Transcripts For SFGTV Health 20240703

Ramaytush ohlone community and by affirming their sovereign rights as first peoples. Thank you. Next item on 2. Approval of the minutes of the Health Commission community and Public Health Committee Meeting of march 19, 2024, meeting. I believe secretary morewitz a few corrections. Im sorry on the bottom of page 5 the word um, skilled should say guide. And actually i need to run and get a copy of the minutes. So i wear my sneakers and on page 6 commissioner chow asked for a correction so at the top of the page states out of the 91 million spent on Health Services on the spec addressing medical conditions. Any other any additions or deletions to the agenda . All right. Seeing none, a motion to approve the minutes. So moved. Second. Second. And any Public Comment and then short statement about Public Comment autopsy lets see in the Public Comment in the room first on the minutes. There is a hand before we begin i have a statement members of the public can make comments up the three minutes. Feedback in the individuals and community the process is in the meeting for the Public Comment to engage with back and forth with the commissioners and members of the public when discussing items making requests and individuals will have an opportunity to Public Comment maybe sent to the Health Commission the word health dot and commission and. Org if you wish to spell your name for the words with the state and federal prohibits harassment and all right. So we have one hand everyone gets limited to 3 minutes per speaker as i noted before and first caller let us know youre there this is patrick code aa 24 minutes on page for about the march 12th la j. C. Meeting and the court asked how many appeals the results has been unfortunate despite my records request the commission never answered me simply to file an appeal and that is totals 34 people with 10 cases unexplained and on Troy Williams come out to be get the Good Government award with dr. Colfax in 2019 to change the recertification and williams was there then and now the quality officer by choice failure to have for decertification and might not had the 26 million for insuring the process is against mr. Williams is bad and then promised to reform the program in 2019 but causing the recertification so not honored for something that was partly responsible for creating and owe would resign in disgrace. Thank you. Thats the only Public Comment on that item. Take a vote. All in favor, say aye. Aye. Thank you. Next item is general Public Comment and the script i read before answers one additional statement you may address the members of the public on commission from taking action or discussing any item not appearing on the posted agenda, including those items raised at Public Comment. I believe we have one one minute sir, to bring it up. Go ahead. As you know im chief Financial Officer and previously talked about the illegal system and provided you that led to the patient harm like sherlocks and others and into the home invites people with solutions and outcomes but talking about a citizens arrest can execute one. I prefer not to place individuals under arrest. I prefer we let people to stay in their room and move forward without compares and today, im your honor, the Health Commission to have a criminal complaint on multiple people this is illegal. And people talk in a negative way and i ask you include in our health those charges and recommendations should have california code 502 damages and unauthorized access to Computer Data and systems and california penal code makes it a crime to send Electronic Communications with reasonable fear for his or her immediate family and i urge you the Health Commission to kwefrmg youre the right people at the right time to make that happen to put San Francisco back in the right direction within our gentrification i want to read what several people said you have the right to remain silent anything you say can be held against you in the if you cant afford an attorney do you understand those rights . I will make myself available for questions or comments for the Health Commission, however, i strongly urge to assist with needs and tomorrow to the Commission Information technology this is coming out and i think i would urge us to get ahead of that and i would recommend getting the Department Heads and communications so anyone that is miss using it people are dying over doses suicide because of this so i urge your assistance in this whole communication. Thank you. We have also a remark Public Comment. Are you unmuted please begin and it is patrick again. Ill provide written communications for this agenda item. Thank you. Thats all there is. Thank you. And i would say definitely read all the written communications we received secretary morewitz sends our way we to review them indeed the next is the directors report dr. Colfax. Thank you, president green and good afternoon, commissioners we have the directors report in front of you referring to that ill not read all but provide highlights number one, is the laguna honda hospital with the center recertification update the hospital diligently working for recertification for the centers for medicare and medical and called that in august laguna honda member mathews row certification and now to recertified or service the laguna honda submitted the plans for the ems recertification safer the Fire Life Safety was submitted on january this year and the Health Portion within january 17th this year we eagerly await in the department of health and the next steps towards april ems recertification and in addition in march of 24 laguna honda submitted the response and we are pleased to share those communication have correction for it and this department has an ongoing work with laguna honda and brings us closer to full recertification. We anticipate that we must successfully complete the safer for the laguna honda to be recertified in ems. And laguna honda team working with the survey and decided yesterday saferers arrived at laguna honda and have currently conducting a very expensive survey. Keep i updated as when that more information becomes available if cms and dph is leveraging from across the departments for reducing overdosing in San Francisco and this on increasing access to treatment we epic that the two key treatments for disorder and medicating done are cut the risk of death by 50 percent. And that which is remarkable if you think about others like diabetes and people are effected and want to get the word out and make sure that people have access to the treatments. And ore dozing team making progress targets those goals and strengthening the goals and support for high risk for overdose and in the last month dph has expanded access for people with disorders in the south of market and between the night Navigation Program and worked with the state regulators to standard the retention across San Francisco and specifically Assembly Member haney has a bill that will modernize the mebt done in the state of california and along the lines of california policies around medicating done with the federal modernization of messaging done so the state is more restrictive at that point the makes mepth done more flexible we are in strong support of the bill and hoping that that will pass the state so people can access medicating done and speaking of surveyors in march had three survey teams and with the followup from their training and in their cancer surgery the health surveyed the psychiatricy department and looking at at the system care and it went well and one surveyors or our was impressed and wants additional level of finding so she continues to be responsive to surveyor finding and quickly addressing the issues and then finally, i want to recognize Health Information information week which started yesterday information professionals week this week and our dph helped the professionals work with data and adoption for the quality patient care and so many more i want to thank the teams for theyre important work in supporting this and making sure they have access as well as revenues can be generated for the department and personally for the Health Information i appreciate the work to make sure that that system is up to date and are secure so thats my presentation and ill be happy to answer any questions you may have thank you, any Public Comment . None in the room but one commenter. Mr. Shaw. Again happy anniversary of the recertification think april 14, 2022, and a half month later dph hired to clean up the mess by the managers miss managing our key hospital and reservicing the physicians and a senior agent director dated april 15th, frour to be recertified and years and years and still no progress we need an update and though dph has chief quality officers overseeing this and a 60 day rereform program so many gives to service 2022 and a lot of microphone feedback decertification. And up to one hundred and 27 million in actually costs and potentially one hundred and 54 million. Why has recertification been to lenient and for two years doing it and another Facility Survey inspection adding another 6 months before theyre recertified . Thank you. That ends Public Comment. Any other Public Comment great. Commissioner giraudo. A couple of questions. A couple of questions. On the overdose work is there data how many people were actually engaged in the outreach of this 26 supportive of housing sites . As well accessed to tenderloin at the reach outreach. We have those i dont have those numbers in front of me but can get you those numbers to enforce what were doing here. Will be helpful just to really give us a better multiple voices . We have them. Great. My other question on um, the Public Safety inventors and Response Branch im wondering in the Branch Members of the branch folks are members of the National Pedestrian erratic coalition . Because continuation worst asking if they have excellent nationwide training virtual for pesticide trick im aware of their training im not aware of that until a couple of years ago. I dont have the answer but we can for the. The pesticide erratic National Coalition not thought of as a separate group. Thank you for raising that. Another commissioners comments and questions. Commissioner chow. In regards to the fine work for the Environmental Branch is doing im wondering there is a percent on here of the number of additional enforcement operations i wonder um, if there is a way to understand how this has actually impacted those communities in terms of at the im not sure after hours operations at giants and warriors people went home that is what were looking at there and in the others have we been able to bring this to a minimum or what will it take to that as we heard in the report that unpermitted food vending is unhealthful i want to know aside what it looks like increasing our activities but um, can we say what is still out there on the streets . So i think ill clarify if i understood youre wondering in the after hours operation what we. Yeah. Thats a sort of a separate thing i was not quite sure what after hours are but i understand a pregame multiple voices . Oftentimes ive exercised and others when a game is over, or shows at night a number of vendors line up and many vendors are not permitted so there is lots. multiple voices . Okay. Thats the case in that situation and in terms of the other question you, you asked about i believe online virtually provides more context to that. Patrick are you available . I am my video ive been looting my video it it takes time sorry. We can hear you fine. Great. I want to turn that on. Thank you dr. Colfax and commissioners for the question. There is quite a little bit of vending that remains and otherwise and has grown after the pandemic and remains a challenge i you know our Environmental Branch is tasked with making sure the safety of the food that people eat and unpermitted food vending on the street is an ongoing risk so quite a number of situations and quite a number of incidents a large number of people who are selling food without permits including dr. Colfax mentioned with the special events but in the neighborhoods of San Francisco. As a followup a wonderful feature in the chronology of the night market in chinatown and talked about the thirty or show booths were those all permitted in terms of having varies foods appropriately um, i guess supervised . Yes. Yes commissioner that situation in which again, our Environmental Health branch is involved to make sure the food safety that was a fully permitted venue that is that is a way in which we hope to encourage that type of food vending but not in a way that has oversight and aware of the safety is better for the public that is eating it. Thats great i appreciate that and like to ask one more question flarmdz to the Current Survey what do we think will be a step will be taken either from, you know, past and present it sounds like there for a few cases and after that do we expect a report back from them and have the usually back and forth. I know may not know but i want to understand the steps following the survey. I take the question and it is had a right to speculate. Theres not a do you mind um, protocol but baselines what has happened in the past the surveyors complete their visit and there is a period of time can we get the report back with finding and have to respond to those finding i expect that will happen the same way. Right. I want the public to understand what were expecting with the surveyors go on friday or something all surveys find issues that needs to be resolved i understand and therefore we again respond and um, of course, any point if they have to like what they saw they can tell us; right . We can get them recertified. Thats their option. So i think again, it is very hard to speculates what will happen theyre there to look at the different following up on the correction plan and to consolidate the correction plan and again, i think will get a response sometime in the future to see what theyre finding and once we respond to those finding well see what happens. At least waiting for sometime for them to be able to look at our correction plans and our review of the work that was done so at least that is a another move forward to our recertification so that way is important we submitted the questions in january. And it is april. They provided april 15th to come and visit for the corrections. So lets see this is helpful for any other finding addressed quickly. Thank you. Thank you very much. Any other commissioner questions or comments. All right. Seeing none, hope for a favorable outreach for the survey we know youll keep us abreast what is going on and the next item were looking at for the neighborhood the written presentation was exciting. Thank you, commissioners. For having us. And um, she is remotely diagnose her slide and just say next slide, please. Im kathy less than im the Program Manager for the program of the 2023 national hiv Behavioral Surveillance and willi mcfarland, md, phd, director, center for Public Health research with healthcare for people experiencing homelessness and next slide, please. A today, were going to do an overview at the stuart street response and go into more details about our street care teams within dph to answer the questions that was asked and then will discuss the recommendations next slide, please. Um, so im very proud to share the citywide has made a lot of progress theres a motion on the floor part of cross effort to work instead of in silos to find out how to do that together and wrap around people and with the dependents so we work closely with the department of Emergency Management and the Fire Department and department of homelessness and Supportive Housing and this is no not only communicate but make sure the timely responses are and with the department of Emergency Management you asked explicitly the street coordinator the manager somebody whom i started with and been in context and helped mow move forward seeing the essential coordination well talk about a little bit more next slide, please. As with a lot of healthcare we love our acronym and so i think youre familiar with that street ore dose Response Team many past year was the launch of homeless engagements for Response Teams and um, and that is this is the healthy street Operation Center that organs San Francisco hot street medication and the post Overdose Engagement Team the office of triage team and my program and using those acronyms a lot next slide, please. And so in following with um, Mental Health and the attitude towards that the citys response overall trying to make sure we are meeting people where theyre at we have a Response Team 911 those are emergencies and so they are triaged to the overdose Response Team and also Rapid Response the community is once available and that is how the before mentioned heart Team Responses and our teams are focused on planned engagement focused on individuals. And so that is also there the encampment work as a team and street medication and as well as the triage in the neighborhoods. Next slide, please. And so those are objective have a lot of Civil Service teams engaged and also working closely with Community Based providers with the Services Providing Peer Services for the best neighbors and the center providing Mental Health work and couldnt do this without them an overview of the process that is the level of coordination we do across the departments we do have more flexibility and agreement about how you we are working with people experiencing homelessness and Behavioral Health crises on the street so this is sort of illustrates that and we develop our cup president green asking do we have target were surveying and were moving people closer to the safety and health stability and how the street teams is by treatment and care and how people improve their access to healthcare and people that are experiencing Substance Abuse we are Offering Services to meet people in different stages of change and were going to share a few examples like connections and the healthcare and Behavorial Health care will showcase where we are leading people in the stages of change and um, and again to slide 16 we want to go out of order i can offer an anecdotal story to highlight what were talking about with the care coordination stabilization for people and this scenario is mary and this is someone we came up that that scenario based on realtime experiences with hospitalization and she is 43 she experience bio policy and uses fentanyl and shes unsheltered and in a crisis 911 is engaged and the street crises Response Team meets mary. They asked about engagement refer her for followup for behavorial for the triage team so if dispatches into the neighborhood my team. Our Team Responses to the following day and mary is highlight visible person. Next slide, please. And staying on the street experiencing crisis and has Substance Abuse. So that Neighborhood Team i mentioned outreach the following day they find her and she expresses not in a shelter not interested this physical healthcare and very clear shes in need of all those things with her communication from the street crisis Response Team and the adoption there and she does agree backpacks the neighborhoods to come back to speak with her again so we do. Next slide, please. And we provide another engagement the following day. And we this time are accompanied by a nurse in the care and as of an initial engagement mary allows care and on the street with street medication and so we followup quickly and so this in this case three times a week um, will be a many times and needed if this person is in crisis and Building Trust by coming back after several weeks she opened up to the team about some of our Mental Health challenges and the team offers psychiatry as well as street medication and psychiatrists addressed her and recommendations mentioned. Mary has medication but concerned about being on the streets and taking those and can compromise her safety the team visits the shelters because an opportunity to motivate someone and shes able to agree to that we hope her move into a shelter next slide, please. And scientists are able to start marion medication and provide that medication for bridge support and mary connects with the shelter team instead of medical nursing team by the management and other medical needs. She continues to decline the treatments and the best Neighborhood Team and shelter teamwork on using activation motivations and simultaneous is the team works on obtaining permit for mary by connecting her to another team. They becomes more stable for shelters but work on her car to intensifies Case Management people in shelters housed and serves in the community. The Case Management takes over her Mental Health treatment and helps her to move forward and she has reduced the stress a packet to housing. And so if we could go back to slide 8 please thank you for the detour i wanted to share what we think is a Success Story a really beautiful path for someone to follow id like to talk about that in a way that with he if we have the lowest moments of our lives to see people through care to coordinate on a level we are a remarkable and we are im very impressed with the coordination were doing. So our 17 street team we as you can see we in 2023 have over 23 though encounters with people experiencing homelessness and offering a wide range of the overdose preservation and make sure we wrap around all peoples needs and go into that in the next few slides. Next slide, please. Um, like many dph teams in Behavorial Health care we find a disciplinary approach is the most successful those are the way people are compassionate and also a way to really work people towards goals quickly an example is mary in the moments she is open to medication the quicker we can get her into shelters and treatment better so having nurses street psychiatry with the Behavorial Health clinictions and i dictionary medication providers fortifies building that needed trust with the system. And focused on short term and long term i think that mary needs both there is in stopping to wait for one thing to happen before we move forward we are pushing Supportive Housing additional assessments Meeting Needs around psychiatry and supply food and transport and other resources next slide, please. And im happy to share about the best neighborhoods one of the streets care teams um, and so we launched in march of 2023 as part of office of corresponding care with Behavorial Health assessments for People Living on the streets with acute Behavorial Health needs and our team is placed we are neighborhood based and the same teams in the same neighborhoods through the the week so not just people experiencing homelessness but getting to know the geography for other communitybased organizations and find that approach is incredibly helpful to wrap around people and level the information needed to work with people. Um, we are working closely with the e m street medication and why think any of our work is done on the owner it is alcoholic and our clients are like mary referred to the followup for the teams come to the triage team and we also work with shared clients those are people that are having contacts and garnering many 911 highrisk and not doing well experiencing homelessness so we work to elevate their needs. Um, in march our first year of service march 23rd to this, 85 engagements on the street and we had 11 hundred offering 11 hundred links to the services and medical care and sheltered and our budget is over 6 million and we currently are staffed about Civil Service and peers unintelligible . Thank you. Next slide, please. We also sorry have the street crisis team those are actually led the work on the ground by the Fire Department. The dph did collaborate with the build contracted staff on the rigs or the 911 dispatch vehicle and graham peers on the Response Team in addition to the hsh staff. And dph contracts other peers on the streets for over dose Response Team next slide, please. Kathleen thank you for your leadership and we are in meetings and communication not daily but many, many times a week it is longerterm 6 days a week and statements are provided for in the moment for you are talking about care needs oftentimes when theyre seen by another Outreach Team and providing what we can transition to primary care people that have a hard time connecting so in a number of situations the street medication providers is oftentimes through someone you might think of we go to them and people find care we have 16 offline clinics at home reduction we want to go where people are experiencing homelessness. So in this community um, our street medication clinic providers work at the center and a lot of times 1340b will be connected to street medication by a Outreach Team and get to know the medication and get software and were going to build a relationship and street medication in the past year about three thousand mentioned for over 11 thousand folks it is 5 million and there is about 18 and a half staff that is nurses and house workers and medical providers and also have peers who help out on the Peer Services. There was a followup question. So and can we go to the next slide, please. Our next slide the teams that is in about one year and reading with survivors experience a nonfatal overdose but the paramedics that respond to the new any call and the post overdose compensated team that works with the followup in engaging people in an ongoing way that team has about 15 hundred in clournts in the past year for 6 hundred clients and seven hundred and 8 three treatments and commissioner giraudo had a question about accessing treatment and how to get the integrated data about mebt done and a door of opportunities to connect people for disorders and knowing that people may slow over time when someone says no theyre not interested we take that as were to refer to another way to engage people. Weve done a lot of counseling about the owe dose and talk about in a minute. But we look at the numbers for fy202223 our team did a lot of clournl on ore dose prevention and providing medication and describing a little bit of referring to management the budget is four and a half Million Dollars and that is the staff dph staff and Health Workers and providers and the communitybased organizations contracts. For Behavorial Health. What we really found and president green asked a question about is we had a really found out was an amazing window of opportunities for people to seek change after on overdose we found that it is try that is really the high road for people and other people were in a state of crisis feeling sick not wanting to engage at that moment we spent a lot of time looking for people that we couldnt really find so we got the information from the Fire Department. About who they had seen the day before our staff goes out and loose for people and people offering information and hard to get to know weve been doing a lot of work what is that model for the program that the program around providing at the right time to do this work and we have been shifting from running around the city looking for a market and 7 to try to identify more individuals with a higher and i cut and higher priority like people that have experienced overdosing and to move forward those in is in a overdose and needs treatment for medication people that are interested in medication for opioid disorders or other treatment we want to make sure we are there for the windows of opportunities and people that are referred by Community Partners who have higher risk conditions who might be pregnant or oat Health Issues to make sure we are focusing on our vulnerable survivors our clients are in two groups those were working with that are interested and people that are really hi risk and not interested in care were looking at how do we sort of come up with the metrics for those models and making sure were providing care i know that president green had a question about the testing and screening which is a offered for through our street Medication Team um, and people have a positive test we have two people in the field to get to people and make it as easy as possible. Next slide, please. We have had a number of improvements and really working on reporting on that goal we know those are questions you asked us about and really want to make sure we are capturing the data across the teams and doing a lot of great work in the neighborhood and tracking and supporting them and street medication on a number of quality goals computing monitoring the number of clients that are screened important alcohol and tobacco and we or able to bring our Healthcare Services to the street and using telling help services we launched looking at the metrics around hiv and undetected fiber left side and there our medical team reporting what were doing and as part of the our coordinated iron collaborate in the use of acid on a citywide level to identify the citywide serves and the players and individuals that can attest moving forward i was in two meetings about this and after reporting today so well have the board informed about that and. Next slide, please. We had several recommends for things we want to provide i update on one of them was the service model. To improve the success rate and followup for clients referred to services and the followup rate at the time of the street audit was 64 percent that increased from up 20 percent in 2022 and beyond. And merged the Response Team into the office of care that provides health coordinates and photocopy for people that have multi contacts and i know we talked about some of the changes we made that were spending less time looking for people. And who may not be in San Francisco. And really focusing our effort on the higher acute and for poet we are working with the specific through the Mayors Office of engagement to make sure the team our poet team and work with people if permanent housing and really have a connection so we dont lose people as at the move through the system i know that president green had a question about followup and a lot of is the office of coordinated care with the fire and the contacts and we also do a chart to insure that were in a position to learn more about the individual we know where they are in the system so we are not relooking at services and bring in the partner that people maybe working with a lot of time our team and then by triage and we connecting important potentially a new service. And. Next slide, please. We have talked about this scenario again to define that intensive story to look at working with the Vulnerable People in the community really takes a number of teams and our team developed specialists in certain ways i know that brings a lot of questions and really wonderful in the past year to come up with the coordinated ways in which were kwopd and working hard to help support people. Thank you so much for the presentation it is encouraging to hear about the coordination working together with that is important we appreciate all the work youre diagnose a huge challenge that we all have great concerns my Public Comment on this item. Yes. We have one remote Public Comment. Hand up the person. Mr. Shaw youre unmute. And i didnt lower my hand. No Public Comment. Commissioners comments and questions . Commissioner chow. Yes. Um, thank you for this whole list of 9 different organizations in cooperation and i was looking at all the numbers and you actually were answering some of my questions where you want to go in the future. What im curious about right now with all of those teams is whether or not the individual well, first of all, a central file on those individuals so that all the diversity teams what look at that additional then the individual side is there a particular person that the individual can identify as being theyre what we call in clinical medication primary care but would be somebody they trust and then look at where they want to go you 2345ekd mary through a Different Team but if i were mary, i might really want to know, you know, who can i count on can look for the teams for me. Those are kind of two questions. Ill take that [off mic. ] i would say in terms of where the centralized we our team in street medication in the best neighborhood of coordinated care that is will be helpful essentially getting the data how many times this person has been to the hospital and how many engagements with the software and that is also information were sharing across the departments helping us the coordination allows us to see most updated care plan and the next step for the person the point person for them and so those that is what were communicating in realtime. Um, the office of care ill say is filling that piece of people transitioning the point person is mary is in the best neighborhood were talking her through the roll and being there with her transitioning for her ongoing care in the interim is meant to be that for people in the best neighborhoods serving that role for the point person living on the street and for the primary care. In the person it depends on the individual that is important for them to feel trust in one individual all helpful for them and team we get to know and we dont want them to be on vacation or sick and a lot of times medication is with a disciplinarian team is gathering for healthcare working we try to have consist staff that is helpful they get to know more than one person so theyre familiar and so someone is on comfortable talking with one person well find a way they can identify a point person. So we looked at the example im trying to picture how this all groups or teams kind of Work Together. How did mary, i guess get all the information Different Team members come to her . And then was she able or someone like mary for them to guarantee id like to see if i want to go here and start treatment and if they did feel they wanted some person how do you assign in that which of those blocks or teams. So i think in this situation that neighborhood will be the point person. And i think for mary usually a lot of like getting to know her asking her questions can we give her water has she thought about open to telling us about you wear red a better color and find ways to work have you thought about going inside. And so a lot of times when we talked about our staff identifying were concerned about mary for the monitoring the first couple of times people met her they went away but building the relationship and planting the seed were taking mary to place maybe next week ill be here and introduce you and were going to get you into shelters and introduce you to the staff. And we have a helper feel free to call me, you talking about free to call moan in the team . Yeah. It mary was connected to a person theyll be saying student shelter we need youre having a hard time connecting with mary, i, join you. Okay. So you look at significant your offering a team and if theyre comfortable with the team youre taking the team and they work with the team and people otherwise somebody really look like to be able to make decisions with one person and then ask that one person probably out of best program and i think, you know, even one person for the best program mary had specialized needs that require medical services so thats the best coordinated im there making the introductions and having her connected with the services. Thank you. No, thank you. A lot of hard work corresponding with the teams and needs to help the individuals really appreciate the report. Thank you. Vice president guillermo. Thank you for your report and all the work and that been able to put into that and report for the progress i know a lot of this in the coordination is new the collaboration is new so difficult to be able to reports peacefully are but you helped us to understand. It is analytic out labor intensive and skill intensive and intensive this whole effort across the city for such a large challenging problem im wondering as part of the your evaluation of how this is going we think about the numbers on growing is that possible to stress test this model and think about what is the capacity for this model, you know, to serve the number, you know, in the judge a scenario planning thing whatever. However, that might get done and probably need more data to do that but is it potential we look at the success and missing 5 ftes and i think that are in the best interest the best and then recruiting the kinds of clinical and other specialized talent to this. Really need i think real critical realistic look at what is possible and how much of it is possible. Um, so is it possible to estimate that . And then to plan it accordingly assuming as you described are the best ways to do it . I lost. Thank you for at acknowledgement of coordination i know to step out and the leadership of the dph and in a collective way with the departments never works in silos but a leadership directive that people are not take care i cant tell were working together and the same goals and clients and that has been really level for our work in some of the organizational changes are working together and we think this it partnering from our sister, you know, department unintelligible so the place of capacity feels to me were in the best practices we work with the authority and really looking at each of the teams has that capacity of individual unintelligible oftentimes in the thousand and for the people that really need the alcoholic coordinated Work Together that is vulnerable and oftentimes seems less interested what we have to over that is the place were to identify with what are the numbers we can work with. Um, understanding some people will be coming in working with them intensely and hoping backing off and destable them and connecting them to others things why have a concrete answer but backing both that and i curious what my colleagues. The pirate list working with the staff and youre talking about the stress test with the most at risk who are they and to begin with you. Part of what i was getting at can we predict or estimate the capacity that requires needed the resources all the kinds of resources and what might is take . For our job, you, know, we need to be able to put that in the connection as we look at the individual programs that come to us. And we, you know, um, maybe will be annual report on the coordinator effort but in a time of dylan resources and higher assuming were making a difference it sounds like we are. We have to say then and be able to support more of this; right . Were a modification and the other priorities; right . This really important to have that from you what is potential not just in terms of outcomes of individuals but it totality and prediction into the future. So that will allow us to take some of the integrated data systems and people are experienced homeless with multiple departments visits and multiple fte visits with over dose with which one Health Issues youre the integrated data to identify this and help us tell you what were seeing as the collective data. Commissioner giraudo. Thank you for answering my questions i appreciate it excellent presentation. Within the things i often do i represent the General Hospital foundation and also present at the meeting something here on ive done it video think those initial crisis Response Team and im presenting again which im going to use some of your slides but will be helpful i dont need a slide but to um, mark a 5 sentences and what it is because i think, you know, what youre saying this is going to be a key. Yes. In pulling things together will be questions of many of those techie members and, etc. So you wouldnt mind just. unintelligible . Im not incorrectly quoting you. Thank you very much. Is helpful i looked forward to continued information from you. Thank you. I echo that looks like you have a really thoughtful infrastructure in place i think that we will especially about the poet team im wondering when you look at our prescribed morphine 15 percent for the management what kind of context can you give us for that i thought that was interesting obviously, the moment of crises people are not thinking beyond the moment i guess the question if you could create and realistic statistic what will it be . And secondarily another thing like boston many years involved the best practices to accelerate our work and hips us avoid effort that exact may not be as effective as others im wondering if you can create help us understand if you you were to refer back in a year on poet what will be europe dream presentation and then are there lessons to learn to accelerate the work. I know our teams are working across the country and going to healthcare for the homeless and a number of medical doctors and frequent speaker at at number of, you know, National Conferences and thank like i said and i can get the information about the specific partners as well as were work with the partners and coauthor what might be expected outcomes as far as, you know, medication starts and other patients to care treatment is supposed to have that i dont want to misquote that information off the top of my head. It will be helpful to have a benchmarks from other jurisdictions trying to had the same work like a fat problem so appreciate what youre doing everything including to the loss of collaboration and objective every success is tremendous we support our work entirely and in the commission can help you most honored and appreciate what youre doing. Thank you. Amazing. Staff youre out there everyday and had a lot of rain recently and youre out there in there in the rain and with the air quality is bad and youre incredibly condominium to building relationships for vulnerable neighbors. Thank you to your team as well. Wonderful. All right. Next item on the agenda is Committee Report for laguna honda. Thank you. At the april 9th laguna honda hospital j. C. Meeting the committee reviewed the reports for the executive report and the vacancies the h. R. Vacancy report and also had recertification updates as dr. Colfax noted we had at the time i participated and hoping that the survey team was going to be arriving at the laguna honda any day and fortunately, we heard they arrived yesterday and as far as we know hadnt been anything untoward to report from there but, you know, there is a lot of that so hopefully, well hear they have completed their review and were going to continue to move on is recertification june in a positive way and reviewed the Regulatory Affairs report and, you know, is in the midst of recertification and stabilization issues that laguna honda has been quite a recognition of some of the work going on otherwise at laguna honda. And the leadership were asked to present as conference and in reporting back to us sandra simon at laguna honda noted a number of the folks at the this as National Conference whatnot Just Healthcare but a lien across the lots of implementers ask what they thought was an interesting unique complication of the liens with realignment care that is blazing a trail i think that is important for us to know a lot of good work coming out of an unfortunate um, period over the last couple of years um, so said to make sure we noted that and during the review policies the committee requested that one policy approval delayed to the complexity of subject matters and the need for additional clarification well be putting that on the Consent Agenda for today except for one policy well hope to review in the meeting next month and in the closed session we approved the report. Any Public Comment on this item . One hand up. Mr. Shaw you have limited to 3 minutes per speaker. Thank you. This is patrick again. The j. C. Meeting summary presented didnt men the chart on april 9, 2022, with the certification two years on april 14th a total of 4 hundred and 15 facility incidents reports on a Regulatory Affairs report present for the jcc those after recertification occurred one had the and 29 roecht 1 3rd for the events 5 three major incidents 41 percent including 26 events and 11 major injuries one thousand corrective action incidents costing 40 million. And unfortunately, members of the public do the right thing how many of 11 injuries included about the residents and were in the regulatory report finally revealing the jc dying within and number 7 forward Regulatory Affairs report complaints not investigated is concerning the 70 the march 16th, predicament finding may change due to the patience to investigate they received a final citation and unfortunately, didnt indicate in the jc had anomalies complaints are not investigated. Thank you. Thats the only comment for this item. Any commissioner comments or questions on the Committee Report seeing none, next item is the Consent Agenda have before you the policies that were reviewed and recommended for the full Commission Approval for this um, group of amount of policies is there a motion to approve um, the Consent Agenda. So moved. Second. Any Public Comment. I see one hand. Mr. Shaw youre unmuted. I want it thank the commission for house voting the um, policy from the jc meeting for additional revisions but other than that no to the Public Comment. But thank you, commissioners. All right. Thats the only comment. Okay. Thank you. So you see is before you an action item go to a vote. All in favor, say aye. Aye. Thank you. So it is approved. And the next item is the report from the Public Safety commissioner giraudo. Two interesting presentations. The first was health and it focused on the medical Behavorial Health programs of j ph the jail and their goal to screen stabilize and link um, the incarcerated the Services Include both from primary care and control Mental Health and Substance Abuse disorder. In last year were 11 thousand three hundred and 6 incarcerations seven hundred and 7 thousand plus and 82 percent male and 6 february of 24 this year 26 were latino and black and 44 white and three 23 percent and the average number of patients from july to march was um, those that were screened for opioid per month were seven hundred and 67 people. But today 7 which is a very few are still in in custody and only 19 agreed to further treatment out of those folks. 76 percent of those that are incarcerated are released within 7 days so today 1,000 plus people in the jail. Um, what is interesting was noted theres a 5 three percent theyre in um, those that are in jail from may 20, 2022, to now. Um, one of the areas we really decided and they gave us great information was on the difference that kelly aim 97 percent in the jail were qualified and allows the providers to come in and link with the patient for post relieve services. Um, they have are um, jail help has an application to cal with bulk to start month of services under cal aim are jailhouse programs have already are Ongoing Services but there are new and as of april 2025 have their applications approved and be able to build those services and be able to connect those do not have medical and it was a Interesting Data driven report and with the challenges that they definitely have. Our second report was the hiv 2023 national hiv Behavioral Surveillance which is fund by grants and paralleling nih that is reported is men who have sex with men and the goal of the study was to look at preferences approximate and care programs and emerging Health Issues the example that was conducted in San Francisco were 5 hundred and 45 were enrolled up the in n h in 2023, 24 percent and were one in four men who have sex with men are living with hiv. Um, there is a disparity in with in the numbers of those 45 percent of that population are black africanamericans with the last x population on the other hand, merging and their numbers are rising. Of those surveyed 92 percent have insurance and 82 percent were tested for hiv a slight increase of 82 percent and settlement on the engagement with preparing that is statistics in San Francisco for those engaged with preparing are higher than in the rest of the country. Um, but those who used prep in the last 12 months the numbers are slightly down. In 2022 since 2022 that is the last figures they have one had and 57 new dialysis one of the concerns is that the numbers might be stalling because of the use of the medication for a variety of reasons. Um, one multiple which they noted but many of the providers one the biggest one it is the primary care providers not asking the patient about whether or not they have used prep or access to prep that is surprising but within the questions i asked they came up with the data. But the positives that came out was in p. O. Box were still one of the most successful in the country and as well as in hiv not only identification but prevention continue to be one of the leaders in the country so was an update on the study. Um, cannibis a little bit different which is great different than proving we can presented for. So that concludes my report. Anything more to add. Thank you for the report any Public Comment . I see a hand. Actual the hand went down in Public Comment. I have a question commissioners questions or comments. Commissioner chow. Incidental the only comment or perhaps we know since the amount of the money is a work order from the sheriff if we do do billing will we be able to keep that . My understanding is that one be separate. Oh. Okay. Thank you. And also pay for additional staff theyre going to be hiring a mutual budget. Oh. Okay. So we should be getting more. multiple voices. and that is double. Part it is fair right now targeting at least 15 staff they will be hiring to be able to implement the program. Right thank you. Here we go no other commissioners questions or comments thank you, again. And well two to others business. Any other business . No Public Comments. In Public Comments. The next motion to go into closed session. Second. And any Public Comment. No Public Comment. I will unmute the caller mr. Shaw limited to 3 minutes per speaker. Thank you secretary morewitz. Here we go. As i go into closed session dont forget this commission clearly do you mind the declaration as it is coming up as the governing body didnt perform its fiduciary duty it costs the city 1. 5 million for the hospital and failing for two years for emissions the declaration was clear and replace the Governor Brown body failures and san franciscans deserve better oversight mechanism and the declaration that lawsuit is not my journey and with objections for double and trip that is preposterous. City attorney is asking us, we for our lying is referring to the 5 hundred and 7 pages of documents for the 268 million and document the pms coughing why does i expect us to believe without our own eyes for the recertification this doesnt be how they operate and now we are asked to look at the pages with double and triple mismanagement and by the declarations for the fiduciary objections. Thank you. Thats the only comment for this item. Great. All in favor, say aye. Aye. Going that closed session. Please give me me sfgov well be back sfgovtv im going to move you to in closed session . By disclose or not disclose. I make a motion to not disclose. All in favor, say aye. Aye. Thank you and now consideration for so moved. All in favor, say aye. Aye. Thank you, everyone [meeting adjourned] tenderloin is unique neighborhood where geographically place in downtown San Francisco and on every Street Corner have liquor store in the corner it stores pretty much every single block has a liquor store but there are impoverishes Grocery Stores im the cocoordinated of the Healthy Corner store collaboration close to 35 hundred residents 4 thousand are children the medium is about 23,000 a year so a low Income Neighborhood many new immigrants and many people on fixed incomes residents have it travel outside of their neighborhood to assess fruits and vegetables it can be come senator for seniors and hard to travel get on a bus to get an apple or a pear or like tomatoes to fit into their meals my my name is ryan the cocoordinate for the tenderloin healthy store he coalition we work in the neighborhood trying to support Small Businesses and improving access to healthy produce in the tenderloin that is one of the most neighborhoods that didnt have access to a full Service Grocery store and we california together out of the meeting held in 2012 through the Major Development center the survey with the corners stores many stores do have access and some are bad quality and an overwhelming support from Community Members wanting to utilities the service spas we decided to work with the Small Businesses as their role within the community and bringing more Fresh Produce produce cerebrothe neighborhood their compassionate about creating a healthy environment when we get into the work they rise up to leadership. The Different Stores and assessment and trying to get them to understand the value of having Healthy Foods at a reasonable price you can offer people fruits and vegetables and healthy produce they cant afford it not going to be able to allow it so thats why i want to get involved and we just make sure that there are alternatives to people can come into a store and not just see cookies and candies and potting chips and that kind of thing hi, im cindy the director of the a preif you believe program it is so important about Healthy Retail in the low Income Community is how it brings that health and hope to the communities i worked in the tenderloin for 20 years the difference you walk out the door and there is a bright new list of fresh fruits and vegetables some place you know is safe and welcoming it makes. Huge difference to the whole environment of the community what so important about retail environments in those neighborhoods it that sense of dignity and Community Safe way. This is why it is important for the neighborhood we have families that needs healthy have a lot of families that live up here most of them fruits and vegetables so thats good as far been doing good. Now that i had this this is really great for me, i, go and get fresh fruits and vegetables it is healthy being a diabetic youre not supposed to get carbons but getting extra food a all carbons not eating a lot of vegetables was bringing up my whether or not pressure once i got on the program everybody o everything i lost weight and my Blood Pressure came down helped in so many different ways the most important piece to me when we start seeing the Business Owners engagement and their participation in the program but how proud to speak that is the most moving piece of this program yes economic and social benefits and so forth but the personal pride Business Owners talk about in the program is interesting and regarding starting to understand how theyre part of the larger fabric of the community and this is just not the corner store they have influence over their community. It is an owner of this in the department of interior i see the great impact usually that is like people having especially with a small family think liquor store sells alcohol traditional alcohol but when they see this their vision is changed it is a small Grocery Store for them so they more options not just beer and wine but Healthy Options good for the business and good for the community i wish to have moretelevision. In 1948 swensens ice cream used to make ice cream in the navy and decided to open up an ice cream shop it it takes time for the parent to put money down and diane one of the managers at zen citizen in arena hills open and serve oldfashioned ice cream. Over 20 years. Yeah. Had my own business i was a firefighter and came in in 1969 her dad had ice cream and left here still the owner but shortly after um, in here became the inc. Maker the manager and lead and branded the store from day to day and in the late 90s was obvious choice he sold it to him and he called us up one night and said im going to sell the Ice Cream Store what you you talking about diane came and looked at the store and something we want to do and had a history of her dad here and growing up here at the Ice Cream Store we decided to take that business on. And have it in the family i didnt want to sell it. To keep it here in San Francisco. And unintelligible . Share worked there and worked with all the people and a lot of customers come in. A round hill in the adjoining areas loved neither ice cream shop in this area and support russia hills and have clean up day and give them free ice cream because that is those are the people that keep us the opportunity to stick around here four so many years next generations have been coming her 20 er thirty or 40 years and we have the ingredients something it sold and, you know, her dad said to treat the customers right and people will keep on coming back and 75 or 74 years, you know, that is quite an accomplishment i think of it as our first 75 years and like to see that, you know, going into the future um, that ice cream shop will be around used to be 4 hundred in the United States and all gone equipment for that one that is the first and last were proud of that were Still Standing and people people are you tell people its been around in 50 years and dont plan on you are watching San Francisco rising. [music] todays special guest is mano raju. Hi. Im chris and you are watching San Francisco rising the show about restarting and rebuilding and reimagineings our city. Our guest is mano raju San Franciscos public defender great you could be here. Actual at this time us about yourself how you became the public defend and why it is important to provide legal representtation to people that cant afford council. I started in Contra Costa County graduated from berkeley and a liven deputy for you a number of years special jeff recruited me to San Francisco the former elected public defender of San Francisco and i began as a Line Department here and then asked me to be Training Direct and the managers of the felony unit the unit most serious case. After he passed away, i was appointed to be the public defend and electd and recently reelected. But you know what i think about what you know the story of public to the office i like to start with my parents. They come from a farming village in india and dad was the first in family to finish high school. There were a couple people in his village who saw him and encouraged his parentses to pursue studies and move in the country when i think of what public defenders dot most person thing is to see our clients so than i can hopefully realize their full potential that is important to me and to our office and the cult usual of our office. You know the right to a public defender was developed in 1963 in gideon case ensuring the right to a public defender. We take this very seriously in our office. My vision is that anyone in our office should be representing the people represent the same way they want their love 1s to representd and people think if you have a public defender representing you in San Francisco you will bet better than a private attorney. We will leave no stone unturned no motion unfiled and try to perform the highest level for clients thats fantastic often when people think public defenders they jump to the idea of somebody defending somebody in court your office does more than courtroom representation. Im an elected public dem felonieder i campaigned on that it is important we break the mold of what is public for our office on accomplish. Fiercely defending is the core of what we do and that will never go, way. As the only elected public defender there is an elected da and sheriff in every county. In the state but one elected public defender. It is important our office pushed envelope and engage in the national and state wide and local policy that will Impact Community how Public Safety and our clients. We have local policy directors, state policy director. We are active in sacramento in trying to make the law change in order to be more humane system for our clients. We are believer in advocating for community power. We have two 501c3s in bayview and fillmore that are be more magic under the umbrelast public defenders office. These are Youth Empowerment organizations that do programming throughout the summers. Which back pack give, ways to kid school sflois start the school year and believe engaging youth will prevent them from become clients. And put people on the path to thrive. We have a program, end of cycle program. Culturally competent social workers going to the jails and finding out what the individual needs. Well fight for their best legal outcome in the case. And the position of trust the fifth amendment protects the conversations that our clients can have with us. We can use that to really encourage a trusting rep and telling us what they need and be frank and connect that individual with the Substance Abuse or mentor or housing or employment and Educational Opportunities hamp that individual needs to thrive and reach their full potential. That is another piece behalf we do. 17 units across our department and you know we take collaborating across units something we try to do every tail to meet our mission, vision and values. A part is ensuring recidivism does not reoccur of course the left thing we want to see is a client to return to be a client again. We work intentionally from the moment we start representing a client with our Skilled Staff and other members of our team to try to figure out what is that future going to be for the client when they leave our care . Now, some critics argue public defenders have a heavy case load. How is your office mechanicing this and what issues are most important to you. Why we have a heavy case load. Unfortunately, this is a problem across the country, public defenders are not funds equal low to da offices our fund suggest 61 of the da office. And the Police Department has 14 time the our budget. And there is the Sheriffs Department and any time the entities are detaining our cloinlt in i way it is up to us to defend this is manage we are working on locally. And alsoination wide to change that. We need more staff and every wing of our office. The logo is greater than one. So we know that we need to be greater twhoon individual in the office and use our teams effectively and strategically and skillfully and put in more hours to make sure we reveal truth and make justice happen in courtrooms. Greater than one also symbolizes the fact we are collaborating with other communities organizations to try to support and help our client and move policies that will help our clients. An example of this is the pretextual stop campaign we collaborated with 110 organizations throughout the city to convince the Police Commission to pass the general order that stops some of the stops traffic stops for things that dont impact Public Safety and lead to often con41ational interactions with the police and civil yens and. We wanted to minimize that mostly the shootings we read about and the the violence of inneraction gets in car and tragic occurrence that can happen. By collaborating we can be powerful than the sheer numbers in our organization. Sure. So you know like cities cross the country San Francisco struggling with fentanyl and homelessness, how can our office contribute to help mitigate or solve those problems . One thing we can do, again often times with Community Based organizations; is to really try and figure out how we address the demand. You know. Treatment on demand. Again. Finding people opportunity with housing or employment opportunity. You know mitigation or just any form of counciling that helps people. Move in more positive direction in a way more inviting oppose to co hearsive. Now we dont have enough beds for everyone who needs that intensive treatment. Contributing to staffers to get more funding for people to get treatment they need. Because the reality is there will always be someone to fill the need. We work on the demand, which evidence based there was fee of dealing with addiction will move in a more positive direction. Then, finally, what else would you like residents of San Francisco to know about you and your office . I think what i like the San Francisco residents to know is how muchow important it is that the public defender be aggressive. Right now we had a huge backlog of cases in San Francisco. There were over a housand passed the last day. A right to a speedy try and have case passed the last day. We had to plaintiff and against the court t. Is important this we have an independent public defend 30 is willing to do that. And we got a good decision from the court of appeal and now the courts move quick and are honoring this and the effort from policy team to 850 bryant the courthouse is to draw attention to this issue it is important we have an aggressive public defender. Had someone gets convicted for something they did not do it impacts their family. Clients are greater than one, it is important we fierce low defend. The same time because when someone gets convicted of something they did not do they are less likely to access the j. W. They need for stability or housing and then will impability a lot of people and lead to more issues on the streets and affect Public Safety. Also to realize we are a Public Safety organization. We have social workers and take this social worker mentality or support facilitative prop and get cloinlts to a better place. When our clients get to a better place we are all safer thank you mr. Raju. We appreciate the work. Thank you for your interest in the development. You know i wanted to say if anyone wants to know more about a lot of the initiatives and unit in our department they can go to you tube we have a dairy defender series. And people should look at that to learn more about the different units. Also we talked about the dibilltating impact of convictions we have a Clean Slate Program exsponging hundreds of records every year. And people can go to our website sfpublicdefender. Org and move their live in a positive direction thank you very much. Thank you thats it for this episode we will be back shortly for government government im chris manners, t complaints and not indiscernible that concludes todays overview. Thank you for your time. What happens after a complaint is submitted . When dpa receives a complaint, the first step is it to assign it to a investigator. If the complainant provides contact information, they receive a letter telling them knoo they assigned investigator will be. If the complaint is submitted anonymously they will not receive further contact from dp. What happens when dpa finds a police miscucktd . The dpa find misconduct, meaning sustain a complaint, the next step is to determine how serious the misconduct is and what discipline the dpa will request indiscernible the dpa does not itself impose discipline and can only recommend discipline in a sustained case. What happens if a complaint turninize to a chief nonnob if the dpa decides to recommend 10 days suspension or less, the chief of police is the final determner of both whether misconduct occurred, and if the chief agrees misconduct occurred, what the disciplineitary penalty will be. In those cases if the chief disagreewise dpa, the case is over and dpa does not have any recourse. If the chief decides that misconduct occurred, and to impose discipline, an officer has a right to a hearing before that decision is final. What happens if a dpa complaint turns into a Commission Level case . If the dpa determines a 11 day suspension all the way up to termination is the appropriate outcome for a misconduct case, a trial is held in front of the Police Commission. Normally, one commissioner presides over the trial, then the entire commission will read the transcript and vote. If the commission determines misconduct occurs, then the Commission Also determines what the penalty will be. If you are stopped by a Police Officer you should follow the officer direction, keep calm, keep still, and do not make sudden movements do not reach for anything, especially in your pockets, keep your hands visible at all times. You have the right to remain silent. This means you do not have to say anything. Tell the officer i want to remain silnts. You have a right to a attorney. Tell the officer i would like a attorney. If you are arrested do not talk about your case or immigration status to anyone other then your attorney. Do not sign anything without your attorney. Do not lie to Law Enforcement officers and if you are property are being searched make sure i do not consent to the search. Do not challenge the officer, you can file a complaint about Police Services later, if you are not comfortable speaking english you can ask for a bilingual officer who speaks your language and also ask for a interprerererererererere im ready. Good evening. The chair has called the meeting to order. If you could please rise for the pledge of allegiance. For which it stands. One nation under god, indivisible, with liberty and justice for all. President , id like to take roll. Please do. Thank you, commissioner walker. Commissioner benedicto, present. Commissioner yanez. Present. Commissioner byrne here. Cois