Transcripts For SFGTV BOS Government Audits And Oversight Committee 20240712

Threatening, and that, in all of the laws, that govern break the glass, both at the state and the federal level, allow this emergency use case to occur. Working can your medication and managing your appointment. I believe there was a question are we able to manage telehealth appointments yet. Through my chart, the answer is not just yet. When we do that, well be obviously, greatly improving expanding and unifying our telehealth experience and we hope to be able to then offer more enhanced scheduling for those appointments. Most appointment management today, through the my chart tool is for primary care. For our activation rate for my chart, basically, how many patient dos we have, we consider active. A little over 10,000. 10 percent to 11 percent zone. Not surprising to see most of our my chart users by h cohort are between 18 and 65 years of age. I was actually really pleased to see, that 60 of my chart users are over the age of 65. Some of those include some of the residents. We move to the right, and look at preferred language, just a reminder that perved language is something expressed english is their preferred language, although 9 spanish, and 7 cantonese also made it on our list, as well as all other languages. And if you want to take a slice by race and ethnicity. We request see across the board, can you look at the horizontal access. Those are the rates, categories that are in if you look at the map, 10,288. That allows us to record patients who express that they are multi racial. When you look at the bar. You will see two colors, orange, being an indicator, ethnicity of nonhispanic or unknown and blue being hispanic ethnicity. So this is the way to look at our initial firstyear view of epic my chart user byes rates and ethnicity. The things that we have done so far, that are most important on the left, are that my chart wasnt something that was just deployed. My chart, just like the rest involved a lot of input and in this case, input from pates. From patient advisers, who are involved with many decisions about the design and look and feel and functionality of my chart. My chart is currently available in english and spanish only. More languages should be written in and coded in to the softwares that support the my chart capability. But i think thats the flip side of that concern is this is a proxy consent, much like the [indiscernible] that shares the beginning is important. Because if somebody is unable. Because they are not fluent in english or spanish and they have someone they trust, they can grant that person proxy access to their record and that can really help the engagent with the patient. And to help navigate the health care experience. On the right side, what are we planning to do, were really trying to understand where we have disparities and how we go about closing the gaps. I was reminded this afternoon. Just before this meeting started, my chart is a piece of software. And is assumes you have access to a computer or smartphone, and the internet and that you can actually afford to do those things and thats doesnt compete with food, shelter or education or going else. Ensure more people with take more command of their Healthcare Experience with us, with the understanding that not everyone has access to a computer, and the internet and a smartphone. Arcr, after a lot of challenges at go live and of course, challenges with covid19 as with our dramatic decrease in operations, which means we werent collecting as much revenue. The ways i know that were stabilize side that we are now starting to collect more per month for Services Rendered than we did prior to having epic. I think its a little later than we all wanted it to be. But we are starting to see those collections trend in a favorable direction. And epic actually recognized the folks with access and Revenue Cycle in dph with recognition for basically, a solid install called the automaticimation pulse recognition. I had a hard time understanding what that meantime, too. But essentially, what it means is that we have completed a very thorough employment of capability that allows us to do access and Revenue Cycle and we are allowing claims to go out the door. We also know there is still a lot of opportunities to collect more revenue. And some of the reasons we know that are because of the analytical capability that is epic provides us. Where it sundays us lots of signals and gives us a lot of intelligence about where we should be looking to understand where we may not be capitalizing on this opportunity. So thats our way forward is to use the analytics to make sure that we can improve whether it be the human processes or technological workflows to maximize all the Collection Opportunities before us. In 2019, followed by a stabilization period that took us to the beginning of 2020. What we havent talked about is when you implement new software, you usually have to free the version of the software that youre on so you dont change it as youre training thousands of users and making lots of configurations. So we were no different than any other organization and in the early part of 2020, we flished three upgrade its one time, which was a fantastic accomplishment. It resulted in a very short amount of down time for all of our epic users. If we move forward with wave 2, which we reset our expectations. By nature of how you see all of the subparts of what make up wave 2. Everything from integrative care, and coordination of care, all the way down at the bottom where you can see the last row where we have integrated video visits and interpreter services. Thats what we were tbawsmght integrating services into the my chart experience. Each one of these can be a justed and moved around and theyve been as a result of our heroic response to covid19. So we have adjusted so that we can accommodate when our line of business appearance are ready. There are a lot of people chomping at the bit to move into the epic environment. So we are flexing and adjusting to make that possible. So its committing to see that were able to actually still maintain our Covid Response and take on components of our epic program thra if you ask me back in march, with the time of shelter in place. I think i would have said, i dont think were going to do anything with wave 2. But this is an Amazing Organization and we are continuing with our work. Finally, to talk a little bit about our h. R. Budget, some knowns and unknowns when i spoke in early july, we have wrapped up. We have learned a lot about what we actually spent, against what was predicted, against what was budgeted and that has helped us predict, spend for the remaining years of our epic experience. We also know after reconciling many, many contracts and purchase agreements that consulting cost consist bring up a big bill. We are going to take a more surgical approach, as we need a boost or as we need expertise that we simply dont have, that we need to get us over the bump of design or implementation and we become and save the owners of the work. I think its important to comment that we have really very few consulting resources right now, as weesk operating over the course of this calendar year. We will start bringing in ray few here and there, as we start moving through more wave 2. Top right, something we dont really know, are all of the subordinate contracts for epic. Epic is huge. We all know that, but we have about 5 dozen other contracts that help support all the different aspects that we epic do themselves. Enhancing our telehealth capability. In order to do that, we have to partner and have an agreement with an organization that can do sort of the audio visual part of the work. And that has the right linkages into the Epic Software so woo y wee can combine epic with the partner solution so we can have an experience in my chart, with the video visit. We have a number of these contracts that are still yet to be awarded and several of them havent even been through the rfp process. We have done our best to provide good estimates the future year costs through 20 twesk of both contract you and our staffing for epic were under separated. So im going to move to the numbers to see how that actually pans out. Fist line is proposed budget, which is what your comitionz saw from some years back request that was assembled. What you can see beneath that is what we believe to be our actual ehr spend for that period of time. When i met with you last, we had predicted that we might have to dip into our project contingency. As it turns out, request we reconciled all of our contracts at the closeout of this fiscal year, which was obviously a really big one, it was our golive year, we ended with a positive variance. That was important. As we move to the next column to the right, fy21twesk which is our estimated budget, youll see the proposed budget was about 140 million. Were actually estimating that our ehr spend is going to be closer to 211 apply our project contingency, which we have not had to touch. And apply our net balance from our first three years of work on epic. Youll see that we are just slightly positive. And so im glad to report thats our current status. I think my take away from that is being responsible for ensuring that we stick to both our targets and our budget is that we will be paying close attention to have we have enhanced our estimates and understand variances on a more frequent basis, now that we are in regular and normal operation with this solution, but also, were still i. Implementing. Ask i leave you with this quote from president John Quincy Adams but it explains a lot of what is going on in our organization. So much perseverance and patients and im pleased to take your questions. Thank you, mr. Raffin. Do we have any Public Comment . Those of you on the Public Comment line, please press 3 if youd like to raise your hand and make a comment. Ill give you a few seconds. I do not see any. So we can move on. With commissioners comment. Commissioner green. Fist, thank you for the presentation. I think we all feel from implementation othe epic project has really succeeded beyond our expectations. So congratulations to you and the team and also to the seamless transition and leadership which i think came at a very difficult time. And i applaud you for having done that so well. I had one question about my chart. Are you gathering any data . You know, there are four areas you can use my chart for prescriptions, appointments, test results and for contacting your doctor. I was wondering if you were keeping any roarsd as to proportion of which those 4 possibilities are being used and also, knowing that our system means that doctors may not, we have many people that arent in clinic every day and so as people start to want to contact their doctor, what kind of guard rails are we putting there. So ask, people will send something vee at website, thinking it will be read in 5 minutes and i just wonder, especially in our system. What kind of guard rails we might be putting in],the communicate withing your doctor component on this. I dont have the data, im confident, i know that we have a guard rail on what to expect when you send the message to your provider, as far as a response and a reminder even before you sign up for my chart of what tox peck as well. So we can get you exact information. To your first question on the data im sure that we have that available. Again, i dont have it at my fingertips. Ill be happy to get it and break that out in as much detail as we can. Somebody responds to you right away, its going to be very confusing to patients to figure out what the best modality is of reaching out if they get so fatigue and next thing, youll find something. I mean, that happens to me. Im in labor. Oh, god. You sent me an email. You know, that kind, how were going to go forward with that. Yeah, its no trouble to get that information. I can answer that so hi, commissioners. Its clerc and ive been really pleased pleaseh how its rolled out in primary care. We dont have that many my chart user bus my patients of course very pleased with t. And i think holly and robert have done a great job setting it up, we have the call center the and nurse advice line so we can knock off all the issue that is can get taken care of by a teambased care and patients are informed that they are sometimes a bit more of a way for us to get back to them. But it really takes care of soy many issues. We have a protocol for cuing up prescription refill when is that comes in by call. Getting paicialghts on my chart, and i think that can help them across a Digital Divide and id love to be a part that have solution to them. Too. L thank you for the presentation. Im really excited about number to begin with as a data geek. And with what dr. Horton just mentioned, i was wondering if we as a commission would be looking forward to like, future reports that actually indicate how the adoption improve User Experience and lead to Better Outcomes and like, improve streement strategies were just coming out of the first year using the tool. So thats always luck to use data from your first year. But i do think were going to be able to provide extensive information that we can track in a number of dash boards about how well were doing. Its really the first time that we have that face where we have the capability to see what were doing scrks share that information with others, such as this commission, in a way that is more unified and complete than i think we have probably been ever able to do. So with a years worth of data, we are starting to understand, thats how, for instance, othe Revenue Cycle side, were feeling much more confident about where we are as weesk able to seat trends. Week by week and month by month and its really no different to look at how were operating medically as well. Where we can see a lot of our measures and Key Performance indicators. Its something we can start bringing forward and encouraging folks to ask us more questions so that we can bring you those answers and show you exactly what it looks like. Thank you, i look forward to it, dana. Thank you for the updated implementation sequence. I would imagine that knowing all the things that have happened, one, which youve englished already, we can follow. Two as the road maps that you have. So i was thinking that we might be able to get is seeing the new budget, essentially that you have for the coming 6 years in terms of what youre look at to spend, to build out the rest of wave 2. In the past, when these contracts came before the commission and they were enormously complex with multiple contracts as i know mr. Wagner was aware of, we were able to put them into context because they were broken out into buckets and we could tie them to buckets so that we could feel that tarpnt just that you went and today was september 15. This is the one wed like to present to you. But wed like to sort of see this at the budget commit easy part of the whole. What is the whole that were doing . So maybe were not prepared to do that right now, although you do have some estimates perhaps a presentation as to what this new build out over the next six years are going to look like. And how youre going to be bringing subcontract ors in. So when the contract ors actually hit the committee, they can be slotted in and be seen as as part the schemes that have been worked out. Those linkages will not be terribly difficult and i think it will help ground everyone in how to spend capability that is were adding to the epic program. The model used during phase 1, really, i dont want what the chair budget things but i thought that actually worked out quite well as we saw the different component parts. Not at this moment, but thank you for bringing that up. Any other detail . s all right want thank you very much for your excellent presentation, its been exciting to see how this has come along over the years and how useful this tool has been as we also navigate a pandemic at the same time. I think we will not be be in as good as we are in now, without epic and the state that is it is in. Thank you. This is grant colfax. Can i just add my gratitude to erik, mr. R affin and his team. Its just been a year since we have implemented, a year and a month. Seeps loppinger than that and the culture of epic has really taken root root in the department and also with our covid19 response, we are now planning link other epic for us to be able to better monitor the pandemic. So, so much progress in just a year and a month and just appreciative of all the work thats happened. So thank you. All right, thank you, mr. Raffin. Well move on. To our next item which is other business. Commissioners. Any other business . Okay. Well move on. To joint Conference Committee reports. Commissioner guillermo, had some issues. Yeah want i can hear you and i pulses. Somehow i got frozen out of the meet expghts webex so im calling in. We received a report from Michael Phillips qhorks is still relatively new to honed a. As unfortunate we have not had a chance to meet him in person, he jumped right into the position and gave us a thorough report on the status of things like niguna honda and a finance report which we have not been able to get updated last time. Which was good news because it appears that were doing quite well at la gunna honed a. One of the things that Committee Members are always interested in is the data on residents who leave the hospital without being discharged, i guess awol residents and patients and although the data has improved, in the situation has improved with regard to those residents, and the ability to follow up on them, the Committee Member commissioners who are interested in just getting a better understanding of those awols and how social Services Follow up. If conducted with them. So well be getting more information on that in a future report. We again, reviewed the Regulatory Affairs report, those are still pretty much on hold because of covid and so there is not a lot of information that we were able to get, with regards to status of the number of facilities reported incidents. We did have a good presentation on the culture of saist. A survey that was implemented last year at la gunna honda in october, was supposed to be retaken in may of this year, but again, because of covid19, it was postponed until august the sponse rate was much smaller to last year, it did show throofs a slight improvement from staff in terms of the sense of safety, s, but there are still a few areas that need more outreach, more followup and more data that we will be hearing about in particular, probably in november because the survey will be taken again in october of this year. And theyll be doing a conservative outreach to make surety Response Rate is as close to, the Response Rate as we had last year. Then we wante we went into closd session where the committee reviewed the Quality Improvement report Patient Safety Group Minutes and we approved the staff credentialing report and that is the extent of my report. Thank you, commissioner guillermo. Do we have any other other questions about the laguna honda jcc meet . G seeing none, we can move on. To our next item which is adjournment. Do we have a motion to adjourn . So moved. Is there a second . Second. I will do the roll call commissioners. Commissioner guiellermo yes. Commissioner dorado yes. Commissioner christian yes. Commissioner green yes. Commissioner bernall yes. Commissioner. Commissioner chung yes. Commissioner chao no response . I think youre muted. I forgot to unmute. Yes. All right, thank you much. Thank you much to the team at dph for your excellent work. Were so grail for you and proud of the work that youre doing. Hang in there and well see you all in two weeks. Thank you, commissioners. Thank you. adjouradjournment 6 50 p. M. Pd. Good morning, the meeting will come to order. Welcome to the mooting of the government audit and oversight committee. Im supervisor gordon mar and joined by vicechair peskin, and supervisor haney will join us. And i would like to thank s. F. O. S. F. O. For staffing this meeting. Mr. Clerk, any announcements . Clerk in order to protect the Board Members and the public during the covid19 health emergency, the board of supervisors and the Committee Room are closed. This precaution is taken to local, state and orders and directives. The Committee Members will attend through Video Conference and participate in the meeting to the same extent as if physically present. Public comment is available for each item on the agenda, on cable channel 26 and they are streaming the callin number across the screen. Provide Public Comments during the Public Comment period by calling 1 415 6550001. Once connected and prompted to the meeting i. D. , todays meeting i. D. Is 1467063442. And then press pound twice to be connected to the meeting. When connected you will hear the meeting discussions but your line is muted and in listening mode only. When your item of interest comes up, dial 3 to be added to the speaker line. Please wait until the system indicates that you have been unmuted and you may begin comments. Best practices are to call from a quiet location, speak clearly and slowly and turn down your tv and your radio or streaming device. Everyone should account for potential time delays and speaking discrepancies between the live coverage and streaming. Alternatively, you are invited to submit Public Comment in either of the ways. Email me, john ds carroll, and the email is john. Carroll sfgov. Org. And if you submit the public by email i include it as part of the respective legislative file that youre commenting on. And your comments may be sent to city hall by the u. S. Postal service. For the Clerks Office is 1 doctor carlton b. Good ds let place, San Francisco, california, 94012. And, mr. Chair, items acted upon today appear on the board of supervisors agenda of the 29th, unless otherwise stated. Supervisor mar i would like to note that supervisor haney is present. Mr. Clerk, can you call item one. Clerk yes. Agenda number one is a resolution declaring the intention of the board of supervisors to receive and approve a final annual report for the propertybased Business Improvement district, known as the top of Broadway Community benefit district for fy20182019 and to remove a multiyear assessment on all parcels in the district and ordering and setting a time and place for a public hearing of the board of supervisors, sitting as a committee of the whole, on november 17, 2020, at 3 00 p. M. On the proposed disestablishment and approving the form of the notice of public hearing and directing environmental findings. Members of the public who wish to provide Public Comment should call the number that is 1 415 6550001. And enter the meeting i. D. Of 1467063442. Press the pound symbol twice to connect to the meeting and press the star key followed by the number 3 to enter the queue to speak. And prompts will indicate that you have raised your hand. And wait until the system indicates that you are unmuted and you may begin your comments. Mr. Chair . Supervisor mar thank you. Supervisor peskin, do you have any remarks . Supervisor peskin no. Supervisor mar i welcome the department here to present. Good morning, supervisors. Ill be sharing my screen. So, please let me know when it pops up. Are you able to see that, chair mar . Supervisor mar yes. Good morning, chris corgis from the office of Workforce Development and im part of the team that oversees the District Program on behalf of the city and county of San Francisco. Today were hearing the fiscal year 20182019 report for the top of Broadway Community benefit district and a resolution to disestablish the district under the board of supervisors authority per article 15 of the business and tax regulations code. A legislative Overview Community Business District are governed by two sets of laws the state law is known as the 1994 act and its the streets and highways code 36600 and our local article law. And it covers the annual report for the Previous Fiscal Year 20182019. Oewd ensures that all c. B. D. S are meeting Management Plans and an annual review of the report and c. P. A. Statement and we provide the board of supervisors with a summary memo. The top of broad way c. B. D. Is a propertybased district with a been of budget of 106,000 and they submitted an assessment roll of 11,000. It was established in 2013 and set to expire june 30, 2021. The staff of the district is executive director, and the district director dominic, who is here to present on the c. B. D. And their Service Areas are district identity, street operations, beautification and order, administration and organization and corporate operations. Oewd reviews four bench marks for each c. B. D. And the first whether the varyians for each Service Category was within 10 Percentage Points from the Management Plan. And bench ds mark ds and benchmark three, whether the varyians between each Service Category was within 10er is Percentage Points from the actual. And bench mark four, whether the c. B. D. Has any amount of funds from the current fiscal year and designating projects to be spent in the upcoming year. For bench mark one, the c. B. D. Did meet this requirement and has historically met so as well. For bench mark two, the c. B. D. Raised approximately 25 of its budget from non assessment sources so it did meet this requirement. For bench mark three, the c. B. D. Did not meet this requirement and they spent below the varyians in district identity and they overspent on sidewalk operations as well as administration. Upon further review this was done to increase the amount of street cleanliness operations for that fiscal year. And for fiscal year 20182019 they did indicate their Carry Forward but as they are establishing first date law they have zero dollars in their account so there was no funding to Carry Forward. And in completing the review, oewd set forth the following findings, it met three of the four bench marks. There was a significant decrease in the amount of contributions given to the c. B. D. And the number would have been lower if not for a grant that the c. B. D. Received and utilized in year 20182019. The Owners Association of the c. B. D. Requested that the city and county of San Francisco disestablish the c. B. D. Early due to the loss of outside financial subsidies with supplement special assessments and the Owners Association believes that oewd concurs that revenue alone is not sufficient to continue operations. The resolution associated with this item is setting a committee of the whole date for the board of supervisors to disestablish the c. B. D. In accordance with article 15 on november 17, 2020. In conclusion, the c. B. D. Did operate in accordance with its Management Plan since the establishment in 2013. And the decrease in outside revenues led to the c. B. D. Not being able to maintain services with special assessment dollars alone going forward. The Owners Association has requested that the city disestablish the district, the letter is part of the file. Oewd has confirmed that the c. B. D. Has met all requirements to disestablish early and there are no money in their accounts and theyre now up to date on annual reports. And there is support to disestablish the c. B. D. Among the Owners Association and ratepayers. And new or renews c. B. D. S have enough special assessment revenue to not provide Supplemental Services. While forming, stakeholders should be mindful of how Funding Sources relate to true operation costs and work with oewd to ensure theyre in line so that the longterm health of a proposed or renewed district and Supplemental Services are stable. If there are no questions for oewd, id like to turn the present over to mr. Lamandrie. Sounds good. Thanks. So my name is dominic, and im the deputy director. Next slide, please. So like many of the c. B. D. S in San Francisco, the top of broadway was formed with a very Clear Mission statement. And that Mission Statement is before you now to make the area around broadway safe and an enjoyable place to live and work and visit. And to have economic vitality. Improving the livability and promoting identity and area history. And this is the crux of why the c. B. D. Was creteed and to facilitate this mission it carries out projects through three advisory committees and having staff implement at the Mission Street level. Next slide, please. So this is the General Information about the top of broadway. We were formed in 2013, and we began shortly there shortly thereafter in 2019. And i think that the last count was around 130 businesses and its the smallest c. B. D. In the city and at our last fiscal year we had 160,000 operating budget and we were able to stretch across seven days a week to have consistency. Chris, next slide, please. This is the breakdown of our budget for our last fiscal year. Can you see that we took in 113,000 on assessment income and then we made up for the rest through non assessment income grants and a very, very small Carry Forward. And how that money was distributed, the jority into keeping the street clean and with services and the city abatement and then a couple streetscapes that we will go through in the presentation. Next slide, please. And the projects are through federal operations and this is indiscernible . Next slide, please. These are some of our highlights from our last fiscal year, and the operations committee. We are able to provide near daily coverage throughout the year in terms of Porter Services and pressure washing. Were able to have 9,000 pounds of brush on broadway. And compared, its not a lot but we are only two square blocks so thats positive. indiscernible you can see the rest that we have moved into indiscernible and animal waste and pressure wash the district at least once a month. Next slide, please. Some of the crowning achievements of our district Identity Committee which really we hoped or we envisioned that would encapsulate the identity that we wanted to portray about broadway, and some included 10 commemorative plaques around broadway, commemorating the history and the institutions on broadway and the surrounding area. We had worked with the foundation to install butt cans on our street poles, approximately 10 throughout the district to prevent the litter in our storm drains. Thats a very ecofriendly project that we did and costeffective too. And the last one is a lighting project that we did with local artist Joshua Hubert called shimmer and it was over the steps and it is still chugging along. I just got confirmation on monday that its been operating for three months without any issues, despite the weather and what ds not and now that its synchronized to a local radio station. So more is incoming and well post it to our website that im maintaining right now. Next slide, please. And these are some of the Partner Organizations that we work with, with the top of broadway c. B. D. , and chris has been instrumental in the c. B. D. Surviving as long as it did. And on a daily basis as any c. B. D. S would tell you, those institutions really are jurisdictional with the sidewalk appeal and livability and we work with them regularly and the Central Station and the broadway entertainment Cultural Association that was supplements our income with helping us to maintain the quality of sidewalk cleaning on broadway. And n. B. N. And those are some of the resident yal organizations and commercial organizations surrounding us and supervisor peskins office that spear headed efforts to grant us the grant in 2016 that allowed us to perform the investigations and expand the district. And then that is leading into this slide. So joining the top of broadway unfortunately, after we received that grant with the help of the Supervisors Office in 2016, we performed over the next two years a rigorous investigation and we expanded the boundaries down to or the investigation down to broadway and down columbus to about pacific i believe. And we got as you can see on the map to your right, we got some mediocre responses really. Nothing that would impact momentum or a critical massive interest. So over the course of two years, you know, we werent really able to build that momentum that we needed to crete or to expand the district beyond its boundary that you see in blue. And in spring 2019 we made lastditch efforts, but as you can see it was still unscefl. Next slide unsuccessful. Next slide. And we arrived before you today, faced with the chronic structural deficit, and the positions established in 2019 and a wind down in operations on what was essentially left in the bank come july 2019. And since then we have essentially made the rounds with the Property Owners to collect their signatures on the expanding the district and to this date weve had a weighted percentage of 42. 9 of Property Owners return those signs to disestablish the c. B. D. S. Next slide, please. Thats the conclusion of my presentation. Supervisor mar thank you, for the presentation and for all of your work at the top of broadway c. B. D. Supervisor peskin . Supervisor peskin thank you, chair mar and supervisor haney. I just want to thank all of the par it tis pants in the top of broadway c. B. D. And dominic and marco for their work. Im sorry to see it go, but it is what it is and maybe some day in the future it can be recreted with a larger scale that will ultimately work but, clearly, that time is not now so thank you for your work over the years. And im sorry to see it go. But as i said, it is what it is. Agreed. Supervisor mar thank you, supervisor peskin. Why dont we go to Public Comment. Mr. Clerk, any callers on the line for this item . Clerk thank you, mr. Chair. Operations is checking to see if we have callers in the cue. Please let us know if we have callers that are ready. For those who have already connected to our line, press star, followed by 3, to be added to the queue if you wish to speak for this item. For those on hold in the queue wait until youre prompted to begin and your prompt informs you that your line is unmuted. For those watching our meeting on cable channel 26 or streaming link or through the website, if you wish to speak on this item now is the time to call. Do so by dialing 1 415 6550001. And enter the meeting i. D. Of 1467063442. Press the pound symbol twice and then press star, and followed by 3 to enter the queue to speak. Do we have any callers . Mr. Chair, there are no callers in the queue. Supervisor mar thank you. There are no callers, Public Comment is closed. Supervisor peskin to make a motion . Supervisor peskin i would like to move this item to the full board with recommendation. Supervisor mar thank you. Mr. Clerk, please call roll. Clerk on the motion offered by supervisor peskin, [roll call] mr. Chair, there are three as. Supervisor mar thank you, mr. Clerk. Call item number 2. Clerk yes. Agenda item 2 is receiving and approving an annual report for the castro upper market Community Benefit district for fiscal year 2082019, submitted as required by the property and Business Improvement district law of 1994 and the california streets and highways code, and with the districts Management Agreement with the city. To make Public Comment call 1 415 6550001. Enter the meeting i. D. Of 1467063442. Press pound symbol twice to connect to the meeting and then press the star key, followed by 3 to enter the queue to speak. When its your turn to speak, the system will prompt you by telling you that your line is unmuted. Mr. Chair. Supervisor mar thank you, mr. Clerk. I welcome back the presenter for this item. Thank you, supervisors and chair mar and ill be sharing my screen right now. Are you able to see that . Supervisor mar yes. Great. Thank you. Today were here for the castro upper market Community Benefit district annual report. Im chris corgis with economic and Workforce Development. As previously mentioned, c. B. D. S are governed by two laws, state law in 1994 act and our local law which is article 15 of the business and tax regulations code. This resolution will cover the annual report for fiscal year 20182019 for the castro upper market c. B. D. , oewd ensures that all c. B. D. S are meeting Management Plans. Our staff has an annual review of the reports and Financial Statements and oewd provides the board of supervisors with a summary memo. The castro upper market c. B. D. Is a propertybased district, established in 2005 as one of the first c. B. D. S under article 15. The initial assessment budget was approximately 413,000 in fiscal year 20182019, and they submitted an assessment roll of approximately 516,000. The c. B. D. Is set to expire on june 30, 2020, unless renewed. The c. B. D. Was renewed in fiscal year 20192020. The executive director is here to present on the program attic achievements of the c. B. D. In this fis dal fiscal year. And district identity and streetscape improvements and corporate operations. Oewd reviews four bench marks for each c. B. D. And one, whether the variance was within 10er is Percentage Points from the Management Plan. And bench mark two, whether 5 of the actuals came from other than resource revenue. And three, whether the each Service Category is within 10er is Percentage Points from the actuals. And four, whether they are having funds carried over from the current fiscal year and designating projects for the upcoming year. For bench mark one, the c. B. D. Did not meet this requirement. Bench mark two, the c. B. D. Raised approximately 42 of its budget from non assessment revenue, so they did meet this requirement. For bench mark three, the c. B. D. Did meet this requirement. And for bench mark four, the c. B. D. Did meet this requirement. The castro upper market c. B. D. Has met all requirements and the c. B. D. Continues to perform well in respect to bench benchmark two with found aggression grants and donations throughout the year. And it implemented recommendations from the fiscal year 20172018 annual report. The c. G. Has worked with oewd to meet the bench marks to renew before the district expires and oewd will provide Technical Assistance to the c. B. D. To guide them through the renewal which they completed sceflly in 20192020. It has performed well in implementing the plan for the district and it continues to sceflly to market and successfully have increased opportunities in partnersing with the agencies for the implementation of castro cares and maintained an active board of directors and subcommittees. If theres no questions i would like to turn the presentation over. Good morning, supervisors, and thank you for all of the time and hours that you have put into helping the city to thrive. Im andrea ioalla, with the castro upper market benefit district. And i want to thank chris corgis, he is so helpful and has been so all these years, so helpful for us and all of the c. B. D. S and was critical in our scefl renew success successful renewal this year. This is our district map and many of you have seen this before and the c. B. D. Boundaries. Beginning in the east at octavia and Market Street and go up market to castro and downcast row to 19, and include the area where the Public Library is and the Health Center and it includes parts of church street, where safeway is to midway through 15th street. So its a very long and sprawling district map. Next, please. We have quite a few active committees we have an executive committee and a finance committee and streetscape and Identity Committee which is a beautification committee. And Landuse Committee and retail strategy committee. And a castro care lp team. And the Services Committee is the committee that oversees our cleaning and Public Safety services. Next slide, please. And the grants that we received in fiscal year 20182019 were all from oewd with the castro cares grant and to activate Jane Warner Plaza and to supplement some of the expenses related to the renewal. Next slide please, chris. Our cleaning services, we power wash on a regular basis, a lot more actually than mandated in our Management Plan because of the dmed demand and we remove graffiti from public and private spaces throughout the district. Next slide, please. And this is our cleaning up by the numbers for 018 20182019. About 60 tons of trash was picked up in fiscal year 20182019. Quite a lot of graffiti was removed and id like to bring your attention to the human waste incidents of human waste removed, 3,062 instances and 2,559 dirty needles collected. Next slide, please. We are also in contact with the San Francisco Patrol Special Police to provide and to supplement the Public Safety Services Provided by the sfpd. And we have we collaborate with many of the merchants and other neighborhood organizations to help to patrol the special police and they provide services seven nights a week in vehicle and foot patrols. Their focus really is in line with their direction from the Police Commission is to focus on quality of life issues and so they do combine Compassionate Care with enforcement and we do supplement their work with some funding from the castro cares grant to bring Additional Services to the neighborhood. Next slide please, chris. This is our street outreach worker. And this is through our castro cares grant. We had a contract with the San Francisco aids foundation and this gentleman worked through the aids foundation branch in the castro. And the outreach worker in 20182019 had a referral guide that he distributed to merchants, but also to people on the street. And provided a variety of services to unhoused individuals, about 306 unhoused individuals. Some of the highlights of those services were 64 health and Wellness Services and those are referrals and warm handoffs through the aids foundation. 26 related to Harm Reduction services, which is really around services to people who are have a Substance Use disorder and two to housing with the help of s. F. Hut and d. P. H. And one was given a ride home through the homeward bound program. Next slide, please, chris. As we said, we have a program called live in the castro which during the pandemic has been suspended, but this is Jane Warner Plaza and throughout 2018, 2019, we had live entertainment, concerts, readings, speeches in the Jane Warner Plaza throughout the warm nonrainy months. And i think that the next slide is the end, right . Next slide, thank you. Yeah, so if theres any questions im really happy to answer any questions. Supervisor mar thank you so much for the presentation and its all impressive work at the castro upper market c. B. D. Do you have any questions or remarks . Why dont we go to Public Comment mr. Clerk, any callers on the line . Clerk operations will check to see if we have any callers in the queue. Let us know if we have callers that are ready. For those who have already connected press star, 3, to be added to the queue to speak to this item. For hold in the queue please continue to wait until prompted to begin and you will hear that your line is unmuted. For those watching our meeting on cable channel 26, or through the website, you can call in by following the instructions on your screen. Dialing 1 415 6550001. And entering the meeting i. D. Of 1467063442. Press the pound symbol twice and then press star, followed by 3, to enter the queue to speak. Any callers for agenda item number 2 . Mr. Chair, there are no callers in the queue. Supervisor mar great, thank you. Public comment is now closed. I would like to move that we send this item to the full board with positive recommendation. Mr. Clerk, can you call roll. Clerk on the motion offered by chair mar that this resolution to be recommended to the full board of supervisors [roll call] mr. Chair, there are three as. Supervisor mar thank you. Thank you again. Thank you. Supervisor mar mr. Clerk, call item 3. Clerk yes, of course. Agenda item number 3 is a resolution receiving and approving an report for the noe valley Community Benefit district for fy20182019, submitted as required by the property and Business Improvement district law of 1994. Those who wish to speak on this item should press star and followed by 3 to line up to speak. Others who may be interested would begin by dialing 1 415 6550001. And entering todays meeting i. D. The 1467063442. Pressing the pound symbol twice to connect to the meeting. And then pressing the star key followed by the number 3 to enter the queue to speak. Mr. Chair . Supervisor mar thank you, mr. Clerk. Chris corgis, the floor is yours once again. Thank you, chair mar, and supervisors. Ill be sharing the screen once again. Set up . Supervisor mar yes. Fantastic. Good morning, supervisors. Were here for the fiscal year 20182019noe valley report and im with the office of economic and Workforce Development. All c. B. D. S are governed by two laws, the state law which is the 1994 act and the local law, article 5 of the business and tax regulations code. This resolution will cover the annual report for fiscal year 2082019, and oewd ensures they are meeting Management Plan and an annual review of reports and c. P. A. Financial reviews. And we provide a summary memo to the board of supervisors. The noe valley c. B. D. Was established in 2005, one of the first c. B. D. S after article 15s passage with a budget of approximately 230,000. In fiscal year 20182019 it had an assessment roll of 269,000. It was set to expire on june 30, 2020, but like the castro c. B. D. Was renewed in 20192020. And the executive director is Deborah Nieman here to present on the program of the c. B. D. And its streetscape improvements and administration and corporate operations. Oewd reviews four bench marks for all c. B. D. S. And the first is whether the variance for each Service Category is within 10 Percentage Points from the plan. And two, whether the 5 of the actuals came from sources other than assessment revenue. And bench mark 3, whether the budget amounts for each category is within 10 Percentage Points from the actuals. And four, whether the c. B. D. Is showing the funds carried over from the current year and designating projects in the upcoming year. For bench mark one, the c. B. D. Did not meet this requirement and it has historically not met this requirement due to the changes in city requirements on the c. B. D. Since its initial establishment and oewd believes that the new Management Plan which was renewed will address these structural issues and allow them to meet this bench mark going forward. For bench mark two, the c. B. D. Did meet this requirement with approximately 35 of their operating budget coming from nonassessment revenue. And for three, it did meet this requirement. And for bench mark four, the c. B. D. Did meet this requirement. In completing the review, oewd set forth the recommendations, that it would sun set in 2020 and begin the renewal process in 2018. The c. B. D. Did not meet bench mark one and has not met it due to structural weakness in the Management Plan. In order to correct this, the c. B. D. Would need to decrease the budget for the administrative and corporate operations by 1. 79 and enclose that percentage for public rights of way by the amount deducted from the previous category. Oewd as previously mentioned anticipates upon the renewal they will meet this requirement by upidating the plan appropriately. Although the c. B. D. Did not meet the one bench mark it has performed well in implementing the service plan, the board is active, and the c. B. D. Has sponsored events, including the noe valley town square. Oewd will work with the c. B. D. To ensure that it meets all bench marks going forward. If theres no questions i would like to turn it over to miss nieman. Hi. Am i on at this point . Supervisor mar yep. Okay, great. First of all to give a shout out to aaron peskin who started this 16 years ago and then a shout out then to give a shoutout to chris who is always by ouricide in terms of helping us to do our work and to give us the equipment that we need, especially during covid. Anytime that we call chris because were out of masks or gloves, somehow or another he comes up with the resources that are necessary, so were very grateful to him. And john carroll, i dont know how you do this but you do a great job of repeating all of these rules, so hats off to you too. Next slide. Our map is pretty simple. This is from our district. We discontinue the property up by douglas and 24th street because we just had the four commercial properties up there and there were a and the new laws state that wed have to join the properties between diamond and douglas which are primarily resident yal. And that did not seem worth the effort to do that for us. Next slide. And we have three active committees, the Green Committee and the streetscape improvements. I mean, i could go through a litany, you know of 28 benches and 40 bike racks and opening gardens and things of that nature. Next slide. And were very active in terms of trying to get people to the 24th street because noe valley is between two hills. And parking is limited. Its hard to get people to come to the commercial district. So we work with the noe merchant and professional association and the Farmers Market and we put on a number of events, primarily at the New Town Square which was formed about three years ago. Next slide. And these are just, you know, some of the events that we put on. And we have the park that is always a big hit. Next slide. And i already talked about this. So you have the professional Merchants Association which is a professional group. You have the friends of noe valley, that is resident yal. And then the noe valley town square. And the town square raised over half a Million Dollars from the residents and businesses in the district. And then we were able to raise the rest of the funds for the open space fund and working with s. F. Rec and park. We havent done much with them during covid but were starting to open it up for restaurants to use possibly during the day during the evening because the more that are put in front of restaurants on 24th street, that reduces the amount of parking and it gets a little more difficult to entice people to come. Next slide. And so oewd has been very good to us and we have seen the number of grants. And the fiscal agent for the noe valley town square and we activate this public space a loe events. Next slide. And you can see these numbers yourself, but we mostly remove a lot of trash from the sidewalk for people who moved out of apartments. And theyve certainly done that in the last six months. Weve had to remove a lot of it this year. And the only c. B. D. That screens our sidewalks 10 times a year. It was within our initial Management Plan and we continue in the renewal plan. And the best thing is to put a flower basket, because people love those. And we planted initially 135 trees and now have 229 that we take care of and we have two street porters and a parttime gardener. Next slide. Oh, so we didnt get to install it in noe valley town square. But we got rec and park, miracuously to put a bathroom behind the bulletin tin board in the town square. Next slide. And we always want to do murals because theres a lot of blank wall space but, again, during covid and in the Previous Year we were preoccupied with renewal. I think that is it. This is just for reference to show you what used to be there. So on my left is what used to be a parking lot and on my right is now the town square which is murals on bothicides. Its very activated and its a very busy part of the district. Next slide. I think that is it. There you go. Nice and easy. Any questions . Supervisor mar thank you very much for the presentation. Noe valley c. B. D. Is one of the more scefl c. B. D. S in our city. So thank you for the great work. Youre welcome. Okay . Supervisor mar cool colleagues, any questions or remarks . Clerk operations will check to see if theres callers in the queue. Let us know if theres any callers. If you have pressed star, 3, to speak to this item. For those already on hold in the queue continue to wait until you are prompted to begin. When you are prompted it informs you that your line is unmuted. For those watching on cable channel 26 or through the streaming link, if you wish to speak follow the instructions on your screen. By dialing 1 415 6550001 and the i. D. 1467063442. Any callers for agenda item number 3. Bl mr. Chair, no callers in the queue. Have a good day. Supervisor mar thank you. Public comment is closed. I move that we send this item to the full board with positive recommendation. Call roll, mr. Clerk. Clerk on the motion offered by chair mar that this be recommended to the full board of supervisors [roll call] mr. Chair, three as. Supervisor mar thank you, mr. Clerk. Do we have item number 4 on this is our final c. B. D. Presentation. Clerk we have it right here. Agenda number 4 is resolution receiving and approving an annual report for the ocean avenue Community Benefit district for fy20182019, submited as required by the property and Business Improvement district law of 1994 and the districts Management Agreement with the city. And if the public wishes to speak on this item, call the Public Comment number, 1 415 6550001. Enter the meeting i. D. Of 1467063442. And press the pound symbol twice to connect to the meeting and press the star key followed by 3 to execute to speak. The system prompt will indicate that you have raised your hand and wait until the system indicates that you are unmuted and thats your opportunity to provide comments. Mr. Chair . Supervisor mar thank you, mr. Clerk. Chris corgis to present again. Thank you once again, supervisors and i will make this as quick as possible. This is the fiscal year fy20182019 annual report for the ocean avenue Community Business district and im chris corgis with the office of workforce and economic development. Its developed by state law, the 1994 act, and the article 5 of the business and tax regulations code. This resolution will cover the annual report for fy20182019 and oewd ensures they are meeting Management Plans and the staff has an annual review of the Financial Statements and oewd has a summary mental memo to the board of directors. It was established with a budget of approximately 239,000. In fiscal year 20182019 they had approximately 320,000. The district is currently set to expire on june 30, 2025. The executive director of the c. B. D. Is mr. Daniel weaver who is here to present on the Program Achievements of the c. B. D. And their service area are ambassadors, a cleaning program and administration and corporate operations. Oewd staff reviews the following benchmarks for all cbds. One, whether the budget amounts for each one is within 10 Percentage Points and two, whether one of one percent is from the revenues. And three, whether the budget amounts for each category is within 10 Percentage Points from the actuals. Bench mark four, whether its indicating the funds from the current year and designating the projects to be spent in the upcoming year. For one, the c. B. D. Met this requirement. For bench mark two, 18 of the operation came from unassessment revenue and they did meet this requirement. For bench mark three, the c. B. D. Did meet this requirement. And for bench mark four, the c. B. D. Did meet this requirement. Our findings and conclusions, ocean avenue c. B. D. S has performed well in implementing the plan for the district. They did implement our recommendations from the fiscal year 20172018 annual report. They partnered with the district 7 supervisor norman yee to have the first ocean avenue Lunar New Year celebration. Oewd believes that the c. B. D. Though could benefit from a review to evaluate the overall effectiveness of the organization to ensure that its operating at the highest capacity and to have outreach to determine the direction of the organization should it be renewed. Oewd believes that the organization should have a Strategic Plan to look at the short term and the midterm and the longterm needs of the district and to focus on ensuring the Management Structure is effective and including the board staff relationships and engaging the effectiveness of four c. B. D. Programs and to provide recommendations on how to be improved. And improving the c. B. D. s overall effectiveness and the respect in the broader ocean avenue community. And, four, identify the strategies to ensure the longterm Financial Stability of the organization, especially related to non assessment resources. The c. B. D. Has sought an early renewal and oewd say to explore the expansion avenues, up to the ocean avenue corridor that is incredibly diverse, including many cantonesespeaking businesses and the c. B. D. Should conduct outreach to those in multiple helpings. Although the c. B. D. Should be commended for efforts to provide outreach to money on lingual communities it should build on this with the renewal and expansion campaign. The oewd recommendations from the review to be specifically implemented in a future Management Plan for renewed and expanded districts. The c. B. D. Did have several subcommittees and they believe that the ocean avenue c. B. D. In general is a wellrun organization that will carry out its mission. If theres no questions for oewd, i would like to turn the presentation over to mr. Weaver. Supervisor mar that sounds good. Mr. Weaver . Mr. Weaver, are you there . Im seeing that dan weaver is connected to the call but not responsive at this time. Supervisor mar mr. Carroll, are you able to unmute him . Clerk im not able to. Hed have to unmute himself. Supervisor mar okay. There he is. Good morning, mr. Weaver. Clerk you have muted your microphone again. There we go. Try now. Im here. Clerk very good. We can hear you now. It looks like i need to keep my finger on the button, which i will do. [laughter] so, first of all, i would like to extend my thanks, like everyone else, and every c. B. D. To chris corgis for doing a remarkable job of keeping us all happy. And he should get a raise. [laughter] okay. This first slide is a picture of our landmark building, the timothy pluger theater which is currently undergoing rehabilitation to be, amongst other things, a theater some time in the future. This is a map of the current Community Benefits district. Next. We have two committees. The Street Life Committee which is focused on the activation of the Retail District through public art, entertainment and design. And the Business Committee which is concerned with Business Growth and retention within the district. Next. Our Partner Organizations from the non Profit Sector include western neighborhoods project, liveable city, o. M. I. , Cultural Participation projects and neighbors in action and the Park Association and the homes association. Next. Our partners in government include the oewd, public works, Planning Department and the Bay Area Rapid transit district, and the city college of San Francisco. Next. In 2018 to 2020, we have received a number we have applied for and received a number of grants. Let me quickly run through the purposes that were trying to achieve here and the grants. To provide Additional Services to our assessment payers as well as the surrounding community with grantfunded projects. To support our Small Businesses, to employ a coordinator, funded by a c. B. D. Grant. To understand the corridors aspects and difficulties, we are completing a public life study this year. To plan a possible c. B. D. Expansion, we have received an Organizational Support grant from oewd. To improve the Small Business facades we have also applied for and received for in a number of fiscal years there are a few fiscal years, f. S. Shine grants. Next. Our main projects are main activities in terms of funding is cleaning, maintenance and safety. Clean scapes provides our cleaning. They come six days a week and they are constantly sweeping the sidewalks and the gutters, removing graffiti and providing cleaning, steam cleaning. And now arborists maintain the trees on or near ocean avenue. And in the past two or three years we have had to provide additional cleaning and maintenance to the various grooming spaces that we have creteed within the district. We are continually adding to the cost of cleaning, maintenance and safety because were continuing were providing more spaces to maintain. But thats what everyone likes the most is actually seeing our district becoming more green and more attractive. Next. Heres that subject, maintain the sidewalk gardens on ocean avenue and on perpen dick icide streets. And out utilize the neighborhoods for garden maintenance. And we also at our meetings the attendees and Board Members are asked what theyd like to see done in terms of neighborhood beautification and also business support. And to maintain in an area close to the 280 freeway ramps at the corner of ocean and geneva three different green spaces which have been established since 2017. O. A. A. Organized second sundays, a music event series held in Small Businesses and community spaces. Beginning in 2018, o. A. A. Staff organized events in unity plaza and having a monthly popup Crafts Market with live music. Next. This is one of our most successful projects which is an event sponsored by a high school. And the youth art exchange. And this is the picture of unity plaza fully engaged with people. Next. Some of our challenges, which seem to go from year to year, although theyre particularly unique this pandemic time, a couple years ago we were looking at high rents and design challenged business spaces which have led sometimes to longterm vacancies, Property Owners and Business Owners underinvest in their store fronts and giving some this experience. And Prospective Development projects, sometimes are positioned to displace longterm businesses and not allow them to come back but instead replacing the historic ground for retail spaces on ocean avenue with something else. Often an office or a medical facility. Next. Opportunities theres a high interest in the neighborhood for public art and music events and entertainment. O. A. A. Is working with the free events and installing new public art work on the corridor. And new businesses establishing on ocean avenue bring the potential for Business Owners to participate in advow indicating for the ocean avenue community. And the Development Projects have the potential to provide new retail spaces in a variety of locations. Our ideas in the future are programs at unity plaza and to have the park area and other transit yards and public lands. And this pursuit is leading us to an early reauthorization in order to bring into our district, if possible, the park station and the adjoining muni green facility as well. Were aiming to successfully raise funding for the gateway at the library which is now succeeded. We have raised that money. Development for the projects in the o. A. A. Plan for the c. B. D. Corridor that folk ises on the sfmta transit station around the park station. Add here when we talk to people about whats wrong with walking or bicycling to the batter station in bart station instead of driving, almost uniformly people say that its a bad walk, its scary, its filled can cars and trucks. Streetcars and buses. And pe destians dont have much of a chance. So this is the reason for focusing on the bart station and the other transit facilities around the bart station. Next. Theres the theater in the background. To give you a perspective. Supervisor mar thank you so much, mr. Weaver, for the presentation and for all of your work with the ocean avenue c. B. D. And i would say that its great to see a successful c. B. D. On the west side of the city and im in your neighborhood a little bit more often than the other three c. B. D. S that were highlighted in the previous item. And i really do appreciate all of the public art and the activation events that you are doing out there. I just have a question around one of mr. Corgi ds s recommendations is that you looked at how to develop a plan to outreach and engage with chinese merchants on ocean avenue a little bit more. And i was wondering, i didnt really see that highlighted in your, you know, your presentation. So i was wondering if like what you are doing, the c. B. D. Is doing to engage with the Chinese Businesses which are still significant proportion. Mr. Weaver, youre muted again. I think youre good. Clerk if you could just hold down that button, please. There we go. Can you hear me . Clerk we can hear you now. Thats straifnlg strange. Involving chinese merchants, in a number of them involved in creteing the c. B. D. S and they are happy because we focused on what the needs were as we built it. But in terms of the expansion, we are trying to figure out particularly in terms of the area along ocean avenue to the west, to work with the Chinese Business people, all business people, and were going to utilize all of our information sheets and questionnaires and our people who walk around are going to use people who use chinese to try to engage them and to find out what they are interested in. So that is basically that effort to expand the c. B. D. Focused on talking to homeowners as well or the renters as well as Business Owners in that additional area. Supervisor mar thank you. How are you engaging with the money on lingual mono ds lingual speaking merchants on ocean avenue . Do you have folks that are part of the ocean avenue c. B. D. That can speak to them and communicate to them directly . We have i think three or foud members who speak chinese. And we engage them when necessary to talk to their fellows about the issues concerning the business or the c. B. D. Or anything that comes up that is an issue for us. Or for the merchants. Thank you for that. Thank you for all of your good work. Colleagues, unless you have any questions, maybe we can move to Public Comment on this item. Clerk thank you, mr. Chair. Theres a question. No. Clerk okay. Operations will check to see if theres callers in the queue. Let us know if there are any callers ready. For those connected to our meeting by phone press star followed by 3 to be added to the queue to speak to this item. In hold in the queue, wait until you are prompted to begin. You will hear a prompt informing you that your line is unmuted. For those watching on cable channel 26 or by streaming listening or through the website, call in now by following the strkdzs on instructions on your screen, by dialing 1 415 6550001. Enter the meeting i. D. Of 1467063442. Press the pound symbol twice and then press star, followed by 3 to get in the queue to speak. Any callers for agenda item number 4 . Mr. Chair, there are no callers in the queue. Clerk . Supervisor mar great. Thank you. Public comment is closed. I move that we send this to the full board with positive recommendations. Mr. Clerk, please call roll. Clerk on the motion offered by chair mar that this be recommended to the board of supervisors [roll call] mr. Chair, three as. Supervisor mar thank you again, mr. Weaver. And, of course, thank you to mrd work on this. Thank you. Mr. Clerk, call item 5. Clerk yes, of course. Agenda item number 5 is a resolution authorizing the Fire Department to donate a retired ambulance to the city college of San Franciscos Emergency Medical Services academy. Members of the public to provide Public Comment should call the number which is still 1 415 6550001. Enter the meeting i. D. Of 1467063442. Press the pound symbol twice to connect to the meeting and then press the star key followed by the number 3 to enter the queue to speak. And the prompt will indicate that you have raised your hand and wait until you have been unmuted and that will be your opportunity to give Public Comment and once Public Comment is called. Mr. Chair . Supervisor mar thank you, mr. Clerk. I would like to welcome mr. Mark corso who will speak on this item on behalf of the San Francisco Fire Department. Welcome. Thank you, good morning, mr. Chair, and members of the committee. Mark corso from the Fire Department to speak to the donation of a surplus ambulance to city college of San Francisco for the e. M. S. Academy. The Fire Department has a great relationship with city college including instructor Service Agreement with them and we have worked with them in the past and were supportingers of the academy. They have the use of a surplus ambulance for a tool and prop for those going through the academy. Theres a surplus ambulance that has no longer use in the Fire Department for these donation purposes. And this ambulance would only be used for instructional purposes. This donation would strengthen our relationship with city college and be able to reuse surplus equipment. So i thank you on behalf of the department for your consideration of the item and i am happy to answer any questions that you may have. Supervisor mar thank you to the Fire Department for this donation to support the Emergency Services training at city college. Workforce Training Programs like these are essential to empower working people with the skills and jobs and to provide a pipeline to essential Services Like Emergency Medical Services. On which this pandemic has shown to be so truly essential. So thank you, again. And id be happy to sponsor this item. Clerk mr. Chair indiscernible . Supervisor mar colleagues, any questions or remarks before we go to Public Comment . Mr. Clerk, any callers on the line . Clerk operations is checking to see if theres callers in the queue. Let us know if we have callers that are ready. I will repeat the instructions. For those who have already connected via phone press star 3 to be added to the queue. For those already on hold in the queue, please continue to wait until you are prompted to begin. You will hear prompts that inform you that your line is unmuted. For those watching on cable channel 26 or streaming listening, if you wish to speak on this item, please call in by following the instructions on your screen. That would be by dialing 1 415 6550001. And enter the meeting i. D. Of 1467063442. Press the pound symbol twice. And then press star, followed by 3, to enter the queue to speak. Any callers who wish to speak on agenda five . Mr. Chair, there are no callers in the queue. Supervisor mar great, thank you. Our Public Comment is now closed on this item. We will move this to the full board with a positive recommendation. Mr. Clerk, can you please call roll. Clerk on the motion offered by chair mar that this be recommended to the board of supervisors [roll call] mr. Chair, there are three as. A ds ayes. Please call item 6. Agenda 6 is an ordinance to require notification to prequalified contractors and written documentation of contractor selection from prequalified theirses and written documentation of contractor selection for work assigned under asneeded public works professional Services Contracts and to require the controller to audit such selection documentation. To give Public Comment, call 1 415 6550001. Is code is 1467063442. Wait until you have been unmuted and thats your opportunity to provide comments on agenda item number 6. Supervisor mar thank you, mr. Clerk. Welcome supervisor stefani. Would you like to make remarks. Supervisor stefani thank you for scheduling this today. And through the chair i request a continuance to the next meeting because we is have an amendment with the City Attorney office and i want to thank the committee for their patience while we work out the details with this legislation and the amendment. If you would like me to go through the legislation now, fine. But if you would like to wait until i have the amendment ready, that would be fine too. So its whatever you would prefer that i do. But i do request a continuousance to the next meeting, please. Supervisor mar yes, thank you. And given the length of this committee agenda, perhaps we could go with the second option that you mentioned and hold off on, you know, your presentation on it until your amendments are presented. Supervisor stefani thats what i assumed. I was ready either way but thank you for that, chair mar. Supervisor mar thank you, supervisor stefani. Colleagues, unless you have any questions about this item or comments, we could go to Public Comment. Mr. Clerk. Clerk operations is checking to see if we have callers in the queue. Let us know if we have callers ready. If you have already connected press star, 3, to be added to the queue to speak on this item. For those on hold in the queue, please continue to wait until you are prompted to begin and you will hear a prompt and you will be told that your line is unmuted. On cable channel 26 or through the livestream and you wish to speak follow the instructions on your screen. That would be by dialing 1 415 6550001. And enter todays meeting i. D. That is 1467063442. Press the pound symbol twice and press star, followed by 3 to enter the queue to speak. Let us know if we have callers for agenda 6. Mr. Chair, there are no callers in the queue. Supervisor mar thank you. Public comment is now closed. Thank you, supervisor stefani. We will look forward to a full discussion on this important ordinance at the next meeting. Colleagues, i move that we continue this item to october 1 meeting. Mr. Clerk, please call roll. Clerk on the motion offered by chair mar to continue to the october 1st regular meeting [roll call] mr. Chair, there are three ayes. Supervisor safai thank you, colleagues. Supervisor mar mr. Clerk, call item actually i would like to note that item 7 was scheduled as a special order item for 11 00 a. M. , but given that its already 11 15, yeah, were going to just move ahead with it. So please call item 7. Clerk yes. Agenda item 7 is a resolution urging the city and county of San Francisco to expand the definition of vulnerable populations for services for people experiencing homelessness during the covid19 crisis. The members of the public to provide comment on this resolution should call the number which is still 1 415 6550001. And enter the meeting i. D. Which is 1467063442. Press the pound symbol twice to connect to the meeting and press star followed by a 3 to enter the queue to speak. Wait until the system indicates that you have been unmuted and you may then begin your comments on agenda item number 7. Mr. Chair . Supervisor mar thank you, mr. Clerk. I would like to welcome supervisor peskin sorry, preston. Thank you for sponsoring this item and the floor is yours. Supervisor preston thank you so much, chair mar. And i just want to thank you and the committee for getting this on your calendar. This as well as the next item that we have on the agenda, also something that i am sponsoring. And i know that you have a full agenda today as well as quite a backlog because of the budget season. So i really appreciate you making time for this today. So, colleagues, this resolution urges the city to expand the definition of vulnerable populations to include people who are under 60 years old, but are homeless. Our Public Health department defines vulnerable populations using an age limit that does not distinguish between the people who are housed and people who are unhoused. And the premise of our resolution is that this should be reconsidered going forward, given that those on the streets age more rapidly than folks who are housed. This is not just a theoretical exercise. When it comes to eligibility for services, including hoe telerooms for people hotel rooms for those during the covid19 crisis, being considered vulnerable or not vulnerable is the key criteria in determining what is offered to that and available to that individual. Its now been 26 weeks since shelterinplace began. We have thousands of san franciscans continues continuing to sleep outside without the ability to shelter at home. And to this day, colleagues, despite our advocacy and our unanimous legislation of the board, despite our pleas to the administration, to more boldly to address our homelessness crisis, thousands remain on the streets. One thing that we have all agreed on at least in theory from the early stages of this Public Health crisis is that the necessity to shelter our most vulnerable san franciscans to prevent the spread of covid19. If we look back to march 9th in a press release with the mayor and the Public Health department and the Emergency Operation center, our department of healtr grant colfax is that our chief concern is for vulnerable populations that are most at risk of getting very sick or dying if they get covid19. And he continued, that is why we are recommending that people over 60 or with certain Underlying Health conditions stay home as much as possible. So, clearly, the folks housed or unhoused over 60 are deemed vulnerable by the department of Public Health. Furthermore, after extensive advocacy, we received assurances back in april from the director of h. S. A. That vulnerable Homeless People, whether on streets or in shelters, would be moved into hoe telerooms ho ds tel rooms. Something that we have not lived up to. And so this addresses the simple but the key issue how do we define who is and who is not vulnerable . And why do we use the same criteria when it comes to age for those housed and those unhoused . We urge the city to have a broader definition, 45 or above when it comes to unhoused san franciscans. You know, looking forward to hearing i know that theres brief presentations from departments, but, you know, some of the data is clear. According to the last point in time count, 35 of those experiencing homelessness are over the age of 51. 74 of those experiencing homelessness have one or more Health Conditions. In one of the richest cities in the world, 275 unhoused people died last year. And the c. D. C. , which had initially primarily warned of increased covid risks for those over 65, now warns that among adults that risk increases steadily as you age. Its not just those over the age of 65 who are at increased risk for severe illness. The despite the emergency ordinance that i referenced before urging the city to house all Homeless People in hoe teles, the city has limited efforts to those who meet this criteria of being vulnerable. And the citys definition as i understand it and d. P. H. Will explain further, is that it applies to people who are 60 years or older or have an Underlying Health condition. I want to be clear, this means if you are 58 years old and you are living on the street and you do not have certain specified medical conditions that you are deemed not to be a person vulnerable to covid19 and you will not be eligible for a shelterinplace hotel room. This is not consistent with the research on geriatric homelessness and aging. So it shows that homeless adults have medical ages that far exceed their biological age. According to research, by a professor of medicine at General Hospital and director of the ucff center for vulnerable populations, people experiencing homelessness have geriatric conditions and functional impairments at a higher prefer lance than that seen in housed adults who are 20 years older. Based on that and other Research Showing the folks who are unhoused age at a rate on par with individuals 20 years older, our resolution urges the city and the department of Public Health, h. S. H. , and h. S. A. To expand the definition of Vulnerable Persons to include those who are 45 years or older for purposes of hotel eligibility and any other covid19 related services that are currently limited to vulnerable populations. I want to thank jen snyder and afry yu in my office for their work on this resolution. I want to thank my early cosponsors, ronnen and walton and haney and also all of the homeless advow indicates working every day to help those unhoused in this pandemic. So i have asked d. P. H. And h. S. H. To each speak briefly if thats okay with the with you, mr. Chair. And i understand that d. P. H. Has a short power ds power point presentation and both are available for questions. Thank you. Supervisor mar thank you, supervisor preston. We could go into the presentations right now. Hi, i am deb borne, and im in a room alone and im taking off my mask because its safe. I am a physician and my role is that i oversee the Health Policy for people experiencing homelessness. In my now night job, i take care of people that live on the street and im part of the street Medicine Team. I actually work in district 5 and i live there as well and i have the distinguished pleasure of just turning 65 this year. So from that place of experience im interested in talking to you about these measures. So next slide. Thanks. So first of all, what are the shelterinplace hotels. Its part of a multipronged approach that were at the initial part of the epidemic, where were trying to decrease the risk of the spread and the risk for people that have a high impact to covid. So we opened up shelters in place hoe teles like many areas across the country and theyre indoors, in hotels that are commercial hotels, people have their own bathrooms and theres medical and Behavioral Health and Harm Reduction onsite. People have to follow rules and its not free to be you and me and they have to mask and social distance and theres strict egress as well. So why the hotels . To decrease the risk of becoming infected with covid that could have a bad outcome and die. And they are designed to decrease the outcome that would be with hospitals because we know that hospitalizations and i. C. U. Stays impact all of us and increase the risk for San Francisco, which is why its one of the indicators that we have on the state and national level. So we prioritize. At first we prioritized people in shelters so as we have those individuals that met the risk for covid. And we prioritized hospitals and the homeless street medicine to work to identify individuals every day. Next slide, please. So what is the most vulnerable . And to levels for all of us. I have done this for 30 years and i reviewed some cases. And i wanted to make sure that its all clear that we say covid vulnerable is different from what is being vulnerable on the street. On the street its someone with a Mental Health or other issues who is an unaccompanied woman or minor or lgbtq. And those are things that make us vulnerable on the street. Thats disifnt from different from what covid does to someones body and what makes you covid vulnerable. And covid wont care if we get it right or wrong, but we do have to get it right on who covid will affect. Thats who we need to look at. So what you see on your screen right now, the green, is the current c. D. C. Guidance for who is at risk for data from covid, and for hospitalization and for death. And originally it was 65 and now theyre saying they have a gradation system but the illnesses theirsed here, a lot are driven by a high body mass index. You can see that type 2 diabetes is on there and not type one. Some of the ones originally are not on there currently. What you see in the blue is what the department of Public Health has looked at and taken from them from the might be at risk category to i kind of lead out and operationalize the criteria. From the beginning we used 60 and ill get to that in the next slide but i want to talk about the medical conditions. What we have added and this is not on the highrisk definition, meaning that it is not reimbursed by fema. Uncontrolled h. I. V. And people with uncontrolled h. I. V. And with counts of 200 or a detectable viral load and pregnancy is on and off the high risk and we keep that in for San Francisco. And diseases that makes you immune compromised because you cant make proteins to fight illnesses and oxygen dependent. This is different than what will cause the risk of death not from covid. Theres been four cases of syphilis since the epidemic started and this is what i did before covid. That person at risk, its not the systemic cause of that risk from covid. I want to make a comment about margos research. I talked to her yesterday and shes my friend can colleague for over 20 years. And i reviewed with her how thit misinterpreted. So it was based on the fact that the jority of the people that you see in the community have medical illnesses and its because of those medical illnesses and the inability to care for them when you are in survival mode or on the street or being moved frequently from place to place, to be able to take your medicine and to be well. So she truly believes that its not actually just being homeless alone, but that it actually is the medical conditions accompanied. So this is slightly a misinterpretation of what and what her research is showing. Ill go to the next stage and talk about age and maybe answer questions there. Supervisor mar could i jump in a second before you do, through the chair. Just if you can go back a slide. Can you my understanding so the interpretation of this slide is that theres certain conditions that have one viewed as increased risk of covid under the fema regime and the c. D. C. Theirs and that the department of Public Health and the city and county of San Francisco has added these six additional criteria, suggesting i think that the definition of vulnerable in terms of Health Conditions is broader under San Francisco no. Is that correct . No, sorry. Thank you for the clarification, i really appreciate it. So this is these medical conditions put you at risk for a death or morbidity or mortality from covid. The ones on the right are based on data. So the data is not great around the world on which illnesses that requires reporting, etc. So we really dont know. And from what the c. D. C. Reported, for example, the immune compromised state with solid organ transplants, but when you dive deeper into the research, people who have no immune system or tcells from uncontrolled h. I. V. , this is coming from fauci and i think that he knows a lot are at greater risk. This is deeper diving into the data from the c. D. C. This is the current c. D. C. Covid vulnerability criteria and thats a disifnt thing what people different thing that fema is reimbursing. This is based on San Francisco experience for the covidrelated outcomes that we have had. And not necessarily based on someone who is street or otherwise medically vulnerable. Okay, setting aside reimbursement and fema issues, in terms of comparing the c. D. C. Definition of vulnerable Health Conditions or Health Conditions that render one of increased vulnerability, versus what we use at the city level i think that this is very important my understanding is that under the c. D. C. Definition that there are a number of conditions that are deemed to make one of increased susceptibility to covid, but are not covered under San Franciscos definition. And those are include maybe there are more but it includes cancer, severe and moderate asthma, and hypertension or high Blood Pressure and Liver Disease and smoking and other conditions. So do i have that right, that our definition of vulnerability is narrower than the c. D. C. When it comes to health . No. Im sorry, theres a slide further on and you can use it for your reference that can clarify this. The c. D. C. Took and broke down their categorizing, instead of having these are the vulnerable, they said these are increased risk, we have good data, this is what we know. And maybe we might be at risk. So they have an increased risk its at the end of the slide and you might be at risk. The illnesses that you theirss are you theirsed is at the listed is might be at risk. And its a state that we include on the blue side. So people with a bone Marrow Transplant and people in chemotherapy, and people with uncontrolled h. I. V. Are in an immunecompromised state, but the evidence shows, data shows, that they are higher than might be and they will probably get moved to the increased risk. So we looked at the data in the might be at risk group and said who do these people that we think that the data and the evidence is compelling enough that it should propel us to put them in the criteria theirs . Does that make sense . So theres a might be at risk and we looked at the the day data of who might at risk and which groups need to be in our criteria and thats how we came up with the medical illnesses, regardless of fema reimbursement. Thank you. I dont want to belabor it and let you to move on, but just so were clear, there are might be at risk category, under c. D. C. Guidelines. And then the department of Public Health has selected some of those based on data for which people may be eligible for hoe teles and being vulnerables. And theres others that might have injury and death and so forth from covid19 but who are not. So the department is exercising discretion based on the data to deem some of those c. D. C. Might be at risk criteria as making people vulnerable in San Francisco and others not, right . Yes. And if the data changes we would change the theirs. For sure the list for sure. And these are all very difficult. And when im the clinician advocating for someone who is a paraplegic and they have this, and its very difficult. So we really we have few resources and these are Public Health decisions that we have to make in order to help the most people with the resources that we have. And those c. D. C. Chose 65 originally, in San Francisco 86 of the deaths in San Francisco are aged 60 and above. And 51 of all of the deaths in San Francisco, regard regarding was housing, is 81 and above. The higher you get the higher the risk that you have regardless of your Underlying Health conditions. And 5 of all of the deaths are in the group of 6070, so the higher that you see with the picture on the right, so were seeing the deaths in our city at the higher theres only a few that are housed or not housed that are 40 to 47. And 1 of the deaths are individuals identified as homeless and we think that person died of another illness and 3 of the cases in San Francisco with covid are people who are currently homeless from our current data. This looked like a doctor slide but ill take you through what this is meaning and its looking at national and International Data that has come to us and why we made the 60 decision and why well want to keep that. So if you look to the right, these are two graphs and on the bottom of the slide, from china and korea and italy early on in the emdemmic that, once you get to 6069, you see the growth of the curve is exponentially increased. So an individual from that, not the numbers but the rate of chaism, is why we have chose this as the point. The data is consistent. The bottom picture on the right is the United Kingdom and new york city that you see at 65 increases. In the blue, just to take you te access is the years. This is by log and key value is how much deviation and the broader definition is meaning that this is definitely more accurate there. But if you look at 6069 you get a 2 cut. And theres a huge drop between 50 and 69. So why that group might be at risk . Or higher risk . This is why the c. D. C. Said that theres a gradation but when you look at it from a Public Health standpoint, San Francisco has decided that 60, because of the disirches, because of the the disirches is that this is the best for San Francisco. If you have an individual, you have an individual that is 60 years old and has no other illnesses, theyre at less risk than an 80yearold. And less risk than a upon 70yearold with diabetes. So we want to get the people at most risk and with a medical diagnosis. Ill turn it over to suesy next to talk about the fema reimbursement. Good morning, everybody. Can everybody hear me. Susie smith from the Human Services agency. I have the last exciting piece to present on fema, what is reimbursable and the cost estimate with the proposal to lower the eligibility age to 45. I actually worked with the Controllers Office and they actually did the Data Analysis on the cost and the reimbursability but the person had another matter at this time that they couldnt get out of, so im presenting on behalf of the Controllers Office. So in terms of the issues with what fema will reimburse and by how much, for covid19 pandemic, feel fema covers up to 75 of all eligible costs and ill go over eligibility in a moment and the city local cost share is 25 . There are three fema eligible populations for the hoe hotels. One is people who are diagnosed with covid and do not require hospitalization and people exiting out of the hospitals. Second, people who are exposed to covid, so close contacts, and do not require hospitalization, but we want to isolate and quarantine them. And, three, the group that were talking about today, are people who are not symptomatic but they are high risk if they got the disease for severe acuity and potential death should they contract covid. And four but that population fema, while the c. D. C. Recognizes that people over 60 are at high risk, fema only covers the cost for people over 65. They also cover the costs again, this is a 75 share, with people with certain Underlying Health conditions. And another piece to note is that the city has to obtain preapproval of femas continued support for any shelter, like hoe teles, hotels, every 30 days and were putting owfers ourselves at risk because they can end the support with 30 days notice. For the cost protections that we have done, the Controllers Office has assumed that the federal state emergency will continue through this fiscal year and that fema will, in fact, continue to support the hotels throughout that time but theres a lot of unpredictability with the federal government and theres not a guarantee of that commitment. So i wanted to note those pieces. And then we can move on to the cost estimates for the expansion. Its costing about 180 million this fiscal year. And if we expanded to the population between the ages of 45 and 59, according to the most recent point in time counts, that would be an additional about 3,000 people experiencing homelessness who would be eligible for the hotels. So if we lowered the age to 45, we need to do a combination of entering into the new hotel agreements, to significantly expand our capacity, of course, coupled with placing newel new really eligible people to existing units as they become available. So the Controllers Office estimates that the range could be an additional 250 million to 495 million. And extend the occupancy of the hotel sites into fy20222023. And the actual cost would depend on the mix of how many were able to put people in in the existing units with the need to acquire Additional Hotels and units. Secondly, that the city is able to exit clients into alternative housing and shelter placements. That assumes that we maintain our cost levels and, again, no fema reimbursement because the population would not be eligible for reimbursement. So that covers the financial piece. And before we move on to any questions, certain summary d. P. H. , h. A. H. , and the Controllers Office and the m. B. O. H. S. A. , we have been working handinhand in this response in a way that is unprecedented for the city coordination, to be honest. And we have been work working tirelessly to upthe day the most uptodate data on which populations really are getting sick and dying of covid. Again, the Financial Risks of further expanding to nonfema eligibility at a time when, of course, we have an unprecedented city deficit. So the Health Department has helped us to prioritize the most at risk of acute illness and dying as dr. Borne had shared based on the best data that we have available. Well continue to tweak that definition. And, you know, none of the work is without constant challenges but we can say that the data, our early choices around expanding eligibility beyond femas definition have born out that we prioritize decisions that have, in fact, saved lives. And we are happy i know that theres others on the line, but were happy to answer any questions that you may have. Supervisor mar thank you. If i could just followup, just back to dr. Borne for a second with d. P. H. I just want to go back to your point in relaying of your conversation with dr. Cru ds crushell, though its not good to have second or thirdhand conversations, but i want to understand your position here. I understand the argument that people who are unhoused and under 60, but who have specified conditions are at higher risk. I do understand though for the people that do not have those conditions, is it your position setting aside issues of the limited, you know, limits on the supply of units, just from a health perspective, is it your position that someone who is 55 years old and unhoused, is that the same risk if they dont have one of these specified conditions, theyre at the same risk as someone who lives near ds by who is 65 or who is 62 and is housed. Or even at the same age and housed. Lets use the same age. Because that doesnt make a lot of sense to me and its not consistent with my interpretation of the research or the other research that we have reviewed. There are stresses on one living on the street that cause one to age whether or not that results in someone having diabetes or one of the specified conditions. Can you just clarify what the position is take two 55 year olds and one housed and one unhoused and each lacking the specified conditions. Are you saying that theyre at the same risk . This is a great question and im going to try to clarify it with three disifnt points and im 55 so i can use myself as an example. Okay, so a lot is driven by the data, and the average age of death was 42 in San Francisco. Im going to a memorial for a dear patient who passed away who are 32, those are not related to medical, its due to the stress on the street. Its hard we have to get our brain around that has nothing to do with covid but it has to do with disease. And then you have covid, and for covid for 55, i at 55 have a higher without diabetes, obesity, and the other conditions, that would put me at risk for this. And as a Health Provider we have risk because repeated exposure might be a condition, and how youre exposed and put you more at risk so theres some of those things in there too. But an individual just 55 alone, has less risk than someone who is 65. Has less risk than someone who is 75 and less risk than someone who is 80 and we think its because of the things that happen to us as we age with this. And so when the flu season comes and the flu or the spanish flu, those flus hit younger folks, its actually the way that the disease works. Its not the disease itself that does it, its our physiological response to the illness and our body trying to do something with the illness. So the question about age and how you age. How you age from the stress and from life, and if youre living as in a yurt and eating unpasteurized yogurt, those are a whole area of science and research in what does and doesnt age us. We dont have good evidence. Margos data doesnt look at that and it doesnt say what happens to you physiologically when you age and if that age from stress, whether its internal stress or Behavioral Health, or people, you know, with severe Mental Illness that have a lot of internal stress that causes increased court cortizol, and those things that happen, we dont know if that impacts on covid. Does that make sense . So when youre in a stress response, what happens to you is that you have chronic cortizol, and it drops your immune system. But we dont have good data. What were seeing with the Health Providers that have a higher rate in italy and poor outcomes is because of their cortisol response and they think that what we were seeing was 5 or something high like that, and if it was actually because of how they were exposed. So we cant answer that question. And i can say in this middle group that im describing, margos data and i am third party but i literally spoke to her on the phone and shes my friend and colleague and we talk about our research and data all the time. And that her data was not talking about what happens to you as you age and does the aging process is the age process set up and thats why you have that outcome. We just see that with h. I. V. , for example. If you have h. I. V. , and youre 65, your heart condition looks like someone who is 65. Because of the physiological mechanism of h. I. V. We understand that. Does that make sense . What we dont understand is what happens with stress. So we dont actually know what happens with stress with the age response in particular to homelessness and the age response with covid. So i that was a longwinded question, this is what happens when you ask a doctor something. But death is higher for those with homelessness, 55, housed or not housed, and the increase with the data that i showed you and is margos data saying that home homeless alone is aging us and increasing the morbidity and mortality . No, and we cant make those conclusions. But i do hope a stress response and Trauma Informed Care and how that impacts, is my area of research and im interested in this. But we cant answer that question. Im helping you and im trying to help you one of the things is that we have been working together unprecedented and i want to work with all of you to help all of San Francisco to make the best decisions. I really do. And i want everyone on the street to get inside. I dont want to see the suffering. But i literally see it every day and i see in your district as i work there. But that is not the covid question. Covid doesnt have a heart and compassion like all of us here in San Francisco do. Covid is going to affect a body and a physiological system in a particular way and thats what this data is. 45 to 60, the evidence is not enough to say to open up the flood gates because what will happen is that a 45yearold with no other medical illnesses is going to get a room and limited resources, because there are limited resources. So, you know, if this was bill gates and suddenly gave us a room for everyone, sure, but thats not what is happening. I have been trying very much to separate the policy decisions that the board has engaged in around the supply of rooms from this discussion around health. So i appreciate your comments and i think that, you know, a fair statement of where we are certainly at least with how this supervisor looks at it is that we have consensus that as you age your vulnerability to covid19 increases. We have i believe from all of the data and research that ive seen, that we have we have plenty of support for the idea that one ages faster on the street when they live on the street due to a lot of the factors that you have talked about and then its the connection between those two that the department it sounds like is agnostic on and saying that those two things dont necessarily mean that one is by nature of being on the street somehow at higher risk to covid. So i think that is a fair characterization of where we are. You know, i believe one plus one equals two there. And there may be some disagreement on that. I do want to just give just a quick question or two over to miss snyder from h. S. H. And then and then try to wrap up my questions. I know that the Committee Members may have questions as well. Miss snyder, and through the chair, i just wanted to ask you if you could clarify around the the actual outreach and vetting for vulnerability and this is something, you know, that i think that we have discussed before or sent questions on this issue before the hearing. Were trying to just ascertain for the people, how many people are currently on the street and what percentage of them have been have there been outreach to and a determination of whether they meet the vulnerability i have tearia of criteria laid out by the department of Public Health. Sure, through the chair, thank you, supervisor preston. I will try to keep this brief because i know that we need to move on. But i do really appreciate your office sending these questions over in advance and we have done a lot of thinking about them so i wanted to provide a little bit of landscape on this. I think that its an excellent and a challenging question at any point in time to say how many people are on the street, how many of those people are vulnerable, and we say vulnerable from our precovid definition and covid vulnerable in our covid world. And how many people are we capturing in our systems and outreach. Not everyone who outreach interacts with is going to want to enter our system and so we have a few different kind of current interactions and strategies that id like to share with all of you. But, first, what i would like to do is to just talk about it in terms of data that tells us how many people are experiencing homelessness in San Francisco at any one time. We often go back to that point in time count, that every other year count with the National Best standard because it gives us a standard methodology both in the number of people experiencing homelessness as well as the demographics that we can measure across time. We know that homelessness itself is an experience so there are people exiting and entering homelessness on a daily and annual basis, which is why we use that standardized methodology over time. You have quoted some of this, but the 2019 head count had about 8,000 people experiencing homelessness or in temporary shelter and unsheltered. 65 of which were unsheltered, about 5,000. I know that our data team go a little bit further and dig in, 800 of those people experiencing homelessness were over the age of 60. And about 3,000 were between the ages of 45 to 59. Now what weigh know from the count and this is all selfreported by those that were serving, is that about 31 of the respondents recorded having a Chronic Health problem. Now we have just spent a lot of time on this definitions on what Chronic Health and medical vulnerabilities are and this is the broader definition that the count uses as well as coordinated entry. And its not covid informed. So when i say 31 , thats one of the percentages that we use when we make estimations about how can we look at who might be vulnerable for multiple reasons. But that is not necessarily tied directly to who might be at higher risk of covid vulnerability. Ill move along. The other point in time count that we can make on who is on our streets right now experiencing homelessness is the quarterly head count. Excuse me. That is the healthy streets operation center, and the quarterly count where they count vehicles and structures in San Francisco. And as of july that number was 1,806 structures. So as we know that we know that there are people on the streets that have varying levels of vulnerability. And is that precovid vulnerability and the high risk to covid vulnerability. So your question is really about outreach and how we are interacting with and capturing the folks that are on the streets. So the San Francisco Homeless Outreach team their mission, again, precovid was to work to engage and stabilize the most vulnerable homeless individuals. Again, those are the individuals that have Chronic Health problems and that are have severe illness and Mental Illness and Substance Abuse and lgbtq etc. And they work with these individuals on a casebycase basis to make sure theyre available to resources, particularly shelter and housing. And so two things on that we have trained the hot teams at every one of the hot teams is able to offer to enroll anyone that theyre engaging with in the one system. So that means a brief data capture that puts them into the one system so we can follow them on their journey through the homelessness response. And additionally we realized that especially in light of covid where before we encouraged people to visit our Access Points that are for adult families to complete a coordinated entry assessment. We have some mobile teams and we realized during covid that sending people to travel was not the best option so hot has trained both the supervisors and the shift leaders to be able to provide mobile data. And so if i come up to you the street please stand by . They can work closely with the d. P. H. Street Medicine Team and work with them to go to the shelter in place hotels. And they are also with the encampment resolution when we are able to say are you at the highest risk of covid . To take a moment to thank you in the budget process and we know those will help the people not immediating eligibility for the finite resources that are costly as well. I will stop there. Thank you for the overview. Are you able to quantify what percentage of the estimated 5,000 people on the streets of San Francisco during shelter in place have been enrolled in the coordinated entry system that you described and vetted for their status of whether theyre vulnerable based on age or medical condition . I hear what you are describing. I know there are a lot of folks doing a lot of hard work and adjusting to the way we used to do this versus how we do it now, but i think what id like clarity on is what percent of that a,000 people have actually been evaluated for vulnerable status . Sure. I can answer the majority of that, and that is that i had our data team pull data as of yesterday. And as of yesterday, we have 4500 active clients in the coordinated entry system which means they are either in shelter or on the streets and engaged with coordinated entry. Anyone engaged with coordinated entry in some way had that assessment. And so would be flagged as meeting the vulnerability. That is 4,500 out of since you are now combining street homelessness with folks who are in a shelter of some kind, that is 4,500 out of what . 8,000 . That is yes, comparable to the 8,000. This is when the data gets a presumably everyone who is in a shelter by definition has been, i would hope, evaluated and so the gap there between 4,500 and estimated 8,000 would be folks on the street. And by my math that looks like at least 2 3 or more of the people on the street than have not been evaluated for that you are vulnerability status or actually put into the coordinated entry system. Or am i misinterpreting . That is what that sounds like. Im sorry because this is when we have so many systems that it gets a little bit tricky because some of those people that are captured in coordinated entry, as you said, the 4,500 people are engaging with the system. We also have people that that are captured in the one system that might not want to have gone through the coordinated entry system but might have been evaluated for vulnerability through outreach teams. They are not captured in the same way because they are not active in coordinated entry. So that is not tracked . It is tracked in street outreach in the one system. I dont have that data right now. I can look at the number of engagements. That would be something that is tracked and working with street medicine, but it doesnt necessarily mean it is reflected in the coordinated entry. One other question and i will wrap up. When a sick hotel is offered to a Vulnerable Person by any of the folks you mention, whether h. O. T. Or street medicine, but when it is offered, what is the percentage of unhoused people that accept or vulnerable unhoused people that accept the offer of a shelter in place hotel . Force that is a good question. I can only answer that based on observations i have heard from the h. O. T. Team. We have heard a lot of people say yes to sick hotel. I believe what i heard last about was it 8085 acceptance rate with sick hotels. An i am shaking my head because we asked this previously and i would really like clarity. The 80 figure is my combining safe sleeping sites and sick hotels. I think we need some clarity especially with the misinformation out there that somehow people wont take sick hotels because in our experience in talking with folks on the front line, it is virtually accepts sick hotels. I would love for us to eare move that from the equation, but if you can get updated data on that, it would be great. I think it is important to inform the policy here. An i am happy to check back with our outreach teams and get clarity on all of those. Off thank you. And again, chair mar, i appreciate the time here. I know you and others may have questions. I do just want to observe that one of the concerns and one of the driving forces of the resolution is its one thing to say as a city we are committed to providing sick hotel rooms to vulnerable populations. The concern is there is a lot of people who are vulnerable who arent being contacted, talked to, and put in the system. So were narrowing the pool from the outset of people were even talking to. So there are a lot of presumably many Vulnerable People who meet the criteria were out on the street. The second concern is whether the vulnerability criteria itself is broad enough. And those are the two things guiding the resolution. I appreciate the time and thank you, chair mar. Cha thank you for your presentation and supervisor. I dont really have any questions myself. I just wanted to say that i really do appreciate supervisor preston, you and your staff bringing this item forward and all the work that you have done on it. You make a very compelling case that people experiencing homelessness, a. , age at a much faster rate than general sheltered folks. And that we really should extend our definition of vulnerable populations to include those under 60 years old that have experienced homelessness to ensure that theyre able to have that adequate protection through a sick hotel room and other services during covid. So i really do appreciate this. And i would like to be added as a cosponsor to this. Supervisor peskin or haney, do you have any questions or remarks before we go to Public Comment . An i would, yes. First of all, thank you, supervisor preston. I know we were we worked on this together early on. I guess im just want to clarify something because it seems to me that hopefully we all agree that anybody who is on the street right now is vulnerable. Were seeing that in the numbers of deaths that have increased recently. Obviously people who are unable to shelter in place safely were on the streets, and hopefully also would agree that people who are in this resolution who were explicitly trying to expand the definition for even more vulnerable than other groups who may be younger than them. So is it really just a question of sort of scarcity in the sense that we have to pick and choose . Or is it the citys position actually that these folks who we want to include in this resolution are actually not vulnerable. Is it a choice based on scarcity or do we actually believe they are not vulnerable to covid more so than others in the city including people who are pouzed. Force i can try to answer this. This feels like a really bad crossword puzzle you cant get your brain around and i have done more medication than ever before about how to sit and make the best decisions and the data is not phenomenal. Everything is changing all the time. And make decisions and based on Public Health and what is able to do. And really the data on age alone and dont across the world is not that compelling. And i can tell you tomorrow and age alone is not compelling until you see that logarithmic jump, age alone without an illness. After age 65 is where you see age alone can have an impact. And the data is not that great. Some of the folks had underlying illnesses and even the c. D. C. Was having a hard time with the data and not someone with a bone transplant and have type i diabetes and not type ii . There was a lot of stuff that we were confused about and age alone and the 811yearold would win out. Is that 5 ayearold at risk . To make a Public Health decision and high risk might be at risk. And black and brown people are dying at higher rates alone. The c. D. C. Is still not making that. And it is a gray zone and i dont think its worth the risk to the city. Resources drive this. We will need to have the discussions soon and be coming back to the vaccine and who gets the vaccine and how the c. D. C. Decides about the vaccine. Everyone in the United States will need the vaccine on resources. We dont know there is a lot of things and i hope that i am answering your question. It is very gray. Would i choose that age . No, i would actually choose other thing and the black and brown data is much more compelling to me than the age data right now. So i think its important and these are right questions. And we are all asking the right questions. We dont know if this is the right answer. That is the kind of work we need to figure out together. Sorry to be so vague. Well, i guess another piece of this is do you believe that from what you have seen that being homeless that not having shelter or housing is a risk factor that makes you more vulnerable . So youve had to listen to me talk your ear off too many times so im going to look at what i think makes a human vulnerable. And so if i, god forbid, had cancer around my friend has cannes arenaed look at the work and what i do and i do al tern tough medicine and i do herbal medicine and i believe in other forms of healing. I believe in emotional health. I believe in spiritual health. When you look at that regardless of homelessness, regardless of everything else, those factors help us as overall beings. And if you have an illness and you go to the community of folks and spiritual and those are critical. I know from people experiencing homelessness with a lot of stress response and i believe that homelessness impacts you on your ability to recover. Some of that has to do with cham and our brains and what we can do. Having nothing to do with covid. And what we know about covid is a cytokine storm doesnt care about your relationship with your mother. It doesnt care if you are schizophrenic or at risk or using heroin from our data. Does that make sense . So 100 all the humans are at risk. We dont have enough data to say our stress response impact what is we have with covid. Supervisor and i appreciate all that and i appreciate what you said about black and latino people in our city. And especially black people are with the large percentage of our Homeless Population. One of the reasons why it seems that the shelter in Place Program is so important is not just because of the risk to covid which obviously drives some of it and exacerbated by the covid crisis. With the overdose and other factors and middle age people are in the age group focused on be overrepresented. The way i see it to protect kids from the consequences not only from covid but the larger set of factors exacerbated by the covid crisis. We have a hard time Getting Services to people, accessing health care, accessing different ways that being around other people can protect them. With the infection or death. Just a quick comment on that. We have to try to put on covid classes. And these sick rooms what were doing is like having i was trying to explain this to someone is needing a lung and heart transplant. If there is nothing for the heart, you can only do lung transplant. And the sick hotels are the lung transplant. That person still needs a heart transplant, but we dont have the heart. We have to make decisions together of what the resources are and what these are for the sick hotels are for covid. I would love to come back and have discussions and on the work group with mary ellen and the supervisor from district 10 to say what are we looking at for vulnerable . The rates of h. I. V. And are unacceptable and this is for covid. And we need to come together and say what is for the other things. Which at this point are greater for our Homeless Population than actually covid. That is not what this is about. And open the conversation to be really important and the questions are right and the answer, i dont think the answer is wrong for covid. Supervisor peskin . Supervisor why dont we go to Public Comment right now. Mr. Clerk, is there any callers on the line . Clerk thank you. We will check to see if we have any callers in the queue. For those who have connected to the meeting via phone, press star followed by 3 to be added to the queue if you wish to speak for this item. For those already on hold, wait until you are prompted to begin. You will hear a prompt informing you that your line has been unmuted and that will be the opportunity to speak. For those watching on cable channel 26 or sfgov tv, if you wish to speak on this item, agenda item 7, call in by following the instructions on your screen by dialling 4156550001. The meeting i. D. 1 146706 and press the pound symbol twice and followed by three. Connect us to the first color please. Good morning, mr. Chair. I am the policy manager for glide on behalf of the organization, i am speaking in support of supervisor pestons operation. As a leading service in the tenderloin, glide sees the physical effects of the toll it takes on clients and who are currently homeless and disproportionately black and brown. And people from triaged for care using inadequate model. Fails to distinguish between people who are house and unhoused. We know firsthand how rapidly that condition injured the body. And medical ages, unique Health Concerns and higher rate of comorbidry that exceed biological teenage with 20 years their senior. And higher risk of being exposed and to help ameliorate the defects and medical care. Recent dangerous air generated by wildfires and colder and rainier months approaching, living outdoors will move no kinder to our unhoused neighbors and loved ones. As such we are to strongly recommend that the expanded definition with the personnel. Responsible to the diamond streets. And folks living outdoors and basic human needs are met. We should not be making things more difficult to exploit homelessness and should be making it easier for people to access homelessness. Thank you for your comments. Could we have the next caller please . Hi. This is kristin evans. Owner of booksmith and i also serve as the president of the hate asbury and am a homeless advocate. I have been over 40 of these operations to do encampment resolutions and in listening to the last hour of conversation, i can see the disconnect from the city to address vulnerability and those that are actually receiving the hotel rooms. There was a substantial change into the hotels and as a result we have seen a situation where theyre just hundreds of people with who we have had intensity times for putting them indoors. The city failed miserably by allowing the e. C. Hastings lawsuit to drive resolution with the primary mechanism of identifying people to have the s. A. P. Hotel rooms and now we are left with hundreds if not thousands of people that are extremely vulnerable to the covid virus without appropriate shelter. For that reason i really encourage you to expand the definition to make it easier for people that are truly vulnerable to access safe shelter. Next speaker please. I am a resident family physician at sf General Hospital and i live in district nine. I urge you to support and expand the definition of vulnerable for people experiencing homelessness. In our hospital and clinic, i frequently care for unhoused Community Members and see the challenges they are facing and carrying for their health against massive constraints outside of their control. And especially in light of the pandemic and how to stay protected against the virus further exacerbated by poor air quality and the coming seasons that will risk lives. This is absolutely urgent. The current definition of vulnerable based on age doesnt recognize the no difference for in house people compared to those who are housed including respiratory, cardiac, multisystem, conditions, and functional impairments. In addition to the chronic stressors, Food Insecurity and the Mental Health impacts that they are experiencing daily. Ucsf shows that unsheltered individuals experienced conditions at rates that are on par with housing individuals 20 years or older. This appropriately defines vulnerable at age 45 rather than 60 for those who are unhoused and enabling them to Access Services that as a physician i know are desperately needed to address the preventible health disparity. This could potentially impact the neighbors during the pandemic and also impro