Months. I was proud. We were doing well. Almost everyone in the city did what they asked you to do we are seeing how fast it could move the governor laid out a warning and we are seeing what is happening in San Francisco. Let me be clear, as clear as i can be, its not good. Cases are spiking. Hospitalizations are increasing quickly. Our infection rate is higher than the summer. This is not just about San Francisco but the entire region, state, and country the dangerous winter has arrived. We will have to take more action. We are still working out the details we are working out the details in Santa Santa Clara county. They have limited gatherings. Theres are things you have consider as well as other ideas to stop the spread. No one would like to be here. We spoke about worrying about doing well but having everyone relax and the cases spike like they did during the spanish flu. Im not saying thats what happened but there have been a lot of challenges including lack of national leadership. A lot of people have done well and put Public Health first. We are in the most dangerous periods of the pandemic and we need to do everything we can to keep hospitals from being over run. This is about saving lives. Everything we asked is about that, solution. Today is World Aids Day, this is a day where which remember all of those we lost to the hiv aids epidemic and recommit ourselves to get to zero new hiv infections. Its important where we stair down the difficult months ahead and remember what we can do when we ban together. A lot has been said ability San Francisco building on the efforts to fight the covid19 pandemic and reaching back to our history when we have to confront the aids crisis without support. The trust we build then between residents and Public Health officials and neighbors coming together as so many people got sick and died. Those are hard memories. The spirit of the city and resiliency of the people that live here. Today, on World Aids Day we remember the history fighting hiv aids remember what we can do. I flow people are trying. I know people are tired. I know it wont be easy. I believe in the city and all of you. Finally, today, its been my goal to not layoff any city workers. We were able to do that in the two year budget but we have a long road ahead of us and tough choses to make. The mta is facing a deficit of 230 million in the next two years. Without more emergency federal funding closing the deficit may require laying off between 18 and 22 of the work force. The possibility of losing nearly a quarter of our work force is hard to image. This is the reallity we have to confront. We are facing the gutting of a basic city service that our residents rely on and economy needs to recover. As importantly this means bus drivers, mechanics, and other workers losing their job and ability to provide for their family. San francisco is not alone here. Cities a cross the country are facing the same crisis due to covid19. Just yesterday, washington d. C. Announced their Metro Service would have to layoff workers and eliminate Weekend Service and close stations. Federal cares act funding helped keep us stable through the first year. If we push for more funding transportation must be the top priority along with support for the Small Businesses suffering. A decimated Transportation System will hobble our economic recovery. I hope the Biden Administration will work with Speaker Pelosi and congress to provide support. There are some steps we can take locally to increase mtas revenue and costs in strategickic ways and do what we can in the city. We have to consider every possible way. We are in deep trouble and need to do everything we can to save it. Now, id like to turnover the rest of my time to dr. Grant to provide you clarity around the numbers. Where we have come from, where we are going. And what we need to do to get the city to a another place. Good afternoon and thank you mayor for your ongoing leadership during this unprecedented time. Thank you for recognizing World Aids Day. This is a virus that claimed the lives of so many of san franciscan residents. With the speed that could individual is spreading throughout the city region, and state we have little time to spare. We are in the middle of a major surge threatening to overwhelm our Healthcare System as well as the systems in the sure round surrounding states. Let me be frank. The actions you take or dont take can impact you gledges your friends. Its a that simple we are all at risk and must take precautions. Its uncomfortable to think about and we hope it doesnt happen consider this, if you are a loved ones we becomes ill will there be a hospital bed to treat you or your loved ones we are seeing communities across the country grappling with the issue right now ascoindividual continues to cause havoc on communities big and small and urban and sure bub barn. This past weekend never the less we saw tens of thousands of people fly, drive, and gather with extended family as it virus ran ramped throughout the country. As a result of holiday related activities we know the worse is likely yet to come. Together we will have to take appropriate measures to keep all San Francisco sis ans. Lets review the data that has us so concerned. Slide one please. This slide shows the number of cases of covid19 per 100,000 in San Francisco from the beginning of the pandemic until now. This slide shows how quickly our cases have multiplied in the last three weeks. In the last three weeks San Franciscos positive cases have tripled. And we do not expect this to stabilize any time soon. We have more virus circulating than ever before think about what this mines and how to act accordingly San Francisco has 1 1,600 person 100 resident. We had an average of 34 new cases per day. 34 new cases per day. Now, San Francisco has an average of 140 new cases per day. Thats four times more new cases than a month ago. Yet, we are still in a highly volatile position more than any other point in the year. We have yet to account for travel and gatherings from thanksgiving. Next slide, please. Unfortunately, we know a spike in cases results in a increase in hospitalizations. We are feeling the pressure of the rapidly accelerating cases across San Francisco. In fact, covid19 positive hospitalizations have doubled in ten days. Consider this, we went from 40 hospitalizations on november 18h to 87 on november 28. In addition to the 87 covid19 patients in San Francisco there have been four covid19 patients transferred to covid19 hospitals from other jurisdictions totals 91 patients with covid19 in our hospitals as of november 29th if we continue on this participant, we, as well as other counties will start to see a hospital bed shortage. the trend continues we will see a hospital bed shortage around christmas. Thats a sobering thought. There is a real possibility of no available beds at our hospitals. Of course, i hope, we hope this doesnt happen. Its an increasing likelihood as we see this virus spread locally like never before we have beaten back two surges. Simply put, we need to slow the spread of virus. We have taken a number of actions to slow the spread. We have holted Indoor Dining and closed indoor museums we had limited capacity indoors. We have asked you to abide by the stay at home order. We required all nonessential activities by 10 . None of these have slowed the rate of the spread of covid19 virus. In fact, infections have continued to increase. Therefore wll well implement additional roll backs. We will farther reduce the number of people that can gather especially from multiple households. We will analyze capacity restrictions for indoor shops. We are reviewing the county health order requiring those that travel 150 miles to corn teen we must slow the spread or well continue to see hospitalization numbers that will overwhelm the healthcare center. Well be a city that struggled to deal with the virus in ways we thankfully have not yet had to. We can slow the sprayed. It wont be easy and everyone has a part to play. Im the broken record and continue to be if it saves lives and keeps people from getting sick morningized, and die. Do not gather with anyone outside your immediate yacht household. Wash your hands, wear that face covering. As a gay man and i trained here during the aids epidemic. Everyday i think about the lives we couldnt save. So many lost family friends, neighbors and colleagues. We didnt have the tool but we came together. With this pandemic with this pandemic we have the knowledge. We know what it is to fight the virus. The current surge. We know what to do, what we need to do to protect lives, please, lets Work Together and come together to protect lives and our communities and protect our city. Thank you. Thank you, doctor. At this time well begin the q and a portion with mayor london. Thank you madam mayor. Your first set of questions comes from megan. How would you consider the mention of the kellies. We are still reviewing the allegations. These are serious charges. People are innocent until Proven Guilty the actions are deeply troubling. I have said from the beginning of the investigation we need to do everything we can to restore public trust. Well continue to consult with the City Attorneys Office about our steps forward and everyone should cooperate with any investigation. Thank you, madam mayor. Lastly from scott nbc. Do you have comments about reports that more San Francisco restaurants will have to shutdown or quote hibernate . I think what we tried to do from the beginning of the pandemic is provide faggots about every situation. As soon as there is information from the public we notify the public. As soon as we think there is the possibility of a closure we tried to reach out to people and the industry. We have been in touch with the association and many of them are naturally concerned as we see a spike and places like l. A. County close out dining entirely. Id like to be clear, we cant rule it out. As soon as which think its absolutely necessary based on what we see with the spike. Based on hospitalizations and direction our city is headed in. It could be a possibility. We cant say right now what that would mean in a timeline. Well do everything we can as soon as we know when or if it happens we will provide as much notification as we can and understanding we are not just talking about the owners of the restaurants and places for people to go. We are talking about the food they are ordering. The work force. The people that were on unemployment. It will take forever. We understand the challenges that people are facing. Our goal is to make sure whatever possible, we do what we can to provide as much information. It pains me every time i have to do a press conference where we have to talk about roll backs. There will be roll backs. There will be announcements this week because we expect the state of california to improse other restrictions on San Francisco. There might be farther roll backs we but into place ourselves to curve this virus, so, we know thats to be expected which is why we have to do our part. We must distance ourselves and limit our activities because we have done it before we are seeing a spike unlike anything we have seen since the beginning of the pandemic. We are in trouble and sounding the alarm like i said before. That will mean really challenging months ahead. Thank you, madam mayor. We will transition over to dr. Colfax for some Health Related questions. Doctor, the first set of questions come from erin from the chronical. What will trigger the new orders . Is it possible we will see another stay stay at home order like from march . As we mentioned we are reviewing a number of options including limiting outdoor gatherings. Looking at the santa clara travel order, quarantine order. Some could come out as early as tomorrow. Thank you, from julian with mission local, study after study and your own data show the latino population is seeing higher infection rates than the rest of the city. As we enthe a surge will we offer more widespread testing and resources to those getting sick. Yes, since the beginning we focused on the issues and the infection rates are disproportion nate among the latino populations. We have engaged the Latino Community from the beginning, invested in testing and isolation and quarantine rooms. We have invested into Contact Tracing and Health Department care. We will straighten our strategy and our testing work is increasingly translating. The city will test that site the Farmer Market site monday through friday. This is the southeastern part of the city. We continue to partner and Community Partners to ensure testing we will focus on engaging and working with those effected by the virus. The next question is from david baker. How do you intend people from gathering in groups when people have ignored gathering. We are working to continue to exercise outside of your household. Its dangerous and increasing the likelihood. As much as possible and ensure people understand and understand its against Health Orders to gather in ways that could promote the transmission of the virus. I think what we really need to do is focus on the educational aspect so people understand the virus can and will effect them and their family members and we need to dig deeper and really do the things we know prevents the spread of the virus as much as possible. Well continue to enforce city guidelines and rules if necessary to prevent a major spreader event as much as possible. Thank you, dan with kron 4. What is the timeline for the changes . With regard to one of the prior questions we are looking at seeing capacity of indoor activities and institutions and businesses. This is Group Gatherings and looking at the potential travel quarantine orders and some of the orders could be finished as early as tomorrow. Thank you, doctor and madam mayor. If you have any questions following this meeting send us an email. Thank you. Good morning. The meeting will come to order. The december 3rd meeting. I am joined by Committee Member peskin. Committee member haney will be joining us. I would like to thank sfgovtv for staffing this. Do you have announcements. In order to protect the public and City Employees during the Health Emergency the board of supervisors legislative chamber and Committee Room are closed. This is taken pursuant to local state and federal orders and directives. Committee members will attend through video and participate to the same extent as if physically present. Public comment is available for each item on the agenda. Both cable channel 26 and sfgovtv are streaming the call in number on your screen. Your opportunity to speak and provide comments will be available by phone by dialing 4156550001. Once connected and prompted id for today is 146 2157375. Following entering the id you will press topped twice to be connected to the meeting. You will hear the discussions you will be in his senning mode only. When your item comes up dial star three to be added to the speaker line. It will indicate you raised your hands. Best practices call from a quiet location to speak clearly and slowly and turndown your television, radio or streaming device. Everyone must account for time delays that we may even counter between live coverage and streaming. If you have Public Comment you can email to me, john carroll, clerk of the Oversight Committee john. Carroll at sfgov. Org. If you submit as email i will include ate as the legislative file. The Clerks Office is room 2441, doctor carlton b. Goodlett place 94102. Mr. Chair, items today will appear on the board of supervisors agenda of december 15, 2020 unless otherwise stated. Thank you, mr. Clerk. I would like to start by congratulating the civil grand jury for the issuance of the three reports we will respond to today. I would like to thank everyone who served this year for the careful and thoughtful and valuable time, work and insight you provided. This process and these reports are a testament to the oversight. I am grateful for your willingness to serve the city and hold the government accountable. For each report we will call the resolution and hearings together while taking discussion, comment and motions on the reports one at a time. We will welcome the representative to speak on the reports and hear from representatives from city departments to summarize responses before turning to Commission Discussion and Public Comment and our responses on behalf of the board of supervisors. Mr. Clerk, please call items 1 and 2 together. Clerk agenda item 1 hearing on the 20192020 civil grand jury report strengthen our Behavioral Health services. Number 2. Findings and recommendations contained in the report. The report entitle strengthening Behavioral Health services. Members of the public who wish to comment on these matters call the Public Comment number. 4156550001. Enter todays id1462157375. Press pound twice and press star followed by 3 to enter the queue to speak. Wait until you are unmuted and that is your opportunity to begin your comments. Thank you, mr. Clerk. I would like to welcome our speakers from the civil grand jury. Thank you for all of your work on this report. The floor is yours. Thank you, chair and members of the committee. I want to make introductory comments. I am the foreperson of the 201 20192020 San Francisco grand jury. On behalf of the grand jury i extend gratitude and thanks forgiving us the opportunity to present our report in a public forum. The grand jury embraced our mandates seriously to investigate and report upon the affairs of local col local gove. We worked hard and have reports that are a consequence to the residents of the city. We had the assistance of many Public Servants and ordinary citizens of San Francisco. We have great faith that our reports are worthy of their time and dedication. The chairperson of the committee will shortly present our report, outline our findings and recommendations and carefully listen to all of the respondents. We are excited to move forward. Finally, i would like to recognize each and everyone of our grand jurors. They confronted the task with perseverance and resilience. We trust we have made san franciscans proud. We look forward to addressing all of your questions. Thank you very much. Thank you. Good morning, supervisor mar and members of the San Francisco board of supervisors and esteemed colleagues. I am patricia levenburg and i represent the five members of the civil grand jury who wrote the investigation entitle strengthening our Behavioral Health services. We will review the findings and recommendations. I will take this opportunity to thank all of the employees of the city and county of San Francisco for their experience, effort, knowledge antennasty to reduce the impact of covid19 on the residents of the city. This is atum you will di a diffr country. This is an endeavor where citizens like those who serve on the civil grand jury and legislators like you are working together to improve. [ inaudible ] doing what we believe will be right for the residents. Let me put my headphones on. Hold on. I dont think that wases coming from you. It may have been technical issues in the background. Hang on, please. While our investigation began in the late fall of 2019, we realized early in the spring of 2020 at the onset of covid19 pandemic that our investigation would necessitate modifications to realize our goals and outcomes. We feared there would be insufficient funding to do everything we were considering. At the same time earlier in the year, legislation for Mental Health sf was passed. The comprehensive plan by the mayor london breeds, supervisor ronen and matt haney to address the Mental Health and substance challenges in San Francisco which was music to our ears. They committed to working together to secure the approximately 100 million needed for Mental Health sf implementation. At the outset, we, too, were eager for reforming Mental Health Services Provided by the city. We wanted a Mental Health Services Center open 24 7. We wanted expansion of Behavioral Health and access. A Response Team as in eugene, oregon. A 311 number to call and focus to improve delivery of Mental Health and Substance Abuse services to those in meed of services. , we, too, were interested in the center. We were investigating the conservatorship law passed in 2019. To date we dont have information on the citys efforts to implement Mental Health sf. Our hopes are high for this initiative to be actualized. All of that said our investigation instead examined three areas with Behavioral Health services, which we believe deservetic attention. Number one, a hiring bottleneck and the hiring problem. Two, executive turnover. Three, Public Information challenges. Now for findings and responses. We issued three findings and two recommendations directed at reducing staffing shortfalls. The department of Public Health agreed with all three findings and would implement one of the two recommendations we made. Ththe authors of the study secd recommendation states by jun june 2001 they should fill 50 of the vacancies in 21 days or less intensive case managers. They admit that 21 days might be used as a stretch goal. Department of Public Health responds however highlights an ongoing hiring process which we believe unnecessarily hampers Service Delivery to Behavioral Health Service Clients needs. The department of Public Health response states fastest hiring time projections from the department of Human Services at the department of Public Health is 120 days. It goes on to respond that the current average for Behavioral Health services hire is about one year from when the position is identified as needed, then entered into the system to the start date of that position. In the private sector, filling a vacancy in 21 days might be a stretch, but it is accomplished. Every day while dph indicated that it is working to improve this timeline, we remain extremely concerned that this practice has gone on for too long. Know that it can be solved in other places such as the private sector. We wonder why does it continue to be a seemingly stubborn circumstance at the department of Public Health Human Services office. We wonder when you find a suitable candidate will they wait one year to be hired . Moving to the second area of concern. We commend the department of Public Health for the planned hiring of 40 new intensive case managers by january 2021. We continue to be concerned about the long standing attempt to streamline the process. Also, what can the department of Public Health do to subsidize salaries for the intensive care managers working for the communitybased organization . Reportedly there were 100 slots open for intensive case managers. We may fill only half of those vacancies. How does this change the ratio of providers to clients . The gold stale standard is 110. San francisco has a ratio of 117. There was one other respondent to be made this the recommendation, that is the department of Human Resources for the city. The San Francisco civil grand jury did not receive the response in sufficient time to address it for this presentation. I am sorry to say. We will talk about executive turnover. We issued two findings and two o recommendations at Behavioral Health Services Director level. The department of Public Health disagreed in part with one of the findings and would seek to implement one recommendation and stated they had already recommended the other. The authors of the study sought to clarify what led to this disparity. As of drafting, no change was announced that the jury could report. Beginning with june 2020 and plans filed in public view in october 2020 that the department of Public Health has reorganized and the position of director of Behavioral Health services will report directly to the director of the Health Department and the director of the San Francisco health network. Enhanced remuneration to the expanded responsibilities is also taking place. It has substantially all of these actions accomplished what we addressed. We are pleased with this outcome. However, we would like to know if there is a timeframe for hiring or a deadline fo for hirg the individual. In our last area, the concern for the area of Public Health information or challenges. We issued three findings and three recommendations in the area of report publications on the web and public directories and disability. While the department of Public Health partially agreed with one of the findings, it went on to state it would implement all three recommendations. However, we did not receive a plan to improve the signage, guidance and directory at Public Health Department Site and on the web, nor was there mention of phone assistance with the main phone number to the department of Public Health. We acknowledge the involvement of the San Francisco Health Commission to monitor implementation of these recommendations by asking for quarterly reports from the department of Public Health. Finally, we are honored to have been part of the tradition of the San Francisco civil grand jury. We are pleased to have been part of an ongoing pattern of civic involvement and hopefully improvement in our county and city services. Thank you very much. Thank you, doctor. Is there an additional presentation from Richard Bogan . No, there is no additional report from Richard Bogan. Thank you for all of your work on this very important report. I want to invite up marla simons from the department of Public Health to present responses from the city department. I want to note we have representatives from Human Resources department here as well for questions. Ms. Simons the floor is yours. Good morning. Thank you. That wases a terrific synopsis of the report. Can i share my screen . You should be good now. We appreciate the work of the civil grand jury and definitely saw a lot of alignment. I agree with the recommendations. I did want to clarify. There was one comment that doctor made about dhr not responding. The responses that were provided were done in collaboration with dhr and dphhr. I wanted to be sure that what we submitted was a joint response. I wont go into it. The key points here to the report. What we saw in the report was the recognition of the growing concerns around people experiencing homelessness not having Mental Health and Substance Abuse needs addressed as quickly as they should be, and a lot of work has gone into Mental Health reform and now we have prop c funding to help expand services. A lot of great opportunities, and the same exact three points were raised about the hiring Behavioral Health leadership and Public Information and the summary of the responses. I am repeating the things doctor levenburg said. It is the acknowledgment that hiring is a top priority and very, very clearly understood as a challenge. We did reclassify the position of the dhs director. I am bhs director. I am acting director now. There are a few people committed to the new director. We hope to announce this month and eta in the name of a new director. We are getting close to final selection. That is very exciting. There is a lot of opportunities that we have to improve access to information for dph as a whole and for Behavioral Health. We will be working on more concrete plans. There is a lot of information that we provide online. We acknowledge it is not easy to navigate and could be better maintained. The few points of clarification we want to provide and where there was technically disagreement is that the intensive Case Management position are one type of case manager. We have concerns about vacancies across the board for clinicians and case managers and intensive Case Management is a narrow group within that. Many of our intensive Case Management programs are managed by communitybased organizations for whom we dont have oversight over the hiring but definitely do acknowledge the salary disparities. It is something the city has acknowledged and hopes to address. Again, just acknowledging that 21 days to hire a position given the current hiring challenges and overall process is just not never would be feasible in our Current Civil Service system. We wanted to provide a couple of updates. Currently the Behavioral Health services has 113 vacancies. We prioritized 90 of them. These are not just clinical. We have leadership, analyst, care coordinators and clinicians that are involved and are part of the list. 90 positions are moving through the hiring process. As highlighted here, some of the clinical positions that are vacant, some of the work that we are doing to improve the process. We have improved communication between the Behavioral Health services and hr at the dph level. We are hiring a batch of the Behavioral Health clinicians that include some of those are icms that we expect to on board in january. This will help with a lot of our vacancies. Some of these are covid intended to be for the Covid Response and a couple other positions in dph. Behavioral Health Services we are working with hr to develop reporting tools. The hr team is expanding. Currently they are working on hiring december or january for new analysts to focus on Mental Health sf hiring. One of the other things that is important. Vacancies in hiring is one piece of a more complicated puzzle where we need to focus on retaining the staff we have. We have the Work Force Development plan focused on retention and staff wellness. We are working hard to be sure the polks we are hiring are as reflective of the communities as possible. Karen hill is also with me. We can both answer questions or provide more information, if needed. Thank you for that response. I am wondering about the one year that we keep seeing. Although it was not in the report, along the way we learned there could be up to 65 touch points for an application before it gets before the person is hired. People are lost because they cant wait for a year to be employed. Maybe you can respond to that. Thank you. Thanks very much. I would definitely invite karen if karen is on to talk a little bit about that. There are many opportunities in our system to streamline the hiring process. Unfortunately a lot of those conversations happen outside of Behavioral Health. They are things required in the dhr policy and Civil Service rules that have been in place for 100 years. There is opportunity to improve. I definitely agree that is not acceptable. We need to hire faster, but that conversation how we improve the hiring process really belongs at the city level. Karen, i dont know what else you want to add. Hi, yes, i am karen hill, director of staffing for department of Public Health. Based on what marla actually put the nail into the explanation. Great job, marlow. We have processes in place to create a barrier. I hate to say barrier. We are Civil Service employees but there are processes in place to improve and remove those barriers. We have improved our internal processes with the department of Public Health to increase well decrease the time it takes to hire and remove some of those delays to speed up some of our hiring. Specifically, a pandemic had yous look at our process and to allow us to move quickly to on board and hire front line staff to address the pandemic. [please stand by] to all of our hiring across the department. But, again, with partnership with the department of
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