Transcripts For SFGTV Health Commission 11916 20160124

Robust managed care environment, the consultant engagement helped us identify a few key foundational infrastructure elements that we must have in place in order to be successful. And you see those listed here. The first we just talked about, which is having an Enterprise Electronic Health record. The second is organizational intelligence, which is a proprietary software, which is a Cost Accounting system that allows us to cost out services particularly at our acute Care Trauma Center that we will need in order to set contracting rates. The third, which is Network Operations integration, we have several systems throughout our network that are not integrated. As you know, we have a separate medical staff or the at San Francisco general, one at laguna honda and separate credentialing process in Behavioral Health and from a planned contracting perspective, were going to need to centralize and coordinate those functions so that what dealing with payers, there is a onestop shopping as opposed to having go to each entity to provide that information. That is one key finding from our consultant engagement. Finally our network branding and marketing process. Again, this is something weve never had to market our services before. We have always and continue to take all comers, but if were going to increase the number of members in our network, were going to have to begin to market ourselves. Im sharing this next slide with you in order to give you a perspective of our current environment in managed care. Which as previously mentioned at this point is only limited to medical managed care and of course, that excludes our programs for healthy San Francisco and healthy workers. You see the numbers here. The San Francisco population of that 848,000 population roughly 170,000 plus have medical and majority of which are in a medical managed system through San Francisco system or Anthem Blue Cross and our network of the 150,000 managed care lives has about 62,000 to 63,000 in our network. So in this slide, it shows our planned trajectory based upon consultant engagement for expanding beyond medical. For sustainable, you remember sfhn will need to increase your patient base to 90,000 patients. Im going to go back to the previous slide. That last number 62,000 is what we currently have in our network and we need to get up to 90,000 per the hma report in order to be financial sustainable and final financial viable. As we move to increase from 62,000 to 90,000 in the case of 618,000 san franciscans who have commercial insurance, according to the consultant report, we need to have 1520 of our Overall Network population, which again, that goal is 90,000. Come from those commercially insured. So in essence, we need to attract somewhere between 13,500 and 18,000 of those people with commercial insurance into your our network. A little bit about our marketing and branding. Just as we have done a lot of work in the area of managed care and increased our effort related to marketing and branding and we were fortunate to have a Mayors Office fellow assigned to dph, to develop and begin implementation where feasible of a network markets marketing and branding plan. This next slide gives you a summary of some activities underway and the priorities for next year. That marketsing fellow came on board in october and has been very active in learning our network. Has conducted several focus groups, including key stakeholders, patients, staff, and other systems. And has really helped us be clear about some of the steps we can take now, but also a plan that will be in place by the time that fellow leaves us in the fall of this year. Weve set some shortterm goals in terms of a pilot, doing some promotion of a San Francisco birth center with the obgyn service at sf gh and pursuing contractual relationships allowing for additional births at San Francisco general and do the appropriate marketing and branding to go along with that. We continue to be in negotiations with Chinese Health plan regarding covered california contract, which is considered a commercial contracted. We will need to do the appropriate marketing regarding that contract when it comes to fruition. So from a market point of view, we have three key goals. We need to find new members, enroll them and retain them in our network. And we need to make sure that we deliver a Patient Experience that encourages people to continue to allow our network to serve them throughout their lives. In addition to finalizing our Strategic Plan, and focusing on our true north, there is still multiple other efforts and initiatives that demand our attention and engagement. You see some of them listed here. You heard today that we brought on board our new director of General Health. As know were currently recruiting for ceo for zuckerberg San Francisco and looking for appropriate leadership in our Behavioral Health system as we have Senior Leadership being ready to exit the organization. We have got to open the new hospital. Were going to have a big part in the Electronic Health record, its will be the core of our clinical Delivery System and we have also got spaceplanning to do particularly throughout dph in terms of what is going to go on with our space, and facilities at both laguna honda and San Francisco general. So both priorities also present challenges for us. Obviously, we have a challenge that we must be mindful not to be impeded by overtasking our resources and staff on these multiple endeavors. And its our hope that through using the concept of true north, well be able to galvanize our staff and have one guiding compass in terms of what were focusing on. And finally, just to let you know, that in the midst of all that we are doing, with true north, managed care, marketing, and branding, we have not lost sightful our continued commitment to integration initiatives across the network, and dph as a whole. You see many of them listed here. Our enterprising mr, the continued development of our Business Intelligence unit, and our data warehouse. Our call center expansion, which is one of the major recommendations for implementing expanded health care contracting. And we continue to integrate clinical services. You are going to hear specifically about pharmacy, but Skilled Nursing and rehabilitation across the network. So that concludes my part of the presentation. Im happy to take any questions you may have, and or feedback. Commissioner taylormcghee. Thank you very much for your presentation. I just have one little bitty issue that i would like to sort of point out in terms of your branding and marketing strategy. I would just be careful to make sure that you dont promote yourself as a quality provider for private people, particularly private insurance and i would just shift it to maybe think about it as successfully merging the network as a quality provider for lowincome and uninsured residents. And private people people who have private insurance. Because sometimes you can sort of shift the focus, and then you lose people that way or people begin to think im left out, you know . Absolutely. I just want to make sure. I appreciate that and that was a long topic of conversation within the leadership. We struggled with how to phase it . And part of the discussion was that rather than were definitely not changing our mission or our population, were just expanding it to include others. Right expanding to include others sounds good. Its the same concept. Commissioner pating. First of all, mr. Pickens, congratulations. This is just leaps and bonds the report is leaps and bonds over what we heard last year in terms of our Business Planning and sense of focus, and all the oars rhoiing in rowing in the same direction. I love your mission statement. Its the highlight of my year and i like the areas of the business development, the six domains. The question that i have and most concerned about is your statement that we need 90,000 new or 90,000 enrollees total, 28,000 new enrollees to become financially viable. Could you answer for me what you mean by financial viable . If we dont get that what happens . And the second question is 28,000 people is a lot of people. How do you enroll that many people . So ill answer that by saying that number came from our hma consultant engagement and Health Readiness report that you can find on the city controllers website. What it said, with the growing reliance of the department on the general fund, that the department needed to look for other sources of revenue in order to decrease that reliance on the general fund. And the way to do that was to increase the patients receiving care in our network. And with health care reform, and the move towards more managed care by and large that means moving towards contracted arrangements, where you pay in advance for the care of the population and incentivize to keep them healthy. That was the consensus of that report that we needed to have 90,000 patients that were generally responsible for, coordinating their care, in order for enough revenues in our coffers to keep us financially viable. So again, thank you very much for that. The idea is that to give 28,000 as the context, that is nearly double of what were doing now. Or nearly 50 ; right . Right. So we have to grow some 4050 . Right. That 60 62,000 that you see, predominantly includes people in a managed care type of arrangement with the network. It does not include our feeforservice medicare patients, we have probably another 15,00020,000 and when you begin to add that, it makes the leap to 90,000 a little less daunting. I see, so just people that are already accessing our system to get them to convert, or to stick with us, is that what you are saying . Right. As opposed to new people that have never touched our system . Right. So its always a challenge when we present our numbers, because our patients are in different buckets and sometimes they overlap. There are some that are specifically on capitated arrangement, i can through through San Francisco health plan and medical managed through anthem blue [krosz ] this are actually feeforservice, but we manage them as we are their primary provider. So in essence, another way to think about it, we have 62,000 people in the managed care program, including healthy San Francisco and includes healthy workers and have another 15,000 to 20,000 medicare feeforservice and means we need another 15,000 or so thousand. That is more comfortable and with regards to the risk make up, following up on commissioner taylormcghee, it would be wonderful to have everyone healthy and know that is difficult. But also, if were assuming the risks viable these are people who are already in our system. So its people that were kind of comfortable, down the middle already taking care of. That is what im actually seeing you in terms of the risk profiling . In terms of new populations . Yes. Well, we will continue to focus on the traditional underserved and in terms of that 618,000 circle, those are people who currently have commercial insurance. Who one would think would be healthier than our traditional population and could perhaps be a benefit in terms of bringing in additional resources. So my last comment, and this is not a question really. We might want to look the at where our competitive advantages are and certainly zuckerberg General Hospital that is best in the country and looks great and will be great is a competitive advantage. I know that we have many, many others and were citywide as opposed to some vendors in the city are more localized. One area versus the other. So we can serve and wide catch. I would be interested in the future of hearing how we promote our many advantages as a Health Care System . Absolutely. That is part of the 35year Strategic Marketing plan that the fellow is working on and will present to us over the next few months. So well definitely be sharing that with you. Thank you very much. Commissioner sanchez. Its an excellent report. You really covered the waterfront as you read through it, that is what were really doing and not just in reference to facilities, but in reference to how patients are treated and how were going market them in future pertaining to quality of services. Quality of services that we are still achieving some areas and we heard in earlier presentation about one key critical pathway will be when we have integrated medical records. Hopefully we look forward to the directors recommendations, because i think that is part of the achilles heel and to see sometime in the future not now, but if we could sort of having an overview of the continuum of patients flow . Are we losing patients in certain areas . I. E. , va . Veterans . Are we losing nativeamericansin the Filipino Community . There has been a lot of movement about families being moved out, et cetera. Dadada, what impact does that have pertaining to the cohort and hopefully with the medical records and others when it finally gets aboard, that will be even more of a thumbs up. So we can identify our Patient Population and flow unwhy and sort of like the noshow show appointment. Always of these things its not a critical part, but i think it would give us a little bit insight pertaining to how we sort of navigate the ship as we move forward. Yes, that is our office of primary care is working on so each can see who are the people coming in and going out of your particular clinic . And are there anythings that we need to do to address any particular negative turn . Great. Thank you. Thank you. I also want to commend you, and the Health Network for really developing a comprehensive strategy. That within the short year, as commissioner pating pointed out, has really flushed out where you are going. So my comments are more sort of tweaking a little bit. And most of it is sort of reflected on the payer strategy. I am concerned that as commissioner taylormcghee had pointed out, i think we dont want to be in a compete not competitive simply because its competitive, but starting to look at different marketplaces that may not help our total mission as such. And i think that if you got it from report that we should be picking up 1520 of commercial members, i would like us to review that a little bit more. Because you think when you came down to the numbers and understanding its not really 26 of 618,000 that you need. So these need to really be more carefully thought out and also be focused upon the people for whom we actually are the final arbiter and not because we are the last, but were the best; that these people want to be part of our system and want to find a way to be part of it. So our market can reach this, if that is the final viability of 90,000 or so, easy from being the best within the covered california area. Which i think is even a better marketplace for our type of services that we offer. And and then one reason for being careful is that some of the commercially insured have an expectation different from our own expectation in terms of our patients, and are often then handled in a different way. You may then find yourself spending a lot of resources to do that for a small segment and not really be sure that our resources are going for those who are really our core, that we need to be sure to be able to care for. Its sort of classic for a lot of types of plans that have begun with a focus on a particular, either population or need. And then as they expand, suddenly becomes so overexpanded that they are beginning to try to reach out to different areas and before you know it, you are kind of finding that you are pulling back again. Right. I think the expansion a few years ago is a very good example, in which they tried to also go to over to a hawaiian market and what was distracting to them in terms of their core mission to serve the San Francisco bay area people. I would suggest that trying to work too much on the commercial members versus your other three groups, could be a use of resources that may therefore then detract what we can give to the bigger group. And cover california may 80 plus percent subsidized and a population that we really have an advantage over in terms of types of services that we offer, versus the other commercial plans in the marketplace. If you need to pick up, like you say, its not 1520 , but might be a portion of that covered california. I think that is much more of a viable market. But obviously this is just merely a suggestion coming from our knowledge of where we are, and trying to be sure that we focus our resources to be sure that when we do Patient Experience, and so forth, that we actually put that effort into maybe multiple call centers that we need. Absolutely. Rather than somehow setting up a Wellness Center in pacific heights. Those are extremes, but i would really like to see that we focus our resources on the people who actually we are trying mostly to improve their life. Absolutely. And that is what we are doing. You are right on target. And let me be clear we are by no means ready, nor well be ready to do fullboard regular commercial contracts. The roadmap as laid out shows covered california is our first major one to go after. So as you know, we have been focusing on last two years and hopefully well wrap that up this year. As the consulting engagement, well have to do a small test of change and allows us to test the water. There is a whole series of infrastructure we would have to set up to be able to do commercial contracts. As a very small item, smaller, i would say its not a 35year issue of providing centers of excellence care. Because there we can reach out and we have excellence in Palliative Care and hospice care and rehabilitation, along with some of the specialities at general that are known or trauma of course is also. So i dont think that is a 35 year thing and you could seen sell centers of excellence today. Im fraid afraid, if we dont start looking at where our centers of excellence are, rehabilitation ating at laguna we are in discussions with other systems as to how we market our centers of excellence to their system, where we have that expertise and they dont. Thank you. Commissioners, if we could go on to the pharmacy. If you could keep in communication with us and coming back to us and the Corporate Identity of the Health Network and as we get closer and closer to honing in on what we are trying to do, i think this conversation with us is hopefully helpful to you and its helpful tos us. With the safety net, and safety net plus, maybe we can involve i think if l. A. Cares as a model that has really made a market in serving public sector, but based on financially viable. And i visited the hall and i cant say enough good things that for me it on directors garcia test, would i want to receive my care my familys care there and i would say definitely yes . Its a warm and welcoming place and yet, how we capture this as a Business Strategy is, again, i think its an evolving process. I just want to commend you on it, but keep bringing it back to us as we keep having these conversations. We about definitely bring back the marketing and branding back to you. Not just external marketing, but internal marketing. Absolutely. How we envision ourselves in delivering care. Sounds like im hearing a need for a presentation on our internal external marketing . Whenever you are ready. Dont rush it. Shall we proceed with the pharmacy integration, which i think you are pointing out is an example of how you are moving into being a system. Yes, that is correct. For certain of our services. Okay. Good evening, commissioners. David woods, chief pharmacy officer. Im here to give you a brief overview of integration of Pharmacy Services. Pharmacy began at integration work more than a decade ago with something that was called the chn pharmacy council. At that time the main point of that group was to really align formularies. And this has evolved into something much for than an alignment. The integration of Pharmacy Services is within pharmacy and then we have dottedline reporting to executives at each of the major sites. This ensures operational alignment, as well as ensuring that the sites get what they need from the pharmacy staff. If you look at our budget, as a group, pharmacy is budgeted for more than 50 million annually. We have a dphwide budget process, so that we actually do one budget submission for dph Pharmacy Services for all our pharmaceuticals. This ensures that we do basically a lot of data factfinding look at trends to rends and our own put together what we think is the best possible projection for the coming year. Were constantly look at costs, and how we might be able to utilize drug more effectively to reduce costs . One of those measures is with the Patient Assistance Programs. As you can see from this slide we have over 7 million that we saved last year through the use of free drugs from drug manufacturers in the Patient Assistance Programs. We have 1. 5 ftes of pharmacy technicians which do nothing more than help patients enroll these free drug programs for manufacturers. You can see its wellworth those ftes that we have put into that program. We also have a position called the formulary manager, clinical pharmacist, whose main job is to oversigh see the drug program for healthy San Francisco and attends pharmacy and therapeutic commits for laguna honda and General Health and San Francisco health plan as well, with the goal of providing expertise and evidencebased decisionmaking and formulary alignment and also help with our costsavings measures. Pharmacy is a highvolume, highrisk operation. As you can see a very highvolume, if you looking at almost 4 million doses dispensed during fiscal year 1415. It requires as close as with can get to perfection in order to provide safety as far as operations, Technical Expertise and training of our staff. One thing which we have done in this last year to improve safety in our operations is an alignment with the vendor called ohmney cell for technology across the dph. So we have aligned and have an exclusive agreement withomni cell to provide alignment from operational, clinical, efficiency perspectives, et cetera. Some Program Highlights for 2015 are developing people, it, and then lean work. From a Workforce Development standpoint we have two new pharmacy residency programs which were accredited last year. One is a secondyear specialty psych residency, that we do with ucsf and residents go to ucsf and go to Behavioral Health services and also to sfgh, where they get an outstanding education. And at sfgm we have a new firstyear residency pharmacy program, which receives an astounding 6year accreditation, which is a testament to the great work of this new program. We had a couple of major it implementations this last year. One was in jailhouse services. And the other was in eclinical work implementation at laguna honda hospital and the pharmacy director is also the cmio at laguna honda. This year were working on contracting for outpatient Pharmacy Software with a vendor called qs1 and would like to implement this software at Behavioral Health services and pharmacies the software already existing at laguna honda and would allow the three sites to have Similar Software and potentially allow us to share procedures, operations and hopefully staff at some point. San francisco General Hospital outpatient pharmacy has done some amazing work with lean. Its reduced its wait times from over 2 hours to what is consistently less than 30 minutes right now. They have done this through the use of these sort of lean workshops, which are weeklong workshops where they have actually worked on specific things to improve areas of the pharmacy operations. In these workshops we included staff from laguna honda and ambulatory care and Behavioral Services to get fresh perspective from the pharmacy perspective, but also so that staff could go back to their respective sites and spread the word about it. So for example, with laguna honda after they came to a week longest, they brought the huddle process back to the pharmacy and are doing daily huddles in the laguna honda pharmacy. The pharmacy director there is also worked on the a3 project plans with two she is working on as part of her work with lean. There are ether areas of there are other areas that were involved with and taking expertise at one site and sharing it with other sites. For example, when laguna honda wanted to put together a new anticoagulate clinic, they looked at the standardized procedures that the pharmacy used and pharmacists used there and the operations and took a look at it and they saw what would work and what might fit at laguna honda when they developed that program . Behavioral health has been involved with the dope project for many years and we use the expertise of the pharmacy staff and provider staff there, when we wanted to expand the other areas. Operationally, i have hit on most of those already. Right now the pharmacy for 2016 is going to be working with Human Resources on the performance appraisal project. Where Human Resources is looking at the developing an electronic performance appraisal system. Because pharmacy is also integrated it makes sense to use pharmacy as one of the pilot sites for that. And so well be looking at the different classifications in pharmacy and seeing how that works and how we can learn from it . Challenges so as many of you may have seen, like from the wall street journal at the beginning of this year, here is a quote from the wall street journal, u. S. Prescription drug spending rose 12. 2 in 2014, which astounding. We have been able to keep our inflation rates significantly less than that. But this is what wore seeing throughout the country. A week later the Washington Post noted greater than 10 Price Inflation during 2015. Overall its projections that inflation for pharmaceuticals will increase 2030 over the next five years. Last year there were 45 new drug entities approved by the fda and many of these entities are what many consider to be breakthrough drugs, which offer astounding prospects for our patients. These are drugs which we want to use and make available, but they come at a significant cost. Luckily we have an increased number of reimbursed patients in our system. In fact, all of our almost all of our areas do have patients with significant amount of re, but reimbursement. As the Affordable Care act has come in, it has gone up dramatically and its a wonderful thing for us and our ability to provide these drugs. Well continue to use guidelines and formulary guidelines for these best processes, but we want to use these new drugs and they will come at a pricetag. Other challenge that well face is the 3 43b program this. A federal drug program, which offers deeplydown discounted drug s to qualified entity. At dph we have two such covered entities and we probably save 24 Million Dollars every year through the us use of the program. The definition of eligible patient, is much more restrictive than we currently have. If this goes into effect, well definitely have increased costs and the complexity of managing the program will increase as well. The dph and the Community Clinic consortium are very interested and we actually did submit comments to hrsa during the Comment Period and were hoping that they will take our views into account before they put together their final guidance. Regardless, were ready to meet whatever challenges come forward. We have a really strong group, which is helping move our initiatives forward and develop the best care that we can possibly for our patients. This is the Leadership Team that we have right now in place. Happy to answer any questions that you have. Thank you very much. It seems that if 12 increase in 2014 and 10 , i dont know how you are going to hold it down 2030 over five years. Luckily, actually our inflationary increases have not been that. We have been more in the 4 range here. You can see that Patient Assistance Program number 7 million of costs that we averted through the programs. Some of the programs are really restricting their use, especially hepatitis c drugs. So were probably not going to be able to make use of the programs like we have in in past. Why is why i think that 20 inflation rate over five years is probably what were going to see. Were currently trying to project out a 5 annual inflation rate fighter for the next several years. Commissioner taylormcghee. Thank you for your report, which was very highlevel. I would like to dig in a little bit and ask you a couple of questions about things that i care about. Womens reproductive health, whether its emergency contraception or any other kind of familyplanning measure. How does that fit into your patient care goals . Where is that in the scheme of things . Also Medication Management, which i think is really important. You mentioned pain management, but that is different from Medication Management, as a pharmacist you know that. So give me just a little bit where that fits into the new scheme of things . Womens health, we have a clinical pharmacist, which we hired in the last three years to look at Womens Health. She is based at San Francisco General Hospital and she works with the Womens Health group there. She also works in the inpatient and clinic environment for them as well. She has been active with that group not only locally, but also with regarding some, i guess, items of interest, nationally. And putting her perspective there. As far as mtm goes this is an area that pharmacists have a lot to offer regarding Medication Management. There was a meeting this last month working with San Francisco health plan to determine how we might work with them, in partnership, to provide more Medication Management therapy services. Right now the health plan actually has a plan in place where outside pharmacies can provide medication therapy management to outpatients and were interested seeing if we can use our pharmacists to do that . Because especially our ambulatory care pharmacists know these patients just, as well or better than the Community Pharmacists do and we think its a really Good Opportunity to align and provide care, as well as to get some reimbursement back for the pharmacists. Right now were having a conversation with them about that. Thank you. Commissioner pating. Thank you so much. Im so glad were having integrated conversations regarding our pharmacy. Were one big system and we should try to use as much purchasing power as we can and coordinating that way is the way to do it. The biggest thing that has been bothering me, though, when i have gone through my tours that the jail doesnt and laguna honda dont get 343b pricing. Because i think its the medicare enrollment rate is the driving factor. Is there any other ways that we can get specialty pricing . What about, is there any multicounty collaboratives . What if we linked up with santa clara, los angeles, alameda and the biggest darn purchaser in the country . Could that be another way, not to get around 343b, but to work with purchasers to get really good rateds. We do get pricing at laguna and Behavioral Health. Obviously its nothing like you can get with the 340b or valevel of pricing. There are some collaboratives that the jails have, that we could potentially look at, and i have sat on a number of calls with the state regarding that. Its sticky. Its complicated, and im not sure what more we would be able to get in addition to that . I have looked at the possibility of 340b in those sites. Where hrsa not coming up with the new definition of patient, you probably would have a Budget Initiative for something to do with jail this year. But clearly the draft legislation that hrsa has put out with 340b will clearly not allow that to happen. So if the definition does change, there is something that we might be able to do with the jails as far as from a clinic perspective with 340b, which i think would be a thing to look at. Im really glad that we have smart people like you coordinating our efforts and looking at it. Regarding smartness, the hep c treatment not to name the treatment by name is now medical funded. What would be the cost to us if we bought as much and gave away at medical cost as possible to treat our population . Are there hidden pharmacy costs we would incur . Or would it be strictly a passthrough to get as , as much as this hep c drug to our patients as possible . The 7 million in savings, 5 million is probably hepatitis c drugs. When those drugs came out, healthy San Francisco patients are eligible. Our healthy worker patients, we actually found a way to get that for our healthy worker patients as well. Then initially those medical was denying those until recently in july when they changed their rules and we would actually, if medical denied it would sent to the Patient Assistance Program to get funded that way. Now they are being funded through medical. We could pay for those drugs through our farmcy, pharmacy, if we wanted. We wouldnt make much money on it. So those patients do get them in the community. Does that answer your question . Yes, it does. Sounds like we have a net savings the way were currently structuring. Right now its a lot of gillad has changed the rules for that program. I didnt speak them out earlier, but they are the ones that have completely changed the eligibility rules for their program and basically they are saying now, we go by the persons insurance. If they have insurance, we go by it and if the insurance says no, we say no. Which is different from a yearago. So they have really clamped down on that. The other manufacturers have done that less so, but its once a day and covers most of the genotypes and its the preferred option. Can you tell us the cost without a benefit . A beneficiary or payer . The cost to a patient would be 70,000 80,000 for a course. Our cost is significantly less than that, if we had to purchase it, but its still maybe half that. If we had to buy that for a patient. So were fortunate that healthy San Francisco still are eligible, all of those patients are eligible. Healthy workers are not currently and were probably going to street to pay have to pay for them at some point. With regards to the new computer, well be able to hook up to epic; right . That is such a dream of ours. I mean our world, especially in hospitals we sit between the providers and sometimes between the order and between the nurses administering the medication. Seamless system can go back and forth, being able to do medrack between laguna and between sf gh and others is a dream of us. Its truly a safety initiative. And efficiency. I mean, there is a huge amount of safety and efficiency that the pharmacy will begin by having an enterprisewide Electronic Health record and i cant tell you how happy i am with the epic that is reassuring. Thank you very much. Whatever we have as an integrated system. Uc is epic and sharing resident on the pharmacy side and students, as well as medical trainees. I think most people we actually looked at cerner and epic as part of bill kims process. Epic is incredible. That is another good reason to try to negotiate with the better pharmacy interface. Any further questions . Excellent program. Thank you very much. Again, a wonderful demonstration of where we have moved forward in terms of integrating across our system. Thank you. Thank you. Can we go to the next item, please. Yes, commissioners, item 8 is a resolution authorizing the dph to recommend to the board of supervisors to accept and expand retroactively a gift of 100,000 to the laguna honda. This a very good action item. Good afternoon, president chow and members of the Health Commission and director garcia. We are so grateful to miss molly fleischner, a resident of San Francisco, who has generously provided laguna honda a donation of 100,000, specifically [ inaudible ] who are otherwise unable to obtain them. I am here to request your approval to forward a resolution authorizing the department to recommend to the board of supervisors to accept and expend retroactively the gift of 100,000 from ms. Molly fleischner to the laguna honda fund. I can answer any questions that you may have . Thank you. Thank you. Commissioners . So moved. Could you tell us who miss molly fleischner is in terms of her relation with laguna . And what created this very nice gift . Ms. Molly fleischner lives in zip code district and she is a friend of one of our volunteer chaplains. I meet with the volunteer chaplains on an annual basis and we have a conversation. And in october of this year, when i met with one of the volunteer chaplains, she had informed me about ms. Molly fleischners intent to provide those donations specifically for residents who need assistive technology. Wonderful. Any further questions . There was a motion at had this point to recommend to the board of supervisors to accept this. Very proud to second the request. Okay. Any further questions . If not, then let us vote on the motion all those in favor, say aye . Aye. All those opposed in motion passes unanimously and we thank you and we thank ms. Fleischner. Thank you, commissioners. Item 9 is other business . Any further business, commissioners . We might point out the planning session, which were hoping will also be instructive in terms of the lean process is scheduled for what date . April 19th, i believe or april i dont have the calendar in front of me, but its midapril. Thank you. Great. Okay. Any further questions . Other business that commission wishes to bring up . If not, shall we go on to the next item, please. Item no. 11 is committee im sorry, no. 10 is joint Conference Committee reports and commissioner pating is going to report back from the january 12th laguna honda j cc meeting. We heard three reports. One was on the laguna honda hospital Palliative Care program and again, another model program. Both state and in the country. 250 patients go to laguna honda, but i think what was most amazing is compassion and consideration that the staff gives to making end of life care both comfortable and very spiritual experience. So we were hoping that the commission might at one point get to participate in recognizing on an annual basis some of the wonderful work by recognizing through a memorial of people that passed away at laguna honda and perhaps going agendize it at a future laguna honda meet we also talked in the context of that and give you a heads up, its probably an item that will come up before the San Francisco general j cc, which is the issue of physicianassisted dying passed into law and governor signed it and you think laguna honda and San Francisco general and Health Network staff will probably need to establish a policy around it, so there is consistency. That came up at meeting of the lastly, there was a discussion around laguna honda, moving on to a true north scorecard and we were very excited able to to hear the Strategic Plan and how plan will be implemented and reported out to us on a regular basis. And then in closed session, we approved a hospitalwide policies and procedures as discussed in the administrators report. That is what we did. Thank you thank you. This commission of course is interested in Palliative Care programs. So as you develop something that could be brought forth to the commission, i think we would very much appreciate the update on the assisted dying dont we also need to wait for to be chaptered in law . Which i understand is still pending, but according to the Palliative Care force is still pending. Thank you for the correction. Its pending a special session of the state legislature and i guess it doesnt get chaptered until it comes out of special session. So i just wanted to give a heads up, when it does, there will probably be a need for further systemwide discussion on the issue. Very good. Any further questions to commissioner pating . If not, we can move on to the next item, please. Item 11 is community agendasetting. I think i guess i preempted that already in terms of the planning session. We also have a calendar before us, if anyone has any items that they would question or would like to add to our calendar . If you dont have it right now, if you would bring that to mr. Moras tension. Next item then. Closed session will be deferred because the documents were not ready. Its a simple administrative item and to move on to to consideration of adjournment. Fine. Motion of adjournment is in order. So moved. Second. All in favor, please say aye . Aye. All opposed . This meeting is now adjourned. [ gavel ] the city of San Francisco sfgtv meeting of the rules committee occurring thursdayjennifer 21st 2016 will begin shortly. [gavel] i would like to thank sfgtv staff for their Service Broadcasting todays meeting. Phil jackson and jen hello, thank you for your service. Just a little housekeeping right now before we start. We are going to have items to and three first. They shouldnt take too long. The charter of moments we have already heard in committee a couple times already. So theres not a lot of discussion. Mostly making amendment and moving forward to the next meeting. Probably some Public Comment but they should not take long. At the most i think 20 min. Will get you through those items and the entire rest meeting on item number one on the alternative use of force. Then, i want to make sure people are aware Public Comment will be 2 min. That will be a time limit on Public Comment. Mr. Clark if you can call item number to speak to item number two is charter of the San Francisco to acquire an appropriation for the parks and recreation Openspace Fund based on city spending for park and recreation purposes fiscal year 20152016 and modifying the recreation and Park Department banning obligations to include Equity Analysis at an election to be held on june 7, 2016 before supervisor farrell get started i just want to say ive been working with him on this measure and ive actually from beginning when he introduced it i put my name not yet as a cosponsor but i want to make sure he had a pretty thorough process what they needed in this measure in amending in a way that the need to meet the needs across the circuit i think this issue was around equity and make sure there were measures in place that would give some accountability around equity and the parks and recreation the board of supervisors for approval. I know this was not the steps that a lot of people who were working urgently on this measure were hoping to do, but i do feel this actually broadens the appreciation of the measure and i do appreciate the flexibility and accepting these amendment especially supervisor mark farrell. Thank you. So ill keep my comments on the overall measure since we talked about quite a bit, im introducing three amendment today. I want to thank supervisor avalos for working together with this amendment to making this as tight as possible. I think its a testament to his leadership as well. I want my colleagues and my cosponsors as well for part of this and being part of the conversation as well as everyone involved in making the amendment and working on them together. So, there are three sets of amendments to the First Amendment the annual set aside on a baseline for 15 years. We talked about that topic for quite a while. I will guarantee significant funding for the department in year 1630 Going Forward compared to what we had before. The second set of amendment built on the equity limits we made at the last Committee Hearing and premise made to the department include strategies to mitigate deficiencies in the last set of amendment is to give additional oversight required [inaudible]. From my perspective these amendment represent over 15 amendment since introduction in the fall. I want to thank everyone whos been involved in this. Sincerely a road but i do think were in a good place right now. It certainly look forward to bringing in front of the voters. So colleagues, will open up to Public Comment. I certainly appreciate accepting these amendment ticket underwear to sit before we take it out of committee next week. But again i want to thank everyone involved supervisor avalos over the past few weeks. Thank you. I think we can open this item for republican member if you like to comment, more or less the order i read your names and anyone after that can come forward as well. [calling names]. Good morning. I then before you but how many times and i do want to reiterate what ive said before. At this point i want to thank you for keeping your eyes on the big prize and for the improvements made to this legislation. They do very much and lets go forward. Thank you. Good morning, supervisors. Matt ogrady. I want to echo phils comments before me. Little over two years ago the Parks Alliance adopted a really big strategic goal which is by 2020, we want to see the city put into place adequate and sustainable funding for our entire park system throughout San Francisco. The Charter Amendment including the memories you have proposed supervisor avalos, strengthens this overall measure and gets us a very long way towards achieving that goal. So we very strongly support this. We appreciate the animal amendment and the particularly the longer time frame of the extension of the Openspace Fund and the baseline that provides a much more stable longterm view for that apartment. So were very supportive of the amendment. I want to call out, can supervisor be farrell for his leadership in this effort throughout and all the supervisors signed on as cosponsors for the contributions in making it happen. Thank you very much. Good morning supervise. Kellyi want to add the thank you for all your hard work. Mr. Farrell mentioned 15 amendment to get all four of you have been key in bringing this. We appreciate you helping San Francisco parks. Commissioner norton, welcome thank you. Good morning. I want to add my thanks to my colleagues to the Parks Alliance. I spoke to all of you for all the work youve done. We feel good about it. We think that this is going to provide real flexibility for that apartment Going Forward and the extension of the Openspace Fund, thank you supervisors for finding a way to make that happen. Its going to add to that stability. So were pleased and looking forward to getting it on about and running a strong campaign. Thank you. Before the next speaker ive to other cards. [calling names]. Thank you very much. My name is rosemary came and get him on the board of San Francisco Parks Alliance and one last time, i would like to thank supervisor farrell or is it incredible leadership in getting this Charter Amendment moving forward. We are extremely pleased with it as it is now finally being recommended. We also want to say how much we appreciate all the work that went into getting to this final proposal, including supervisor avalos is leadership in extending the Openspace Fund, which is a truly wonderful addition to the major. So, thank you all very much. We look forward to getting this out of the rules committee, finally, and onto the board of supervisors agenda and then onto the ballot in june. Thank you, get thank you very much. And the other members of the public like to comment . On todd david good im wearing my residence town square have. I just want to say the extension of the Openspace Fund is outstanding for all the communities out there that need openspace. So, i think weve done a good job of starting to tackle open space deficient areas and by extending it were going to tackle even more of those open space deficient areas. So, i love the extension to make sure well have the money for the communities that need the open space. So thank you very much. Thank you. Any other member of the public seeing none, will Public Comment is closed. [gavel] this item is a lie before us. Supervisors he felt Less Government i want to thank everyone involved. Thank for all the Public Comment. And most of all my colleagues. Its been a solid effort together and i think when a good place. I look forward to moving this for. Great. So doing the motion to accept the amendment . Moved and seconded. Would think that without objection. [gavel] we can move this automatically to the next was Committee Meeting. Do we need a motion on that yes. If we can get a date certain on motion we move into next thursday if we can get a date certain on motion we move into next thursday, january 28. Moved and seconded. [gavel] our next item please item number three, second draft of the Charter Amendment of the city and county of San Francisco to require that upon a letter told a special legend is a vacancy in the office of the mayor member of the board of supervisors was originally scheduled election be held within 180 days of the vacancy provided the present of the board of supervisors is an acting mayor until an election is held to fill the mayoral vacancy and provide the mayor shall appoint an interim supervisor to fill the supervisor will vacancy with the interim supervisor being ineligible to complete in that election at an election to be held on june 7, 2016 this is a much i bought four. Briefly, i want other amendment which i like to make today. And then move this item to next weeks was Committee Meeting to be heard. The amendment im making is actually two make this Charter Amendments excludes about filling vacancies on the board of supervisors. We will keep or amending this to keep the existing process we have for filling the vacancy in the Mayors Office. That would lead to a board vote to set in place an interim mayor. Piteously, we were to run this measure as it is. You would have the board president acting as the acting mayor and board president but i dont think it makes a lot of sense. Really, what my intention around this was to have some chance to consider different options because theres lots of ways we could grab this measure. Its never going to be exactly perfect. But to me more than anything in make some sense to have a process and separation between the executive branch and the legislative branch, and have us be able to elect the people who are going to be doing cpr on the board of supervisors rather than having them appointed, which to me is about our democratic process. So, i will make a motion to see we can accept the amendment and then move this item to next agenda. First, what Public Comment. Any member of the Public Comment would like to comment on this measure please come forward. My name isi do not quite understand john avalos about the mayor but am concerned about our current mayor was there to fill a vacancy and promised he would not run and then did run. I think someone in a position that can be manipulated by money influences, which i believe is what happens. It means we got a mayor that was promised he would not do it and started out with a lie about becoming a mayor in the first place. I find it very disturbing. So, maybe you could explain more exactly how the mayor part is because i do not get that. Thank you very much any other member of the Public Comment like to comment seeing none, we will close Public Comment is closed [gavel] i appreciate the question. Actually, i dont recall when i voted for edwards lee for interim mayor in january of 2011 that are requested that he make a promise not to run for may. Was in a condition that i thought was in place. I think you need that to some members of the board of supervisors, but it didnt seem to be a condition for us voting for him in part of our vote. So, to me it really wasnt about that. The changes we are making, the current process right now, the way we have it in place, but as a vacancy in the Mayors Office, the president of the board would serve as acting mayor until the board of supervisors were to select or vote do have a mayor elected. So, that process happened when mayor gavin newsom was elected to become Lieutenant Governor and he wasnt sworn in until around january 10 or so of 2011 good news a little bit of a gap betweenwell a month and a half that we knew he was guilty leaving office and we had the actual boat and interim mayor in place. The board of supervisors elected an interim mayor. In that time, there was a lot of process we went through to determine how these vote would happen. We had not had a process put forth to us in decades. So we actually create a process for how that vote would go for. It was actually a board process showed us that in order to follow our charter, to extended out into the vote if any member of the board of supervisors was going to get elected without the required eight loads but you cannot vote for yourself to become elected interim mayor. So, we actually went on through another process where we just need to find someone outside the board to become a mayor about a month or about a month was spent looking at different candidates for mayor that we finally made the vote around january 4 of 2011. We actually didnt get to an actual vote are generally forth but postponed it for a couple days. To me, that process seems a bit tainted by the process that we were electing someone who actually wasnt in the country, who had indicated to every member of the board he was interested in becoming mayor of San Francisco. That to me was a false in our process. Not that the mayor had made a condition that he was going to not run for mayor. He was elected interim mayor. So, i want to go back. I feel that process is fine, to go back to having a person who is acting mayor and mayor at the same time or and board president at the same time. I dont think it really is good for that person or good for the city to have that person in the legislative branch and executive branch of that object thats a very thorough response to your question. I appreciate the question. So, im going to motion that we accept the amendment is such good essentially, were taken out references to the Selection Process for the interim mayor, and moving forward, exclusively with having the board vacancies filled by a person who the mayor will appoint as an interim supervisor will not be eligible to run, it will be turned out once election is certified and will move forward instead with an election that would be in the voters hands to fill this vacancy on the board of supervisors. To the chair, i made a number of comments last week. Im not going to stay cozier no sure will continue those discussion but todays purposes all make a motion to amend your Charter Amendment incentive for to the next was Committee Meeting. I generate 28 on january 20 will take that without objection. [gavel] okay. Please item number one item number one hearing alternatives to use of force in policing and reevaluating San Francisco please the government general orders 2. 07, 5101 and 5. 02 and requesting the Police Department to report. Supervisor cohen good morning everyone. Thank you for being here during this important conversation. First, i want to start the hearing off them with a moment of silence as we begin to remember those and acknowledge those not here with us today. Deeply those lost to violence. [moment of silence] thank you. I also want to take a moment to express condolences but just to the mother of when the woods of every mother that could hear my voice is lost a child. I can only imagine in my heart aches for your unimaginable loss. But there are some key things i want this conversation to focus on. One of which is the policies that we have in place when it comes to officer involved shooting and it use of force. Since 27 thereve been 37 officer involved shootings in San Francisco and each of them have been deemed justified. After investigation by local investigating agency. I noticed this a very difficult piece of information to accept without being questioned. Which is why we are here today. The use of Excessive Force against the mentally ill African Americans and other minority communities is actually not a new issue. The difference now is that we have readily Available Technology that are capturing irrefutable data and evidence to bring voice to many of the folks that claim to be victims. Thats why we are here. Not only to disclose i did not only to discuss the Police Departments use of force policy, which to date has not been revised since 1995, but also begin to open the conversation of a transparent discussion about policy and more partly because of changes that need to happen across this entire country and how we begin to bring some of that change right here in our own department. Im interested in proven best practices we began to blend the tools here. Its clear the vast majority of the people across the entire country that seen the unfortunate as well as incredibly graphic video of the shooting of mr. Woods, that there is some nonlegal technical method of able to subdue folks when the situation arises. I believe we need to begin to hold ourselves accountable for our successes as well as certainly are failures and leaving this case we failed our residents and we failed mario revealed mrs. Woods we responsibly to fix a broken and failed system. If were going to change what broken we got to come together and identify and address and i know thats a difficult realization for many people that have been on the front line protecting and serving. There is certainly a crisis in confidence. We talked about it all the time. Thats what brought us here to the chamber today. Eight crisis in confidence in lawenforcement in the entire country not specifically here in San Francisco but today talking about here in the city. Were not exempt from this deficit and lack of confidence and trust. An overwhelming majority of our officers are very hardworking men and women that do put their lives online every day to protect our streets. Many of these courageous people want better tools to use when encountering someone that they wantwhen encountering someone as well as looking to better training to be able to deal with the highintensity situations that people are facing every single day. A realtime example is we had a shooting a few days ago at third at the side of and we now have the shooter in custody. I use that as an example as good policing. That is working but in San Francisco we have a number of progressive policies, police policies, that are already in place in hopes of improving a police strategy, but theres certainly room for growth and improvement in looking to continue to Work Together with the community lawmakers as well as Law Enforcement. So that we can continue to see more change at a faster rate. There are several folks here that are joining us today that of opening remarks. I want to read my supervisor avalos are going to offer a few remarks. We have some presentations that were going to be making today of experts that are both within the Police Department and also outside of the Police Department. With that, i like to invite pres. Breed to share remarks followed by supervisor campos excuse me. Supervisor campos thank you very much mr. Chairman and i want to thank supervisor cohen for this request for a hearing. I was happy to add my name to this. I dont knowi was expecting to see police chief in the hearing and im actually very worried hes not here. I think that any discussion about the change of policies around the use of force in the Police Department should have the chief of police present to hear what we as a body have to say, but also members of the public to say. So, i dont know what happened and its disappointing hes not a bit hopefully, hell be coming. If you look at the department general orders that deal with the use of force, its 5. 01, and 5. 02, which specifically deals with the use of firearms. It has been quite some time since these orders, which govern the Police Department, have been revised. If i understand it, the last time 5. 02 was revised was in 2011. I think that the main general order, 5. 01, which deals with the use of force, i think that was crafted back in 1995. I dont know what if any amendments have been made since then. So, i think that the point here is that we have to revisit these policies on an ongoing basis and the fact that we haveits taken so many years without any amendment or revision and summer specs, summer specs, makes what happened not surprising. You have policies and the policies and practices that are so outdated and not necessarily reflective of whats happening out there. So, it is important for the Police Commission to revise these policies. I also one thing i want to note, which is very important to me and which i hope to ask the chief if he comes to the hearing, is that its not just the policies around the use of force, but also how it Police Department talks about incidents involving the use of force. I am very bothered by the fact that not just on the area woods case but on every single case using use of force by police, the chief of police has made statements that basically say, in each one of those incidents, what happened is within policy even though those statements are made before there is a complete investigation, before we know all the facts. Though, if you look at ilex knee xo, the chief of police went to a Community Meeting where he said what they did was justified. When you look atlikewise the chief of police went to a Committee Meeting and said what they did was justified. He did the same thing with mariel woods. I think its not enough to change the apostate i think we have to change how the department talks about it and thinks about it and the other thing i would say is that, i believe, a change in policy around the use of force and other changes to the sfpd operations should be required before we augment resources for the Police Department. One thing that bothers me is that in june of 2015, but a 65 vote, this board of supervisors passed a resolution that was introduced by Supervisor Scott Wiener scene that we need to hire more Police Officers. The reason those of us who voted against it voted it is because we felt before you go down the path of hiring more Police Officers you actually need to reform the practices of the opposites you have right now. Then, the second pointand i want to make sure that we emphasize this am aware that this hearing but also at the hearing later this afternoon and Going Forward, there are many communities that are impacted by this issue. In the Africanamerican Community is key among them. But i want to say that the voice of other communities of color should not be left out. This is not just an africanamerican issue. This is an issue that involves the Latino Community the asian community, so many communities. Every community is impacted by this. I think that its good that were talking about mr. Mariel woods, but i think its not enough to talk about mr. Marriott woods. We need to talk about the other cases that involve other men of color, other people color as well. Alexthe example that and also emile lopez, i look forward to this discussion. I hope the chief joins us because i think thatit makes things worse when the chief of police is not here for Something Like this. Thank you. Certainly that she has been invited and have been notified he would be here pres. Breed ugly breed because i want to get to the hearing and get a lot of the information out there. More broadly, hear feedback from the members of the public. Fixing and repairing the trust between the community and the Police Department is going to require a lot of work. Its not just about changing the policies. Its about changing the culture. We do have a lot of work ahead of us. I want to thank supervisor cohen for calling this hearing, calling attention to an issue within the department that we hopefully through policy can address. This past week, last week, supervisor cohen and i introduced a resolution asking for an independent investigation in the shooting death of mariel woods. We get out last week on tuesday. Thats one way that we can try and get to the bottom of that particular situation. I also mentioned in my remarks they need to look at the constituting the Community Police relations board, which existed years ago under the leadership of christopher mohammed, who helped to bring leadership from the Police Department, leadership from the Community Together to meet on a regular basis and talk about ways in which we can change policies, but more portly, improve relationships between the police and the community and it is important that we look into bringing it back at a party began work on trying to not only ring it back but bring it back to policy so that it never goes away in the first case. Todays hearing is really important. I think part of our goal is to evaluate how training and procedures can be improved and to prevent escalation and violence as a result of those procedures, but ultimately, we want to put the right policy in place so that this never happens again. So, i appreciate everyone who is here today and im looking forward to this discussion. Thank you. Supervisor tang i also want to thank the supervisor for calling this hearing today. I also want to say i apologize after step out for portion of the hearing but will be following up with my colleagues to further discuss this. Thank you. Thank you. Supervisor avalos thank you supervisor cohen. Thank you for bring this hearing forward and appreciate a work of your office work with the community and Police Department. I understand and i see theres been a lot of pressure on you to take this leadership and i think you stepped in well to do good work. Just, also, the other pressure of having this latest incident be right in your district. I think its been a significant amount of turmoil that you faced and so i want to thank you for your leadership. I was very troubled by this latest incident and im troubled by many of the incidents that happened over the years. Supervisor campos talked about alex aikenwho actually worked with 15 years ago when i worked at advocates for children and youth and mr. Perez as well. We have incidents that have occurred that have really created a huge gap between what the Police Department sees is acceptable conduct and what the community sees is acceptable conduct. We talked a lot about Community Policing and to me, like effective Community Policing is really founded on the legitimacy of the police in the eyes of the community. The community does not feel the police have legitimacy, then we do not have effective ways of doing Public Safety work in our neighborhoods. Thats kind of what we are facing right now as a city. What happen with this incident has really discredited not just the officers in the eyes of the public, but also the Police Department at some level. I believe, also, the way that the Police Tournament has come forward and is not necessarily addressed head on back tween themselves and the community, i think theres efforts but in the eyes of the lot of people it has not shown, has really kept us moving as quickly as i think we really could move. So, i think this hearing is a step in that direction and i think theres efforts that have been made before this hearing can about that are the steps, but clearly, theres a lot of work distance still to go. Theres a sense in the community that officers involved in the use of force and even when there is evidence that appears to show that the opposite is to not act within policy, but there are no consequences for these officers. That theres a sense of impunity that people have in the cube when these incidents happened good that sense of impunity that grades that huge gulf and i think as if were going to talk about how we are going to not just change orders but improve overall lawenforcement in San Francisco, that gap has to be narrow. So i hope that we can all commit to doing that and ill leave it over to supervisor cohen to begin with. Thank you very much. Were going to start with our first presentation. I want to introduce to you a man named arun. Hes at Trial Attorney under paterno atty. Gen. Eric holder. Hes leading a complex cuttingedge system of reform investigation and compliance monitoring including groovy and policies, data evaluation of internal investigation procedures. Thats critical to this particular issue today. With a focus on addressing correctional practices which include use of force and Mental Health crisis. As you heard in pres. Breeds remarks, she and i joined in our request for an independent investigation. Erin joins us with a high recognition from judge kordell was the Inspector General in san jose. Judge kordell has been partner to my office. Arun, as well, has been most reworking most risley with judge kordell on the blue ribbon investigation doing investigation assessment and best practice work of the commission on the Santa Clara County jail. So, without further ado just one statement i do not make before judge kordell speaks. Theres been a lot of people who believe that this hearing is going to be discussing phasers. Im not sure if thats the case or not. I just want to make clear on my position on cases. I am opposed to tasters in the Police Department categorically and i see that this hearing is really about alternatives to the use of force, of which phasers are a tool of use of force. So, i really will be disappointed to hearnot that any of the speakers before us right now is going to be talking about that but ill be disappointed to see whats put forward because that would not be an alternative to use of force but rather another tool under the use of force. Thank you very much. I agree. Before begin to evaluate any other tools we need to look at the policies governing and how these tools. Without further ado thank you so much for being with us. The floor is yours thank you for having me. All the supervisors and in particular i want to thank supervisor cohen and her staff for reaching out to judge kordell who then referred you all to me. I have a presentation. So if i can get it up, thank you so much. My name is erins assert. 11 from the south bay. Im a former term with the us Justice Department. My background a little more soothing idea where im coming from. Again, im just very glad to be here to be able to discuss my experience and how that might be helpful to the committee Going Forward as the city reflects on the best path forward in terms of police reform. The committees considering important set of what i view as very interrelated topics, Racial Justice, as additional rights, in particular the right to ugly integrity and be free from the use of force. And disability rights, in particular the right of individuals with disabilities including psychiatric disabilities to live in the community safely and with a service that they need and to avoid unnecessary incarceration and institutionalization. These are all concerns important to the community to the dignity of individual individual numbers of the community, to their sense of equality and inclusion and safety. A National Conversation as Everybody Knows here happens because of what happens in our neighborhoods. In our communities. Mr. Woods was a member of this community and i take my limited vote here very seriously and appreciate the opportunity to speak to. The thing the overall goal that i had in mind when i put together this short presentation was, i understand this committee and the city, the goal is to achieve credible proactive conference of and sustainable reform. This includes involving in a very meaningful Way Community members, stakeholder groups, and of course, taking forming partnerships between the committee and Law Enforcement. So, quickly, my background as you can see on the first slide, i recently served as a Trial Attorney in the Justice Department Civil Rights Division washington dc. For 5. 5 years i was working on systems reform case. I think pattern of practice cases is similar to this committee because arvind calls for pattern of practice calls investigation into the practices here in San Francisco Police Department. I work in the section in Civil Rights Division that conducts those pattern of practices into me Mental Health systems. While there has been a lot of publicity around that offices work on lawenforcement practices, and an enormous priority there for the Civil Rights Division has been to evaluate systems and Human Service systems that serve people with disabilities to ensure they can live in the community and receive the services they need rather than end up in institutions. I worked on a number of those cases. So, i bring to my remarks today a great deal of experience working to achieve change on behalf of individuals with psychiatric disorders, intellectual disabilities, in the corrections context, as well as in the community Mental Health Disability Services context. And ive also worked on race discrimination cases from the Educational Opportunities section of the Civil Rights Division including segregation, harassment,. All this work has involved not investigation individual incidents, which is the task of fbi and criminal section of Civil Rights Division, but rather with a goal towards systems reform and addressing systemic deficiencies. I worked on statewide cases as well as local cases. In addition to the work with the Justice Department, i think the point to mention i worked with a number of legal advocacy organs organizations including display rights organizations and criminal Justice Reform policy groups, and while doj and other jobs i have placed an enormous premium on committee engagement, community involvement, Community Outreach including large statewide investigation where we fan out across the state to talk with all the relevant stakeholder groups. And Law Enforcement. So, i presentation is going to be broken down into a couple, a few pieces. Im going to do a very quick discussion ofi was asked to present some data that shed some light on this problem that the committee is trying to address, and put into a national context. Im going to talk about what is reform actually look like a lease from the perspective of a Justice Department lawyer who worked on systems reform investigations and compliance monitoring. Im going to talk about some of the policies that are being addressed here, but i was notified of this last week. Its very hard to find all the policies quickly. Frankly thats an issue probably. Some going to mention some concerns some initial observations about the policies of interest but i want to talk about some of the things that the supervisors alluded to witches what we have to do the on looking at policies and friday, as a starting point, why only 5. 01 and 5. 02. Anderson with a focus on something. We have limited time and this is a process, but those aussies have an impact on other policies and various other practices need to be put in place were need to be looked at to see if theyre already in place. Im going to talk about the solutions, but poorly, theres been a lot of discussion about what is the best process, the best path towards that reform. Is it a dig investigation . Technical assistance . Is it Something Else . Where does the Community Role come into play in any of those various avenues . I want to just about some of those options which am sure are familiar to many people here. Just some quick data regarding a couple of the issues that are being addressed today. In terms of the disability rights focus, and Police Encounters with individuals with mental on this, National Statistics show individuals with Mental Illness are 4. 5 times more likely than the general public to be arrested by Law Enforcement. This is the mother statistic to many. Agile publishing consists of 1525 of inmates have serious Mental Illness thats compared to 45 of serious Mental Illness and that in the general public. There was a report that showed in many jurisdictions have osha shot by the police have Mental Illness. Then, another data point, theres been a number of doj pattern of practice investigations of one person agencies specifically focusing on use of force on this population. So San Francisco is not alone in having concerns about this issue. The statistics dont necessarily automatically tell us that their systemic deficiencies underlying that this portion hourly. The doj has found repeatedly that in various large jurisdictions that has been systemic deficiencies underlying those statistics. I think of a question the committees but important is that the casings San Francisco and thats an important question . In terms of Racial Justice and Police Shootings of africanamericans in particular, theres honestly a lot of things about racial profiling in various aspects of policing. But, to save the topic of use of force, federal data has shown black males were between 1519 were 21 times more likely to be killed by police than white males that same age group in the years 20102012. Although blackmun make up 6 of the Us Population account for 40 of the unarmed man shot by police in this most recent year 2015. Ive got to say where is putting together these statistics i was shocked by how are these numbers were. Job numbers for latinos or other groups i did look for numbers for latinos but there readily available because their track as well. Im sorry i do not bring that information. So, what does reform actually look like and when we say reform we mean something thats compacted and sustainable. Pres. Breed alluded to this important concept of maintaining the reform, not just being reactive and creating the form in the short term. I want to give a short disclaimer, which i alluded to before, but not San Francisco policies indepth. It something i enjoy doing. Thats the job im doing with judge kordell in santa carries jail and wouldve done as a professional at doj. As provide was also the materials. I understand the concerns by some of the recent incidents. I viewed the video. Ive read the news. But i want to be clear that im speaking hypothetically. Im not talking about there has been a pattern of practice. Some of the policies that are not seen may in fact exist but i wasnt provided and wasnt able to find them in the short time i had to prepare. I just want to be clear about that did not passing judgment one way or the other. So, im going to talk about policies but then im going to talk aboutim going to include in the discussion about policies about policies. 5. 01 and 5. 02 are substantive policies about use of force. But there are other policies on how we revise our policies on how we look to see if the policies are being implemented correctly and enforce. In many places youll see policies on the use of force within the use of force policy, youll have language about revising the policy. Updating the policy. And about ensuring that policy has been properly implemented. That doesnt seem to be the approach here. Its not the only approach but it does make for somewhat more fragmented approach. Im also going to talk about with those of limitation pieces are. We all know about data. We know about internal investigations, drink and those are the kinds of things im going to talk about. And then Quality Assurance. And oversight. This been a lot of discussion about oversight. I will touch on that. Then, not on the sly, but which it pervaded throughout this discussion is this question about culture and leadership. It comes about not just as a result of revisions to policies and procedures, but through Community Engagement as everybody here knows. So, in terms of the policies substantive policies, i know theres discussion and commitment to putting the crisis intervention practices into policy. Thats been noted lately. So, of course, one of the first things i saw was that in the use of force policy theres no discussion of deescalation or crisis intervention and beyond that theres no discussioni think is importantill talk more about this laterbut try to keep it shortbut it should be just crisis intervention training. It speak crisis intervention teams. Proactive prevention outreach to the community, outreach to the homeless populace and that of psychiatric disabilities. This is a concept that should be for mother to us. Its totally consistent with Community Policing concerts. For thing, is not addressed in 21st Century Policing the Task Force Report on 21st Century Policing. Ill explain why that is a little bit later. Are you referring to pres. Obamas 21st century im sorry. Yes, i am. But obamas passports on part of 21st Century Policing which was an important undertaking involves my colleagues and clearly has other imprint in the material. Its quite compressive but it is focus on policing and one thing all talk about is why we should just be focusing on policing. So, theres a number of issues around diversion and crisis intervention that are missing. I cite a couple of the relevant orders that could not to get into a lot of detail here. Although i can so they discuss it later. I can see a marty going longer than i wanted. Really, crisis intervention, the best practices are on forming partnerships with community Mental Health providers, advocates, much as to provide training and knowledge of resources but to actually deploy together and make it team effort to deal with people having Mental Health crisis in the community or risk of encountering a lawenforcement as a result of their disability. There are also policiesi know the focus here is use of forcebut theres a policy on buys policing and that needs to be revealed. I dont have to say a whole lot about it but something i want to mention is only having relevance to this discussion because buys policing takes place in all sorts of forms including news of force. Which may not be addressed in a particular policy. Then, as i mentioned, there should be policies on implementation and oversight. Thus some of those policy. Im going to go through with those different implementation pieces look like oulu to those policy. Alluded to those policies. So, im just looking at my time. Chair avalos says you can take them out of time that you need. Were going to ask questions after. Terrific. Will be here through tomorrow them. Just kidding. Ill make it as quick as i can. In addition to policies, the next visa reform is looking at are those policies implemented. Training is honestly huge way to ensure officers know how to implement the written policies and there should be training on all sorts of things including the things ive listed here, use of force, deescalation, diversion, biased policing, avoiding bias policing and presexual counters and the general order i found there. And procedures. What i mean by procedures, forms, cop processes to whether thats connecting somebody to a Mental Health service or documenting a use of force or what have you. It sort of the paper implementation of the policies. Then, the big topic is oversight. How do we make sure that implementation is actually happening . This whole bunch of ways to make sure that happens. I like to thinka lot of people like to thinktheres oversight or Quality Assurance as having 34 components. Data collection. Data verification. Data review. And response to that review, or Quality Improvement measures, corrective action. So its a feedback loop. You reviewed was going on. You make the changes and new review again and you do this periodically. In various forms. You do through quantitative data, qualitative assessments, civilian input, oversight input, community input. So, i artie mention there should be for example in the use of force policy that should be guidance on how to conduct an investigation. Some of that is in their but you see policies that have much more robust much more digital thing was about how to conduct investigations. There should also be reviews where its not for disciplinary action. Its not for criminal and particularly in the Mental Health context which i figure out we upstream how did this individual get to that moment reason countering the police. That means that review includes community Mental Health. It includes the jail. The probation at other agencies who may yet have involvement with that individual. So, then verification of data. This is what i like to refer to as review of the review. I think this is almost the most important thing. Your investigator is going to look at the officer who engages in whatever conduct has happened. How do we make sure that investigation is complete, thorough, accurate, fair, look at all the things that it needs to look at, interviewed everybody, was timely, was respectful, . There needs to beand there are mechanisms already in placeto make sure those reviews are reviewed. So that, if an incident report comes back as not an excessive use of force not a data point that may or may not be active. We want to make sure its accurate and the individual is held accountable as necessary. We cant rely on the first level investigation. There are also times when civilian oversight agencies other entities will conduct a second investigation of the same incident. That may have its place, but more porn than that second duplicate investigation is again an investigation of the investigation. Also, similarly there should be whether this documentation of deescalation efforts a couple of the bulletins that this there, 14. 11 and 15. 501 view the officers of quality and completeness. But its not terribly detailed and theres some, for example, superior officers only notified if the supervisor believes theres possible misconduct. Well, this. Officers should have a role in deciding whether theres possible misconduct. That may be the case but the policy is ambiguous in that respect. When investigations are reviewed, it is not necessarily. The investigations are reviewed for the quality of the investigation. Thats different from the officers incident reports which are reviewed for quality according to policy. There is also policies on the firearm discharge review board, where theres review of investigations of use of firearms, but those policies dont address the review investigation regarding the quality inadequacy of those investigations and also, i would note here, San Francisco should examine the independence of that review process. I would have to spend more time to learn about how independent that is. As i said, there should be a review of the data to see what about trends, bout spikes, certain kinds of the funds, in underreporting. If reporting of this type of incident has dropped starkly, that should raise some red flags. And then lastly quality proven. How do you respond to that data . Do update policies . What training . Again, the policies i see policies that say this policy is going to be reviewed annually and updated if necessary. Thats one way to go about Quality Improvement based on data and other information. So, the supervisors noted the use of force policy has not been updated since 1995. There are bulletins that attempt to updated but this new technology, new research, new data systems and the policy ought to reflect those. I think the policy refers to logging incident but not putting it into an electronic database. So, how do we get there . I want to talk about the need for multisystem review. I want to talk quickly about some considerations and priorities that we should have in mind when we decide what kind of approach we want to take, and then the various options. With its doj or some other approach. I thought about multisystem reform and by that i mean bringing together not only Police Departments but also committee Mental Health systems and other relevant agencies. I mentioned this work did doj does onto a Mental Health systems. We refer to work as olmsted after 1999 Supreme Court case but the americans with disabilities act with a hell that unnecessary institutionalization of this potus is a form of dissemination under the ada. The Settlement Agreements, which are on the dojs website, have a litany of these different services, mobile crisis teams, crisis services, act supportive housing, and the usual fare of Quality Assurance and Data Collection investigations, etc. So, without looking more upstream, youre left with the police having to be the First Responders were the only responders in a crisis situation in terms of Mental Health. Doj actually has made the link repeatedly although they dont conduct the police olmsted investigation or olmsted prison investigation. I think they should but they dont. In a number of their findings letters admit that link explicit. We said were investigating this Police Moment, portland Police Department. That sort of where they left it unfortunate. In the case i worked on wednesday what case involving use of solitary confinement in pennsylvanias prisons, we also had a note in the letter about the fact that addressing this issue over incarceration of individuals with mental on this requires looking at not only jill practices but Law Enforcement and community Mental Health. You can also bring in juvenile justice and probation and the schools. There is a note in the San Francisco reports about 21st Century Policing, i believe, about mou or memorandums of understanding various schools about data online force and moment with students on campus. Ive not seen the mou. Sounds like they could be reviewed and enhanced. As we go forward, and think about the right approach, heres just some of the not compressive listof considerations. A dag pattern practice investigation is looking for example at legal apartments not best practices or policies were committee values of those subtly inform the remedies and those are robust Settlement Agreements much more robust than you would get from other legal organizations. The law is therefore not assume. Best practices among policies, thats what you guys do. It goes well beyond the law. There needs to be consideration to give into whether a legal investigation gets you to that place. And these of various avenues address the multisystem reform approach i mentioned in terms of bringing committee Mental Health . How transparent, how community oriented, how much do these different avenues involve Community Engagement including, as one consideration, the diversity of the Team Involved in addressing the reform . Is dear g teams doj teams show up on the site and your joy with a command color is not always a team that reflects the population are trying to address the concerns of. I then must respect for my former colleagues but we all have our limitations. Ownership versus accountability. We want to own the process. But we also want to be held accountable. Then, how long will these processes take . The practice they all take a long time and we need to be patient and delivered it. And cost, of course. Just very quickly all mentioned, the albuquerque Settlement Agreement 1 million a year to pay the Court Monitor at the portland Settlement Agreement 3 million a year to pay the staff forbut always come with some kind of cost. I like the Settlement Agreements a lot out of doj and is a really good process. Its just there are other resources and i want to go through those quickly. I was asked to comment briefly on the need for independent investigations incident as opposed to the pattern practice investigation. Its an easy one. The newsman independent investigation. Whether its the fbi or another entity. I know thats already happening thats being requested. I dont a lot to say about that. Under the Comment Section and Civil Rights Division takes those kinds of cases extremely seriously. Sometimes they find they need to prosecute it and sometimes they dont and i trust those decisions. Thats one persons perspective. In all these different avenues to achieve reform, theres going to be an assessment or view. This 20 recommendations on policies and procedures. This can be making sure implementation happens and monitoring for some for lack of time to make sure it sustained. So, the special litigation section pattern and practice investigation, is one avenue that there are limitations, as i mentioned addresses constitutional minimum constitutional requirements. There is a cost. Theres the multisystem concern. Theres a lot of outreach to the community and fair amount of transparency they can disclose everything theyre doing, of course. Then of course of huge benefit this accountability. The court is go force them to do it. Doj, Court Monitor but still collaborative. My expenses still very collaborative with the Police Department were with the agency being investigated. You can see all the Settlement Agreements and findings of letter are on dojs website very easy to find and very interesting to look at. But theres notyou dont get any extra abs routines the dear g investigation that you would get from hiring consultants because those consultants that you are the same people that do the Court Monitoring an expert consulting for doj. Theres the cops collaborative reform which i know the mayor has addressed in this incident. They provide technical assistance. Some the same limitations in terms of a multisystem approach. Committee outreach is probably not as robust as Civil Rights Division investigation. Its not nearly as extensive and then there are grants for example the justice and mental Collaboration Program federal grant, which it looks like the sheriffs departments arty involved with good so, there may be opportunities therefore bringing committee Mental Health together. Theres other grants. As i mentioned, theres independent consultants. Devotion to the monitoring. The organizations that are familiar to a lot of people here cna and the rest all those acronyms. Im happy to provide some of those names. I did want to make a pitch for local resources, too, because this is the bay area. It is california. We have some outstanding expertise from academia. Other former doj attorneys and Court Monitors. Judge kordell is obviously an enormous resource. Community Mental Health agencies but some experts on pretrial diversion that are National Experts in the bay area. You have more control over the process if you bring in your own consultants rather than these outside agencies, but you get to make sure this committee engagement. Youve got to make sure that its a diverse team. Thats addressing the multisystem issues, and the last thing i want to say, no matter what course to take i said this over and over againthats to be the involvement of advocates, the committee, families, affected individuals. Thus to be attention paid to disability groups, Racial Justice groups, him and immigrant rights groups. One thing that i found over and over again during this worker doj was more than anything else, adhesives and request that any of the individuals made it was always want to see at the table. I want to be involved in the process because they can trust with the subset of outcomes are. I would go to say to individuals, the feds arty. Were going to get amazing relief. If you could wish for anything what would you wish for . They came up with i want to see a seat at the table but half the time that the vast four. There should be a plan for that too many hours. She organized, thoughtful. It should be meaningful outreach. And not just the service to involve the community. I dont think anyone here would engage in Just Lip Service about community involvement. So, with that, i went way over my time and appreciate the opportunity to speak with you. I want to again thank the committee. I want to thank the community for bringing these issues before being here for having Holding Everyone accountable. This a good audience. I certainly hope to be involved in some capacity im back in the bay area for the last year. Working on issue. I said our commission in oakland on disability rights. Involved in Santa Clara Tony with a blue ribbon commission. I want to be involved in my community and i consider San Francisco to be my community. These are issues for the committee to adjust. Racial issues, civil rights, as this is not rocket signs. This policy. Implementation. Review. Quality improvement. There are different approaches and different considerations. Theres a lot of available resources locally and nationally. I look forward to hearing from this committee about next steps and being available to provide any additional information. If you have questions am happy good i think what well do is take questions afterwards. So dont lose all our presenters. Thank you so much next speaker is going to be mr. Glenda jackson a set of director of the Bar Association of San Francisco as well as president of the criminal Justice Task Force of San Francisco. Weve also joining here in the presentation is julie truong. So julie truong is also of the Bar Association of San Francisco and cochair of the Data Committee of the criminal justice passports of San Francisco. Enqueue good morning. The morning to our city we. Thank you for having this hearing and for inviting us to speak. When we got the call from supervisor cohens office we rest to talk about some of the work that were doing to his committal justice passports which was formed in february or march of last year. It came on the heels of all the killing of young africanamerican men happening around the country. When we brainstormed with the focus of the midi should be, we wanted to do work that is unique to lawyers. We know theres a lot of groups come together to put thought around how policing should change and how different parts of the Justice System should change to become more fair, but we want to take the opportunity to utilize the skills that lawyers are trained with and license to do to Bring Solutions to this issue. The task force is made up of federal and state judges and we can give you a list of everybody makes of the task force if you like good highlevel attorneys in the district attorneys office. Highlevel attorneys in the public defenders office. Top rank officials in the Police Department at sheriffs office. The president of the Police Commission. The executive director of the office of citizens complaints. Various private Defense Attorneys and law school deans. The host of other bar associated members were just interested in the topic. Its been amazing to watch all these leaders who are often on the opposite sides of the aisle was on issues and the koran come together to come up with Real Solutions to these problems. Even in the short nine months the group has been together there had been a lot of success stories. One, being we got behind the grand jury bill those put forth by Holly Matilda went to sacramento, and we were able to get that bill passed that led to a grand jury the da not be able to convene a grand jury when there is a Police Shooting involves the man that now has to be vetted in the public to figure out whether or not charges can be brought against an officer in those instances. Then, we very actively engaged around the issue body camera particles. We had one of our members sit on the working group that was formed by the mayor. We made a written proposal on what we thought those protocols should look like. And got two of the three things that we were proposing happen in terms of those protocols. We are committed to staying engaged in terms of data storage and other issues that are to come back down the pipe. Another uses protocol looks like when a meet and confer phase in those issues are just implementation protocols are being worked out. The other subcommittees we have other than the grand jury and the body cameras are data and analysis groups which is becoming very active now for all the reasons my predecessors just spoke to. In that committee and julie will talk more about thatbut that committee has met in death with top officials from the Police Apartment in the office of citizen complaint with the San Jose Police on an open Police Apartment and they were very candid meetings with very robust information a change on how those two offices and apartments i should say, have made huge changes in how they police and how they work with their officers to be more Community Leasing bodies. We also have a pious committee to just look at these behavior issues that go into policing. And we know that is going to be the biggest challenge because changing peoples behaviors and mindsets beginning to organize spices and not act on dioceses is a huge huge undertaking. Both had meetings with the police chief on this and i know hes done some training this year with kimberlyaround that but its is sustaining sustained training model. Its not train once i hope they remember everything because we talked about changing human behavior. In the final group is the civilian oversight. So, if we can pick some of the issues happening daytoday on the streets of the Police Officers, when things do go wrong, what is the process look like in terms of people filing a complaint, being her, getting feedback and feeling they were treated fairly in raising their complaint. Again the executive director one of her top staff are on the task force and working very closely with us on that. For next year, we are going to probablywere considering we have not made a final decisionadding a use of force committee to start looking at issues around use of force and better policing and issues like Mental Health nurse citizens that gets stopped by the police and then we are also, which is not much about the policing issue but tangential, looking at the veil and pretrial detention and lack of fairness there in San Francisco. So doesnt deal with Police Moment but get charged deal with how people are charge of pickup and the how the rights are restricted on how bail is set. Some going to introduce to you now julie truong was the cochairman of the Data Analysis and Corrections Committee of the group and shell talk to you again about some of what shes learned melodically from oakland. That done Amazing Things in a short period of time. Was important they had to do it under order, but they got it done. I think San Francisco can learn a lot from that. Good morning. So im the chairman of the Data Collection committee and went to previous speaker, we initially took some of our direction from judge kordell. We met with her and she advised us that what we really needed to do, more than anything was to collect data data data. Without Data Collection accurate Data Collection is no basis for analysis. So thats where we started. We start by reading all of the material that has been circulated nationally, the 21st Century Policing report, the president s report. One document, which we received recently which i know we sent to supervisor cohens office, if youve not read it, i think you should. To beengineering training on police use of force published by the Police Executive let me interrupt you. Do you have copies for i dont but i can forward it all electronically to you. If you would like it. Im not going to rely on him just mention it. Colleagues, ill make sure you get copies of it. Its a very interesting article regarding the use of force and the cultural change that is needed in all Police Departments about the nation as we transition from what we call , opened cause, the warrior to the guardian form of policing. At any rate, we started by researching what was available and then we started with meeting with various Police Departments. Judge kordell opendoor for us in san jose. We met with their assistant chief as well as technology people, and on my committee is a commander from the San Francisco Police Apartment donnie chaplin, whos obviously involved and very committed to doing this work. Also a staff attorney was with joyces office, with the opposite citizens complaints, and member of the aclu and judge Laurel Beeler and ed linda the committee activist and i think well known to all