Transcripts For SFGTV Health 20240704

[reading of land acknowledgment] as well as all people who reside in traditional territory. As guest we recognize that we benefit from bobingering and living on their homeland. We wish to pay our respects by acknowledging the relative of the ramaytush ohlone. Thank you, the xhex item is approval of minutes from february 20, 2024 and there may be some corrections. Yes, first of all i apologize these are all clerical errors on my part, i usually cut and paste the Public Comment on page 11, under patrick last full line i added an l to make the hh make sense, so its llhh correction. Next page, under resolution honoring holly hammer commissioner guillermo comments, i added an e to make her here. Under that commissioner chung comments, the last line, the last word should be endeavors and that is the last im sorry, on page 3 under resolution honoring greg wagoner, third line, there is a w was missing from the word was, thank you for sending the corrections, my apologies. Thank you very much, if there are no more corrections, there a motion to approve the mibz. So moved. Second. Is there Public Comment . Is there anyone in the room that wants to make Public Comment. I see nobody in the room, let me make a statement, i also want to remind folks who are watching that only those that received accommodations from me from yesterday at noon can participate remotely and weve got three of those folks today. For each of the item, public will have an opportunity to make comment for up to three minutes. The process does not allow questions to be answered back and forth conversation. The commissioners do consider comments from members of the comment when making request to dph, please note that each isindividuals may not return more than once to read statement frz other individuals. Written Public Comment may be sent, the health Dot Commission dph. Org. If you wish to spell your name, you may do so in robo comments without allotted time. All right, please unmute the caller. Caller youve got three minutes, tell us youre there. I have testified declaration file in superior court case following thompson was damming indictment of the failure as governing body. Between 2 19 and 2024. I agree with dr. Palmer, shame shame on each who have credited to this problem. Four commissioners who served during the patient abuse sex khander including commissioner chow which remain commissioners to this day. Clerk thank you, thats the only Public Comment on this item. Lets go ahead to vote. Were all here. Old fashion. All in favor say aye. Aye. Aye. N. Any in opposition, great. We now go to the wonderful part of the agenda honoring medical director and is now going to retire. And for this dr. Suess an philips who is our Health Director, i believe will come forward. Should i read the resolution or make comments. You can make comments ux ill read the resolution. Happy and sad for dr. Brown. The resolution says, he has worked for dph since 1996 an incredible nearly 30 years of dedicated service to the people and county of San Francisco. As an emergency medicine physician, as an educator and as a trusted and so valued Public Health leader in San Francisco. On a personal level, john has always been so generous with me as i stepped into my role as a cph director and always willing to explain the complex and critical way in which the system inter acts and it works to serve the people throughout the city and county. And the which in they work on Continuous Improvement to incorporate equity into the work that happens before hospital transport, to assess people and to take care of them in the field. And hes been such a, such a dedicated Public Servant in advancing all of the goals that we share in those efforts. He has a really demanding job here as you can hear from my brief description of all the things that he does. But i will ask john what hes doing in his off time, the answer is that hes flying to help with Disaster Relief efforts there. So i think that tells you a little bit about what you need to know about dr. Brown in his heart and efforts. The other thing that is important to know that its been over a week long celebration of john, i can count three parties one of which he has to leave this meet to go go afterwards. From his dph and preparedness and the one today with ucsf and dcsg colleagues as well. I will stop is there and say thank you so much john for all of your did occasion and service and commitment and wicker you a wonderful retirement. Ill read the resolution, we thank dr. Merry merser who helped us draft this on her own time. Where as dr. Jack brown, yes, dr. Brown step up to the podium. Exceptional leader of leader of department of Public Health since 1996. Where as dr. Brown has sefbd over nearly 3 decades to ensure the delivery of high quality medical and trauma care for all san franciscans where as dr. Brown has lead local and local improvement efforts for specialty Emergency Care such as stroke and cardiac arrest which have been shown to improve patient outcomes. Where as dr. Brown has been a strong advocate for clinical innovations. And wer as dr. Brown served as a physical in volunteer educator for general raisesing of ucsf medical students fezes and fellows. Where he helped coordinator oar californians regional 2 and as a federal of the assistant team for the regional 9 and served in leading response and leading the response to many local regional and global disasters including the covid19 pandemic. Where he has contributed to medical malpractice and Population Health for emergency and trauma care and where dr. Is considered by his xlaoegz and respected mentor whos expertise and intelligence and integrity and empathy will continue to impact the well being of all residents to residents of San Francisco. Results that San Francisco Health Commission honors dr. John brown for his outstanding leadership and wish him well in his retirement. So we will entertain a motion to approve this resolution, commissioner chow. Yes, would i like to move the resolution in honoring dr. John brown. Second. All right, is there any Public Comment . Any Public Comment in the room . Is see none online and none in the room. All right, commissioner comments . Commissioner chung . Yeah, we appreciate all of these years that i get to see you coming to present and Population Health committee, you know about ems services. I really learn a lot from the way you present the materials and the way your energy showing, youre perfect for somebody emergency because you have that whole aora of all maniness. Thank you for all the work that you have done and glazesing on your retirement. Commissioner guraudo. Im fairly new but gratitude for your commitment and that youve really, youve made a difference. And i just want to say thank you very much. I know commissioner chow who has known you the longest to speak. I googled you and besides enjoying the presentations, i was so impressed by the article i found because it says you have an absolute level head and chaos that youre humble and understated that youve done some incredibly great work. And that somebody was singing your praises and along you came on a bicycle and dinged the bell on the bicycle which i think is so emblematic of somebody to humble. It sounds like retirement will be relative for you because there are a lost disasters in this world and somebody tells us youll be there giving your best where ever youre needed. Were so grateful to have you for so long and your legacy will be felt, including the app every time we think about at that i look at the wonderful work that our ems has done. Dr. Chow . Its been a great xhunt to work with dr. Brown, it is clear that during the course of these 30 years, he has been the steady hand in Emergency Services here in San Francisco in the city owes you a debt of gratitude. We would not have been as prepared even responding to covid with the integration of the systems without the help when we had the opportunity to practice and create the ems processes and emergency intergent commands that went through. Personally weve gone through a lot in working with the various hospitals and particularly a chinese. I was happy to hear that in the last few years, you have been able to work with chinese to bring them into a full ambulance basic ambulance system. Something i think that for many years, those of chinese were touring and that has brought a level of service to the community i know the community may not realize but should be endebted to. And your steadiliness has shown through the change through dph and paramedic and working with the Fire Department to say that the paramedics were properly i simulated and later, dph moving or the mayor moving the our deployment. Emergency room physician at San Francisco general, its amaze ing the handson that therefore youve had both as a skilled physicians and as a administrator for your department. Weve been working on that for many years. For the work that you have done for us. So thank you, john brown you deserve a fulfilling retirement. So again, im very pleased the commission has a resolution for you. Thank you. Dr. Brown, i want to reflect on the commissioners comment that the incredible work that you have done in the city at dph. One thing i want today lift up a little bit more was your legacy of of several generations in turns residents fellows are trained in medicine in emergency response. And just, you have a huge network of john brown alumns that are grateful for that. And having personally been able to work working with you as a intern in zuckerberg and then as a resident and reminded me we were in the emergency room on new years eve of 2,000 which was if we all recall that was quite a moment because we were all waiting for something to happen. Im glad that you were there for the city sake and for my sake. So, really appreciate everything that you have done and i also wanted to rei am force when i asked what comes next, you mentioned about 8 other things that youre going to be doing in your socalled retirement. Im not sure how i think the retirement is specifically signing something on a page and moving on to other work. Thank you for being such a leader for the Health Department for San Francisco and for global health. Thank you, dr. Brown. And before you talk about. Hi. All in favor of approving this resolution, say ayele. Aye. Thank you. Unanimous. Okay, thanks, thank you very much commissioners, dr. Colfax. I will spare you a long speech but i do want to say a three things. First i want to say i really appreciate the work that you do for the community and San Francisco. Some of it is quite obvious, makes news et cetera, thank you b u there is a lot more that doesnt. And because of the way that you do this work, the inclusivity the attempt to improve continuously a real legacy that people dont recognize is the things that have not happened. So director colfax talked about that night that we were on duty, the department of health that night spent over four Million Dollars in preparation for that event for contingencies and things that may not happen. Everybody came through that night in San Francisco but without having any bad occurrences that would have been a bad outcome for them. So i think this work happens more frequently than a big event like that, it happens daytoday and as a result of the work which i know sometimes is, you know, worrying and taxing and difficult. So i deeply appreciate that and your work in that. I would like to recommend or ask you humbly that you continue to think about the prehospital providers, the disaster providers that are in the field that are doing this work right now. Its is he very moment there are 20 or 30 missed calls going on and theyre providing essential patient care of all types. And they dont get that rossing on a daytoday basis. Its their work that actually touches the patients, right. I can help, i can do things, i can manage, its they that they are providing the cure. So i want to acknowledge that and ask you to continue to recognize them and to support them. And i think that director hulkon and agency staff are in a good place right now. I appreciate your continuing support for them and especially in the arena outside ofer ms. Skilled nursing facilities theyre for the hospital patients and you can bring a tremendous amount of help in that area that thetion itself cannot perform. So i appreciate your interest, your continuing and i invite to you hold us accountable. I have very much appreciated coming to the commission doing reporting, getting you data that used to be reports but please continue to hold us accountable because i think as Public Servant as i wrote an editorial, i think that is so crucial to our work as public stewarts. So please continue that accountability. And finally the last thing that i would ask of you is to replace, so one of the reasons that im here is 10. Plan at that came from the 19 80s, i believe and one of those 10 points improving ems and disaster care in San Francisco was having a medical director. I think its so critical that the direction of ems care be considered a practice of medical care and that it comes to the Health Direct and her that you evaluate and give your comments and suggestions and orders for improvement. I would hope and one of the reasons this is the timing for my leaving, we have a deep bunch, many many people that have coming through the Training System i know there is going to be tough decisions and continues ahead but i appreciate the consideration that this is really Important Role for the people of San Francisco and its been my pleasure and honor to serve them in the last 27 years. Thank you. Ill take an opportunity for a picture. Okay, as my family says, act like you like each other get a little bit closer. One, two, three. Another round of applause. The next on the agenda, and i believe you reinforced some fpt guest statements. I have another skipt, at this time members may address the commissioners within the subject jurisdiction of the commission but not on the Meeting Agenda and Everything Else i said in my past script still pertains. I know we got two people in the room, i know we got at least one but please raise your hand if you would like to make general public. Okay, well start with the person in the mask every ones got three minutes. When the buzzard goes off, you please know that is the time to end your statement. Speaker thank you, and you identified you me as the person in the mask. My name is imelda and im here on disability action, were tender that dph plans to remove for the masking of personnel and jail settings, currently our understanding is that dr. Philips plan to remove the order on april first. And we know the masking continues to be crucial for health. Ideally we know what we have now is not enough. We would like to require masks and provide those masks. But at a minimum, we hope that San Francisco can continue the protection that we have in place by requiring personnel and healthcare and jail settings to wear masks. The first rule of medicine, its a donoharm and nobody should have to expose themselves to covid. If health cares stop Wearing Masks many people will avoid healthcare potentially dying and many will get sick. 10 or more of hospital infections lead to death. And you know, there may be an argument that we have vaccine now but its not nearly enough. According to the march third report, only 29 of San Francisco are uptodate with the Covid Vaccine with the latest vaccine. And we know that rapid test have a high rate of false negatives, even if healthcare takers are testing, they may go to work sick. And also necessary part of our commitment to equity and diversity as our pandemic is affecting people of color and even people who may not consider themselves at highrisk, its becoming clear that long covid is a serious risk for all of us. 11 in 7 of people that got could vid had symptoms for at least three months with serious impacts on their participation and school and as were trying to recover pandemic. In addition, requiring healthcare personnel to wear masks protects patients who cant mask. People with severe opd and maybe some people that may go to er requiring the personnel in these location to see wear masks protects every one in the setting. So we are in conversation with dr. Philips who we just heard from and appreciate that and urge to you also speak to her and urge her to continue this mandate for the safety of our community. Thank you. Thank you. So dr. Colfax mentioned something about y2k and all the computer glitches. Over 1300 overdoses last year 66 in january. 19 98, less than 10,000, today about 110,000 overdoses. The fact of y2k everybody knew that all the systems were going to talk, they were trying to get a man in the middle attacks. And thats what ive been talking about the last couple of times that ive been here. So its the man in the middle access, they can alter outcomes. So i pass this around or this secretary pass this around. This is my c b. C. Freedom of information report. It says that im completely healthy, i have no reportable injuries, however i was given multiple misdiagnosed to influence me so. Its virtually illegal and unconstitutional. I have reached out to multiple not just Public Health but human services. On the next page, its basically, the compliance and acceptable usage. So all of the same guidelines, so regardle of Public Health or sherlock, im going to read a couple of ones that i highlighted. You may not use the service to see commit an unlawful activity or use use would lead to physical damage, dust or mental harm or personal injury. All they need to do that is an email or land line. So its pretty serious that a system can cause injury if somebody is using it incorrectly and irresponsible. The other one i want today read for example, you may not use the service to see protector handle protection to find 160103 under United States federal regulations. So emergency is somebody is collecting information and its false information and then they use that information against you or they slander to defame you. So this is a pretty serious issue, i was talking about maybe having all the information that i have to streamline into a power point presentation just a high level presentation so you can actually see. Luckily for us, we have people who are working behind closed door. But here in San Francisco 813 overdoses, there is something happening with the man in the middle attack. Thats not normal. So, it is being worked, i think the Health Commission should learn more about it. Thank you. All right anyone else in the room . We have one remote caller, please unmute them. Youve got three minutes. This is general Public Comment. Personal, Tommy Thompson lawsuit against the city. Please mute the caller, thank you. Thats all the Public Comment. All right, well thank you. The next item is the prop q hearing is the second of two planned hearing with the Dignity Medical center to ucsf and well hear from representatives as well as uc and dignity. Im here for the second around the Health Acquisition of dignity hospital and associated clinic. For todays meeting you have received a revised regular losing for discussion and for your vote today. And the resolution included suggests provided by the Health Commission. And among the revisions include the frequency of health or updates along with information that uc has been asked to report on. And two additional clause thats were added today so im going to read those into the record. And so on page three, its thed third further resolve. Outpatient clinics will not have an impact in the community contingent upon ucsf health and we added a bullet point that says, maintaining a workforce of providers including physicians and advance practice clinicians accepting all health plans currently contracted at saint marys and Saint Frances hospital and clinics. And next further resolve, we added another bullet. And provide the Health Commission with updates, every six months to the Health Commission through june 2027 regarding the acquisition and hospital process to include the following. And weve added a bullet that states, data and information about the workforce in saint marys and Saint Frances, including physicians and advance practice clinician. And i want to thank health into resolution that added clarity. At this time, i would like to invite ucsf health. And now theyre walking up, i want to note for the public, that the clauses that you read into the octobered posted online so the public can read it. Hey, good afternoon, i guess good evening, at this point. Its a pleasure to be with you today. Can can i move this. Its being done remotely. Againstinger appreciate all of your feedback through the revision through the resolution, weve really appreciated the ability to dialogue with staff who have been helpful in enhancing this presentation. But there were a couple of key areas that we were asked to come back and focus on. Soy wanted highlight three specific areas. First is the transaction structure and to put it simply, were maining a structure that allowed this to be a separate division. Move into that and were simply substituting the board of regents. This allows all the existing contracts, all existing relationships to stay in a separate structure, it has the benefit to maintain the licenses of these apartments separately and other needs that we talked about. Second it allows a clean pathway to maintain the existing guidelines that they have with pairs, with others with little disruption. And it allows to acknowledge that the business model, the way that we will operate is fundamentally different than what we do at our main campus. It will still fall under the same structure and all the policies et cetera of this structural apply. Next slide, please. There is been how committed to seeing the medical population. I thought to set a base line for the commission that we provide some data but we can provide more uptodate and what you see here is the number of admissions that are medical by San Francisco hospitals. And what you can see here is that in 2021ucsf health was the second largest in patient provider of medical services in the city. Slightly behind the general. And you can see here that dignity also a substantial provider of medical services as is sutter, at cpnc and other locations. So ucsf health has always been committed and we continue to move forward. Were making a full commitment to maintain all of those service sxz specifically Behavioral Health. Next slide please. In the programs and we will operate those as separate operate both of those grad units as acute service maintaining the existing contracts exactly as they are today. We will honor care and other contracts, both for in Patient Health services as well as outpatient. So i believe as we think through this, this will be something that we remain committed to. And saint marries to maintain the continuity for patients that receive care today and continue to serve the needs of the community as we move into the future. We will continue to honor all the programs and services. We look forward to maintaining the present workforce. We continue to want to enhance the Community Providers that participate at both of these hospitals and hope to recruit more as we move into the future. We appreciate the opportunity to discuss this with you. We also have been engage withing Community Stakeholders about the saint marys france as they have very very deep roots in the community and were commit today learning and enhancing them. We had merchant lock so we can introduce ourselves and begin to community about the community that we serve. Well see much more visa bleed Work Together with partners not only from San Francisco general but other organizations as well. We know we have a lot of work to do and were really excited to do that. Im dwg to ask my colleagues to help me. Ill take the first question, is there any more information from the ags office about your process with the a. G. Theyre in connection with the proposed transaction and in the process of providing communities including the acquisition agreement to help document the details of u. S. F commitment to the hospital and the communities that they serve. We have not committed a formal application to the a. G. And dont have anything more to share at this juncture. We will furnish the commission more. Thank you, ill answer three more questions. The next question is what happens when they need new, what if theyre replaced by communities who did not accept medical . How are we going to maintain access and what happens if replacements come from uc and dont accept medical for certain Specialty Services . And they discussed the structure does maintain the policies that are in place at the hospital today. And, what that means is that the medical staff will continue to have the authority to control who is credentials and privileged for those hospital. And an open medical staff is anything that practices is required there. These physicians are able to participate in government problems including medical and medical. Only a number of physician right side employed by Dignity Health. The rest will be employed by ucsf health in the future and as access is needed we commit to recruiting additional physicians either from the community or practice independently or into the medical foundation which these Dignity Health members will move into transition. Ucsf does accept medical and there is a process that were working on right now to minute nice what is a coverage, that were committed to access on all practices and errors. A. G. Review and report and investments and our medical record implement. And ucsf is working very close with dignity help and he is part of the integration council. We expect that several of our investments will be and infrastructure and investment in life safety and other facility improvements. Many of these timelines are not fully in our control but were working actively to transition the project and purchases over to ucsf once that is complete. Day one is when the regulatory hurdles are met and that would include the approval by the attorney general, we are estimate thating this will happen sometime in the date spring, early summertime time frame and thats when the two will occur. We have done this before and it took start to finish 16 months and that is the timeline that we are working from. And integration structure when will the requested Data Resolution be available to the Health Commission . We know that today, the data is reported through multiple venues. This will show all services but you can have a and were happy to report progress on all of the investment that we are committed to which includes the commitment that we have to make more broadly from a regulatory stand point. And lastly anything that is requested by the attorney general, were happy to include in the sixmonth report as well. Thank you. Thank you, so at this point we have a resolution, i just want to remind everybody in the public that were not in a impact the sale but to assess whether this is beneficial to the health of san franciscans and then to monitor and followup on behalf of the public. So you have the final version of the resolution before you, and i believe on correct me if im wrong, secretary that we need to entertain a motion as to whether this will or will not adversely affect the health of san franciscans. The proper procedure is to make a resolution and then go to Public Comment. And yes, the recommendation is that its not detrimental. So moved. Second. Now we go to Public Comment. We have somebody in the room. We have three minutes. Speaker im executive director of curry seen for older adults. And all 52 years, weve been partnered with the Health Department we worked with their clinical staff. We talk patients out of the er room. And show that reducing social isolation is a health benefit. We support this merger and believe that it makes all organizations stronger, our big point is we want to make sure that Saint Frances remains a community hospital. Its a community center, its many think its the best food in the neighborhood. So we appreciate all the comments today and we look forward to working with you as we go along, thank you. Thank you, is there anyone else in the room . Weve got one more on phone. Pb is my code, this is dr. Palmer. What worries is the hospital mergers do involve going into debt. And this, resulted in increase costs to patience and also a great incentive on the part of the hospital to generate revenue. And the most lucrative is the one in out of the hospital quickly and has a surgical procedure. And charity care and psychiatric care, and for that reason, we no longer have sub acute service and hospital base rehab which we have no beds in the city. And in this care, primary doctor especially if youre medicare. And so i am very worried that there will be lip service in the begin to go maintain, we willand getting rid of market share in the tenderloin. And in the more working class areas south of market. Im grateful that theyre going to monitor more closely and has put some caveats and please keep a close eye on this. Thank you. Thank you. Please unmute the caller, thats the only Public Comment. All right, i think its time for the vote. Oh sorry, commissioner questions. Shelby about your presentation, if you can clarify for me, you mentioned that ucsf continues to work on Behavioral Health and medical. There is a step for us related Outpatient Services that has a combination of work to do with the city that is happening right now. And also work to do from a federal stand point just in the way that we are licensed. We have made tremendous progress over the last year i would say and that is part of our goal to resolve that. So what youre working on is then finally having medical cover Behavioral Services at ucsf which you do not cover currently. Thats correct. Well we dont have a contract, we still see patients but our cost but were working on getting the contract. Okay, and will that include reporter in Patient Services as well. Yes, thats the one with the federal requirement with a waiver which were working on as well. What would be helpful to us is when youre finalized, as either part of this report or separate, to concern for us as people of the city. Thank you very much. Any other commissioners or comments . Commissioner chow . This was mostly to try to understand the scares in the box that you share. About the Legal Process so i was trying to understand the scares. Youre saying that, and the regents are going to create a private Nonprofit Corporation . Close. You go ahead and do it again. And let me ask this other question too, i believe the way i heard it, we were going to have two separate hospitals one not called Saint Francis. So lets justboth hospitals are going to have their name changed, saint marys Medical Center will now become ucsf health saint marys. So those are the new names for the two hospitals. In terms of the legal structure what were doing is is today theyre housed in a non for profit structure and were going to maintain. But what i was referencing is today they were in two separate and putting them into one. Thats where youre seeing an era from going to common spirit dignity over to ucsf board of regents. Were going to main a community structure, and put both hospitals into the same box and they will get moved from one parent to a new parent which is the register enters. Okay, so i understand this will become actually the regents hospitals. Just explain for me, because historically it was initially my understanding that Saint Francis was more of an affiliate of west. So youre saying they are now part of dignity . Yes, they are. Okay, so that was part of my confusion. And, thats where i was confused because i was still in the old system where Saint Francis was an affiliate, they became a full owner on the part of dignity and spirit and Dignity Health combined. Okay. All in favor say aye. Aye. First of all, i want to thank everybody, this was tremendous amount of work and really emblematic collaboration from uc is dignity, the memo that we received from our own Health Department staff was so extensive. Youre work is incredible, you made it so complicated so clear. And having heard this meeting from so much different, San Francisco constituents all of us agree that we have the greatest hope that this will make an incredible impact. And we know that structure of uc will probably make all the we pass this resolution but the idea that youre so willing to spend back and give us reports so that we then as representative can share this publicly were very grateful for that. So thank you all for everything youve done. And we will really look forward to seeing how this evolves and how this develops, thank you very much. The next, calendar report and for this we have january louie which is our c. F. O. Public health the Second Quarter Financial Report for you. If i can have the next slide, please. In some ways im glad because there is the significant amount that has changed from First Quarter to our Second Quarter primarily around the mayors instructions which i think occured around october so the didnt reflect which how we adjust. What you see reflects the midyear budget reflections. And then, another 8. 4 million for total saving expected from dph about 98 million. With that said, we planned some of these savings in conjunction with the fairs service. Earlier as part of last calendar year when we had the final details from the Mayors Office for a total 2. 8 as part of that exercise so when you take that out, then above the what the mayor office is expecting, were looking at 67. 3 savings, of projected surplus overall yearend. And our step down but if we were to compare our improvement from First Quarter to Second Quarter in between quarters and not looking at budget. This is an improvement of 69. 4 million but a portion is the balance reflected that i discussed. Next slide, please. Most increases around San Francisco about 78 million higher than budgeted and this is 30 million of one time and 48 of on going. We used a lot of this data which we were developing in january and use as part of our february submission. Some could be on going. We also did some of the onetime dallas, there is a lot of onetime dollars that we get consistently, at some point, we know that there is just because of how the cost, cost report settle in prior year with the state and get adjudicate, so a portion has been assumed and thats what you saw. To offset some of the costs increases due to the higher senses and operating costs including registry and invasion airy costs. I will also point out with laguna honda, we have no pro ex jebsings, it felt too speculative. As well as significant change at the stages proposing around the distinct partner supplemental for all, what we call across the state not just laguna honda. Theyre propose to go do a threeyear interim rate that is affective january 2023 for three years before they actually revisit all of the rate of reimbursement for all across the stage. They are still in the process of developing that formula and it is unclear what the impact will be, we dont expect it to have necessarily adverse impact but its, you know, as they negotiate, impact all, across the state, its a little bit hard to tell so we cannot look at the same data but we know what is happening in the areas. Were hoping to get information in terms of may only, the interim rate would pass the final rate bit end of this calendar year. So hopefully possibly we may have some information by Third Quarter but its a situation that were working closely with the state. On this area. So for these reasons, so there there be a negative shortfall your end, we do have that management reserve that could buffer around this time. This is in part due to the part that recertification is extended longer than expected and were still going full force and maintaining that were maintaining all improvement while we go through the approval process itself. Most of this is in the net patient revenues so we do expect that to be on going. We have one time settlement around the hospital and care pool of 10. 6 million. And we have supplemental above budget, the program was a change that happened in last quarter which the state changed the reporting mechanism but we can claim a few ip dollars that made it more favorable. So we were not able to get that changed into our budget for this coming year. Given the updated report requirement for us. Due out of network costs. Were working with the health plan to understand what is going on there. There is and hope to have more details soon. But one area is around gender affirming services as of possible like cluster of area where were seeing some out of network costs and were work withing zuckerberg San Francisco general to see what are some of the opportunities in terms of managing this cost 6789 we also have 15 million as part of the Education Program which is also one time. Were still working on the Specialty Pharmacy contract that we expect to be in place, but until then, were protecting, shortfall. On the extend tour side, were seeing short falls and salary infringe as well as non Personnel Services primarily due to registry and materials and supplies higher senses as well and some covid testing costs that we actually did not move into operating budget. We have 3. 66 million of work order saving and also, its budget annual budget but its a Pit Stop Program which is a Restroom Program for campus. We want to make sure that there is a place for people to go and its program that is supported by provided by dpw. Next slide please. Some at laguna honda, expecting a shortfall, some inpring but offset of 21. 2. 3. 4 Million Dollars and some shortfall related to departmental services. Next slide please. This is in part of some of the payment reforms that were seeing as well as one time dollars. Were seeing a slight improvement in realignment dollars and then a shortfall for not metrics. This is the one time program that will end at the end of this year. Were seeing a saving and benefits as a result of this vacancies that we have. In the workers comp and Behavioral Health, next slide please. The primary care, there is a 14. 7 Million Dollars surplus. Its immaterial proofment and then a shortfall and then in terms of expenditure salary and fringe benefit of 7 million again relate today vacancies. I know the commissioner had a question whether the surplus is sustainable. We should be able to be hiding those metrics. Skem, but on the expenditure side, i think thats salaries infringe that could be some variation there as we continue to do batch hiring. And fill positions. Excuse me. Okay. Im back, all right, next slide please. For general health, we have infringe savings, thank you. Excuse me. Make sure that we maintain the staffing there. Next slide. Evening Population Health, there is 8. 6 Million Dollars shortfall on revenues waiting for approval to build for medicare, at the labs and were hopeful that will come through this year. In part of the vacancies but 4 Million Dollars shift that we made to grapt as part of midyear savings. So you see the costs. Moving to the next slide, our revenues, our revenue right side short. 2. 4 million for enhanced management as were working to get the program off the ground. Correction as part of our budget initial tifp and then a slight up tick in our ordinance, just minor. And then, california the medical sima which is the medical administrative activities, its offset by variance nz California Children services. And again were seeing some variances on a surplus on non personnel. And next slide, please. Were seeing that shortfall and in terms of expenditure, 2. 8 million which is part of our saving for the midyear. And then our workmens comp. Is fluctuating 4. 4 Million Dollars. Next slide, please. And with that, we turn to our management reserve and in the last quarter, we expect last fiscal year, we received a payment of 21 Million Dollars, that we were actually expecting to get in the current year budget. 1130 million so our balance remains at the cap and maximize and i would not expect it to be expected until yearend. I think that concludes my presentation,. Thank you is there any Public Comment on this item. There is a hand from a remote Public Commenters. Janet please unmute the caller. Caller youve got three minutes. Speaker on page 3lhl has 22 Million Dollars short he will two to certification and increased registry usage. by my records of tracking costs related to the mismanagement, the patient scandal in 2019, wants lead to hhh recertification expenses lhh was up to 123 Million Dollars in costs related. But who knows how long recertification is going to take and how much more its going to take to get recertified. On going support Law Enforcement and expenses. Two, lost medical revenue and 3 state fines and lots of expenses or other miscellaneous ex tenses. Additional Service Contract approved spending balance. Thank you. Any commissioners questions or comments on this idea. I noticed i failed to respond to commissioner, a question about ucsf, its essentially considered out of network so any costs severed to ucsf would likely result in out of network impact. And other areas, laguna honda is the most significant swings that were looking at. And then, you know, the new changes to the epp that i mentioned as part of the budget. So something were watching but not a current impact. It comes in patches and also in some cases, the new highers, actually dont result in necessarily new costs. Thank you. All right, thank you so much for the report and well, there is quite a bit of encouraging information on there. Yor Public Health having a surplus or the general better than we thought. Hopefully well catch up on laguna and i appreciate the hard work. Thank you, thank you, commissioners. The next item on the agenda is the directors report, director colfax. Good afternoon, director. There is a lake breaking item that was too late to include in your report but ill let you know that dph presented at the conference on retro viruses which is the premier confidence in the country. That a affective in reducing a certain stis. And we were the first to make a recommendation for certain populations including trans women, we adopted that very early on. And the team in Population Health to the remarkable job of analyzing our sti rates since we adopted that. Reduction is about 50 compared to what modeling shows would have been the rates. So this is a, late breaker at the conference was picked up by the press. But as you know, we have seen sti rates increase in the city. So this intervention is very promising, and rapidly analyzing results and presenting at the conference. So well continue to follow and report back on that. I also wanted share that is now controller of San Francisco and craysings to him. Congratulations to him. I was pleased to attend his ceremony on december 9th. And extremely Important Survey they went through a fourday training in midfebruary, and overall, the survey team was very complimentary of the cares and sevensers they observed. And they expect a followup. Another item very important to emphasize to the commissioners. We have launched the initiative, dpi Wide Initiative that is being lead by Behavioral Health. You know this is a national epidemic. O efr 80 of the overdoses is due to fentanyl. And you know the history has been fuelled by pharmaceutical companies that mislead and promoted poor prescription practices for opioids. The commissioners know that is a remarkable statistics. So there are a number of areas that core team is working on and im happy to have Behavioral Health come back to the commission to report on this very important initiative. The team is coordinating with the team, which is one of the programs that was accepted with the Mayors Office of innovation. So its a program that we have to followup with people with hospitals of resent hospitals, we make sure that were doing what we can to support them. Making sure what we can do and what we need to do differently. Then a very brief laguna honda recertification update just to remind the commissioners that the laguna honda submitted the correction for survey on the fire life portion respectively on january 13th and january 17th and we continue to await for approval and validation from both cdp and chms. Thats all i have on my report. You have other information. Thank you, is there any Public Comment. There are several hands. Please unmute caller 3, first. Caller you have three minutes. Speaker this is patrick again. The written background file of this skipped the information on la hh is worrisome. Colfax should have addressed why the shortfall is driven by incrassed staffing is needed. Has 264 fewer patients having dropped from 710 on october 14, two and a half years ago. Observers wonder if hhh has to rely on pickings. Mr. Pickens has told that mrs. No reduction in lhh. Lhh is 100 on youll ordinance has not changed significantly and incrassed increased by 30 to 50 more ftes. Given census 37. 3 thon october 14, six months and midrelatively plat with stable ftd why do they need registered usage. After all, 62. 7 percent as full as it was in 2021 but overall fte to authorized staffing. Thank you. All right, thank you thats the first of two. Janet, unmute caller 4. Youve got three minutes. Oh hi, this is dr. Palmer. I, would like to know if there is any cms requests for reducing to the plan of correction. That was not specifically addressed by dr. Colfax. And i would like to a lucidation for assumption of readmission hopefully when recertification is achieved. The public should be able to understand who is in each tier. People who are waiting for a better beinger need a bed, this is very relevant. We would also like to see, a written procedures for out reach to san franciscans who were forced to league laguna honda because of eviction who still survived and still need care. How will they be reached to get them back into county . And also, how much resident right side still waiting for discharge from laguna honda now . And, why is this process so slow . And of course my last question is how will the governorance be modified so laguna honda is no longer forced to admit that San Francisco adequately care for to the destriment of those in need of a nursing home bed. And will governorance be changed so, and this does not simply lapse after recertification and go back to the old reality of inadequate and inadequate oversight. Thank you. Thank you. There is no more Public Comment, the next item on the agenda isoh sorry, commissioners, sorry. Thats okay. I keep for getting. You had mentioned dr. Colfax if we wanted more information. I would lofp more information on cole and poet, and i dont know if there is a way, and i dont know to have a short presentation that is not rolled into the whole bh, because those get lost, you know. But i think its important for us more about these to. Of course, we can certainly, i mean what im hearing is, i dont know if its so much on what we call it but just the efforts that were making across the system this is one of the catalyst. Yeah, i mean, just more a little more in debt information, so that i better understand. Yeah. The extent because i think its important to understand to advocate in the public for what dph is doing. Yeah. And this is top of peoples agenda so to speak, so i like for information. Well work with the secretary to make sure that we get something on the agenda soon. Great, thank you very much. I actually have one question, i have a friend that is a kaiser member and only been given prep not doxy prep. At what point, do we know what systems are using that. Where are we in terms of adopting the practice . Well, dr. Philips still on . She may have, with respect recommending foefrt city. One of the things that we saw is that there was very slow up take. So thats turned around thanks to the work of people in community members. What is poper, is people want it and they take it. I prescribe it in clinic a lot. And you know it must have had, the numbers the decline so quickly suggest that the up take is very high. And its not just youre giving somebody a prescription but theyre taking it. I was surprised, we even looked through medicines and it was not among them so it would be helpful to get more clarity. And its pep, this one is doxi pep. Yeah. Exactly. Kaiser has a rebust h. I. V. Program. Maybe they need to ask for it, because sometimes they know what is going on. Thank you, i think that is it. This person takes prep without question, but we never heard of doxi pep. Thank you. Any other comments now. I will not forget to ask commissioners for comments on upcoming items on the agenda. At the february 27th committee they reviewed the Human Resources report was really encouraging. The commission congratulated the whole team, at csfg for their excellence performance as reported by the director today. Feedback that general shown brightly in its regulatory work. Resurveyed in the upcoming months. Which are on consent calendar today. Committee approved the report and the partnerships minutes report and that was a summary of the year of piped and showed up take for the equity measures that each of the various departments and divisions were taking up. Thank you very much and let me know if president green has anything to add to that. Theyre remarkable organization and its really inspiration every time we hear a report from them. So really thank you. Is there any Public Comment on this item . I see no hands. All right, is there any commissioner comment . All right, got it right for once. The next item which is Financing Update which is from commissioner chung. Good evening, commissioners. The finance and Planning Committee meeting met earlier today and we went through went through the left over item from the report and we had a pretty robust discussions on how things are being presented to the committee and were able to get a lot more clarifications and we anticipate further conversations just to make sure that we get on the same page and have the same understanding of each and also line item means on the report. And then we also approved, the march contract report and have added that to the consent calendar. And then there are a couple, two new contracts that we recommend to approve. One is for csi healthcare it to provide overall projects manager to as you ren, when we were transitioning to epic, we have a large scale to help staff understanding how to use epic so this is going to happen in the smallest scale for Behavioral Health. And another contract for Multi Services and i believe that this is one of the program that, commissioner jer ard o is really interested. Its a program where peers are the one that would go to community and do out reach and also education. To clients who might have have episode of overdose and need to connect with services for support. And then we also have added a couple of vendors on to the social list that we have approved previously. And and they are the goepio, im sorry my my head is not working well today. There are agencies that the dph have been working with in the past before. So they can quickly move on the contracts, here are the three lists. San francisco africanamerican Faith Base Coalition support for family cofamilies. Okay, that concludes my report. And yeah. Thank you, is there any Public Comment on this item . There is a hand up, yes. Janet please unmute caller 3. Speaker this is patrick again, since todays finance committee considered the consent calendar, i urge the commission to not approve the new contract. The minutes of the full Health Commission february 27, reported dph had entered into three Million Dollars contract, a total of 3 Million Dollars for similar for this new contract. Those february 7th, 2023 minutes also reported in response to a question raised by commissioner green about whether dph receives onsite. Dph provides its own super user trainings. Really far along by hiring cif of End User Services even before december 2024 . Finally given massive budget reductions ordered by mayor breed in need for the next two years, this should take priority. Thank you. That concludes Public Comment. Okay, any commissioners questions. All right, seeing none. I was thinking that it may be worth while just mentioning that the, because i asked the question, in favorial health, you know, whether or not basically its handson staffing so this is different from the technical contracts. That several dozen will be involved in this and that this is very different. So even though, we normally dont comment on consent calendar because this did come up and we spoke about it, the committee is still sound. Okay, so we can move to the consent calendar, the items that we were asked to approve, is the march report as well as procedures from csfg. And the sole source. Okay, is there a motion to approve the consent calendar items. So moved to approve. Second. All right, there any Public Comment. There is no Public Comment. All right, well take a vote, all in favor. Aye. Aye. Wonderful, got to get used to this inperson. So the next item is commissioner guirado postponed from last meeting. Yes, i will it was interesting meeting and the first presentation focused on unpermitted food vending in San Francisco which is quite an issue. The food truck have dph decalls or placards usually visible. There is multiple neighborhoods where these vendors are. Mission, tenderloin, fishermans war of are the target and there is over 4400 that are unpermitted which is quite astounding to me. So the foc sus education is primarily but it is, there is a concern because the environment can be very aggressive. And i know we also brought up the concern for food inspectors as well. We were presented with senate bill 172 by hopefully will modernize the food code. And that would be back relate today food issues, we were highly educated. On the food vending and integration with these unper mitted food carts that seem to be. They are their boast they hope that they would definitely help the situation and the safety of the food. So that was one. And the second presentation was the threeyear mental Health Services act which, the mental Health Services act was enacted in 2005, just a refresher, and its a one percent tax income over a Million Dollars. They have 7 Service Categories such as recovery, recovery treatment peertopeer support program. So there is a lot of information, there is 85 programs within this group. Community process is very infor tiff. The outcomes were presented. The peer specialist are key to the success of this work. As we just added in our consent calendar. These are the highlights of these two presentations. Thank you, any Public Comment. I see no hands. Any commissioner questions or comments. Commissioner chow. Yes, i have commented that the report from Behavioral Health was exceptional and more importantly it tied together a large contract number of programs that we passed through here. It would be nice to figure out how we can tie that together and know how much of programs that we were passing these various programs. And the amount of evaluation is considerable. And those in the finance committee were asking redundant questions because it was already there. If there was a way that we can figure out how to merge the information in with the financial side of it. Somehow, so just, just happen to want to, you know, call out that report as being really a framework for much of our contracting. Thank you, all right, i guess, the next thing is other business . Is there any other business . I see a hand from the public. Okay. Janet please unmute caller 3. This is patrick lasts comment. Dr. Palmer and others have been asking for the Commission Performance although all City Employees face annual appraisals dullinger the close session of this commission. There is no mechanism in the city toe value ate the performance of individual commissions. Or when you fail something on what to do. As the christopher declaration in the thompson lawsuit, this committee did not perform your fiduciary duties, to mismanagement of lhh and trying to get lhh recertified in new patient. The attorney declaration makes it clear you should be replaced for governing body failure. Lhh deserves a better mechanism. Before you blindly reappoint like commissioner chow who has served interrupted for nearly 30 years as he admitted while honoring, dr. Browns retirement. Thank you. I see no more Public Comment. Any commissionerokay, the next item is motion to adjourn. So move to adjourn. All right, all in favor. Aye. Aye. Thank you. Item 50 is resolution calling on department of Public Health to provide medically necessary transition related care for transgender related people and remove restrictions. In 2012 gender health sf was born out of advocacy from Community Stakeholders and local leaders. Really as response to providing quality, accessible jnder aaffirming care for the most underserved. indiscernible the way i see it, there is two ways of folks we serve at our program. The first wave of folks who never imagined surgery access was accessible to them. Many folks who had to save money or par ticipate in underground economy to access the surgery outside the country. indiscernible really to make Something Real in terms of being able to connect with the gender identity and external indiscernible and so transform so many lives of many of trans folks who never imagined it was accessible to them. Now we are in the different era and time where transrights is in the social political and general indiscernible and now we are serving young folks to support them and making sure their gender identity is connected to who they are, so providing a space to support transfolks to live authentically and that is the goal to provide the level of care trans folks deserve. When it comes to access to healthcare, while we all believe in cost control and make sure we deliver healthcare in a Cost Effective manner, i dont think that cost is a reason or legitinate rational to exclude people from healthcare indiscernible colleagues i ask for your support. Thank you supervisor wiener. Colleagues on this item can we do this without role call . Same house same call, without objection the resolution is adopted. [applause] im chanel joyce im a firefighter for the San Francisco Fire Department. I currently am the station 4. In the mission bay districtism lived in San Francisco in noe valley. Grew up with my mom and i went to high school in san ma teo. After high school i went to mississippi where i played volleyball in university of southern mississippi. What got me going after college was i was applying to place related to fire and police i loved my experience but my family is home. I grew up here and could not be far from my family anymore i came back. I have been a firefighter for 4 years the transition to the Fire Department has been seam tells is the same. Team work and coming together. Transitioning to the job med me comfortable that i made the right decision to come become and work for a Fire Department that is big in diversity and equality and becoming a fell. I got to be a member at a few different fire stations. Each station has their own culture. I worked in places that are xroem and with a young crew and had the most seniority have 3 or 2 years in whatever it may be. Learning stuff when people have been in the job for 20 plus years and learning from people got in it grew me to adopt and work with everybody. A lot of people will come up to mow and say, thank you for your service noise to see a woman in the Fire Department. You are doing it. It is nice to see kids waiving look a woman firefighter. They get excited i love that part of the job seeing the excitement that people see. You are a woman you can do this job. Every person has a good experience with the Fire Department. No one ever spokous they say, they are here. Theyre do this work and Everybody Loves them. Not everybody gets that in their job. I dont do it for the recognition but niez nice to see people that respect had you do and know you did a lot to get here and you still do to work and you set your life on the line for other people. It is cool. Good morning everybody [applause] good morning. [applause] and welcome. [applause] theres my grandma. Well