Transcripts For SFGTV Health 20240703

Couldnt be here today so i have the privilege to chairing and delightful to see all you here today. This is the biggest in person attendance we had since before the pandemicism i want to acknowledge the presence of former Health Commissioner margene sako. Well start with roll call. [roll call] wonderful. Now, commissioner gerardo will read the land acknowledgment. The ramaytush oholone and acknowledgment. The San Francisco Health Commission we acknowledge that we are on the unceded ancestral homeland of the Ramaytush Ohlone who are the original inhabitants of the San Francisco peninsula. As the indigenous stewards of this land and in accordance with their traditions, the Ramaytush Ohlone have never ceded, lost nor forgotten their responsibilities as the caretakers of this place, as well as for all peoples who reside in their traditional territory. As guests, we recognize that we benefit from living and working on their traditional homeland. We wish to pay our respects by acknowledging the ancestors and relatives of the ramaytush community and by affirming their sovereign rights as first peoples. Thank you. The next item on the agenda is approval of the minutes of the Health Commission meeting from august 1, 2023. I believe there was some kind of correction, so secretary morewitz, if you can share that with us. Page 2 of the revised minutes i added Public Comment for Robert Rinehart and apologize for leaving that out. Otherwise, the minutes stand before you as posted. Thank you. Any other additions or corrections from the commissioners . Alright; seeing none, is there a motion to approve the minutes . So move. Second. Is there Public Comment . I believe there is notices for secretary morewitz to articulate . Yes, for each item members of the public will have a opportunity to comment up to 3 minutes. The Public Comment process is designed to invite input and feedback from individuals in the community. However the process does not allow questions to be answered in the meeting or for the members of the public to engage in back and forth conversation. The commissioners considered comments when discussing item and making request. Please note each individual is allowed one opportunity to speak per item. Individuals may not return more then once. Written Public Comment may be send to the Health Commission at health. Commission. Dph s fdph. Org. Please note policy along with federal, state and local law prohibit discriminatory harassing conduct. We will first take Public Comment from individuals attending the meeting in person. We will then take remote Public Comment from individuals who received accommodation for disability. I have given each individuals a code to speak when they begin commentts and given two people a code for todays meeting. Finally, we will hear from remote Public Comment from all over individuals. There will be a time limit of 20 minutes of Public Comment heard on each item from individuals not received an accommodation for disability. We are item 2, the minutes. All comments relate to that and see one hand. Jaime or janette, not sure who is doing Public Comment. Please unmute that caller. It is patrick. Can you hear me . Yes, please begin. Shamefully these minutes report the august 1 meeting was called to order at 403 p. M. Sfgovtv never has problems with the audio system which was used as a excuse when that meeting began broadcasting online. It started without a call to order or the land acknowledgment. Taking agenda item 5, the Health Commission resolution 2306 approving submitting applications to cms first. Completely out of order. Members of the public knowing you changed agenda order items. indiscernible an opportunity to testify about the proposed resolution. Commissioner bernal wildly claimed later on audio that there was an agenda mix up with two versions of the agenda, trying to ajustify what the agenda want taking in pub lishedorder. That mythology was complete nonsense and spin control. The two versions of the agenda obtained both in the resolution agendized for the middle of the meeting, not the first agenda item. Commission president bernal indiscernible and Nancy Pelosis chief of staff should know about roberts rules of order and agendas being fallowed appropriately. Furthermore, Commission Secretary Mark Morewitz earned total pay of 182. 576 in fiscal year that ended june 30, 2023. He is paid handsomely to insure all audio and video equipment are functioning properly before meetings begin by testing the equipment prior to the start of the meeting. This was completely shameful. Thank you. I think thats the only hand i see. Again, we are on item 2, the minutes. No other hands, commissioners. Well move to a vote. All in favor of approving the minutes . Aye. Wonderful. Thank you. The next item is general Public Comment. I believe there is another notice. Yes. I have a little script. At this time members of the public may address the commission on items of interest to the public within the subject matter jurisdiction of the commission but not on the agenda. Each member of the public may address the commission for up two minutes. The brown act forbids the commission taking action or discussing a item not on the agenda including those raised in Public Comment. Each individual is allowed one opportunity to speak and individuals may not return more then once to read statements from others not able to attend the meeting. This item is for topics not on the agenda. Well start with folks in the room. I have several people have given me their card. Lets go with remo morelli. Everyone has three minutes. Please feel free to adjust the microphone if you wish. Dr. Green. Members of the Health Commission. My name is remo, the chief of staff at Saint Mary Hospital where i have been practicing since 1985. I respectfully request the Health Commission take a closer look indiscernible to ucsf to understand how the sale will impact patient care, the cost of healthcare in San Francisco and the overall delivery of healthcare in the city. Saint mary San Francisco oldest continuously operating hospital founded by the sisters of mercy 1857. indiscernible cared for victims of the indiscernible 1906 earthquake, hiv aids crisis and mostly since covid19 epidemic. We do not oppose the sale to ucsf, in fact we welcome the union, but we ask the Health Commission help us preserve the services we now offer at saint mary so we can continue to provide compassionate affordable patient centered care in a Community Hospital setting by independent physicians. Through the sister mary indiscernible for thousands of individuals each year, including the homeless and uninsured. The mccally institute provides acute patient psychiatric anywhere for youth and young adults in crisis, a service not available anywhere in San Francisco. Through the medical residency program, Training Ground for new physicians in internal medicine, orthopedics and podiatry. Many residents stay in the bay area. We request the commission closely monitor the sale providing regular updates to you and the public to insure that they are keeping their word and maintaining saint mary Vital Program and service. The loss of any saint mary programs will be detrimental to those most in deed of San Francisco, shifting the responsibility for care to the cityt a a time when San Francisco can least afford to shoulder more burden. We do not want to see repeat of Mount Zionand Children Hospital in oakland. indiscernible doctors and patients. Within two years all the doctors at mount zionrelocated and now now longer a acute care hospital. Children hospital indiscernible which relocated across the bay to the mission bay campus. This forced patients to cross the bridge incurring tolls and parking fees and access to care more difficult. Furthermore, studies have shown the cost of medical care in Northern California is already 30 to 70 percent higher then Southern California and insurance premiums are 31 percent higher. Due to the indiscernible medical services. The loss of Community Hospitals in the one major factor driving these high medical costs. Input from doctors patients residents and this commission are included as a indiscernible im confident saint your time is up. Thank you. I thank you for listening. Pamela lewis. Good afternoon. My name is dr. Lewis, chief of surgery at sant mary hospital. Thank you to president bernal, Vice President green and commissioners for commitment to the health of the city. The women center at sant mary provides state of the art Breast Cancer screening and imaging to the community. The only center providing these services on the west side of the city. I ask the Health Commission row view and monitor the purchase of sant mary and saint francis. I understand the sale is early stage, but as a private practitioner i urge you to look at the impact the sale will have on independent physicians programs neighborhood access to care, Service Consolidation and potential damage to ambulance response times. The uc parnassus rebuilt starts now and will be completed in 2030. To where will the Campus Service relocate during construction . One of the main reason for acquiring sant mary is manage capacity demand at parnassus. Where will they send Campus Service and what will be sent to sant mary . How will neighborhood impacts be managed . Will ucsf future plans for expansion be exempt from city regulations . Had what will happen to sant mary partners, Crestwood Behavioral Health with sant mary and dph and centfield the longterm acute care. Sant mary and sant francis are full Service Acute care suvs the west and north areas of the city. Will the sale effect ambulance response times if Emergency Rooms are consolidated at parnassus . Not long ago there were 19 hospitals in San Francisco. Each time a hospital was acquired medical care eliminated and neighborhood in consolidated. Sf general, sutter, kaiser and uc. My colleagues and i are Small Business and office in the neighborhood like inner and Outer Richmond and sunset. We may lose our choice to operate businesses and thousands patients lose easy timely access to care. It is perfect to look at broader policy issue jz put the acquisition on agend paw for future meeting. Uc stated they like to close by the end of the year so time is of the essence. Look at the sale through the prism of your Health Service master plan and future direction of healthcare in San Francisco. In closing, thank you president bernal bringing congressman pelosi and commissioner guillermo. Thank you lori green for all your care for women, myself included. Thank you for your attention to the proposed action of the two important historic institutions. Thank you. Thank you. Anyone else in the room on general Public Comment . We can movei see one hand. Jaime, please unmute the caller. Thank you mark. This is Public Comment. Im addressing a issue not on todays agenda, so please dont cut me off. As i testified august 1, during past Health Commission meetings, Roland Pickens stated division was in sfdph is conducting a study regarding expanding Behavioral Health beds in San Francisco. What sfdph entity is conducting the study . Is the meetings open to the public . Per pickens previous statement during Commission Open session meetings, that work group is studying and considering whether to use space at laguna honda hospital by placing separate cohorts of patients in laguna hondas two towers. Sniff patients in one tower and Behavioral Health in the other tower. Which Health Commission subcommittee will this report eventually be presented to and when . That report should have been issued before laguna honda applied for recertification from cms. Why hasnt this commission answered these basic questions that i have repeatedly asked you about who is conducting that study, when it will be presented, whether the public will have an opportunity to comment on the study bindings before they are finalized, et cetera, et cetera. The commission has repeatedly refused to answer me or provide any further information about what is going on with that study. Thank you. That is the only comment on remote Public Comment. The next item on the agenda is gregory wong, adman strative analyst resolution to recommend to board of supervisors to authorize dph to accept and extend gift of retinal imaging machine values at 496. 500 from University California San Francisco. Good afternoon Health Commission members. Please speak closer to the microphone. Good afternoon Health Commission members. We ask for approval for acceptance of this retinal images gift from university of california San Francisco. This donation from the University California San Francisco has indiscernible conduct and facilitate comprehensive eye care for the city and county of San Francisco. Please approve acceptance of this gift and director indiscernible is happy to answer any questions that you might have. Thank you. Is there a motion to approve acceptance of the gift . So move. Is there a second . Second. Is there any Public Comment on this item . Any Public Comment in the room on the item . Folks on line, item 4 recommending the board of supervisors to authorize dph to accept a gift from ucsf. Please let us know by pressing star 3. No hands. This is great news, because these imaging machines are so important especially people with advanced diabetes, so well take a vote. All in favorno . Aye. I do have a comment. Sorry. Actually, it might be that in your second whereas, im not sure it belongs there. Perhaps you can explain to me, it says university of california has notified the department of Public Health proceeds from the gift will be distributed, but i thought that we were getting the retinal scanner. Sorry, that was a error on my part. Can we exclude that whereas . Yes. I like to amend the motion to exclude the whereas that is the second whereas. Before we submit it to the board of supervisors. Is there a second to that . Second. Alright. So, we would approve vote on the motion to amend and then vote well vote on the motion to amend. All in favor . Aye. Alright. Now you can vote on the full resolution without the amendment. That vote was just the amendment. Now we vote on the approval. Lets vote on the motion then. All in favor . Aye. Wonderful. Thank you for that correction. And the next item also is resolution to recommend to the board of supervisorss to authorize dph to accept and expend gift of 204. 250 from the Epic System Corporation. Thank you members. We ask your proval for acceptance of this gift from the Epic System Corporation. The donation from the Epic System Corporation is vital helping frunlt line medical personnel to treat indiscernible please approve the acceptance of this gift and eric who is chief Information Officer is here to answer any questions you may have. Is there a motion to approve this resolution . So move. Is there a second . Second. Any Public Comment . Any Public Comment in the room on the item folks online, we are on item 5. Press star 3 if you like to comment. I see no Public Comment commissioners. Is there any questions or comments from the commissioners . Commissioner gerardo. Second bullet it says the Epic System Corporation has notified the department of Public Health that proceeds from this gift will be distributed. Is it proceeds or the gift . It is the gift of okay, so we should amend this as well so it is not the proceeds. I propose that we amend bullet two. The Epic System Corporation notified department of Public Health that the gift will be distributed. Is there a second to that amendment . Second. Shall we take a vote on the amendment . All in favor . Aye. Now well vote on the whole resolution. All in favor . Aye. Great. Thank you very much. Thank you so much. So, the next item is laguna honda hospital rehabilialitation Center Closure pan and cms recertification update. We have Roland Pickens. Good afternoon commissioners. Pleasure to be here this afternoon to give a update on laguna honda and our quest towards cms recertification. Next slide. The last week of California Department of Public Health arrived at laguna honda hospital for an unannounced survey. That focused on areas of fire, life safety and Emergency Preparedness. California department of Public Health was there total 4 days and last friday concluded that survey and gave us their preliminary verbal exit report. That exit report showed that there were very few findings of non compliance and that those that were found were miner and we are awaiting their final written exit report that is typically available up to 10 days after the closure of the survey and then well know for certain what the findings are, but preliminarily it was a excellent report. Very much improved from the last Fire Life Safety survey conducted november, december last year where as you know there were significant findings. In fact, the survey commented on the amount of improvement they saw from this past survey compared to the previous survey. And i think the improvement is a direct result of all the hard work that the teams at laguna have been doing, particularly in the Facility Department where we brought in new leadership and also Emergency Preparedness where actually the Population Health division from dph has actually had their staff at laguna for the last year and really have reinvigorated the Emergency Preparedness component to the extent there were no findings. It was a stellar flawless survey on their behalf. We feel that wanted to share that good news with the commission. Going back to the first slide. Kenya, first slide. Next slide. There we go. You recall that little over a week ago the Health Commission approved a resolution authorizing laguna honda to apply for recertification in the Medicaid Program. Accordingly, as a result of that very positive Fire Life Safety survey we had last week and the good news in terms of limited findings, we felt that that great showing along with the good showing we had in the Health Survey that occurred back in june, gave us the confidence we are ready to submit the application for recertification, so last friday, august 11, we submitted our application that was allowed by virtue of your approval of the resolution at your august 1 meeting. The application is with the California Department of Public Health and we are awaiting further communication from them on the status of our application. As you are aware, that application to be reinstated into the Medicaid Program is significant because the vast majority, over 95 percent of the residents at laguna honda have medicaid as their reimbursement source, so this is great news when we are notified and are successful in that process that we can have most of our patients covered through this process. We anticipate that there will be a survey in order to fulfill the requirement for recertification, but the submission of the application was the first step and we are just waiting Additional Information from the state in terms of where that goes from here. Next slide. So, wanted to just continue to provide you updates on our Journey Towards recertification. We submitted the application. At the same time, we are still required to proceed with all of the other terms of the settlement agreement, which includes fulfilling the action plan milestones related from iminating from the root cause analysis from that third 90 day Monitoring Survey which occurred june this past year. July 12 we submitted our action plan for that survey. Submitted it to cdph and cms. They returned it to us with corrections. We since made those corrections, resubmitted those and still waiting on their final approval. However, our work even though they havent given final approval, we are still moving forward with all the milestones with the expectation they will be approved so we make sure we are going to meet all the requirements. As you know, we have been doing milestones since january of this year, over 500 of them, and we never failed to meet a deadline and dont expect to start now, so thats why we are still moving forward, despite final approval. In terms of the survey last week, fire, life safety, under the terms of the settle agreement, it will follow the same process. The cms Quality Improvement expert Health Service advisory graup will do a root cause analysis oen the few findings, once we receive the final report. They will do the root cause analysis and work with laguna honda to put together a action plan in the form of additional milestones we will then submit to cdph and cms asking them for approval and typically they return them to us for comments and so well again go through this process. All that is going on while our application is at cdph, so a lot of things moving at the same time, but well continue to track them all. I think they are all in support of moving towards recertification sooner rather then later. Next slide. So, one of the milestones that come out of each of the 90 day Monitoring Survey is a really big educational fair at laguna. Those surveys typically show us opportunities for improvement in terms of staff knowledge and education. As we did with the two previous 90 day Monitoring Surveys, we had a week Long Hospital wide education fair. Over 1,000 laguna employees went through week long trainings in areas last identified in the last Monitoring Survey. You see some of the topics covered of abuse and prevention and grievance response,lenen handling, meal indiscernible you recall in that last Monitoring Survey that was a new area of finding that the survey team at that point asked us to do a better job of making laguna more a homelike environment for the residents. For example, they suggested that we begin to use table cloths on the table during the dinner time. That we begin to take plates off the tray and put them on the table. Thats an example of something we have to train the staff with. That was something new, so you cant just turn the switch without doing proper orientation and training with staff and so thats what we spent the last week doing. I went through the class myself, so very up to date on those current topics. Next slide. Excited to share with the commission that our new nursing home administrator, ceo at laguna honda has been designated as the laguna honda abuse prevention coordinator. This is a role cms and cdph expect to have at each institution and our new nursing home administrator has a lot of experience dealing with abuse and neglect allegations and are already hit the ground running doing additional orientations and trainings with staff and helping improve the abuse coordination process. As you know, all employees and contractors at laguna are mandated reporters, so part of the training we did last week was to remind everyone of that mandated reporter status, and that is something we have done consistently every since 2019 when we had initial issues in terms of patient abuse. I think for those on the joint Conference Committee, you have seen that, because we have seen increase in the number of reporting, which is good, because we want people see something we expect them to report it. Everything that is reported is investigated to determine if there are any merit s to those and if so, those reports are also reported to the California Department of Public Health and state ombudsperson. Next slide. Just an example of some of the abuse training material shared last week in terms of different aspects that consitute abuse, neglect by definition is a form of abuse, so making sure staff understand that a resident who doesnt receive care as required or ordered by the physician that is an example of abuse. You denied a service to a resident, so making sure the staff are aware of just all aspects of abuse and the required reporting. Next slide. Also, during that education process reinforce the smoke and tobacco free status at laguna. That smoke and tobacco free status applies to our employees, visitors and contractors. It does not apply to our residents under cms rules, residents have a right to smoke if they choose to, however, we are required to have designated smoke areas for residents who choose to do that, which we have done. We have what is called, serenity, which is a outdoor area staffed by employees and as you know, over the years previously residents were able to keep their smoking products with them. That has not been the case at laguna in a long time. All smoking products are held by the organization and dispersed to residents one cigarette at a time as they request them. They are closely observed in their smoking process. Next slide. So, one of the other areas that we are working on at laguna is to really hearing more of the voice of our residents and their families. To that extent, the Patient Experience team at laguna honda lead by jennifer cardenwade and indiscernible are distributing a resident toa survey to the residents and their families to get more feedback in terms of the care being provided, what is working well, whats not and what are the areas for improvement and well be sharing that information with the laguna honda jcc. Next slide. Finally, this is a recap of the most recent quarterly statistics in terms of number of discharges and admissions and expirations. As you know under the terms of the settlement agreement, we are not accepting new admissions, so that is why that is zero, and discharges relate to those individuals that have chosen to do voluntary discharges either to home or to board and cares at other facilities. This also shows the expiration total during that time. That concludes my formal presentation and happy to answer questions or take comments at the appropriate time. Thank you so much. Is there any Public Comment on this item . Yes, ill check. Is there any Public Comment in the room for this item . Folks on the line, we are on item 6. I see one hand. If you like to comment on this item please press star 3. Please unmute patrick shaw. Thank you mr. Morewitz. These are the august 14 Media Statement and mr. Pickens letter to laguna honda residents and family, nor today s presentation mentioned that pickens had told indiscernible residents who are transferred to other facilities during the 2022 relocation process will receive priority to come back once the hospital can resume admitting new patients again. Is this Health Commission impact prioritized, repatriating these residents evicted . What is the process notifying those residents and their families of some hope of being able to return to laguna honda . The second slide in the presentation today noted laguna hondas application to obtain only medicaid provider status when submitted on friday august 11. Has medicare provider application been submitted yet . If not, whats the delay with the application . It is needed for admission to laguna honda rehab center beds in the pavilion building and other reasons . Has cms approved the action plans for root cause analysis reports, number 3, number 4, number 5 and number 6 . Have they been approved yet . When will root cause analysis reports number 5 and 6, mentioned in the two ie 6 monthly report dated july 10 be publicly released . Have all additional 120Monitoring Survey and 85 non Monitoring Survey action plan milestones that mrs. Baba reported on august 8 been accomplished yet . If not, how could laguna honda submitted its medical provider Agreement Application on august 11 if all 375 of those milestones have to demonstrate being sustained for some period of time to pass a medical Application Survey inspections . You have not presented yet information that was submitted to the San Francisco Civil Service commission outlining i see 2 other hands. Folks we are onfolks who received accommodation for disability should be raising their hand at thais point and i only received two requests, so if you did not receive an accommodation, would you put your hand down please so we know who to call next . Jaime, please unmute the caller. Hi. Dr. Palmer, this is ww accommodation. Mr. Pickens has told us about applying to medical without telling us what it really means. How does this relate to medicare recertification . Will submitting an application lead to a life saving delay of the september 19 date when indiscernible deadly evictions and closeier, must begin . Have there been discussion about thatd . What will happen september 19 . Also we heard nothing from you about the closure and eviction plan cms required from the state and due july 31 . Where is that plan . What is in it, and where does the state plan to send 500 nursing home residents . The other thing im confused about is, if recertification goes as hoped, can you give us some idea when admissions will restart . Maybe a range. You are not really kind of saying anything about that. The third thing is, i dont understand how a nursing home administrator and ceo can also be an abuse prevention coordinator. If you are worried about retaliation, having your boss be abuse prevention coordinator doesnt make any sense and it is not like the nursing home administrator doesnt have enough to do. I just dont understand why a separate independent abuse prevention coordinator isnt being appointed. I also would like to understand when we can apply for the 120 bed waver and i like to understand where is the guarantee that people who were discharged from laguna honda, still eligible for sniff beds will be able to come back. Thank you. Okay. The last caller please, jaime. Hi, caller, please let us know you are there. Yes, hello, my name is art, the board of the sf gray panthers. I joined dr. Palmer, asking several question. Number one, will the submission of the medical recertification application of august 11 lead to delay of the september 19 date when cms dictates eviction closure procedures must begin . Two, regarding the september 19, 2023 laguna honda hospital closure evictions, where will the state send 500 nursing home residents if laguna honda hospital can not approve in time for the feds and state of california . Three, a San Francisco Health Commissioner said, it will be impossible for the state to make a closure plan because 500 nursing home beds that accept laguna honda patients do not exist in california. The gray panthers and San Francisco contend san franciscans cannot afford to lose anymore nursing home beds so all laguna honda beds must be recertified for use. Finally, when will laguna honda sfdph apply to cms for a waver of 120 bed cuts . These beds are badly needed by the peachal people of San Francisco and architecture is modern and safe. Thank you. Okay commissioners, that is last Public Comment . Thank you for your questions and comments well go to commissioner questions and comments. Commissioner chow. Yes. Mr. Pickens, thank you for the very good news that we have applied for certification and or recertification on the medicaid side. Could you then perhaps elaborate a little on what we are kind of expecting off ramification in other words, we submitted that, we havent submitted medicare yet. What are the sequences for those and where youim sure been working with the state, giving a projection or timeline. Obviously, it is very much up to the state what they will do as i understand, but to your best knowledge, are we getting a certificate tomorrow or is it going to be next christmas . What might we expect of potential surveys and so forth . Thank you for the question dr. Chow. So, a lot of still unknowns. Obviously by virtue of submitting the application for medicaid provider status last friday, one of the benefits of submitting it then is that, we hopefully have given enough time between that date and september 19, because of course we all want to avoid any situation that would even entertain the notion of trying to transfer residents out of laguna. We are confident by doing this more then a month ahead of time it provides the state and cms adequate time to do whatever processes they would need to do to do a survey process that would hopefully then be successful for us to be approved back into the program and then not have to implement any type of transfers. One thing i want to remind the commission and the public about is, remember that for our submission of thep aication to the Medicaid Program was for the Skilled Nursing beds. It did not include our acute medical or rehab beds because those never lost medicaid or medicare status. Those have always maintained status as Medicare Medicaid providers, so that submission last friday was only for Skilled Nursing beds, not the acute beds. In terms of what is next, we are waiting to hear back from the state in terms of our application to know number one, if its going to be approved, and then what does that approval mean and when might that approval take effect . If we base upon the experience we have seen to date and what weve been planning for all along is that, once we submit for applications, we are preparing then for the survey and that is qulaut what we are doing. We are telling staff now, when we submitted the application last friday, expect a survey any day now and we would anticipate again the survey would occur before september 19 because all parties said there is no desire to resume transfers, so if you do the math that narrows the window when they might come out for a survey so that is the expectation. In terms of medicare, we are definitely taking one step at a time. We submitted the medicaid application. We need to get that approved and whatever survey process and then i think we can determine then what our are next steps for medicare. The good thing is, 95 percent or more residents have medicaid, that is the major source. As you know, medicare is not a major funder of Skilled Nursing facility coverage in this country. That is a medical program. Medicare provides limited number of days, usually for individuals coming out of an acute stay to have shortterm stiff status and that is by far not the case of most residents at laguna and so for those resident who have medicare, they eventually convert to medicaid or medical during that time within their medicare days. So, we are continuing to work with both finance staff and our Legal Counsel in terms of what are the next steps for medicare and as we get more information we will certainly keep the joint Conference Committee and the commission aprize said as we learn our options for medicare submission. If i may follow up then, that i think is very interesting. If we become qualified under the medical program, then would it be possible to admit under the medical Program Patients that might need longterm Skilled Nursing Services Without getting the medicare certification . So, that is one of the questions we have for the state. Once again, a positive response on our application, once we are surveyed and back in the Medicaid Program then our question will be what does it mean for the admission status. Again, this is new ter torey for us. We obviously want to be back in a position to make laguna available to San Francisco residents as quickly as possible. So, along that line then, has the state actually shared with you the proposed plan that they have that they were supposed to be submitting . No. You recall that was a requirement of cms, and so so, in other words, you dont know if it had been submitted . Exactly. They did not request any information from us for their plan. So, thats not anything we have in control and cms hasnt informed you as to the status of that either . Correct. Okay. So, really i want to complement the process that you have undertaken during these several years with your teams to be able to bring us to this point. The move from all most hundreds of potential areas of concern, some of which were very high risk and now to have achieved in the third Monitoring Survey, plus now youre fire and safety and emergency survey really what appears to be minimal concerns, very important that we be hundred percent of course for the benefit of the residents, but i think it does show the track you have all taken may well now be coming to fruition in terms of all the very hard work so that your entire staff, im sure i leave that to the Commission Chair here to reiterate certainly our feelings from members of the joint Conference Committee for the amount of work that has transitioned laguna into this level of Skilled Nursing facility. Thank you very much. Thank you dr. Chow. Director colfax. I just wanted to also acknowledge the moment of applying for recertification. It has been a long journey and thank mr. Pickens and his team and every person who works at laguna honda and the residents for their leadership and work in this area and acknowledge that thingsthe fact we had another survey last week with regard to fire, life safety and Emergency Preparedness and those findings were minimal, again, really reflects how far the institution has come and thats not based on what im saying or what mr. Pickens is saying, it is based on what the surveyors actually told the team, so just to acknowledge that. Yes, thank you. I think all the commissioners want to associate their sevls with the comments of commissioner chow and director colfax and this really is a milestone when we think back where we all started and think there are so many stakeholders who had indiscernible impact on this. We are so grateful to you and all the dph Staff Members that came from other divisions as you said, the Population Health division, the general, all these individuals who have worked tirelessly who worked weekdays who have selflessly left other responsibilities while still doing in the background to help lead us to this point and of course the City Attorney office has been so helpful and cooperative and the patients and their families. This is certainly a rollercoaster ride for them and it is remarkable how they maintained loyalty to the institution. Partners have been remarkably copative. The members of the public who continually support us. They remind all the administrators and bureaucrats that dont live in San Francisco how incredibly important this precious institution is to the citizens of San Francisco, so i think it has been in a time where there is so much contention in the world, the idea that everyone has marched in the same direction to try to reach this point and i probably left some critical stakeholders out of my comments. Commissioner bernal would not have done that, but i think i speak for all of us, this is real milestone and are appreciate the hard work and very grateful. Thank you so much. On behalf of the team at laguna, we appreciate all your comments. Thank you. The next item on the agenda is the joint Conference Committee report. The only one we have is laguna honda jcc and commissioner chow will tell us about that. Yes, sorry chair indiscernible unable to be here today and asked i give youi will be brief because at laguna as you heard, there were surveys all most literally every week and that week july 11 was another survey and that required staff be present all hands on deck so therefore our agenda was truncated due to their involvement in this regulatory survey. The committee did approve the minutes and we discussed and recommended that the full commission recommend thefull commission approve the policies in the consent calendar that is on our agenda for item 8. Pending response to a number of commissioner questions so well discuss that when we get to item 8 as there will be some changes to that item that we will then discuss. The jcc also then discussed that the admission policy be brought back to the jcc6 months after implementation on the corrected versions that had come out fromp the jcc and before us today. That ends my report and the majority of the work was done reviewing the 60 some odd policies we submitted, so thank you. Happy to answer any questions, but it was a veryit was a short agenda, but very long meeting because of the policies, so thank you. Is there any Public Comment on this item . Any Public Comment in the room . I see two hands. Well take those who received accommodation first. If you received accommodation i think there are people thin room that raised their hand. Im sorry, yes. This is on the laguna honda jcc report . This is about report back from a meeting that took place at laguna honda about the joint Conference Committee. Ill give three minutes and when the buzzer goes off your time is up. I was a resident at laguna honda for about a year and it is very well needed and the carer up there at that time was very good. The people were excellent. Didnt have toomany problems. However, with that being said, i want to reiterate questions you had for the gentleman. I know that is a hard job up there. Love laguna honda and general, by the way. One of the participants called and they were talking about patient abuse, which i didnt experience that. However, with that being said, i believe it will be a conflict if he is the employer and head of the abuse over the patient abuse. Just want to reiterate that. That is imperative because we dont want any barriers if experiencing that. Nothing against you. The second one to reiterate was with all these things for recertification, what is the contingency plan if it is not done in time to be certified by medical, medicare, et cetera . Lastly, i think which is important, what is the realright now we dont know, we hope, we are wishful, sitting here with 500 patients, right . It could become real. Where do they go . What happens if this doesnt work out . That is real consideration. Those are 500 human beings. That was pretty much it. Thank you. Thank you. Anyone else in the room . Yes, please. Hi. Im indiscernible and i just wanted to first say that i have been here all my life. 6 decades plus, and laguna honda is given. It is part of a San Francisco institution that this is a prime example of how it brought someone who waswe didnt know what the chances was of him coming back, and once they had to go through the extensive rehab, laguna honda was there. I never thought in my life that i would have to even think about laguna honda being closed down. It was just one of those natural institutions here in San Francisco that we took advantage of and that we knew was there. If we were not able to care or provide the care that our family needed. We have laguna honda. A loving institution that we all supported. Now, lastly, i wanted to say that thishe very humble, humility, but not me. The president of the Young African american leaders. It is importantlook where him rehabbing from laguna honda put him back in the community to give back, and then lastly, i want to say art from gray panthers, please Pay Attention to the questions that they put forth before you, and then another point, we like to see answers to that. We know protocol you are not able to answer those questions with this, but please you know, note those and underscore those and have that something you want to answer. Thank you so very much for your time and service. Alright. Anyone else in the room . Okay. Thank you so much for your really eloquent description of what laguna means to all of us. Thank you so much for being here. Im glad that will be in public record. Now, who on the line . We got one hand. Jaime, please unmute the caller. Hi, commissioners. It is patrick again. Laguna honda august 8 meeting report commissioner chow did not acknowledge removal of the agenda items had been unnecessary. Under the claim that Roland Pickens had to stay on site at laguna honda. indiscernible only conducted the Fire Life Safety and Emergency Preparedness Program Survey inspections. Surely laguna honda new ceo sandra simon could have filled in laguna honda for pickens for a couple hours. Alternatively, laguna honda coincident commanders, could have attended the jcc meeting in pickens place. You didnt have to curtail that august 8 agenda and the meeting, which appears to have been a ruse to cut the meeting short to avoid public transparency and accountability. Commissioner chow also didnt report i testified on august 8 that as you went into closed session, i noticed that had the september 3, 2019 60 day laguna honda reform plan Troy Williams and dr. Colfax had cowritten to address the patient sexual abuse scandal, if that plan had been more robust and effective, laguna honda may have avoided decertification three years later. Finally, i want to mention that laguna honda application to the Civil Service commission to acquire 18 million in potential grant and consultant hiring authority clearly outlined the period itfollowing submission of applications to cms and cdph that you have to have a survey and you have to wait another 90 day reasonable assurance period, fallowed by a second full inspection survey before you are actually granted recertification. This commission and mr. Pickens needs to clearly explain to people that it will probably be a good four months from last friday, august 11 before you get the green light. Thank you. Thats the only Public Comment. Alright. Any commissioner questions or comments on the joint Conference Committee report . Alright. Well go to the next item, which is consent calendar. For this item, we are supposed to approve or exclude a number of policies, which there are 63, and because of various discussions, we divided these into three traunchs, some of which the commission can approve today and others which require further discussion because of the complexity of votes. Secretary morewitz will lead through this portion of the agenda and well give you the floor. Again, folks on the line, those who know our procedures this is unusual we are pulling out but talked with the City Attorney and the process is codified. The commission in a moment will begin to separate out two batches. There will be three total batches. The public has the opportunity to comment on all three batches. Lets move forward with commissioner chow. I believe has a motion. Yes. The motion is to extract the following from the consent calendar, which by the way has Something Like 60 some odd items. Our extraction in the first batch we are talking about, which actually the consent calendar is batch number one, so that everybody can track where we are going. What im hoping to extract with the commissions approval as a group is the following as batch 2, which is policy 2014, leave of absence and bed hold. Policy 2006, indiscernible policy 2301, resident care plan, resident care team and resident care and policy 2207, restraint free environment. We wish to bring those as a separate topic under those four as batch number 2. So, i suppose should we take a vote on that first . Yes, sir. That was a motion. Is there a second . Second. For Public Comment. Folks on the line, if you like toactually, yes if you like to make comment on batch 2 andim going togive me a second, ill post these batches so you can see what were doing so we are transparent as we possibly can. Okay, we are on batch 2. The commissioners are going to discuss some of them separately. If you like to comment on that item, please do soi cant see the we havent extacted it. If we are taking Public Comment it is whether to extract. Exactly. Whether to extract. The Public Comment was to be on the actual content, but we can do Public Comment at either time i would suggest that we talk about which ones are going to extract and because the public can comment on the that are being extracted . Sure, because you will go back to vote on each batch . Correct. Why dont you vote on the extraction of the 2 categories. I suggest that we first take this one to extract and then we will go and extract a second batch and then well explain the reasons for the extraction. Let the public discuss any of the three that we are going to be taking up as we take each up. Thank you. Then we take up those that were not extracted, then batch 2 and batch 3, so the public can then make its comments on the policies in batch 1, 2 and 3. I think that sounds great. There is 2 motions and all you need to do is vote on the extraction of batch 2. Right, at the moment we are on batch 2 and we should say we wish to extract that. As a batch . Take a vote . Is there Public Comment . That will come later. All in favor we are merely extractsing and then well continue to accept Public Comment on all the issues so the public isnt excluded. All in favor of extracting batch 2, say aye. Aye. Now go to the next motion. The next motion is to do what we will call batch 3 and those are then four items. Number 201, which is the admission policy. And number 2 is the 20222023 Security Management plan. I pleev believe that is 7510. Then food and nutrition scope of services, that is 1. 01, and lastly, payer eligibility certification, 5501. There is a motion to extract batch 3. Is there a second on that motion . All in favor . Aye. Alright. The two batches have been extracted. The procedure is to go back to the original consent calendar so those not extracted and for you to take Public Comment and then vote on that. Well take Public Comment on the items not extracted. Ill quickly flash those extracted so the public is trying to onboard with us, because i know that is confusing. The policies the commission is going to vote on in a minute are those that are not included on the list im posting. These have been extracted for discussion and vote. I will take ai cant see Public Comment and share this. If you like to comment on the other items, which are called batch 1, consent calendar, please let me know. Anyone in the room like to comment . Alright. I see one hand. Jaime, please unmute that person. Mr. Shaw. Mark, i want to comment on the admission policy, 2101. Can i do that quickly, please . No, sir. That will be batch 3. Alright. Thank you. Okay. Commissioners, now youthat was the only Public Comment. You can consider a vote on consent calendar, batch 1. So moved. Second. Any questions or discussion from the commissioner s . All in favor . Aye. Great. Now we go to batch 2, which again i will flash so you all can see. This includes the leave of absence, out on pass, resident care plan and restraint free environment. Well take Public Comment. Is it okay if im saying this commissioner green. Would you like a explanation so Public Comment can reference that. Batch 2 has been chosen because as we put forward from the joint conference that we were putting together the entire batch of 60 some odd items that was pending the fact that we were going to be seeking responses to questions that came up during the jcc. So, questions that came up during the jcc did respond partly to the items in batch 2, but we did not really have a chance to review them all, however, there was not a question related to the operations of these items and these items are needed in order to validate that the operational process would be in place in policy, especially now that weve asked for certification and are going to need to show a current policy. So, my recommendation is that we will accept these as they are operationally correct, but the areas that the commission has spoken tothat the joint Conference Committee would like to review those and be sure that they responded accurately to what was said. We are asking for a vote of approval with this thenwell, we are asking for the delay of thelet me seei just got to make sure we have two batches here. May and step in and help . Yeah, we are going to vote on these so we can vote today on the operational process, and we will then review and bring back our modifications at our next meeting. At the next jcc meeting . This is the next jcc. Yes. Right. So, jcc will review them again to be sure the comments we received last night accurately reflect or else we might bring forth a new revision, but we believe that the operational part of the policy should really be approved at this point. For all we know, tomorrow they will come and recertify us, so we want to have it in place. If i may add commissioners, part of the reason we are separating the batches is so the public can see the proposed revisions so this isnt behind closed door so this is on the up and up. This is part of the process to be as transparent as policy. Some of these were few words ambiguous, could tell the spirit but thought it is most appropriate to make the written word much clearer so anyone reading it would understand, not just people who work at laguna and we want to respect the public ability to read every word of the policy and feel cullfortable and have all comments taken into account. If you can do a motion to approve this and then take Public Comment and you all can move forward. I would move approval. Second. Now Public Comment. We are looking at batch 2. If you have Public Comment on these, please let us know anyone in the room . We thank you for your patience, we know this is arduous for those not here for this item. I see no hands commissioners, so you can vote. All in favor . Aye. Batch 3. Batch 3, yes. So, in batch 3, these were not as critical. We need and the public needs time to be able to review the revisions that were made in this, so our proposalmy proposal is that we delay these until our next commission meeting, which would make sure the corrections that were being made were being seen by both the public and the commissioners who asked for those corrections so they are prepared to be moved forward on the september 5 meeting. Yes, please motion. I would move that we would delay consideration of these policies until september 5. Is there a second to that motion . Second. Anyone in the room like to comment on this item . We have two callers. Jaime, please unmute caller two first. Yeah, hi, mark, it is patrick, can you hear me . Yes. I think i understand the submission policy is going to be delayed until september 5, but i do want to comment on it today. All though there is some progress made in revising the admission policy, it is still problematic. Prioritizing the flow Behavioral Health patients from sfgh is a higher priority then disabled and elderly san franciscans languishing in out of county and nonmedical facilities prvented from receiving skilled care in mare own community at laguna honda is still obscene. San franciscans dumped out of county or nonmedical facilities who qualify for sniff care should be granted admission priority to laguna honda over sfgh flow project patients. Other San Francisco hospitals should also be allowed to discharge patients to laguna honda too, rather then dumping them out of county. Laguna honda residents who were evicting to out of county facilities following laguna hondas indiscernible should receive priority to return above all other patients. Laguna honda indiscernible 496 patients. It is probably less as of today. When admissions can resume, the Health Commission must mandate laguna honda managers rapidly repopulate laguna honda to indiscernible patients through an aggressive outreach program. I command dr. Chow and the commission for apparently recommending that once this policy is adopted that you want it to be reviewed 6 months from now and im going to hold dr. Chow and this commission to that hopeful promise. Thank you and ill let you go for the night. Please mute jaime and unmute the next caller. Hi. This is dr. Can you laer hear me . Yes. It is dr. Palmer. I really feel that if you are going to prioritize the return of San Francisco residents that were transferred out of county that you should do that in writing, and ones transferred out of county because they were evicted in 2022, or ones transferred out of county because they couldnt get a bed at laguna honda because of the admission had shut down. Certainly sfthe department of public helths needs to work assertively and the mayor office and Everyone Needs to work assessively with medical and longterm care providers to increase incounty longterm Care Capacity of all kinds, longterm mental healthcare, Substance Abuse and traditional Skilled Nursing care. We should not pit one community against another. Elderly and disabled residents who need nursing home care should be individually prioritized and i dont see why San Francisco general patients have priority over other patients who may be less safe. Even if they are not so unsafe they had to do a report or they have public guardiansism. I think it should be individualized. Laguna honda is a public facility, a county facility. Elderly and disabled people who want to stay in their community, there should be a even Playing Field for those beds. You have a waiting list, it is many years long. It would be nice if you will be transparnt how long it is, actually. I really dont want to wait 6 months. I think this should be revised now, before it goes to vote. Thank you. Thats the last Public Comment. Someone in the room secretary morewitz. Would you like to come up . indiscernible september 5. indiscernible this isnt back and forth. Sorry. Not back and forth. So, if you allill talk to the gentleman. I cant follow how this comes up, but how does the lawsuit chamber versus laguna honda where laguna honda is supposed to assist people returning homei havent seen any evidence of that. How does that fit into all the rest of this . Chambers versus laguna honda. Laguna honda is supposed to assist patients to return to homes to age in place like every agency and organization now recommends and the last century disabled people were all sent to nursing homes. Now, they are supposed to age in place with home care. Thank you for comments. Is there any additional commissioner questions or comments . We have before us a motion to delay consideration of policies in batch 3 until september 5 meeting. All in favor . Aye. Wonderful. Thank you secretary morewitz and commissioner chow foring my back and carrying us through this so efficiently and thoughtfully. The next item on the agenda is revisions to the Health CommissionHealth Code Article 31 regulations and for this we have patrick fosdahl the director of the Environmental Health branch. Good evening. My pleasure to be here. Director of the Environmental Health branch at department of Public Health. The Environmental Health branch is regulatory brarch fwr the Health Department and enforce the health codes. You heard from jonathan a couple weeks ago about article 38. Here tonight or this evening because we propose to amend one of othe regulations we enforce and those regulations are article 31. It should be noted that we are not proposing to amend the actual ordinance. We are actually just proposing to amend the regulations tonight, which requires a vote of approval from the Health Commission. If we amending the actual ordinance we would need to go to the board of supervisors and legislative process. Next slide, please. This slide should look familiar from jonathans presentation. This shows where we are located in the department of Public Health. We are in Population Health division. Im circled on there, and i report to dr. Susan phillip who is the director of the branch. She is also the Health Officer for San Francisco and im going to be asking her to address questions when im done raised by the community and Public Health committee when we met with them. Next slide, please. This is the Environmental Health Branch Organizational chart. You can see it is fairly large. I think we have over 30 different programs that enforce the health codes. Again, this evening well talk about one of those and thats article 31. It is circled on there and we currently have indiscernible who has been running that for over 30 years. Shes being replaced because shes retiring at the end of august and we have her replacement, bill chen here tonight. One of the rare opportunities where you get to hand off the torch while the person is still here, so hoping for a seamless transition there. Next slide, please. We will be covering the health code to give reminder what that is about. What does article 31 do . Why the amendments are being requested . What is amended and the Public Comments solicitation process we went through before this evening. Next slide. This map should look familiar to some of you. This is a map of the Hunter Point Naval shipyard. The navy purchased the property in 1939 and covered 936 total acres. Only 493 of those are on land. The rest is under water. The red line you see represents the original shoreline. The navy extended to extend the footprint excavating land from the hills to fill the bay. You can see just how much of that property is landfill. In 1974 the shipyard decommissioned and designated a Super Fund Clean up site. The federal level the epa provides the oversight of the cleanup work on this federal property. At the state level, the department ofalso overseeing the cleanup work. As noted on the map, you can see it is divided up into parcels. There is alpha designation ag. Those represent the different parcels that the property is divided into and they did because they there are unique cleanup issues and the idea is once they are done they will get turned over to the city one parcel at the time. The ones yellow, a1 and a2 are the only parcels that have been turned over to the city. That was done back in 2004. A1 has largely been developed at this point with housing and a2 is in the process of building itself out at this time. Next slide, please. Just by way of background, regarding article 31, San Francisco has something called the indiscernible ordinance which you may have heard of. That was passed back in 1986 and the ordinance requires soil testing and remediation of contaminated soil prior to building or grading permit. Found in San Francisco health caer 22a enforced by Public Health. The shipyard because it is federal land, that responsibility falls to the epa, department of toxic substance control and Regional Water control board. The city advocated for a robust process infr the shipyard recognizing we were not involved in overseeing the cleanup from a regulatory standpoint, we wanted to have a ordinance and regulations for overseeing how the property was developed once it was turned over to the city. As i mentioned earlier, the only two parcels turned over to the city so far is a1, and a2. Article 31 is necessary to insure things like deed restrictions, dest plan requirements are not violated during property development. Again, we are not proposed to amend article 31, just implementing regulations which as mentioned were passed back in 2005. Next slide. Article 31 in the regulations insure that when property from the nave shipyard is turned over to the city for development it is developed in a way that insures public safety. This is done after the epa regional board insured the property is safe for development. As i mentioned development can involve digging in the ground, creating dust and importing soil to the site so article 31 anticipates all this and requires the 7 reports and plans you have listed before you. Thats required for all parcels. Then certain circumstances where the reports and plans listed 811 are also required, but not on every parcel depending what activity is taking place. Just to give a example, number 5 listed there is the soil import plan, and this plan is needed to insure that only clean soil is brought on to the site by a developer. The regulations we propose this evening will require the current most stringent testing requirements for testing soil. That is a important change. Next slide, please. We proposing to amend the regulations as administrative cleanup. We feel it is easier and feel the easier we make the regulations to understand the better for the public to follow. Also make it easier for the steak holdsers to understand the process which include the ubpic all, scunltant Community Organizations and developers. The first 18 years we had only 5 applicants go through the article 31 process. Those were for those again parcels marked in yellow, a1 and a2. But we anticipate moving forward as the property is cleaned up that we will have a lot more potential parcels turned over to the city, so this is a good time while we are in the in between stage to make changes, amendments to these regulations. Our best guess is that the timeline there is maybe 8 years out for the next parcel. It is slow moving process. Next slide, please. Okay. What is being amended . Have a description in the packet you are provided with that list all 12 changes with attachment 2 and i think commissioner chow you had questions on that . It looks Something Like this. Thats a detailed description of all trevl areas that are being changed, but i think it is easier for the sake of the presentation if we summarize the 12 into 4 categories. The first one is we are reorganizing the regulation so they read better and added definition section that wasnt there for key terms. Number 2, updated the regs to moreclearly lay out the elements required in the plan and report. There are 7 plans and reports required for all Hunters Point parcels. There are additional ones that are required as i mentioned for specific instances, maybe where parcels or if a building is being demolished. In addition, and mentioned earlier, we are adding language that requires the most stringent chemical screening applied for imported soil. The epa indiscernible will periodically update these and this provides a way of requiring the most current. Lastly, the boundary map for article 31 is updated to reflect just the Redevelopment Area, the old map included a Railroad Area that extended outside the boundary area, and i think commissioner chow you had a question on that and i dont know if you saw in the packet, there are essentially two maps. There is the first map which includes the tail that i highlighted here and that is the railroad spur outside the development area. The updated map, the only change is that has been removed so that area outside of the Redevelopment Area isnt included. As i said, the changes we are proposing are administrative, like the items you were discussing earlier. We are try toog make it easier to follow and this is a Good Opportunity to do that. Next slide. Our Public Comment outreach is summarized here. I should mention we originally posted for Public Comment back in march of 2020 and then the pandemic hit and so there was a delay, so we did another public hosting march this year, 2023. Both times emails sent out to over 1500 stakeholders which included Community Based organizations as well as people who had expressed interest in affordable housing, and others who expressed interest and opportunities at the shipyard. We also posted the notice in the San Francisco examiner and our website. The posting on the website had been up since 2020, so very long period of time. We received essentially no comments during that time, so i think that speaks to the administrative nature of what is being proposed to these regulations. Next slide. This shows example of email languagesent out. Next page. And then this is a copy of the web page announcement, which includes links to spanish, tagalog and chinese. It has been posted for three years withi think we got one comment. Somebody sent us a poem, so wasnt really relevant. Reiterate why we are here. We are asking you pass a motion to approve these proposed amendments to the regulation for article 31 this evening. Having said that, i know there were questions from the community Health Committee members when we met with them. I think that was in july, and so ill turn it over to Health Officer dr. Phillip at this time and there will be time for questions after that. Good afternoon commissioners. Susan phillip, the director of the population Health Commission and Health Officer in San Francisco, and the Population Health division of course includes the Environmental Health branch lead by director patrick. We also have an extensive responsibility for Community Engagement and collaboration in trying to improve health and our focus is on Health Equity and continues to be on working towards Health Equity. To that end, i have with me very proud to be able to introduce a new position, leadership position at the Population Health division, Deputy Director of Population Health for Community Health and asa king is our first Deputy Director for Community Health. I say that to say that, the colleague s we have in Population Health, the people i work with both have expertise in the regulatory and technical aspectoffs the work that has to happen at hunter point nave shipyard and we care deeply about the community connection, Community Work and aspects of that. We know there is longstanding very strong and well informed advocacy by the community that lives around Hunters Point Naval Shipyard and we welcome the opportunity to continue our goal is to again to work for Health Equity in this area and then all areas of health. We know there are multiple areas in which there are Health Disparities among the neighborhoods in the southeast sector of the city, including neighborhoods around hunting Point Naval Shipyard and among black African American residents in San Francisco and my goal as the director of Population Health division and Deputy Director kings goal is to work collaboratively with communities to address those disparities. Director stated the role we have at certain phases of the cleanup of Hunter Point Naval shipyard and our role comes into play once the land is turned over to the city, but regardless we know we have a responsibility to collaborate with residents of the city whether we have the clean up role now which we do not for the shipyard. What we are committed to doing is continuing to build on the long history of work that happened within the department, within other department and also with the community and to start from that long basis of history and work, and to build collaboratively to meet with community and our role is certainly to advocate with the navy as the primary cleanup agency with the leg yul torry agencies for Clear Communication for a timely communication to make sure we can understand and that we can make sure that it is clear and accessible to the public in a timely manner what new information is emerging. Our commitment is to meet with community, to talk with community, to understand the concerns and advocate for Clear Communication on these very complex topics and long standing topics. Those were the primary points i wanted to raise and to recognize the longstanding history of appropriate concern and expertise within the Community Focused on Hunter Point Naval shipyard and look forward partnering with them to continue the conversations and to again be advocate for Clear Communication and for transparency as these processes move forward. Thank you for these presentations and welcome mr. Chen and Deputy Director king. Thank you so much for being here. I believe we need to entertain a motion. Yes. It looks like commissioner has a comment. Before commissioners comment you do a motion and take Public Comment but ill leave to commissioner gerardo just wanted to bring upgo ahead and vote. Before we vote i wanted to bring a couple things up. Sure. A motion then Public Comment and then go to you all for those comments. Is there a motion to approve the presentation for regulation for Health Code Article 31 . Is there a second . Second. Alright. Now we will go to Public Comment. Those of you who are online please raise your hand by presser star 3, but we have a couple people in the room and well start with indiscernible everyone has three minutes and when the buzzer goes off please finish your statement. My name is tonia randel, the administrative director of Community Foundation for social and Environmental Justice. Aerobic time i hear something about health and the department of health i look around and try to see what they are doing, are they really taking care of us . Article 31 there is nothing about testing residents to see if the dust has contaminated their lives, their children and effected their health. My biggest concern is the disconnect between industry and the community. We already have 40 thousand units in San Francisco that are unoccupied. 140 percent of high end homes have been built. Only 35 percent of low income and moderate income, such as teachers, only 35 percent. 145 percent, 35 percent. Where we live it is very dangerous. The environment. Not talking about the people, talking about the environment. Even if you bring in new soil, once that soil gets wet, whatever is under the ground will come up. My concern is that we need a full cleanup. My concern is that we do not need housing on contaminated land. My concern is while housing is being built the community is second. Our health is second and that needs to stop, because whatever goes on in the bayview Hunters Point district 10 will travel all over San Francisco, san jose, the east bay. We are one people, and we need to consider the health of our communities. In this regulation, i dont see anything that has to do with testing people. I have been tested. I have a high rate of arsenic and mag niece. I have no idea what that will do to me. Im all most 60 years old, so it wont be good. We have people who have died from lack of healthcare. We dont have enough healthcare and it isnt targeted. What are the standards for the health of the people . Have those been created because i went all through this 6 or 7 times and i didnt see anything. Everyone in this room will be effected by everyeveryone in this room will be effected. Every time that land is moved. Every time it rains and peels up. Every time diesel trucks go through and kick up the dust. Some residents had to move out of their homes. Thank you for listening to me. Thank you very much. I apologize. I can only read the first three letters of the next person the last name is harrison and indiscernible indiscernible social Environmental Justice. Glad to be here today. I know some of you guysheard my story already. Im here to repeat it. We have several in the indiscernible to be sarcastic but also to say that San Francisco Public Department of Public Health, we need you. We need you to look at this community from a real Serious Health lens. It is one thing to beto have people you are supposed to indiscernible on paper, however that have happened in [difficulty hearing speaker] it is a shame. We have people coming up positive for indiscernible exposure. How could you miss that . If you are not testing human beings to see if the damage already been done in the community then you are not doing anything. We know the indiscernible because we found out indiscernible we were able to successfully sue and win that case. Lets not lose sight of that as well. Then we have the census that go up in the communities when anxiety is high. I dont indiscernible i dont think a fence is going to be a dust barrier for anyone. We have the highest rate of lung disease, indiscernible in district 10. The highest rate of cancer among adults in district 10. We indiscernible age of 20 and younger diagnosed with Breast Cancer. Howt about that . Who imagined that . There is a woman that has a brain tumor and indiscernible is that coincidence . If it isnt the truth then investigate it. Im challenging you to do the work. Im challenging you to test human beings that have lived there and put in repair for the harm that has already been done and stop misleading people moving in. You cant put pretty over a mess. You have to take into the science indiscernible Sea Level Rise that will be a problem for all of california and San Francisco as well and what is going on at the Navy Shipyard will effect every shoreline community. Follow the science. I believe you guys got your degrees and indiscernible we need you to not protect the property, we need you to protect human beings. Everybody has indiscernible im not opposed to any [difficulty hearing speaker] thank you very much for having me today. Longterm Bayview Hunter point resident. indiscernible Community Foundation for social and Environmental Justice and my community is indiscernible is there someone else who would like to make Public Comment, please . If you feel comfortable saying your name, please do so. My name is camilla eelm with all things bayview and i just have to want to first thank you for giving us the grace as you hear us fighting for our lives. I find myself again behind a podium begging for my life. I just want to start off with the inadequate and inaccurate statement on the memo, which states the Hunter Point Naval shipyard is a federal Super Fund Site and actively being clean up by the navy. That is mistruth on the first line. They plan on capping radio active toxic waste at the shoreline as we are facing climate change, Sea Level Rise and ground water rise, and again i appreciate you know, Susan Phillip coming up here but she reminded me of a care giver taking care of a hospice patient as they are waiting to die. As a Third Generation impacted Bayview Hunter point resident and front line mobilizer and organizer, im gravely concerned your amendments do not include Health Impacts as people are dying and surviving to live a shortened Life Expectancy in bayview Hunters Point. I just want to emphasize that we need article 31 to address the lack of legal protective fence lines along the western boundary of the base in the region of parcel e2, land fill radio active. As a kid in the early 90 i was able to easily access the shipyard and 2023, the youth are able to access the same contamination on a regular basis. Medical monitoring and surveillance of the ship yard workers and residents within one mile perimeter on the base. We have folks telling us during the work at the shipyard are coming up with cancer. The accuracy and adequacy of independent retesting for radio active sail contaminants, the trust is gone. You got to do better, we got to do better. The need to fortify the land fill and specific of human Health Screening criteria. As the navy is covering up Dangerous Levels of toxic waste, over more of a 40 acre naval testing site, where i live is the walking dead. During this summer i witnessed childhood friends neighbors with health gravely declining and bayview Hunters Point we were walking yesterday and wheelchair today and dead tomorrow. Please thank you for hearing us out and as you are amending 31, please consider our demands as well. Thank you. Anyone else in the room . Good afternoon. My name is dr. Chi. In december of 2004 i spoke before this Health Commission in opposition to the adoption of article 31. As a ordinance. My concerns were born out in 2010 by the report of the superior court civil grand jury, which identified the conflict of interest that exist that is cocodified in article 31, article 31 of course generates revenue from earth moving activities at a federal Super Fund Site from the master developer and we have documented as you are well aware numerous instances in which that conflict of interest has lead to activities that are corrupt. I know i overwhelmed you in 23 years with email communications. I will make my statement short and concise and going to give you a update to the geo spatial mapping the Monitoring Foundation has conducted that identify the clusters the chemical and radio cancer clusters density cited around the shipyard front door. The main entry and the western fence line of the pan handle. You will be happy to know the work i so carefully and dearfully conducting since 2019 is confirmed by the greater bay area cancer registry. There are two women with radioogenic Breast Cancer. That is what the atomic bomb survivor registry describe of under the age of 30. Most frequently women indiscernible the cancer clusters include 10 year old boy who died of a defused indiscernible in 2021. There are three Childhood Cancer deaths that should be considered suspicious and wrongful. There a minister with two brain tumor s in his brain. He lives and has a church. His father built on oakdale a quarter mile from the western fenceline of the base. There is a woman who was alluded earlier with multiple brain tumors and her dog died of a sarcoma, a cancer that is linked to radiation exposure. There are cancer clusters with the uc residents are. There is a employee who just underwent surgery for colen cancer. He has indiscernible and high concentration. There is Thyroid Cancer and there are pulmonary noduals. The Police Officers have brain, lung, Thyroid Cancer and sarcoma in two service dogs. These findings are irrefutable. It is time you accept people are exposed to radiation from nuclear waste. People living within feet of a radio active landfill so i like to leave this to you. Thank you. Could you bring it over here . Thank you. Would anyone else like to speak today . Thank you so much. Alright. We can movethere are two hands i see. Well start with caller 11 please. My name is art. I love in San Francisco on the board of San Francisco gray panthers. We are allies who want to bear witness to and support the eloquent and well informed Public Comments made by dr. indiscernible and others today. All whom have first person experience with the tragic contamination and damage to their land and themselves as residents of bayview Hunters Point. I support the community request the Commission Delay their decision on article 2131, until all issues related to article 31 are addressed and they are, number one, the lack of legal protective fence along the western boundary, the base and parcel e2 landfill and radio active panhandsal. Need for medical monitoring of workers and residents within the one mile perimeter of of the base. Three, the need is meant for retesting. Four, need met to fortify the e2 landfill parcel. Human Health Screening criteria met. Please convey to commissioners, i request the Commission Delay the decision on article 31 until the Community Members who live in Bayview Hunter point have adequate time to consider all unresolved issues relevant to article 31. Thank you very much. Thank you. Jaime, please go to the next caller. Hi, caller. Yes, im carol harvey, San Francisco human rights and civil rights executive reporter focused since 2014 on a neighborhood of San Francisco, Treasure Island. I call naval station Treasure Island and naval station Hunters Point simese twins. During a meeting wednesday august 21, 2015 and asked indiscernible radiation specialist on the naval base parallel to hunter point specifically former naval station Treasure Island that sfdph conduct a Health Survey of Treasure Island residents. During the 8 years sfdph has not conducted that survey. Treasure island is an official Super Fund Site. In the 1980 the epa gave Treasure Island the super fund identification number, indiscernible . Treasure island has ranking score for toxins and twice the amount required for super fund status. The number qualifying is super fund status is 28. 5. Treasure island was 51. 78. The navy has openly stated during 53 years of use of toxins on Treasure Island, radiation, chemical grade weapons and heavy metals like arsenic and lead saturated Treasure Island soil and ground water. These toxins are concentrated in former burn pits under site 12 town houses inhabited by Treasure Island residents. Again, Treasure Island is a neighborhood of San Francisco. I observed among Treasure Island residents i know prnlly many cases of asthma, respiratory disease, heart failure, heart attacks, spontaneous bleeding, strokes, seizure, tumors, blood disease, rashes and indiscernible and never seem to heal. Cancer, hair loss, even indiscernible painful swolen legs and feet, indiscernible spontaneous breaking bones, fragmenting teeth. Loss of extremities, amitations and back pain kidney removal unexplained panic attacks and death. All of which is attributed to toxin exposure by the residents themselves. indiscernible conduct non intrusive home to home survey residents living on Treasure Island right now may risk talking to you. The survey is long supressed it should be conducted immediately because the truth will come out that after more Treasure Island residents become sick and die. The result of this survey must be made available to the city of citizens of San Francisco. Thank you your time is up. Jaime, please unmute the last caller. Hi. This is dr. Palmer. I really think you should not vote on this today. You should look at more information that is available. It doesnt make any sense to build on poison land and to put people on poison land. It does matter how big the profit might be. You need to do medical monitoring and surveillance of workers and residents in the area and you need independent testing of the radio active soil contaminants. The dust will poison everyone who lives there. No one in their right mind at this point would move to hunter point if they had any choice. I beg you delay this vote. Dont vote on this. Collect more information, and dontmaybe find a way to give this land back to the navy until they really clean it up, which may not be possible. Okay, thanks. Thank you. That is the last hand on the remote and no one else in the room. Thank you all members of the public for expressing your informative and legitimate concerns. We very much appreciate you being here and telling us your story. I believe there are commission questions and comments. Commissioner gerardo. I like to just bring back our discussion with the community Public Health committee and how we were requesting followup, and some of the information you gave us patrick today was very helpful in what we had requested, but what we had said specifically in the minutes was that we approved this with the understanding that dph would provide more information about Community Safety concerns and i really appreciate dr. Phillip, your feedback. The community needing the feedback. I guess one of my comments too is when with the 1500 emails that you did and all the publication, et cetera, i really like at this point in time to consider a Community Meeting. People in person where the Community Members could gather within the Bayview Community to discuss what their safety concerns are. I dont want this to be another unmet challenge that the community faces. The other thing that we had discussed as well is that we would really like to see comparative health data from the bayview Hunters Point area as how the health data compares to the other neighborhoods within San Francisco and i know that that is i believe it is available, but i think that would alsois what we had talked about in looking if the update on the Community Safety concerns. If we could have what we had discussed as well a updateobviously i fully aware of the vacancies in some of the difficulties with all the departments, but if we could get some of the updatesobviously not soil data or anything specific because that is really not our purview, but within a three month timeline so that we would have what commissioner christian who is unable to be with us today as well as commissioner chung here willis what our request was from the committee meeting. indiscernible thank you for the presentation and thank you for the Public Comment. As a former human right commissioner, i heard this issue over and over again and my hands were tied at the time because it wasnt our jurisdiction to compare health data and human rights commission, but now i think that because i have the ability and commissioners christian have the ability, we just want to make sure that we investigate, like the public wants us to do by comparing the data. We are not responsible for the toxic soil. We are not responsible for the initial cleanup, but we should be helping the residents who have Health Concerns to hold those who are accountable, so i just want to put that point forward and to really make that as a statement. I dont think people are saying we did that to the community, but if we continue to look the other way, then we are not doing our job. If three months is too short a time to get some of these updates, please let us know. Whats a reasonable working timeline so we can really start looking at this and not excuse me, this isnt a time for Public Comment. So we can continue to look at this, because they are part of San Francisco and we want them to know that they are and they are not forgotten. Commissioner chow. Yes, i have heard the issues at hunter point for many years and i do think they do deserve further hearing and further investigation and be able to try to resolve some of the problems that have gone on for these years. We heard conflicting reports back over the past several years about whether or not the cancer and so forth are not related directly to the contamination and so, i think i have two thoughts that have come from this discussion. One actually is related to the Public Health and equity issues and obligations on the part of the department to perhaps reviewnot perhaps, but to review again where we are with the health of that population and whether article 31 hasis a mechanism to try to resolve that or that there are other meck hanisms that do. The other thing i think thatso, i do think thats an important topic we should not lose. Whether we then carve that out separately as verses what this is, which is really as i read merely a restatement of where we are now, but written in a clearer fashion for the public to be able to follow. I think there are two issues. I think by bringing the regulations back to us it again raises our awareness the problem we never really fully resolved, and that we need to take that on and i think it is of concern. We are adding new units over there and aparently they are much closer then the ones built out in accordance to this map, but regardless, there are people who really are still on this map that are in a property and we never from a Public Health standpoint fully resolved the reasons for the disparities thati think there is separation. We shouldnt get this mixed up with the larger African American disparity. This is very specific to hunter point. I think one of the speakers also brought up whether or not first time i heard that Treasure Island might be more suspicious, but if we can bring that all together in some way and bring it so we can really look at the Health Issues regarding that. Regardless of that, this actually before us today is actually a simp lifiication of the regulation each of the points director has shown up, merely sort of move the administrative code around the way that they are carrying out the Current Article 31. We are basically talking how else we could strengthen or improve our oversight. Article 31 does exist and our department here is trying to assist people in trying to move through article 31 and thats what thisi believe the request here is is to actually rewrite the regs and so i think we can do both. We can rewrite the regs for what they are right now, but keep the topic available and agenda as commissioner gerardo has desired, have it vetted over at the jointconferencecommit tee level. Truly Public Health committee and prepare it for presentation back to us all here. I would actually personally favor voting for the simplification and clarification in the regulations that are related to the administration of article 31 and take out again the public topic and have it vetted through our Public Health committee and brought back to the commission with a time certain. Thank you commissioner chow. Thats what our committee had recommended, is that the organizational Administrative Changes we had approved, but with the understanding that the information that we are requesting on Community Safety concerns and with the health data et cetera, be brought back to us three months or whatever dr. Phillip feels is possible for that information, because it is awe all three of us commissioner christian as well, felt that we hadwe all share a Significant Community concern that yes, we are not in charge of the map, but we are in charge of monitoring the health of what is happening and thats where we were concerned about the Community Safety concerns thatthat was our recommendation. And hope everyone in the community, commissioner chow did a very good job summarizing the issue that there are certain things within the purview of there department and some that are not. That this article is passed by the board of supervisors and what we are trying to do is make the execution easier and clearer for those involved but we absolutely have a responsibility to monitor the health of our community, especially in light of the fact that it isnt within our purview to access the soil or do things within the epa and governmental realm out ised the department of Public Health. I guess i would ask director colfax and directser phillip what you think would be a appropriate timeline to try to address some of the issues, including the Community Meeting and bringing back the data that i think will probably clarified. Thank you commissioners. I want to acknowledge the comments from the public today and make sure you understood that you are heard and the department appreciates your comments and there is much more to be done with regard to the issues that you raised today. I think also just in hearingif i interpret the commission comments right, there is article 31. This is basically administrative update. There are both potential concerns around article 31 that could be brought back to the commission depending on what the next potential steps are, which is more Community Engagement around the Hunter Point Shipyard and potentially the broader issue around the Health Inequities in the bayview overall. Am i hearingsorry. indiscernible i think article 31 is not the end all be all. Certainly. Regulation, but we can approve the administrative side of things, but i think the discussions that need to come back is what we are able to do and what are wewhat is not in our purview. In order to achieve like Better Health outcomes and Health Equity, especially Racial Equity for bayview residents. I hear that, so thank you. If i may with regard to the direction fromas i interpret the direction from the commission, could dr. Phillip and i talk about thistalk to other leadership, come up with Community Engagement plan with a timeline and report back to the subcommittee or the commission about how that would move forward, which we could doi can talk to dr. Phillip around the report back, but just want to make sure we do it in a responsive way to what i hear from the commission and also certainly from the Community Members as well. Does that sound fine with the members . indiscernible sorryi know, but it is one way conversation. We would reach out to Community Members including those who have been engaged in the issue for many years. Any other commissioner comments . I think we should proceed and i would suggest that we vote in favor of the Public Health committee affirmation that they believe this administratively this is something that they endorse, and then ask for a report back to them in three months. That sound reasonable to the members . It does, but i prefer dr. Colfax and dr. Phillip be able to give us the timeline maybe by the next meeting of what you think the that would be fine. Correct timeframe should be. At the direction of the commission we will do that. Thank you very much. Thank you everyone for all your insight and comments and i think it is appropriate to ask for a vote. All in favor of approving the updates to the regulations of the Health Code Article 31, please say aye. Aye. Very good. Thank you everyone. May i ask one thing . Folks visiting or sorry here from the public, if you would like toill give you a piece of paper, if you like to leave your email i can update with agendas so you are aware of meetings. I want to make sure we are in communication so ill come over after this and please feel free to pass along emails to me or my email to those people too. In case people have to leave secretary morewitz do you want to tell individuals sure. Ill come and do this again by email is mark. Morewitz sfdph. Org. I will bring it to you all. It is published online and will make sure it is published with this meeting page. Thank you so much for doing that. Now well go to the directors report, director colfax. Good evening commissioners. August 15, 2023 director report. I will summarize some of the components in the directors report and answer questions you may have. First of all, i wanted to highlight a documentary around San Francisco covid19 response. Titled the heart of access. This is a film from the San Francisco department of Public Health center for learning invasion. The covid19 task force and partnership with indiscernible and also education. This film documentary elevates Community Academic Public Health partnerships. Additional screenings are listed in the directors report. I thought that might be of interest to commissioners. Really pleased to announce that dph staff received national tb controller association unsung hero award. A unsung hero is being sung. This is dph felix indiscernible given this award in recognition for outstanding service. The San Francisco indiscernible serves diverse population including immigrants from central indiscernible those are Substance Use disorders. Goes above and beyond to insure it section provides equitable respectful and cultural appropriate service and are congratulate on the well deserved award. Also wanted to highlight dph adult immunization and travel clinic is full swing. Interest in International Travel is recovering. Provides preventive consultation vaccine and travel medication prescriptions to persons with all ages going abroad enabling to reduce risk for health indiscernible to return home feeling well, and as before i return to Department Took advaptage of the service i can tell you the care is excellent and staff are superb. Finally with regard to covid19 update as of august 10 San Francisco 7 day average of new covid cases per day is 49 and there are 37 people in the hospital with covid. 86 percent of all San Francisco residents have been vaccinated and 65 percent received a booster dose. 41 residents received bivalent booster. We are seeing a bit of swell increase of cases boket across the country in the state and across theand locally as well. This does not compare to the surges that we have seen in the past. There is a new variant that is accounting for increasing proportion of cases diagnosed. Thankfully the variant does not appear toit looks like it is more indiscernible and death and certainly indiscernible main medication for people that do become infected is effective as well. Booster update series, we are expectingthe cdc is saying that additional booster will be available in october. I think we are still waiting for guidelines about who will bewhom that booster will be recommended. Thank you. Happy to answer any questions. Thank you for that report. Secretary morewitz is getting reoriented there, the trailer for the film was fantastic and it is playing in two days in the mission and congratulations to mr. Crestman. Any Public Comments on the directors report . Any Public Comment on item 10, the directors report . I see several handswell take those who received accommodation first. Only one person i believe received accommodation, so if you have received a 2 letter code from me, leave your hand up. If not, please take your hand down. Great if you all adhere to that. Not seeing hands so ill just take them as we go. There we go, thank you. Jaime, please try caller three first. Hi. My name is kathleen and thank you for the report. I am here to speak about covid and ask the commission reinstate the mask requirement for indoor essential spaces most importantly for healthcare settings. We are currently in a surge. We have very little data to go on to tell how big the surge is other then the wastewater data and that does show a surge is happening with the new variant of interest. Covid spread both symptomatically and asymptomatically and at least 1 in 10 people infected even with so called mild covid cases, the result is long covid or post covid disability. Leaving masking as a personal decision is not effective. When someone is infected we dont know where the chain of infection may lead and can cause death and disability in that chain. We offer very little to no Public Education on covid or its aftermath. I am a type 1 diabetic and vulnerable to covid and i protect myself, but that leaves me unable to seek safe medical care without masking in the medical and healthcare facilities, but we have learned that we are all vulnerable to covid, even so called the young and healthy. 1 in 10 to 1 in 20 to 1 in 5 will result in disability or post covid damage and that is death and disability, so i implore the committee to keep us safe. Please do your jobs as the Health Committee to help us protect ourselves and each other. The most vulnerable and to stop creating disability where there is not disability. Thank you so much. Thank you. Lets go to the next caller. Caller 10. Hi. Can you hear me . Yes. You got three minutes. Please begin. Hi. I would also like to respond to the covid19 report. It is very clear they are using the same talking points you used for months now that you decided to give up on protecting your residents and just rationalize the spread of covid19 and mass infection, mass disability, mass deaths. Curious how you already know whether a new strain is indiscernible given we are just in a new surge. We also know like the previous speaker said, no matter how mild your cases in the acute phase, you may still experience long covid in weeks to months afterwards. We know mild case can increase risk of blood clots, diabetes, stroke. Ages 2544 were cohort with highest increase of heart attack deaths, and so im so concerned because so many people dont know about long covid or post covid issues. All they hear from you is it is mild you will be okay. It seems the booster rates here are higher then nationally. They are still way too low and just like infections, it is community ranked. I really urge youyou have this documentary about Health Equity but what are you doing now . You are leaving people to die and become disabled. Every time i hear a young person with young covid who said i had no idea this could happen to me after my third infection, my heart is broken. You guys are not educating peeping, not providing people with the data to make informed decisions and not passing implementing Public Health policy based on Public Health and prevention, so i really urge you to reinstate the mask requirement as you enter this new surge and public spaces, especially healthcare. Please do your job. Please protect us. Thank you. Thank you. Please unmute the next caller. Hi, there. Hello . Yes, please begin. Hi. I too like to respond to the covid19 report and call on you to address the surge in the bay area. The best way to do is reinstate a countywide mask requirement in indoor public spaces. We know covid numbers are on the rise, as you said and the new variant is quickly becoming the dominant strain in california. This point we know a large body of research conformed covid is not mild. It is airborne and deadly and attacks the indiscernible on a Cellular Level indiscernible damage every part of the body receiving blood flow. Worse is each reinfection causes further damage to everyone of all ages. Additionally, covid is a leading cause of death in children and young people in the United States, which makes the mask mandate especially necessary right now as schools begin among the current surge. I also think it is important to reemphasize what previous callers stated. The risk to covid are not limited to initial infection. Even mild infection can cause post viral effects and you see this through long covid is third leading neurological disorder in the United States as well as the fact covid disabled over 23 Million People since 2020. Current vaccinations do not protect against long covid so vaccine approach is not efficient. Masks are necessary layer of medication. The more government the allows unmitigated spread, the more variants we will see across the world. Covid will continue to kill and disable people of all ages and background unless we make a Public Policy change. We need you to protect our community here in San Francisco and provide accurate Public Health information policies and tools. It is really hard to watch society abandon the most vulnerable Community Members. This breaks my heart to see so calling on the Health Commission to resist this abandonment covid is not over and you have the power to keep San Francisco safe and set precedent. The best way to keep people say now is be reinstating a county mask requirement within public spaces. Thank you so much for your time. Thank you. Please unmute the last caller. Hi. My name is elizabeth, member of senior disability action calling to reinstate countywide mask requirements in indoor public spaces. We are in a surge. Kids are about to go back to school and many people would be happy to mask if they thought there were a reason to but dont know there is because there is no requirement in place and many people dont know we are in a surge. With expotential growth we know that more infection means more death eventually, and it just feels like we are deliberately deciding not to learn anything, not to implement actions derived from increases understanding we gained. It is really strange and a bit sinister i think and horrified la dropped the masking requirement in healthcare. We cannot follow in their shoes. It is good San Francisco requires masks for healthcare staff, what we need is a return to universal masking in healthcare. Patients spend as much time around patients as providers. Patients are mostly unmasked. We have lots of evidence to show indiscernible again this is information we have. Universal masking in healthcare protects patients from other patients. We also have to remember that many highest risk patients are physically unable to mask such as people with indiscernible implements, people on supplemental oxygen. The Community Members deserve safe access to healthcare and rest of society and universal masking protects those people. They are safer if those around them are wearing masks. We are in a bad time, we dont have the tools, less data in San Francisco making it impossible for the public to assess risk and indiscernible only exposure access was pulled december because it ineffective against the variance. indiscernible they just dont understand the reason for such disregard for the vulnerable. You said repeatedly at the meetings you want onramps masks. The time is now and if we dont more will die or disable from long covid. This is preventative and have a moral imperative to act now. If you care about Health Equity and access you need to bring back mask requirements. The time to reinstate is now. We are in a surge and des serve to safely participate in society and healthcare. Thank you for bringing forward your concerns. Any questions or comments on the directors report from the commissioners . Alright. Hearing none, thank you so much. The next item on the agenda is the report from the community Public Health committee. Thank you very much commissioner green. We had a excellent meeting today with three presentations from Behavioral Health. The first was on the Behavioral Health pipeline of students and interns and just for everyone to try to remember, the internships were across various different sites that interested in a dph Behavioral Health internship. It is now one streamlined part of the website. Made progress. In 20222023 there were 18 interns across 12 sites, and which was fabulous. There were 23, sorry. This is 18 in the next year. There are 23 students. This year there is 18 students across 9 sites, and they are doing a lot more outreach to schools et cetera. Their issue is in supervision, and the ability of the supervisors to be able to carve out the number of hours needed to be able to supervise interns, which is with all of us is a issue who have fellows or interns. It should be noted that the multicultural student stipend has beenwas a formalized policy in 2022, and it had a budget of 70 thousand and dr. Cunnings added 150 thousand to that to be able to distribute to the student interns, which is just excellent. These are Community Minded Behavioral Health people who are training with us, versus training for private practice. The second presentation was on the Housing Conservatorship Program which will sunset in december of 23. I think it was interesting to note in the presentation the total of 5150 in the previous years reported not just at San Francisco general, but all of the hospitals was 13. 669 individuals. In 2122, there were 13 individuals who had 8 or more 5150s in the 12 month prior year, which is how you are on the road to housing conservatorshipism. In the same year, there were 86 individuals with 4 or more 51 50 and they were notified they were on a pathway. In 2223, one petition was filed for housing conservativeship, 12 people were notified they were on a pathway. The goal of the program has been to help connect these individuals to consistent services. That presentation was fallowed by the assisted outpatient treatment program, which is a companion to the housing conservatorship and this program is for individuals over the age of 18 and again, the goal is not only the connection, but it is to get ahead of a crisis. This program is initially voluntarily, and the criteria is 2 or more psychiatric hospitalizations in 36 months. If thereif involuntary, after multiple attempts then there is Court Ordered out patient treatment, but that has not been regularly needed. The referrals mainly come from treatment providers and family members, especially it was noted out of state family members who are requesting treatment forage 2659 and there were a higher percentage of black African Americans in the program. Currently there are 85 clients in the assisted outtreatment program with two clinicians responsible who have been there for quite a while and are you know, doing a fabulous job, so it was great to hear. The outcomes are connection to care and we had requested that the information be brought back to our committee that what the consistencyhow long are we able to have these people continue their care on a consistent basis. Is it 6 months, 12 months, 24 months . The housing conservatorship and outpatient companion programs until december indiscernible they were excellent presentations. You have anything more to add commissioner . Anybody have any other questions about this . Thank you for the report. Is there any Public Comment on the item . Folks on the line, any Public Comment on the item, committee Public Health Committee Report back. Press star 3 if you like to comment. No hands commissioners. Any other commissioner questions or comments . I just had one. Lauras law was i guess the basis for one of those programs. Did the department feel that lauras law is actually helping . Yes. They did, good. Because that has been in question. When it began. Yes. So, it looks like people would stay on the program after they were engaged in the program and yes, so it is positive. Great. Great. There have been detractors to that, so good to hear. Thank you. Alright. I guess well go to the next item, which is other business. Is there any other business . I see Public Comment. Folks on item twebl. 12. If you like to comment press star 3. I see a hand. Actually the hand went away. No hands commissioners. No Public Comment. Then entertain a motion to adjourn. So move. Is there a second . Second. I believe we can make sure there is no Public Comment. No Public Comment. All in favor . Aye. Thank you everyone. Very productive wonderful reports. Thank you commissioner green for facilitating. Wonderful. Thank you. [meeting adjourned] indiscernible i just know it. Excuse me boys, but does anybody have sun block to block this skin from the sun . Yes. Thats right, i need to get my indiscernible many of us last summer indiscernible reapplying sun screen is like getting the second dose of mpox vaccine. Wait, two doses indiscernible isnt it too late to get my second dose . Girl, it is like sun screen, never too late to put more sun screen on. Thats right, i need to get my second dose of mpox vaccine before the summer starts. Lets indiscernible 21201 to find the closest location to get the vaccine or go to sf. Gov mpox. Thank you for the information indiscernible excuse me boys, do you mind checking please . Sure. That doesnt look like a sun burn, you might want to getd it checked out. What do you mean clecked out . Checked out. I was told if i got my second m pox vaccine i would have less severe symptoms. indiscernible maybe i schedule the second dose just to be safe from mpox. Most vackeens offer you a level of protections, just like sun block. Sometimes you need to reapply for more protection. The m pox vaccine is based on two shots several weeks apart to provide the strongest level of protection. Visit sf. Gov mpox to get yours. Thank you boys for that reminder make sure your are fully vaccinated for m pox this summer. Text summer vibes to 21201, to get good evening welcome to the board appeals. Vice president lopez will be the officer tonight and joined by commissioner john tras vinasm alex patrol berg and jr eppler. Rick swig is absent. Also john gib in for legal advice. Im Julie Rosenberg executive director we will be joined from city departments presenting. We expect later mr. Rich hillous from planning and tina tammy zoning