve started, and we really appreciate the analysis and really the detailed work youve done. I believe there may be one Public Comment, is that right, mark . Yes. So i have unmuted you. Can you hear me . Yes. Okay. Youve got two minutes. Okay. Good afternoon, commissioners. My name is dr. Derek kerr, a whistleblower. Page 16 of the annual Compliance Report shows the number of whistleblower reports filed last year. There were 145 whistleblower complaints. Whats missing is the results of your investigations. How many were substantiated, partially substantiated or not substantiated . We dont know because outcomes are not disclosed. Providing outcomes shows that you are conducting legitimate and effective investigations and that you take whistleblower reports seriously. Withholding outcomes casts doubt on the integrity of your investigative processes, and that concealment discourages employees from reporting violations through you. Thank you very much. Thank you. Commissioners, comments, questions . I dont see any hands. Do you, mark . Looks like commissioner chow hayes his hand up. I so just had a quick comment, because i think i missed it on the Behavioral Health audits. Did you say that although you suspended it, you were going to complete them or you werent going to complete the audit because it looks like you stopped them partway through . So we did stop them in march when covid19 hit, and we decided that was appropriate given our response from our partners to the community. We restarted them this month, so we just restarted them as of the first of august. Okay. Thats good, because i and perhaps theres really ways to do it where oh, i guess you figured out how to do it safely because i noted even like with some of the other regulatory agencies, theyve now figured out how to ask for information ahead of time. Yeah, i answered that question sorry. But to answer that question for you, they are being done remotely. So we can go into avatar and pull the information we need remotely without having to risk exposure to people. Okay. And i do have a comment concerning the Whistleblower Program before dr. Kerr even made his comments, which is one that ive made in the past any way in terms of when we do see numbers and im glad you have the comparison of two different years. We dont have any different outcomes. What are the results of the findings, and then thats a way that we would be able to track it, and i think that that would actually enhance the report . Thank you. We will look into include that go in the report. Thank you. Commissioner guillermo. Okay. I also had a question about the health services. Were these primarily related to these are audits of of fraud. Are they audits related to fraud or other issues . Its a very significant increase, and even though you have indicated that youre going to increase the number of audits and implement corrective action, its unclear what those corrective actions are focused on, so just a little more detail would be helpful, given that significant increase from year to year. Sure. So in the audit range, we didnt find any indications of fraud. Forms were unsigned and stuff like that. The corrective action is going to depend on what we find in a specific claim of an individual. So lets say if we have an individual where 15 of their claims were disallowed, we would develop a plan of action focusing on the areas that were problems for them. And then, we htheyd monitor, report back to us, and wed go from there. And just another sort of followup question there. If it turns out that there is data that shows that there is more disallowances from providers that are widespread, would the corrective actions im just sort of wondering how you how you might determine what those corrective actions might be if this is something widespread versus limited to a few providers. And you dont have to answer now, but it is a question that, again, given the increase and then, sort of related to that, it may be that if its widespread that there is something sort of structurally at issue with how these providers report or the information or so on versus something that, you know, any particular provider is doing wrong. I dont know it well enough and understand well enough how these audits are conducted. But it would be interesting to find out whether this is just an aberration or something more systemic or structural. Thank you. Any. Okay. Thank you. I see commissioner christians hand. Thank you, dr. Green. Im new to this, so i may not understand a little bit. Can you explain to me what the audit entails . Do they include the guidelines of the contract th of the services that theyre supposed to provide . Is there any quality or analysis outcome that the person who is conducting it knows how to do it . [inaudible] so primarily, the clients like, are the claims valid . The quality piece is assessed by quality or regulatory with throughout the department, really. Part of why we did readvise this tool is there were some quality elements that have sorted migrated into the compliance review that were not really qualified to assess. So im working with Behavioral Health to try to have that move back into a Quality Assessment for people who cant assess that appropriately. So the quality of care isnt really compliance focused, its more about the validity of the claims that were paying to the provider. So its kind of a dual universe; theres somebody on the same kind of schedule that youre working on, looking at the qualitative aspects . I cant answer for quality or what their schedule it, but that is handled separately. And my second question is in the Behavioral Services context, but it may be also apply to others. Do your audit results come into play explicitly when contracts are presented in future years or renewal or contracts by the same provider, and would we as the commission when were going over that, does that data get presented to us . Thats a good question. Im not involved with the contractual side of things, however, that information is available to whoever is considering the contract, and it certainly could be provided. So i cant really answer that question because i dont know. Well, we can find out for you. Thank you. And at thif i may, commissi christian, ill follow up with the office that deals with contracts, and on the finance side, before it comes to the committee, there is a portion that includes monitoring. My assumption i used to work in that arena, is they would review that as part of the package, so ill get that information to you, as well as the thing with garrett and maggie. Thank you, mark, and thank you to the presenters for this information. It was a very thorough and well done presentation from my perspective, so thank you. Great. Thank you. Any other questions or comments from the commission . I agree, this is really a welldone presentation. And i believe you also supplied us with some information. I guess i only had one question have a comment. My question is can you give us a sense with how many incidents in the fraud side of things, its really intricate and confusing coding. There was mention about modifiers, for example, that can be used in one situation but not others. Can you just give us an overall sense, like, if you had the perfect coding advice, and if you tend to remove that from the issue, whats really left behind . In other words, it seems like most of the time, if not nearly all of the time, the Services Rendered are really properly coated. Can you just give us a sense of this, how many is coding properly and how many you have to confront an audit work carefully . Yeah. With the coding side of things, its generally confusion or not understanding how to code. Most of the times, the providers themselves make an assignment code, and theyre not coders themselves, but theyre providing care, and the assignment code, there are some reviews that Health Information management may review the code, but not on all claims. So thats why were starting to work with a vendor to provide education on the coding piece because its usually just errors. Its not purposeful, its not they dont really understand that oh, medical necessity didnt really meet that criteria. So theyre focused on care, but with we do want to give them education so they can understand how to do that, as well. And then, my last question, wou do you understand how epic might clear up these prompts and problems with coding because i guess their options there. I guess my question is, would you break the glass i know every time you have to check a record at ucsf, i have to break the glass, and one of my 44,000 patients that have gone there for care, that might be part of it, and wonder if were able to understand how epic might or might not actually create incidents that really dont exist because its either Cross Services or you see people looking at a county record or Something Like that. I wonder if you could comment on the whole epic universe. Yeah. Thats the scene we have break the glass, its somewhat overused, we say, from our assessment. There are records that break the glass put on that dont necessarily need to have it. Like, yourself or another provider is constantly breaking the glass or a Billing Analyst needs to break the glass to go in. Now that we have this data, when it first was implemented, we wanted to just understand it, so thats why we started these reviews. Now that we have this data, we are going to try to work with epic to see if theres some kind of criteria when break the glass is applied. And more importantly, the accurate identification of the care team, which is Difficult People because move around. There theres a lot of moving pieces, so its hard to 100 identify who accesses the records, but we want to minimize that because 44,000 events is a lot, absolutely. This is clare horton, c. M. O. Network. Im sorry to butt in, but i wanted to let everyone know were starting the data and budget subcommittee of the epic leadership team, and i think thats going to really be able to work closely with you to look at these types of incidents and use epic platform as commissioner green is saying to help us without creating more work. So thank you so much for your presentation, and i look forward to working with you on that. Yes, thank you. Director colfax, did you have some final thoughts on the compliant report . Yes. I just really wanted to thank maggie and garrett for their work on this. This is historic compliance has not always been a strength of Health Departments, and its just such a key part of our system. Maggies really built and expanded the work, and dr. Hammer, our ambulatory care director, wanted to clarify some of the questions that commissioners had, commissioner green, if i could pass it over to dr. Hammer. Absolutely. Good afternoon, commissioners. Can you hear me . Yes. Good. I just wanted to add onto garretts response to commissioner christians question about compliance and looking at compliance. Behavioral health has a number there are a number of audit programs mostly through medical, and so we have an annual eqro. Its external quality review organization. Its a very expensive weeklong process with visitors, and they do a very involved audit looking at quality both of the Mental Health system and for our drug medical organized delivery system. And if you could like, we could put together a summary of the various audits that Behavioral Health and other sections of the Health Network participate in on a yearly or, in some cases, bi or triannual basis. Yes, that would be great. Thank you. And weve just completed our process, and our Behavioral Health teams really does an excellent job on that. So well pull together a summary for you, commissioner christian. Thank you very much. I think we would all love to see that, and mark, if you could distribute that to all commissioners, that would be welcome. Of course. Okay. Seeing no other commissioners comments or questions, well move onto item 9, d. P. H. Human resources update. Yes. Thank you for all the members of the public and staff that are still with us. Its a late meeting for us, so we appreciate that youre all still here. Mr. Brown, let me know if you need any help with sharing your screen. Yes, i do need help. Can you hear me . Yes. Hold on, hold on. Oh, there it is. All right. Can you see the slide now . Yes, sir. Ga good afternoon, commissioners. It seems like its been a long time. Ive only been here since november. I know we have a new commissioner on. Susan christian, thank you. Nice to meet you. I want to be brief today, because i think this needs to be a report where i would like to have all of my direct rep t reporters come and do a presentation directly to you in all areas. But this is that were going to give you a little bit information, if not update you all the way to today, i think some of the information that youre going to see today is only up to may or Something Like that. But i have some more answers to your specific questions. I think commissioners already have six questions that ill try to address. I am the chief Information Officer for the department of Public Health, and i started in november 2019, and in november 2019 its not advancing for me. Try using the arrows. Yeah, i was. Its not doing anything. I got it now. The page down is doing better than using the arrows. So in 2019, we had the option of adding Occupational Safety and health to human resources. I think its a good addition to h. R. It doesnt help us in terms of hiring, but it helps us in having a safe work environment, ergonomics that we have in terms of employees. This report that im presenting today is going to give you some update for 1920 regarding our merit and recruitment, options program, operations, a little bit about our payroll and our Occupational Safety and health and people inspection. And finally, i want to talk a little bit about our equity within h. R. And some of the plans that i have moving forward. So we know that in november, when i first came, we had a problem with hiring. But after i came in november, we had a problem with covid19, and we had an urgent need to do more hiring faster. What youre seeing now is as of may 2020. We had 149 nurses. Its now closer to 200 nurses that we hired, and were still hiring as we go forward. And i think as of the last report that i came before you, we said we had gotten it down to 20 vacancies in the nursing field. You took me at my word when i said that we would fill those 20 vacancies, but as the pandemic turned around, it went back up to 50. We are still hiring, so that number is not 50 anymore. Its more like 30, with you theyre in the but theyre in the hardertobill areas of specialty that are harder to bill. And we continue with our expedited hiring plan, but were not using the Moscone Center doing hiring events, were trying to incorporate it into the whole process as we go forward. Were using our eligible list, and we can do that because its a continuous posting, and we can update this list any time were hiring. Were looking at converting some of our p103s that are interested in going into permanent positions at the same time. So if we look at the nonnursing kinds of classifications during this covid response, there were like 28 classifications that we had to do fast recruitment at the same time were doing nurses, as well. I think there was an attachment i dont know if you have it. I dont have it right now, but it was an outline of what those classifications were, and there were a total of, like, 59 vacancies. And these positions were, i would say frontline, as well because we need them for patient care assistance or food service or additional port ares; things that we needed to help in response as we were moving forward with the covid response. There were a total number of applications at 6,821. Thats not the total for the whole fiscal year. If you look at the note there, the fiscal year was 16,256. For the previous year, it was higher for the total number of applications received, and the reason why the number is different is because when we got into covid19, we were able to use Emergency Declaration by the mayor to activate old eligible hires in important positions that we needed to hire and fill quickly. So we didnt put out new postings and take in a lot of applications, so its understandable that the total number of applications did go down. Were also looking to fill our director of Behavioral Health for Mental Health services, this 1166 of the classification. We are currently in recruitment right now. Were going to be working with the berkeley Search Consultants leading the search. They are now going to pick up the ball and keep going for us, shall we say. We have my understanding is the most current number is about 70 applicants that are deemed qualified, and we have more than 40 applicants that are qualified i think its 47 or Something Like that. The idea is to have this position filled or hopefully select the person by i think midoctober 2020. Thats ambitious, and i say that because we look at the calendar, and we are now real quickly coming up on november and december, which are the holidays. So even if we get a person in midoctober, im more hopeful that we will have the person on board before january 2021. If we get the person on board before then, with all the hoops they have to go through, the medical and maybe they have to give notice to their current job before they come on board, its going to be somewhere before that january 2021 date. In this particular slide, when we start looking at our rates ethnicity active employees, this is data that weve been collecting for the years in the past, and were looking at what happened in 2020. Whats important to me is the needle really isnt changing too much, but whats important to me, if you look at the two sections, that particular gray section is talking about people who did not want to disclose what their ethnicity was. So we dont know if its going to be equally distributed amongst all of the areas or not. But what i want to see in terms of works that we want to do, in terms of diversity and inclusion and, you know, what we have to do in terms of keeping our true north objectives, is see these numbers actually change and be reflective. And i think one of the questions the commissioners had is what is the actual work with the ethnicity of San Francisco, and what are we doing to hire them . Thats important, and ill get to that later, but if we want to change the hiring process and have a fair representation in the hiring process, these numbers are going to need to change, and they still havent. Weve still been doing the same type of hiring process where we do the hiring process and on and on and on, but theres many other ways that we can look at filling the vacancies faster, and ill talk more about that later. So when we look at hires by location its understandable. I already know theres going to be a Higher Turnover at zuckerberg, and its going to be lower at laguna honda. Im anticipating more hires in the Mental Health programs as we go forward, especially with our new hire, with the director, that will maybe give us a push in terms of getting those new hires done more quickly. When we look at retention, this and i know that this is one of your questions. When we looked at this, when i first saw this slide, i had a problem. But i was able to find out more data. You know, data is just as good as what you put in, and what i found out on the ambulatory care, if youre looking at the first section, it looks like there were 76 hires last year, and there were 41 people that we lost, but thats not accurate data. Based on the most recent information, actually, 63 are still employed. Three resigned, and one never joined, but nine are on boarding, so they actually have a 94 retention rate, so thats excellent for ambulatory care. Its just the data was faulty, but that is great numbers. But then, you look at zuckerberg, and this is where we still have a challenge in terms of the medicalsurgical area or in spsychiatry, a litte bit in emergencycritical care, ambulatory care at the hospital itself, and just a little bit im not too worried about laguna honda hospital because its usually a stable population. Theres a small turnover rate, but theres a small retention problem there. Im going to talk more about my plans on retention and what we can do moving forward, as well. When we move into our hreeo realm, there were a consistent number of claims filed, 84 total for last fiscal year and the fiscal year before that, but it was up from the third year prior, from 58. From my e. E. O. Officer, the actual composition in terms of the locations was very similar. It didnt vary in terms of numbers, in terms of location, so it wasnt fruitful for me to put another slide to show the difference. Its almost the same. I think that one of the questions from the commissioners was do we have more data, and ill get to those questions, and ill have some more answers for you. But let me keep going with the slides. I know its the end of the day, and were running long for everyone. In terms of the affidavit d. A. Requests, its not surprising that the majority of the a. D. A. Requests are coming from San Francisco general zuckerberg memorial hospital. But when you look at the fiscal year prior and the year prior to that, were not doing that bad. I was expecting to see a higher number, especially as we went into the covid response, and the number of people that may have said i need an accommodation based on either a Serious Health condition or whatever it is. This is not a seriously high number, but this is still a manageable number in terms of a. D. A. Requests. Im not upset about the 308. I think its still a relatively good number, and i think were still doing aok with that so far. This is where i have a problem. If you look at, across the board, the total percentage of discipline outweighs the total percent of population for both black and hispanic. Its just the opposite for everyone else, and this is what weve been talking about before the board of supervisors about, you know, people treated like theyre disciplined more, and the numbers actually show that. Were working to make those bars actually reverse. And as i go through this presentation, i do have some words that i would like to leave for you to think about, things that we can do in the future that we can look at in maybe trying to make a change in make a difference in this. We can look at the next slide, the key personnel actions. Were talking about, just looking at protectionary period probationary period. Youre looking at even if the numbers are low, the highest bar at zuckerberg is showing that its blacks. When you see written warnings, it seems to be asians, blacks, and whites that are in written warnings. But when you go all the way