Transcripts For SFGTV Health Commission 20220816

Will you call the roll . Of course, commissioner chow . Present. Commissioner giraudo . Present. Commissioner chung . Present. Mr. Giraudo . Present. And commissioner green. Commissioner guillermo . Here. Commission commissioner guillermo will read the land acknowledgement. Thank you, commissioner green. The San Francisco Health Commission acknowledges that we are on the unceded ancestral homeland of the ramaytush rahmytoosh ohlone olonee who are the original inhabitants of the San Francisco peninsula. As the indigenous stewards of this land, and in accordance with their traditions, the Ramaytush Ohlone have never ceded, lost, nor forgotten their responsibilities as the caretakers of this place, as well as for all peoples who reside in their traditional territory. As guests, we recognize that we benefit from living and working on their traditional homeland. We wish to pay our respects by acknowledging the ancestors, elders, and relatives of the Ramaytush Ohlone community and by affirming their sovereign rights as first peoples. Thank you. Our first item is an employee recognition. Welldeserved for dr. Hali hammer and Roland Pickens who is the director of San Francisco Health Network and acting ceo will read the acknowledgement. Good afternoon, everyone. And thank you, commissioner green and commissioners for allowing me this opportunity to say a few words on behalf of someone i have known for many years and who is well deserving of this award and recognition. Dr. Hali hammer, what can i say . We met over 20 years ago at the Family Health center at then, San Francisco General Hospital, now zuckerberg San Francisco hospital, i think you were the associate medical director a few years out of residency and i was an associated administrator and your department was one of the departments i have responsibility for and so, its a pleasure working with you, both 20 years ago and the fact weve been able to Work Together ever since. And ive seen you progressing your career and all the while helping others along the way both your patients and trainees and colleagues at all levels. You are truly an inspiration for all of us at dph and you inspire you with your leadership and dedication and your diligence towards equity, excellence and achievement. So, its with a pleasure that we acknowledge your many contributions to dph and to the city and county of San Francisco. Thank you thank you so much. Is there any Public Comment on this item . Folks on the line, if you would like to make comment on item two, press star three. In general, a tip is if you would like to make Public Comment on an item when called, this is the best time to press star three and so this is plenty of time to get your hand up so again, star three for this item. I see no hands commissioners and i believe director colfax has something to say. I will, thank you, commissioner green and i just wanted to echo, mr. Pickens comments about dr. Hammer and dr. Hammer, i think we have known each other for also about two decades or longer since we were in training and the first time i heard about you was maybe i was a resident at this time and the work you were doing and the commitment you had and it has been an honor to intersect with you in many ways during your career and to see that commitment and that brilliance expand to a broader leadership work. I had a few comments from other people across the department about dr. Hammers leadership. Theres a lot here but im going to read a few bullets for the commissioners to hear. Dr. Hammer is a champion for new and innovative programs and advocate for Community Based programs, Behavior Health for our network patients, battling ten years as director at the Family Health center but deeply involved in the rebuilding and restructuring of our primarily care clinics including Southeast Center and castro center. And very importantly, a great mentor to so many rising leaders in the organization, and individual strengths and corks in all the areas that she works. Just the fact that dr. Hammer, hali from my own personal perspective, the contributions you make in an area that, in the public dont get the attention it deserves with regard to the incredibly powerful affect on creating the health and wellness in San Francisco and the way that you and your team continue to move ahead, not asking for or expecting recognition but really driving forward and improving health for the communities. With that improvement, it must be in the city and the fact that you and your team get it done and just to thank you also, most recently for the work you did during covid. Thats a good tremendous amount of organization and quite frankly strain on your team with regard to being the deployed to doing so much of the on the groundwork during covid. You also, i think, concurrently were holding so much of Behavior Health as we look to bring in, expand our Behavior Health leadership and that took some time so i really want to acknowledge your work in that. And the fact that you are brought in and pulled into many board hearings and policy questions and you just show up with exactly what is needed every time, so grateful for your leadership and thank you for your contributions to the department and to the health and wellbeing of those in San Francisco. Beautifully said. Are there any commissioner comments . Commissioner chow yes, i think everything has been said about dr. Hammer. I have followed her career. I know that she is passionate. Ive seen here directly in action when we were in china town Public Health, i think the last time we actually met and prior to that, we had many other actions on the finance committee and her work with the covid19 response. I had followed and thought that was just remarkable and the entire city should thank you for that. Dr. Pickens and hammer have said everything about a suburb position who is an accent to our department and to the entire city. Thank you, dr. Hammer. Thank you, dr. Chou. Commissioner giraudo . I, my comment is also to say thank you. And to add one more part of your description is, as a wonderful teacher. As a new commissioner just before our shutdown, both in person and virtually especially on our committee meetings, i happen to ask a lot of questions and dr. Hammer is always very gracious in answering my questions in a way that i dont feel totally incompetent and that i have learned so much from you, dr. Hammer and so, you well deserve this award but ill going to add teacher as well as mentor to your accolades so thank you and congratulations and i look forward to continuing to learn from you. Thank you commissioner chung . Youre muted. I think commissioner guillermo was before me . Oh, im sorry. Commissioner guillermo. Go ahead, commissioner young commissioner chung, ill follow up. I want to add i want to add adjectives. Not adjectives and you see you as an anchor on the entire team and i met you 20 years ago and i was working at gph, oh, boy, i feel old again and to see your presence, you always have this calmness regardless of what type of, like, stressful situation, so around you, it feels like anybody can concord the road if theyre working with you, so and of course, you know, for me, i appreciate that, you know and ive been fortunate with the Homeless Population and there are so many stressors, you know, in everybodys life and to have your presence to really so calmly, like, particularly, like situations and you provide advice that are phenomenal so i have the most respect for you and interesting that ive i guess you know 20 years so im still here working with you all. Thank you. Commissioner guillermo . Thank you. So i just wanted to add my comments and my congratulations and my thanks along with my fellow commissioners, to dr. Hammer. Anybody who has been able to contribute to the city and county of San Francisco in your capacity for two decades, plus in all of the things that San Francisco has gone through both in terms of its pioneering around Public Health and healthcare and its values for our residents really shows up, i think, in the kind of leadership that you have and leadership that you have brought through your career and so i want to thank you for that as a native san franciscan, you know, i have full appreciation. I may not have known you for 20 years but im sure i have benefited for your 20 years and hope to continue to do that in the future. Thank you. Well, im on the fouryear track but i have to say your service has been exceptional and not only have we watched you pivot the entire primarily Care Division during this very challenging time with covid but youve maintained that and that had to be unbelievably difficult trying to figure out how you can support the covid effort and keeping basic primary care for residents intact and accessible. All throughout that you were a great moral builder and that was the greatest challenges during this pandemic is maintain peoples spirit and morale in the face of these incredible and unanticipated challenges and you were critical in leading that and allowing us to get through the worse of the pandemic and intact and with wonderful results and good strategics in our materials of our response to covid so very much appreciate that. And i want to give you the floor to say awe few words, dr. Hammer. Im all speechless. Thank you so much. Mr. Pickens, director colfax and all the commissioners. I have to im speechless. I have to say working for the department of Public Health and serving the people of San Francisco for now over 28 years, so almost three decades has really been the greatest honors of my life. When i decided to become a family physician, i think i was in second grade. I could never have imagined that my career would take me on this path and i would have this great honor of serving with such incredible colleagues with leaders who share the mission to improve the health and wellbeing of everyone in San Francisco. It just has been an incredible honor to do that and like many of us who work in Public Health and especially in San Francisco these last now two and a half years have been incredibly challenging. We never could have imagined what we would be asking our colleagues and our friends to do to really dig deeper and do more and more and more and everybody throughout ambulatory care and through the Health Network and Public Health have gone above and beyond in terms of Public Service and i couldnt be happier to be a part of that team. Thank you for this recognition and im incredibly moved and i really appreciate that. Well, thank you so much. Were expecting another 20 years by the way. That goes with a recognition just to say. No doubt [laughter] thank you thank you . Very well. So, i guess the next item on the agenda is the approval of the minutes of the Health Commission meeting of august 2, 2022. Are there any additions or corrections to the minutes . Seeing none. Is that is your hand commissioner guillermo or is that before . Sorry, that was for before. All right. Hearing none, is there a motion to approve the minutes . Ill move. So moved. I second. All right. Is there any Public Comment . Ill check Public Comment. I want to give a shoutout to the sfgov and theres issues Live Streaming so please make sure youre checking on that. The webex seems to be working and folks on the line, if you would like to make Public Comment on item two which is the approval of the minutes of the august 2nd meeting, please press star three to raise your hand. Star three. And i see no hands, commissioners, so ill do a roll call. Commissioner green . Yes. Commissioner guillermo . Yes. Commissioner chung . Yes. Commissioner giraudo . Yes commissioner chow . Yes. Thank you, the item passes. Great. The next agenda item is the directors report. Director colfax. Thank you, commissioner green and good evening Health Commissioners and health director. Theres a lot in the directors report so ill go quickly through many things. The first is not actually written down but i just wanted to let the commission know and the public know that dhp is hosting back to School Vaccine clinics that are open to all San Francisco residents who are children. These clinics will provide all vaccines required for school entry or were loading were loading the first series of clinics august 22nd through the 26th from 5 00 to 7 00 p. M. In building 5 in the San Francisco hospital and then 10 00 a. M. To 2 00 august 20th, saturday august 20th and august 27th at south Region Health center. On bay view Hunters Point and people can find more information about the back too School Vaccine clinics on our website but just to emphasize that were making vaccines accessible to all children in preparation for back to school. This includes covid vaccines. In terms of monkeypox, just to let the commission know, we are now up to 563 cases of monkeypox in San Francisco. Over 95 of the cases continue to be among men who have sex with men and trans men. Our last vaccine was 10,700 vaccines and were still waiting the announcement about our next supply coming in. The good news is that we have expanded access at our zuckerberg San Francisco site. Our clinic is now double the hours, open 8 00 to 4. It has 600 to 7030 vaccines a day 700 vaccines a day. We have kaiser and usf are open to nonmembers of those Healthcare Center and sutter is providing vaccines to qualified members. In terms of additional doses, we are providing doses to those who are compromised and people at the zuckerberg clinic need to bring a note from their provider or if theyre a network patient, we can access their records to make sure they qualify for an additional dose after the cdc recommended period. And just to say from working at weissmanward 86 which is our hiv clinic, last week, its e siting to see while the treatment is still cumbersome because of the paperwork, theres better systems in place for people to access treatment and people are accessing treatment, qualifying for treatment onsite and were getting vaccines into arms in addition to diagnosing monkeypox cases in the urgent care clinic so a lot happening with monkeypox response across our system and across the city overall. And then we are reviewing, we are and will be reviewing upcoming guidance around inter der mall injections of monkeypox and the commissioners know, we will then be able to provide a smaller dose of vaccine which will allow what is currently indiscernible to be divided up into five doses so once we have the protocols in place and the go ahead, the final go ahead from the state and the cdc, well be implementing that as quickly as possible. Finally, just to acknowledge and thank speaker pelosis leadership in this issue and advocating for more monkeypox resources nationally and locally and i will be jumping off this Health Commission meeting for a brief period of time to join her at a San Francisco town hall where ill introduce our Health Officer dr. Suzanne. That will happen five minutes before the turn of the hour. In other news, exciting news on the, with regard to the opioid epidemic, San Francisco won a landmark opioids against walgreens. San francisco acting on behalf of the people and the state of california and one of the landmark trial against Walgreens Pharmacy where judge Charles Brier for the Northern District of california says walgreens is liable for contributing to the opioid. They did it without proper Due Diligence and this is the first bench trial that decided in favor and walgreens liable. So, City Attorney led this effort and many staff across dph served as experts in the testimony. The next stage of the trial will determine the amount walgreens must say San Francisco to abate the nuance they caused. Positive news in that regard. Next item that San Francisco has sued the federal government over indiscernible hospital closures. San francisco City Attorney david chew and former City Attorney louise announced they file a lawsuit to cut off federal government so the facility transfer all patients by september 13, 2022. Now, i do have some relatively late breaking news. Shortly after filing of this litigation against cms, they agreed to extend the availability of medicare and medicaid payments but lengthening the term of laguna honda closure from november 13, 2022. In addition, transfers and discharges of residents will remain cause for this same duration. Although resident whos choose to be discharged may do so. Dhp and george laguna honda wish to resolve all pending issues so a lot of activity in that legal realm and positive news that just was announced yesterday. On the Behavior Health side, i was delighted to join the bee hafbor health team and london reed in opening victoria house and new treatment care facility. This is a 12month Rehabilitation Center for individuals with serious Behavior Health conditions and Substance Use disorders. Its at indiscernible in the Mission Neighborhood and a beautiful residential and treatment bed facility that offers coordinated highquality and unit care thats deliberate in the least restrictive setting, so really great progress and great work that was done there. In partnership with many other stakeholders that you can read in the directors report. I also the commission had questions about covid and the work being there and i want to share with the commission that in collaboration with ucff and the santa Mateo County Health department, were partnering with local Community Partners to learn more about juan covid and achieve this, researchers ran the project, lets figure out covid and tell us a story indiscernible and well call residents ever all ethnicitys and background. We want to see how prolong covid is in the community. Information that all of you know is critical in impacting funding to local funds and and learn what causes it and how to prevent it. So this is going to be an extensive project. Phase i of the project, researcher will call San Francisco and San Mateo County adult resident whos had covid three months ago and their ex pierce answers will inform researcher was the frequency about covid and all ethnic groups and neighborhoods will be represented and researchers are interested in hearing from black African American, latino, Pacific Islander and native American Community because they experience higher rates ever infections and deaths than other groups. In state two, some people interviewed will join a more detailed study sponsor by the National Institute of health. This study indiscernible and they will be compen said for their time and theres links for these important projects in our, again, in the written directors report. And then im sad to an announce the passing of an employee, very much loved across the Department Israel rivera. Israel was a policy director with a Population Health department. And i will refer to the writeup. [crying] he was a dear friend for some of us and a indiscernible policy and work across the department. Thank you, im here to answer any questions. Thank you, director colfax. And we send our great condolences to the dhp family and to the family of israel and its very sad and we appreciate your report. Is there any Public Comment on this item yes, a lot of Public Comment. Let me read something. For each agenda item, members of the public will have an opportunity to make comments for up to three minutes and Public Comment is to provide feedback and input. The process does not allow questions to be answered in the meeting or people to engage in back and forth with the commissioners. They can ask to dph. Each individual is allowed one opportunity to speak and individuals may not return more than once on one statement for those unable to attend the meeting. Your comment should relate to the item were on and ill be a bit original on this for each of the items moving forward just to make sure that everyone has time to make comments on the topic. So, im going to go person by person. Can you clarify something for the public, mr. Morewitz we have covid19 and monkeypox update. Should comments on that be held until item five is completed and just focus on the other aspects. Directors report . Thank you for that, commissioner. Because director colfax mentioned both topic in the directors reports, than anything mentioned in the directors report can be commented on so the public is welcomed to comment on the topics here and the next because that was a part of director colfaxs report. Thank you for the question. First person. Let us know youre there. Caller, are you there . Im moving along to somebody else. Caller, are you there . Ill unmute you. Hi. This is dr. Palmer, can you hear me yes, youve got three minutes, dr. Palmer. Yeah. I was just wondering, since the lawsuit by District Attorney chiu is questioning the recertification and the arbitrariness of, why do you delicense the 120 beds. It seems like by doing that, were behaving as if the lawsuit means nothing. Certainly, the beds are being, can be emptied but why do we have to delicense them . Thank you. Great, thank you. And actually, dr. Colfax, i want to clarify, did you mention laguna honda in your directors report. I wanted to make sure. Next caller, please let us know youre there. Caller . Okay. Caller, ive unmuted you. Let us know youre there. Yes. Yes, youve got three minutes. Thank you, commissioners. My name is alisa matrotz and im sorry for your loss, dr. Colfax. I respectfully request that sfdph choose the best protection for the vast majority of san franciscans. That would be an indoor mask mandate. Its easy to cherry pick data giving the messaging coming from the cdc. For every doctor or scientist that would like to use the word inepidemic, theres a doctor or scientist who continues to use the word pandemic and push for indoor mask mandates. Please choose indoor masking as your policy. Thank you very much. Thank you for your comment. Caller, youre unmuted, please let us now youre there. Hi there, my name is anemia. I want to say im sorry for your loss. Many of us felt that pain as our Health Officials have failed us and our Family Members and students have died. Today, ive learned that students with iep are at high risk for covid and those struggling with their mental health. Its up to us to keep our students safe and Research Shows one way masking is largely effective especially with surgical mask that much of our district has access to. Also, regarding monkeypox, i ask you to please come up with some plans for when it hits our schools the next few weeks. Lets be more prepared and take care of each other. Lets reintroduce an indoor mask mandate, thanks. Thank you for your comment. Next caller, youre unmuted. Let us know youre there. Hi, can you hear me . Yes. Please go. Okay. Hi, my name is jennifer, dr. Colfax, i also wanted to say im really, really sorry for your loss. I just wanted to call in because you know, we have been, im a member of senior and disability action and we havent about calling in for the past few months and i do appreciate that you guys seem to be hearing us about long covid and i do appreciate you guys, i believe you said youre going to study long covid. With that being said, i do worry that this will kind of provide cover for not doing more to prevent long covid, to just say theres so much we dont know and were just studying it. And the thing is that there is a lot to learn but the things that we do now is that the, you know, it ranges from five to 30 of covid survivors who go on to develop long covid. So, you know, as local long covid advocate, Charlie Macomb has said, one in one thousand is considered a medically rare event so one in 20 is not rare at all. Its a serious issue and i hope that while youre studying this, you treat this as the crisis that it is. I understand that local Public Health departments are under attack right now. I imagine you guys are under a lot of top from the top and the cdc and state government, from mayors, i cant believe that what you guys are talking about, not requiring masks, i just cant believe thaw guys actually believe in it. I know what the Health Department has been task with selling and selling this is not infection. I ask you that gather the courage to stand up for whats right because whats right is doing all that we can to prevent cases and that means indoor mask mandate. Weve had high transition rates for the past few months in San Francisco. And its going to get worse in the fall as more kids go back to school. So, i ask you to please reinstate the mask mandate and i ask that you engage in a massive Public Health campaign to warn san franciscans about long covid, to educate them on highquality masks beyond saying youre doing it and im sure youre doing other things but we need to do more. And i just, you know, we keep calling into these meetings and then you guys ask questions and we move on and meanwhile people live or die based on your decision. And i know that its really hard right now, the Public Health profession, i know your job is probably online. If you lose your job, i think youll be okay but people will die. So please, please, please do the right thing and engage in a more equitable response and please reinstate indoor mask mandate. Thank you very much for your comment. Next caller, youre unmuted. Please let us know youre there. Im here. Thanks so much for the opportunity to share remarks today. My name is kristin and im a resident of the Richmond District where i have lived for last ten years and cofounder and coexecutive director of marked by covid where the nations largest Covid Justice and remembrance organization founded and led by People Living with long covid and people who have been bereaved. Reinstate indoor masking while were in this surge and have clear transparent on rams for reinstating mitigation measures. This goes in line with the heard ship that the city has played over the course of the pandemic and even in the monkeypox epidemic so far. I remember driving over the bay bridge when we declared a state of emergency on february 25, 2020. In that moment i felt a deep sense of pride and relief that we were talking action that would have lasting impacts on the health and being of people in my community and since learning about covid in january of that year, i felt safe for the first time. San francisco despite the National Politics leisure was leading and doing what was right and no doubt that that decision, the indiscernible from disacts and four months later the pandemic would hit my home in arizona on june 30, 2020. I would take a phone call that would forever change my life. My dad would die from covid. He lived in phoenix at the time where his local masking ordinance was illegal despite overwhelming evidence that masked reduced the spread of covid then and now. And as i spent part of my time in phoenix and part of my time in San Francisco during the course of this pandemic, it gave me the front row seat of the best and worst and pandemic measures in 2020 and 2021. As the months of 202 have dragged on, i have started to ask myself, whats happening . What is going on here . Im no longer feeling the sense of security with data. We have transmission levels in mitigation. Vaccines and booster was not enough to vulnerable communities who already have lost so much. And as youre talking about earlier, vaccines and boosters also dont really effect long covid which we only have data pointing to 15 decrease in long covid from the covid case. Were were headed is racist, this type of letting it wrap without mitigation. Sorry, your time is up. Thank you so much. Yeah, im sorry. When the buzzer goes off, i have to stop everyone so everyone has got time. Thank you for your comments. Next caller, please let us know youre there. Yes, im here. Yes, please go ahead. You have three minutes. Thank you. My name is Elizabeth Milo and im a rankandfile member of university of professional and technical employeeses, cwa working out of cwf health care. We passed my statewide union on july 30th, and 31 convention, we passed a resolution opposing the closure. We represent 18,000 members who are health care and education workers, Public Health care and education workers and to tell you the truth, its concerning that the reduction in beds would occur. And its concerning that city would continue to follow to continue reducing the beds at this point and even in calls to transfer, a pause in transfer, knowing full well that of the 57 people, approximately 57 people who have been transferred so far, nine died. That amounts to a 20 death rate. Im here speaking on my own behalf right now, but at the same time, i would like to inform you that i brought this up at the Labor Council and the members that i spoken with at the Labor Council are very concerned about this and very worried what thats going to mean for the vulnerable, elderly and disabled people in San Francisco. This is not something to be taken lightly. In fact, anybody else who continues to indiscernible could technically be charged with manslaughter because they know the transfer trauma is Something Real and people have died because of that. So, i want to make it very clear that what this unfortunately, this makes me think about what is has been happening in in privatization in Public Resources and i saw a report there was some talk about developing some kind of Senior Living facility on the site campus. Theres one field facility that accepts medicare and thats honda care. My grandmother went there, and if not for that service, she wouldnt have gained full function during the time she spent there. She lost her ability to speak and move around and she regained full function and good qualityoflife. When she was released from there, she had a good qualityoflife until she was 91 years of age and died of old age. I so i would strongly, strongly urge this Health Commission to realize that if there is going to be any kind of plan planning of Development Going on, im sure the people of San Francisco will not happy. I feel badly when i cut somebody off. Im doing it so everyone has time to do it. Thank you for your comments again. Next caller, let us know youre there. Hi, can you hear me yes, youve got three minutes, thank you. All right. Thank you. My name is reyes and an organizer at disabilities senior action. Im calling in with a bunch our members as we have the last couple of months about a mask mandate in San Francisco. I appreciated what our member ken said earlier. We know that most of you have worked in Public Health for a long time and know absolutely that masks work to reduce the spread of a respiratory pandemic. Thats true across the board and true, you know, for decades and more around the world and the fact that we dont have one right now is absolutely the result of politics thats putting big businesses and the Hospitality Industry and the interest of democrats trying to get reelected over the lives of san franciscans and that includes our friendlies and family. I have a coworker who lost a good friend to covid. We have people on this call who have lost Family Members and you know, just thinking about all of you who have lost a coworker, a beloved coworker recently, please do what you can in your power to prevent others from going through that pain. Its unnecessary. We know how covid spreads. We know that masks work. We know that one way masking is not sufficient. I dont know if youre all aware that just this week, San Francisco Unified School District had a waiver asking parents to sign theyre aware their kid will be exposed to covid19 in school and implying they are giving up their right to sue if something, if their kid gets very ill or long covid or god forbid dies which is happen and we have lost over one thousand kids to covid already much San Francisco started off the pandemic actually showing a science based approach that was put in Public Health above business interest and thats just no longer the case. Now, its really the same as anywhere else in the country where theres just rampant covid spread constantly. And it has been the case for here for months and we havent had low Community Covid spread since march. If we never bring back an indoor mask mandate, this is the new normal and what were going to be getting from now on and its going to be five hundred deaths a day or more in the summer and god forbid how many deaths were going to see in the winter, so please use your power as Public Health officials and implement an indoor mask mandate even if it makes you unpopular and if the mayor doesnt like it and if you lose your job. Thank you. Thank you for your comment. Caller, please let us know youre there. I have unmuted you. Hi, can you hear me . Yes. Loud and clear and you have three minutes. Okay. Hi, commissioners. My name is naomi and 17 years old. And im a supporter of senior and disability action. Im very disappointed that San Francisco has ended the vast majority of the mask mandate requirements and covid is high in the bay area even when cases are being undercounted due to at home testings and absence of contract tracing. Covid can easily spread on Public Transit where people are unmasked and as a young people with immune owe compromised Family Member, my ability to go out and meet with friends and explore the world is severely impaired with our current loss of covid precautions. Without a mask mandate and other mitigation efforts and strong ventilation and testifying, school has also become an unsafe place and indiscernible . As i try to keep myself and my family safe from this virus. I believe every child has the right to safe classroom and mask are a step toward that goal. Mask will protect everybody. Anyone can potentially get long covid which impacts many including young boosted and formally healthy people. I personally am terrified of developing long covid or giving it to my family and friends. We have we need to protect everybody. Please listen to seniors disabled people and alis and reinstate a broad countywide indoor mask mandate. Im also very concerned about the monkeypox outbreak in the bay area and beyond. And think San Francisco needs to indiscernible nonstigma tieing monkeypox. Thank you for your comment and community involvement. Caller, please let us know youre there. Yes, through receive. With the United Committee for labor party. We had a press conference at laguna Health Department and the sheriffs tried to keep people from attending the press conference but what were saying is, the reduction of beds to 120 is outrageous. Reducing beds to 120 is outrageous. We need more beds in sfr. Its only Skilled Nursing facility for working class poor black and brown people. I want to know why this commission and dan bernal who is a chair of the commission and chief the staff for nancy pelosi will vote to discharge patients knowing theres no place to go . Why is this Health Commission actually voted to send some people to their death, nine people. You know other Nursing Homes cant take people and you know covid killed ten thousand people in california because the conditions that other Healthcare Facilities are much worse than laguna honda. Why would you do that . Why would this commission and the management of Health Department do this . In my view, its because of privatization. You want that land. This is a privatization land grab with mercy housing behind it and the mayor given 3 million for them to develop that property. So the people of San Francisco have to put a halt to this. We need to expand it. We have to keep the patients and allow more patient to go there. The people voted in San Francisco hundreds of millions of dollars for that facility to make it a public facility. And what youre doing is harming the future of it, xavier, the secretary of health and Human Resources is responsible as well and gavin newsom and his department of Public Health. The people in San Francisco are coming in last and the patients are being forced out and discharged under pressure from this commission. Youre creating chaos and more people in the streets. When people are angry in San Francisco about the conditions in the streets, one of the reasons is people should be Getting Health Care and housing are not getting it. Not that laguna honda can be a solution to that but those with serious injurys and Health Illness should have a place to go and you refuse to defend laguna honda. Thats facts and the record and people need to investigate and were going to investigate why this happened. Why did these deaths happened and who is responsible. Its criminal negligence but this Health Department and by the executives and mayor london breed. Dan bernal should be fired. Hes chief of her staff. We have 80 billion and we cant afford to take care of sick and ill people in San Francisco. Its a crime and has to stop. Were going to continue to organize and educate the people of San Francisco San Francisco, the working people and all people to defend laguna honda and make sure it stays a Public Institution and adds more beds, to allow the reduction of 120 beds in the mist of this crisis and its a crisis in the nursing home industry. Its across the line. All right. Thank you for that comment. Hi, caller. Let us know youre there. Hi there. My name, hi, you can hear me. My name is brandy and im a Public School parent and you live in the Richmond District and i was just heartbroken to hear a 17yearold child call and beg you to reinstate a mask mandate. My Kids Start School tomorrow and hell be in 5th grade and i would be excited. Im terrified of him getting covid. They have high covid rates. We have principals and teachers in our school that dont mask and most of them do. My family got covid three or four weeks after the mask mandate was removed last year, so this affects me personally and affects all of our communities and you can i know you know the right thing to do is reinstate the indoor mask mandate in the city and county of San Francisco. And you cannot continue to build your careers on basically maintaining a poll tee that has that, have resulted in people getting sick and dying. Policy needs to be reinstituted, needs to be instituted again now. The time to do this is now. We need people with courage to serve on this commission. We need people to show courage who are serving on this commission. We need that mask mandate right away and Prince Georges County mr. Mayor land, their schools have reinstated a mask mandate, private schools in San Francisco reinstated the mask mandate back in may and many are this fall. Its not fair for our Public School students who are more likely to be, much more likely to be lowincome and likely to be disabled, why do we have a twotier track of safety in our schools in San Francisco. Please, im begging you, reinstate the mask mandate today. Our kids cant wait. Thank you. Thank you for your comment. Caller, please let us know youre there. Yes. My name is brenda. Im a dph employee. And the reason im calling is in support of laguna honda. You need to make sure it stays open. As an employee, i wasnt hearing anything, so yes, i have participated in a rally at laguna honda on saturday because we werent getting any information about what was happening. I mean, it was rough around the edges but no real information. So i think the general lesson that i hope dph has learned, when you dont tell people whats going on, the assumption is nothing is going on. So, the other thing i wanted to talk about is we were in an equity meeting here at the hospital and one of the workers that works in the library, she noticed something very bazaar about the people that were coming to get the monkeypox. She brought it up in there, why is everybody coming to get monkeypox wipes . I know there are many other races of people in San Francisco that are subject to that infection and including some employees that have gotten it. I just feel like theres something systemically wrong, with covid the same thing happened and now with monkeypox, the same thing is happening, so whatever it is that is causing this thing where you know, its not fair, its not across the board, everybody doesnt get it, i remember with indiscernible , it was the same thing, so i just hope you really look into all of that. Okay. Our next caller, i have unmuted you. Let us know youre there. Yes, good afternoon. Its patrick shaw. Director of Public Health, grant colfax and the entire Health Commission recognize the unintended irony between his directors report and agenda item 7 about the laguna honda closure update. Colfaxs report, cms imposed an arbitrary september 13th deadline to discharge or transfer 600 residents there by denying the city due process by requiring laguna honda to close well before the citys administrative appeals can be decided before the department of health and Human Services Administrative Law judge at the end of october, which might render the transfers potentially unnecessary. Yet, theres a clear unmistakable iron pee with laguna honda continuing its plot to reduce laguna honda licenses by 120 beds by september. Although the lawsuit and appeal are hear, if truth prevails theres no need to eliminate those beds which would deprive future generations of san franciscans due process access to beds in county by prematurely closing those 120 beds. Thank you thank you for your comments. Commissioners, theres about six other members in the Public Comment with their hands up. I have to track this manually, so i apologize. Its work inten ten. This is joseph urban here. I want to speak about the transfer and relocation process atly fwun that honda. To stop the transfers at 1663 signatures. Im great envelope that cdp have been explicit on november 13th we recognize this is testimony praury including my motherinlaw betty. We want to keep it until laguna honda is recertified. Regarding transfer trauma, we have 41 Skilled Nursing residents that have been transferred and we have nine deaths so were looking at 22 death rate and i believe we have 6 were on track to see an additional 90 residents die. So, in my opinion, we cant propose a solution to mitigation transferred trauma unless we have a definition of the disease that is transfer trauma. And i dont see how any doctor and a social worker provided by cms can mitigate the risk of transfer trauma via any scientific found methods unless theres at least an official definition of the disease. Now, i also want to say one question to ask yourself, how confident that you understand the issues or issue that cms expect you to resolve before laguna honda is recertified. Dont be surprised by if they say youre continuing to flood laguna honda and flooding them with mentally disabled patients, theyre going to hand you a rejection and everyone will be shocked and the department of Public Health needs to keep it awe Skilled Nursing facility and only a Skilled Nursing facility. The city does not solve the challenges with Substance Abuse the city does need to solve the challenges with Substance Abuse and Health Issues among the its time to build trust with cdph and the commission is committed to the citizens it was originally supposed to support. Thank you. Thank you for your comment. All right. Caller, youre unmuted. Let you know youre there. Hello. This is donna. And im, i have a brother at laguna honda hospital so i want to speak to that item. Although i feel happy that not another person has to die today and the transfers are quote paused that the, the trajectory of this going a little bit more positive is good but were still under the sum of the threat of patients being transferred. When i first hear about this back in april, i thought, is there not going to be a lawsuit . This sounds insane to me and it had no commonsense to it that you would try to create a better environment at laguna honda but at the same time get rid of the patients so it has been a very, very scary, terrifying process to be a Family Member of a patient and not know what is going to happen and i also know that not only has family and patients been terrified but also staff and so what i see here is that laguna honda is on track to update and come into compliance with their methods but at the same time, this patient transfer needs to be completely permanently taken off the table. Its not something as we all know, there is no place for people to go. There are no place for people that is with any good standard. So, to think about even the patients transferring out at this point should just completely soften and have nothing to do with recertification whatsoever and just continue for the hospital to, you know, to upgrade itself and come into compliance and this should be for any place. This should for any Skilled Nursing facility and any Health Institute where they are supported and encouraged to work on stuff instead of cutting staff and cutting funding. So, i am thankful for the people with the lawsuits. The city the city has created lawsuit and this was the only way to get the attention of the cns and so i really hope the cns and if theres anything, other actions we can take to get the cns to just wake up and get real, you know and just support laguna honda as well as other Skilled Nursing facilities in a way that creates a Better Future for everybody, thank you. Thanks for your comment. Caller, youre unmuted. Let us know youre there. Hi. Can you hear me . Yes, please, youve got three minutes. Thanks. First of all i want to say sorry for the loss ever why colleague and my College Dough lenses to all of you. My name is said are with senior and disability action. Im high risk and live in a high risk household and i have called into your meeting several times before and i will keep calling in until all of you decide to stop advocating your responsibility as Public Health officials and actually do the right thing for our community. The new cdc covid guidelines drag us further away from actual Public Health and safety to the point where they have totally lost public trust and have become a laughing stock. One example come from the website where they posted a mocking headline which reads quote, cdc announces people with covid can cough on person of their choosing. Is that how you want to be regarding too . Theres no reason why you is this hide behind a highly po lit tieden competent cdc whose decisioning making is stocks and prayers. You is can and should lead at a local level and reinstate mask mandate. Hospitalizations and deaths while important metrics are not the only negative outcome of a cold infection. Long covid should be a cause of concern for everyone. Its estimated that between 5 and 35 of people who geico individual will develop it. Piling evidence suggest that reinfections increased at likelihood of developing long covid which makes mask mandate more critical to protect our and other each from transmission as the have a variance rant was more vaccine ary vasetive. Despite the fact were in the middle of a covid pandemic, we seem to be replicating the key mistakes and a time to learn from history is now. Its never too late to do the right thing. We instate the indoor mask mandate and actually lead for crying out loud. Thank you for your comments. I believe were down to a few more. Caller, please let you know youre there. Yes, im here. Can you hear me . Yes. Yes, my name is elizabeth and a member of senior and disability action and i just want to echo too that its very sad for me to hear a 17yearold child having to call and advocate for you know, to try and get mask mandates brought back. Im very concerned about kids going back to school right now. And being put in this really dangerous situation where we have widespread transmission everywhere and theres nothing being done to slow it down. We keep sharing we have the tools and that does not apply to long covid. It doesnt apply to children and children cant even take indiscernible . With long covid, its disabling so many people. Its, you know, you have a one in eight chance of contracting it every time you geico individual and its just, if you even just think about the Economic Impacts of this, its going to be devastating as more and more people get this and as a result of this mass infection were forced to live with right now. Its unreasonable and cruel to subject people to this. Youre putting us in a position where we are having to put ourselves in real medical danger if we have to do basic things like using shared laundry facilities or taking the bus to the doctors because again, like if your chancing getting long covid, thats an area where we dont have the tools unless we are stopping and producing transmission. Thats why we need to bring back the indoor mask mandate. Even if you had one where, that was everywhere except for restaurants and bars for instance. That would still help enormously. I really have to ask what is the goal of Public Health . Are the days of control disease what are the perimeters of Public Health because this should be talked about openly. There was a lot of discussion at the last meeting about partnering with the community. And i really urge you to partner, not just with ucf but high risk people and people are long covid, with people who have lost loved ones. You know, i dont know if, i want to think that maybe you dont understand or know what were dealing with but i think more and more that you dont care and we really need to stop transmission and protect our citizens, thank you. Thank you for your comment. I believe theres two more comments. Please let us know youre there and ive just unmuted you. Hi, yes. My name is jordan. My pronounces are she her. Today, i got a letter about monkeypox vaccine. Im glad to hear [audio difficulties] jordan, you cut out, were unable to hear you. Im trying to help you because youre going in and out. I dont know if youre moving but were not able to hear you. All right. So, basically, i think theres difficulties here, so let me just im signing off. Youre coming in right there, you were coming in fine. Oh, im sorry. Okay. One more person. Lets see. Okay. Okay. Caller, youre unmuted. Plea let us know youre there. Yes, this is david elliot. Yes, please begin. Hi caller. This is david elliot lewis. Now, im unmuted, can you hear me . Yes, we can hear you. Yes, okay. Thank you. Im a 40year San Francisco resident. It has been several years since ive called into to the Health Commission but the what has been allowed to happen regarding laguna honda hospital has really appalled me and i understand, my understanding is that the Health Commission does play a role in oversight as does the Health Department and youve allowed conditions to get to the point where certification is lost and patient have been transferred out and lives have been lost as a result, which is appalling, so theres many who are asking and im asking to stop all transfers until you fix these problems. You also have a portion of the residents at laguna honda hospital that are not really skilled facility nursing residents and they should be there. Theyre using the facility as an alternative to homelessness, theyre using it as a shelter and this is not the best use of resources. They should be transferred to a more appropriate facility or shelter. These are hospital beds for people who need Skilled Nursing. The facility has allowed smoking and drug use on the floors which is which is resulting in overdoses. These are fixable problems. Not allowing drug use and smoking, this is fixable problems and allow this to go on and result in lost of certification is just wrong. These problems can be fixed. And residents who dont need Skilled Nursing, they should not be there at all. This is all a fixable problem. So, you really need to do your job of oversight of this hospital and get it back on track and get it certified and get the pay and population it needs which are people who need Skilled Nursing facility beds. Not people who need homeless shelters. Final point before i run out of time, i want to talk about the issue of mask mandates and covid protections. Coronavirus is still with us. People are still ending up in the hospital. People are still dying. And yet youve allowed mask mandates to expire especially in Public Transportation where it should be required. Ive been afraid to take buses because not everyone wears masks on buses. Thats a nobrainer. Thats easy to fix, to require mask in small rooms and Public Transportation. You could fix that. Again, david elliot lewis, tenderloin. All right. Thats all, commissioners, all the Public Comment. Thank you and thank you to members of the public for your input. Are there any commissioner comments or questions on the direct ares report . I see commissioner chows hand . I had a brief comment concerning the study on the long covid and i read the description that there was going to be of course, an attempt to reach all the ethnic groups and neighborhoods which is very important, i think. I want to remind us that with indiscernible , several ethnic groups, everyone really needs to be a participant in this and a third of our San Francisco and probably at least a third of san mateo are actually asians and the challenge are many of them use english as a second language. This is a very important topic so i hope the researchers will take that into consideration and really outreach to also the asian population. As we know here in the city, the asian death rate have been higher. Of course, this is indiscernible covid but most will survive but its important when the study is done, it does include a sufficient representation of the differentiation ethnicitys, so that was just a comment on a very important study that i think is underway now. Thank you. Thank you so much for bringing that up point, commissioner chow. I dont see any other commissioner hands, so weve covered, i think, quite a bit, on item five which is the covid19 and monkeypox update and we is this get the floor back to dr. Colfax and director cohen. Thank you, commissioner green. I i have covid slides and if theres questions regarding to monkeypox, dr. Cohen is available. Theyre publicly available for those who would like to review it and its stated theyre publicly available. I think from, just looking at our cases per one hundred thousand residents, this does not include home test thats not reported. You see that the good news is we appear to be through the worse of this worst surge where our peak is not hitting the omicron cases. Were almost now behalf half what we were more recently with this latest surge from 62 percent one hundred thousand to 27. 3. Thats really across the u. S. Right now where they are gradual decline in cases being recorded across the country. Next slide. In terms of our covid cases and leagues over time, from this slide, we had over 172,000 of covid cases reported. And unfortunately, the 63 san franciscans have died due to covid. This is looking at the deaths due to covid per month and again, its consistent with the fact that when you see surges, you see more deaths because of our very high vaccine rates across the city and because of access to effective treatment to prevent hospitalization. Our death was thankfully much lower than they otherwise would be. Next slide. Our case rate by vaccination status, higher verses those vaccinated verses nonvaccinated and the rate is three times of unvaccinated residents compared to those who have received their series of vaccines. Next slide. Hospitalization numbers reflected in our case numbers and why this gives us confidence that the worse of our recent surge passed and we see the hospitalization numbers are starting to come down now and those would not be affected by home testing numbers so we know hospitalization numbers are delayed, surges in hospital numbers and declines in hospital numbers are delayed by ten days to two weeks after we see a corresponding changes in our case rate. So good news there is our hospitalization numbers are still coming down indiscernible is coming down, excuse me. These are people in hospital with covid. Theyre not necessarily admitted for covid and historically about a third of these hospitalized cases have been from out of jurisdiction. You can see from the box here that our remaining Hospital Capacity remains relatively robust and at this time, were at no risk of having covid overwhelming our hospital systems. Next slide. Vaccine administration continuing to make progress in that regard. 75 of all residents are vaccinated. And you can see that for the age groups that are most recently eligible for vaccine, five to 11yearolds, 77 completed the series, far higher rate than the national rate. Zero to four years, consistent with the indiscernible . Its more slowly in this age group. 25 of it, received at least one doze and nine percent completed an initial series. Next slide. So, in terms of boosters, youll see that our older population for the most part have received, at least 1 booster here and just to emphasize the percent of all residents of all ages with the booster doze, the prior slide with the 75 of boosters are people who are vaccinated who are eligible for our booster so a little change in our denominator there. This is looking at the population in San Francisco that received at least one booster dose which is 64 . And you can see again that commissariat with when and how vaccine, when vaccine, boosters are recommended and vaccines were rolled out in that regard, the older age groups have a higher rate of boosting than the younger age groups. Next slide. I believe thats my last slide with the covid update. We received further news, expecting that an additional booster will probably be recommended in the fall of this of this year, so were continuing to be vigilant in terms of ensuring that people know where to go when the booster becomes available and ensuring our clinics and the public is aware of getting another booster dose so ill stop there and answer any questions about covid and then also we can take additional questions about monkeypox. We dont have formal slides for that. I gave quite a bit of data both verbally in the directors report. Thank you, director colfax. Are there any Public Comments, additional Public Comments on these topic. Thank you. Folks on the line, if you would like to make a comment on item 5, the covid19 and monkeypox update, press star three and i see hands. Take them as you see them. Im in here, thank you. Lets see. All right. Caller, youre unmuted. Let us know youre there. Yes, thank you. First, im so sorry for your loss, director colfax. Mayor beloved colleagues, memory before blessing and i hope we can remember the people who unnecessarily died of covid when there could have been better Public Health protections on a state, federal and local level to protect us. Lets do the right thing and prevent more unnecessary deaths. So, i first wanted to say i tried calling in both for the minutes where theres Serious Problems with and i listened to the recording and the last item because i wasnt able to dial it soon enough for the first one. I wasnt able to get through because i dialed star three, just before the last comment i wasnt called on so i hope i can get extra time since i tried to give Public Comment and i couldnt say everything i wanted to in the three minutes so i would greatly appreciate that. Im alice. Im an active member of senior and disability action and support all the testimony by senior disability action members and by others advocating for safety and equity around covid and pox, often called monkeypox. I i given that we are two pandemics, two serious pandemics. Levels of both are certificatory underestimated. Monkeypox and the materials before hand, actually the materials before hand, scott wiener was talking about how drastically insufficient testing for mpox and im saying mpox to avoid the stigma for African American for africa and in africa. It happens at the same time as often usually transmissed infections and people wont be tested for mpox especially in groups where the spread is not recognized like outside of gay, bi and queer men and many women have trouble getting testing and there needs to be widespread testing and theres an underestimate in the gay men, bi population and other men who have sex with men and who knows how much it is for those sexual and social network and even beyond. You might have seen all the peoples theres a story in people and other sources allison, im sorry your time is up. [no audio] hi again. I heard you use moicron as a marker so i wanted to remind you how bad that peak was and not starting with a mask mandate is going to be worse. This time around we dont have a remote option for our students. So, those students i mentioned with the iep who are at risk for long covid dont have an option to access Public Schooling safely. In january, our worst day was 392 positive cases. Those sections will lead to long covid. We know that. And we also know that people will get reinfected. So many teachers have left because of the failures to keep us safe. And our teachers on special assignment, tsa who came to our schools last year when our teachers were out in the hundreds, theyve already been reassigned so our students, when our teachers are out sick are going to be in mixed classrooms without required masking. This will lead to immense spread. You need to come up with a better plan for our students because our students go home to their families and their families go to work and they take Public Transit like i do and so many people on this call do and like you do too. Its not safe. Be better. Thank you. Thank you. And i apologize. You was muted before. Im going to speak to alice, please feel free to submit written comment. Im not able to take everyones word that they tried to call in. Otherwise, well have people double commenting today and we have lots of people so feel free to email Public Comment. Next caller. Caller, youre unmuted. Let us know youre there. Yes, hi. My name is pante and im calling in support of an endure mask mandate as well. Indoor mask mandate and we need it during a double Public Health emergency and nationally declare, two nationally declared Public Health emergencies and i am, first and foremost, a mother of a schoolaged child in the bay area and a very concerned parent going into the new school. Im also faculty at stanford at the school of medicine and human rights and Trauma Mental Health so im extremely concerned about neurological damage from long covid. I take long covid very seriously. I researched long covid as part of my professional duties and i am also a member of senior and disability action. I just want to comment specifically about the fact that were experiencing a lot of back and forth between leadership that were looking to for guidance but the cdc has disappointed many people in Public Health with its recent avocatino and they have standard bearing for Public Health and they leave it to state and county and local agencies to be the sealing and california and especially the bay area have been a ceiling, a stand tarred for High Standard for Public Health during the pandemic. Were in a state of high transmission and we have been for a long time and we have no metrics for on or offramps for masking and certainly during moments of low transmission, is an opportunity to maintain low transmission and continue being a High Standard bearing. With School Starting, were seeing 40 to 50,000 people in hospital in the united states. 400 to five hundred deaths a day. Thats a its a 9 11 attack every week. It makes no sense lowering standards at this time and the message the public is receiving and the statements about strong recommendations about masking are thinking not effective. We are, public is behaving in such a way that theyve received a message that they no longer need protections from covid19. That were not at risk anymore and thats not true. Mask show that communities care for each other and San Franciscos identity is intact and and were experiencing this after from public life. Theres a indiscernible to understand the science and who dont want to put our children and families at risk. And i really strongly encourage thats your time seriously thank you. Again, i apologize for interrupting you. Your time is up. We can go on to the next caller. Caller, youre unmuted. Let us know youre there. Francisco. Yeah, i would like to stress to the commission that we need qualified commanders for emergency management. And if we did have them, we would not be doing the stuff they are doing today. The mask must be mandatory. Our children must be helped, not put in harms way. And with the monkeypox, not once have i heard yall talk about who is for manufacturing this vaccine. We are the super power and not manufacturing the vaccine. We have to bag it from denmark and stand in line for the vaccine. And representatives will be told not to scare their people. You do not have the ability to manufacture the vaccine. And thats what we should do especially here in San Francisco. With all our labs in the bay area. And you, commissioners, have to be forthright and listen to the people. Dont have the people beg of you about this mask. Its the first fair wall we have, the mask. People are dying and if people die at home, you dont get the stats, you know that. Only the people who die in the hospital get the stats, thank you very much. Great, thank you commissioners, thats the last comment or hand up. Thank you. Thank you so much. Are there any questions or comments from the commissioners on the covid monkeypox update . Commissioner chow . Yes. While, i saw from an a letter transmitted to us from muni that they actually gave an explanation which is similar to what dr. Philip said. The last time they saw that 80 of the public are complying with the suggestion. And also, i thought it was important to let us know that parts of their fleet because i dont think it includes cable cars do have hvac systems that turn over the air once every minute and so thats almost at the same rate as airplanes are doing. However, they talk about the fact that they have asked the public to display signs strongly recommended, but in my i havent been on muni hasnt been out in any public setting in a long time in that way but from what i can see, i dont see that on the buses that i see go through that it becomes very prominent as youre getting on the bus and when they say we are exploring posting additional messaging within our vehicles and on social media, i dont think that this is just a matter of additional messaging. It seems to me we should be doing that messaging at this point so im not sure what relationships dr. Philip is still, you know, working with muni to put up a better things, whether as youre entering the buses. I saw that on a Stanford Medical Center box where it says ride as youre entering. It says, mask required. Now, if they insist on continuing mask strongly recommended, at least a sign like that might be just as helpful as having it on the back of the bus, which you dont really see when you get on the bus. So, i think theres still a lot more muni can do, which i would hope that the department is working with them on if they are not willing to create a mandate on Public Transportation. Thank you, dr. Chow and as we know, a decision to have a mask mandate on Public Transit is not within the purview of that commission as well as that director. As bart has done. And i believe director colfax accident was there further communication from director tumland from the mta especially the mask on muni and i dont know if you can clarify from a firsthand perspective what commissioner chow is referring to . So, i can ask director tumland to provide a more formal written explanation about the stuff theyre continuing to take. I think the the key points include that mask remain recommended on muni transportation and theyre monitoring mask mandate at 80 as communicated through dr. Tumland to me, thats higher than the mask wearing rate at bart. And they do make mask available at certain sites for riders and that you are continuing to do education and supporting people in wearing mask and believe thats being successful in resolving in its 80 of wearing. Thank you. It appears theyre planning and i dont know timeframe, but having mask distributed by everyone in the department of Public Health encourage, them to do as much as they can as soon as possible and make it available to the ridership. Thank you very much. Are there any other commissioner questions or comments . I would like to follow up on that because i think the way i read the note from the director, it was that it would be a valuable it sounded like it could be in station h and the Office Rather than really having it available so that as the public is coming through, if they dont have a mask, they can pick one up. I know theres ex were encouraging masking and make availability for the mask much easier than going up to the station h and asking for a mask. And that seems to be the way that the letter that he transmitted to dph is reading, so i think a clarification would be helpful that i think the way that vicepresident green described it, that agents would be able to, well, i mean that muni would be handing out mask, it would be a lot better than just saying, in a passionate fashion, you can come by and pick one up. Commissioners, if i may. Can you quote so were clear so theres not a question of this . This is from director tumland and we plan to distribute highquality masks to transit and operators so they can offer them to the member of the public who make a request. Those who train everyday will have mask they can distribute. Were exploring posting messaging within our vehicle asks social media. Just to be clear so that the message was exactly that. Thank you, thank you so much for that clarification. If theres no other questions or comments on this item, well move to general Public Comment. Vicepresident green, i just have a comment. Im sorry. All the named are scared on this panelists list. Please. Just want to get more detail or information if possible on the coordination or collaboration between the Health Department and the School District with regard to education on protocols and potential masking recommendations and so on, both for the faculty and the workers at the schools on the facilities and for the students. If you could just elaborate a little bit on the continued coordination between the department and the district . I can provide some broad information, commissioner and then we can certainly follow up either in writing or at the next meeting with more details. Our team has been working very closely with the schools since the beginning of the pandemic. That work has continued under dr. Phillips, with dr. Phillips team ensure that guidance is update and the understanding of covid and the risk and how its transmitted and especially with School Starting now, our school team has been working very closely with the School District and continuing to work with private schools and per roque cal schools to make sure they have the information and as much support we can provide. Dr. Bala, i dont know if you have much more to provide in details but we can come back to the commission with the right well probably working on this right now but were available for commission at this time. Dr. Bala, do you have more information . I can say we have a School Liaison that works closely with the school and childcare and the guidance we have is follow the states guidance in terms of masking and other ways to deal with covid in schools and so, if there is questions, theres a point person for that and as the school year has started, it seems that sfusd and other School Districts are well supported. We havent gotten a lot of questions about covid at this time. But obviously, we have a dedicated team member to schools if theres more questions otherwise. Thank you. I would imagine that as schools is actually starting, we might then get additional questions and comments and concerns raised and so, it would be helpful to have some detail about how that guidance is responding to those questions, concerns and recommendations that might come through, so some follow up would be appreciated as things merge and evolve over the next couple of weeks when school starts. Thank you. Thank you for bringing that up, commissioner guillermo. Now, i for sure dont see any other commissioner hands so we can go to general Public Comment. Ill read a statement before i check to see if anyone is on the line. At this time, members of the public may address the commission on items of interest to the public that are within the subject matter jurisdiction of the commission that are not on this meeting agenda. With respect to agenda items, your opportunity to address the commission will be afforded when the item is reached in the meeting. Each member of the public may address the commission for up to three minutes. The brown act forbids a commission from taking action or discussing any item not appearing on the posted agenda, including those items raised at Public Comment. Each individual is allowed to speak for one item and each individual is not allowed to speak again. This is your time to make comment about something not on the agenda. So if its about covid or monkeypox or laguna honda, i will cut you off. Hi caller, unmuted. My name is francisco. What i want to speak about is we, san franciscans, if you look at higher education, we have a very High Percentage of educated professionals in the bay area. And so, they are not talking about some simple type of outreach that does not benefit the experts. Right now in the uk, you all are aware that the research over there and the outreach over there takes us to the latest technology, the latest boosters that are available to the public in the uk. If that information is not given to us we wonder when were going to get the boosters. Theres no mention made of it. You read about it in the newspaper but you dont have the ability to get the right type of information, the right timelines and the shortterm goals and longterm goals and all this comes with having commenders who have certified who can do a who can do a Needs Assessment and if they cant do Needs Assessment, theyre not good on issues and not good at logistics and then you cant do anything much. Theres a time in San Francisco, not long ago, that link were sent that couldnt be opened. Thousands of people who needed to be housed couldnt be housed. I was told about this. I found a solution. And i have the San Francisco i have the San Francisco Health Department and thats because i was trained to do a Needs Assessment in the military. They are not going to be taking some you know, some comments, general statements. We need good data and we need good leadership, good leaders that know the way, show the way and go the way, again and again, the San Francisco Health Department has failed us miserably. Thank you. All right. Thanks for your comment. Commission, theres a handful of folks, just so you know. Caller, let us know youre there. I am, its patrick. Please go, you have three minutes. I have called for Health Commissioner ed shuder resign because he served for 23 years and its past time we get new commissioners. But i want to commend dr. Chow for his comments during the ohh jcc committee a week ago at laguna honda august 9th when acting ceo Roland Pickens announced last tuesday that laguna honda was 66 in completing its 120 bed reduction and completed by august 19th much commissioner chow thoughtfully spoke up saying reducing the license now is premature and should itself be paused until City Attorney david chow chew appeals before the law judge appeals or heard in late october and take it and the license change be taken up at a later time. Pickens said he would circle back and check with chew if the license change could be postponed. Why is that back for discussion today in agenda item 7 . The commissions word on this should be final and not be brought back for reconsideration again. Thank you. Next caller, youre unmuted. Please let us know youre there. Hi there. My name is brandy markman. I am a parent and a Public School parent and i would like to tell you about what is happening in our Public Schools in terms of communication with parents. We received basically an 8 page newsletter from dr. Wayne, our student superintendent. There was a half a page devoted to emphasizing the importance of covid vaccines which are very much appreciated. There was no mention at all of masks. What i received as a Public School parent in a moment. Im sorry, thats covid related. And we already had a covid item and i apologize but this is general Public Comment so items not on the agenda is what this item is for, and thats what we have to do. Sorry about that. Next caller, youre unmuted and let you know youre there. Yes, can you hear me . Yes, you have three minutes. Wonderful. Thank you. So the first comment i was making is just a general one about the importance of following the indiscernible principal. Its Important Health principle and i hope you can follow it in all of the policy and fortunately in important ways which i cant discuss because of limitations youre not but i wont discuss the specifics. I will go on to talk about the importance of being able to have sufficient time to make Public Comment. I tried two times and the first time i just couldnt dial the access code quickly enough to be able to be called on. There are some, i will not mention it but there are problems with misspelling of names and key concepts, so i suggest that the process for minutes is that the person preparing the minutes listen to the recording carefully and be sure they are, as summarized in the key points accurately. The other thing is that this should be double check by somebody else because its so important to have an accurate record of this crucial public testimony. You need to hear from those who are most impacted by the Public Health policy some of which harm us. And on that topic, one available, viv thats not his gender and not his name. They need, thats one example. Jens name was spelled gena. Alisas name is spelled elisa, and spelled alisa this is a huge problem and we need to be accurate. I hope theres a procedure and wait to give you know, at least give a minute or two. Some are disabled and arent so fast with our fingers because of mobility in his hands like rule tori agent right this and we need a chance to call in so we have to give written testimony and not just public testimony and not lose out. I was hoping to give testimony on all items and ill not able to and im limited because of that. So, just more broadly, i hope that people who are most marginalized who face the most type of systemic oppressions are affected by the policies are consulted with and policy is made in, with that mind that people who have serious, disabilities and those immune owe compromised and people who have hiv and aids, that in a way that impacts them seriously epi sen shlly workers, we should be consulted with and Public Health policy should reflect our needs. It should reflect the needs of people who are most thank you. Your time is up. Thats all the Public Comment we have in general Public Comment. Thank you. Thank you. The next item on the agenda is laguna honda hospital and Rehabilitation Center closure plan and cms recertification update and well give it to mr. Pickens, director of San Francisco Health Network and acting ceo. Thank you, commissioners. Interim ceo at laguna and its my privilege to deliver this update acknowledging that the update was provided in advance both to the commission and also to the public via the website. I will not go over each and every aspect of each slide, but instead will focus on high lates and key areas. And of course, at the end, well be open to questions and comments. Next slide. So, as director colfax, he shared with you the update regarding the pause and transfers in the agreement reached between cms and the city. So youre aware that that pause extends transfers not happening or discharges until november 13th. Next slide. Since our last meeting, we, cms actually dispatched a transmission facilitator who arrived at laguna july 26th and been onsite and has been acting as a resource to both residents, families, staff and anyone else who has concerned about the cms closure plan and how it is and was being implemented at laguna prior to the pause. Next slide. Just briefly, our views was is it an and tucks through july statistics ever july 28th in terms of discharges that occurred. And where those discharges and transfers went when they left laguna. Next slide. So in terms of a closure plan itself, transfers and discharges are on pause. And we are looking forward to being able to refocus many of our closure plan resources and efforts towards our primary focus of recertification and cms and medical. Next slide. So, again, as we focus on proux marry goal which is recertification, the next slide is a brief overview of where we have been and where we stand in that regard. Next slide. So again, from the very beginning on april 14th when the initial decertification occurred, we made it clear, our number one priority then and continues to be recertification, coming back into compliance with all cms, federal and state regulations. To that extent, we brought onboard experts who been on the ground with us since early may and continue to help and direct our activities towards recertification. Next slide. You recall in previous presentations, we presented our onepage roadmap. It gaze the timeline for our path owe certification. We had two different mock surveys and the mock surveyors are surveys are to simulate the kms process by identifying any areas of noncompliance and helping to the organize to the plans of areas of noncompliance. It follows the same process that cms will use when they come out to do the certification so its a good trial run for us. We concluded the first mock survey a few weeks ago. As a result, plans of correction were drafted by staff at all levels of the organization including staff, and management. Those plans of direction have been shared with the commission and it will be shared with others, other Key Stakeholders and others as requested. Next slide. A mock survey, the first one conducted in two phases and the first phase focused on core Skilled Nursing operations, nursing unit and themselves and the second phase of the mock survey focused on facilities and buildings, life safety related issues, pharmacy and Infection Control. In terms of some of the findings from phase ii, some of them mr. Ity the findings from phase i. Continued findings in terms of challenges with meeting Infection Control policies and procedures, keeping the environment of carefree of hazards at laguna. They were deficiencies in bio medical and medical maintenance and . Citations in terms of pharmacy services. Very much like the first phase of mock survey number one, disciplinary teams representing facilities, engineering, environmental services, pharmacy, food they came together in a twoday summit and looked at the deficiencies and had plans of correction that was submitted and approved to the mock survey team. Next slide. In terms of mock survey two, there were three key areas of noncompliance that were noted. Again, similar to the first phase and section control areas. Specifically, continued challenges with staff effect ifshly effectively doing hand hygiene and washing application of gel in between patients when coming out of patient rooms and dawn and giving have personal protective equipment. As a result, there were immediate interventions taken including particularly in terms of Infection Control, we immediately implemented an enhanced rounding unit and facility rounding process where we actually target looking for opportunities where staff are not appropriately engaging in hand hygiene and pp application, giving them on the spot, on the spot just if Time Training but then also beginning to share that information with supervisors and managers so they can take the appropriate follow up action with staff to make sure everyone is being held accountable to our regulations. Next slide. In terms of citations related to the environment of care, survey variances identified inconsistent oversight of environmental safety as evidence for example, there were unlocked evf, environmental carts and this is what janitors and staff use. The carts have chemicals and being unlocked means they were unattended and they pose a threat to residents or visitors who may try and access those carts and so we immediately made corrections to include more audits with the ebs staff to ensure the carts are kept throbbed so people cannot gain access, or who dont require access. Next slide. And in the area of food safety, the surveyors identified that food sanitation, particularly in the nursing unit gallis food was not being stored appropriately which prevented the potential of contamination so correct ifshg actions were taken and there were differ cleaning of the galli and the kitchen the hospital. Next slide. As you can imagine, as a result of the mock survey, we use that information to really help inform what are the areas where we still need to be providing education, training and coaching with our staff. So, from that perspective, we have developed a framework for our recertification, Staff Engagement and education and the next few slides will talk about that. At the heart of it includes, weve talked about this before, critical element pathways or ceps. Through are essentially 39 different areas that cms established for all Skilled Nursing facility across the country. It basically is a tool that high functioning nursing facility use to ensure that all staff at the Skilled Nursing facility are aware of what the requirements are, but also are aware of how they was in their discipline or departments are expected to ensure that overall the Skilled Nursing facility maintains compliance, so these 39 critical pathways are being rollout at laguna. There are 39 and well talk a little bit more about how were implementing those, roughly every week, we go through ten of the 39 so that on a monthly basis, weve covered all 39 of those ceps every month at laguna. Its an on going process and not a one and done. Its baking into the fabric of laguna honda hospital. This core element of using critical e. Pathways and these are the same tools that the surveys will use when they do the surveys at laguna so we feel confident by incorporating this as the pillar in staff in education that were on the right track. The second thing is the recertification comprehensive plan. Again, well talk more, wee show more details in a few slides. But essentially, we, through our both consulting groups took the results of the mock survey and identifying those areas of noncompliance and developed a curriculum specifically informed by those areas of noncompliance. So for example, the training that has and being rolled focused on inspection and control. Residents rights, keeping the environment free from abuse. All of those areas where the mock survey found deficits, thats what were educating staff on and well talk more in detail about what that education looks like in a few slides. And finally, our path toward recertification through education. It is 24 7 rounds. We have three separate teams that do rounding at laguna everyday of the week, 365 per year. This uses standardized tools for identification of areas of compliance with cms and state regulations. These tools are used to quantify data, that data is then reviewed and analyzed and distributed throughout the organization for individuals to see where we in terms of compliance with at least the observations of the rounding that is occurring. Next slide. One more. I mentioned those critical element pathways and just to touch on this a little bit, ceps, while there are 39 of them and they represent all the areas of Regulatory Compliance for Skilled Nursing facilities, theyre basically, ceps are administered by four key concepts and first theres record reviews. Looking at resident records to ensure the quality of care is documented in those records. Then there are observations. So for example, all the rounding were doing, thats part of cep operations. The observations go handandhand with actual staff, interviews. And also resident interviews. Again, its a Regulatory Compliance working its way into the daily operations of both staff and the residents experienced. And then citation vulnerability. As we go through each of those 39 ceps every month, areas ever noncompliance are identified and then plans of the action are created to address those. Next slide. One more slide. So, in terms of their comprehension ichb laguna honda recertification staff education plan, again, that laguna honda specific curriculum was developed by both of our consulting groups and is being rolled during the first week of august. The first month we included Infection Control. Emergency services, freedom from abuse. Last week, we too included education on residents rights, qualityoflife, Behavior Health. This current week, well be focusing on Quality Insurance and performance of the physical environment, food and nutrition and then finally the fourth week, specifically for our nursing and direct care staff, well have additional training in terms of pharmacy, medication and administration and comprehensive Care Planning and patient assessments. Next slide. So how is that education being delivered . Well, its being delivered in four different ways. Its a fourhour process each week. And it involves first didactic presentation during the first hour or two which is followed up by a post test for all participants and then we again to utilize concepts better suited for Adult Learning which includes skilled demonstration where each person who is enrolled in the class have to demonstrate the skills they were just lectured on, so for example, on Infection Control and prevention, we actually have to demonstrate that were able to wash our hands appropriately and effectively dawn and dof ppe. And then theres a verbal skills knowledge check where individuals have to successfully answer the questions related to that. I can tell you, its a very involved process. I personally am going through the classes. I have my week three training on thursday and so im right there with my fellow coworkers and as one of their participants classmates so it has been great to be a part of that. Next slide. And these are just pictures, so the top left is that didactic training weve talked about in the room. Thats also where the post test occurs and then theres the skilled training, bottom left corner, thats the handwashing and i will admit i had to have a second try in order to be pass successfully on handwashing and using ultra violet lot and if they see bacteria, you have to be sent back. I was sent back but i did eventually passed and i wanted to share that. The next slide shows a verbal test at the end. Next slide. Here, we have results from the surveys from the staff who participated in the training and the results from week one, you see here that overwhelmingly staff shared the training they felt made them knowledgeable about the topics thats present and its important because the topics presented are the ones we have problems with, with maintaining Regulatory Compliance and 95 of staff shared that as a result of training, they will change their practice. And again thats again, thats why we have all the rounding observations going on so we can monitor and see where we and are we going to sea a change in behavior. Next slide. And so as we begin to wind down this part of the presentation, i just want to share some of the major initiatives we have done to assist with recertification. I believe we shared before we organized both the nursing leadership at laguna and administrative executive leadership. The early findings from our consultants was laguna needed to restructure itself to be more in line with high functioning Skilled Nursing facilities. So weve done that. Our interim nursing director, indiscernible antonie worked with the director and reorganized leadership at the director and nursing manager level, next slide. We also did a similar process in the nonnursing operation where we have brought in a certified nursing home administrator to work with both of us on the executive staff to show us again in high functioning Nursing Homes the position of nursing home administrator is one that really helps to ensure that the facility is run appropriately according to state and hards and cms and in terms ever maintaining regulatory Regulatory Compliance. Next slide. One more. I want to provide an update to the commission in terms of our covid19 protocols. You remember for the past two years whenever we had a covid outbreak on a nursing unit, if there was one that we would put the entire unit on quote, yellow zone or covid precautions. The feedback from our consultant looking at nursing facilities across the country, weve made adjustments and rather than putting the entire unit on code yellow, were doing individual rooms of where the patients, if theres a patient, then just that patients room is on code yellow which means all the code yellow precautions in terms of enhanced ppe, isolation from other residents will occur but just the room and not the entire unit and that was important because of the findings from the survey show that all residents werent getting a lot of the activities and therapy that they need and one of the reasons was because the entire unit was on covid precaution so this is, we have been in this new code yellow arrangement for the, a little over a month now and it seems to be going well. We have not seen an increase in our covid numbers and i just wanted to make you aware of this change. Next slide. So, in terms of bed reduction, some of this was covered in the comments early on. And as ive mentioned to do chou at honda, jcc, we have relooked at this issue of 120 beds and had reconfirmed the position of cms that the new regulations require that we have room with no more than two individuals in those rooms when we go for recertification. We have not and let me repeat at this point, have not submitted any applications to reduce our license beds, 520 beds and we there are we are actually moving patients internally where there were people where they were three patients in a room. We are on track to moving patients to places where there are no more than two in a room and again, were on track to having that completed by august 19th. In terms of whether the legal action that has been raised will negate the need for any reduction in license, we do not know at this point. So well have to await further consideration and guidance through the legal process. Next slide. Also, i wanted to provide an update to the commission on the laguna honda Kitchen Floor renovation. Earlier on, it was identified thats an area in the Church Kitchen where theres broken tiles and a water leak. This was identified this could be a major facilitys related issue that could prohibit our ability to pass a certification survey. We worked directly with the California Department of Public Health. They have come out and really worked closely with us in looking at the situation and have given us a determination that as long as were able to implement . Temporary mitigation activities related to Infection Control and temporary repair that not having the full Kitchen Floor renovated prior to any recertification will not prevent us fully in any impactful way from a planning recertification. So, we are doing mitigation activities that cdph signed off on. But we are still moving forward with a full fledge replacement of the Kitchen Floor renovation. Its just we dont have to have it done before recertification. We have time to start it before recertification and then finish after successful certification. Thats my overview for the commission in terms of the current update on closure plan and recertification. And im happy to entertain any questions, thank you. Thank you, mr. Pickens for taking us through this extensive Progress Report and for your service in us reaching recertification. I believe theres Public Comment. Are there visuals on the Public Comment line. Folks on the line, press star three if you would like to make comment on this line. Mr. Pickens before we go to Public Comment, theres a statement that we received today around 11 46, is it possible to read that because that would clarify although its a repeat of the issues you have talked about, some is new information and the public it might be helpful for the public to make comment. Are you referring to the 120 beds . Yes. Its three paragraphs and yes it starts off with a responsive, yes, okay, thank you. Ill reread this. In response to the litigation filed by the city against cms, cms agreed to expand the availability of medicare, medicaid payments through november 13th and in addition to the transfer pause and transfer of discharges will be extended until that time. Dph and laguna honda hope well continue to work with cms and cdbh to resolve all pending issues and the citys litigation alleges that c mr. S forced to the city to implement aunt unworkable transplan plan and closure that denies the city due process and puts laguna honda patients at risk. Laguna has filed appeals before Administrative Law judge that challenges the cms decision to materialnate lieu medicare and medicaid provider agreement and again the classaction lawsuit filed on behalf of patients for the Public Law Group alleges that the closure of laguna and rust transfer process violates the america wez a disability act and deny patients and families sub is it a tifk and procedural due process. The litigation filed by the city the administrative appeals filed by laguna honda and the new classaction lawsuit by patients against cms and cdph remain pending and cannot be discussed in more detail in open session. In relation to the issue of a new of patients in each room, cms expressed its view that the termination of laguna provider agreement means that if it seems if laguna honda seeks recertification to participate in the medicaid, medicare program, laguna will have to comply with medical regulations if it was a new facility. If true, this means laguna honda will not be able to have three patients sharing a suite as currently the case at laguna. It is not clear if the litigation and appeals would have any impact on cmss position on this issue. Thank you. Thank you so much, mr. Pickens. Thank you for bringing that up, secretary morewitz. That provides clarification in the questions that i know was top of mind for the public and commissioners so we really appreciated those clarifications. All right. Public comment. Sure. Okay. Folks, ill give you three minutes and again, press star three if you would like to make comment on this issue . All right. First person, please let us know youre there. Yes, its patrick. Its again very concerning hearing that the closure plan update is now 82 towards completion on the 120 bed space occupied by laguna honda. And the hospital still anticipates completing that reduction by august 19th. As i testified a week ago and again today, applying for a reduced license is premature and may well undercut a City Attorney chews administrative appeals, any decision about applying for a new license should be made by a roll call vote of the full Health Commission. I think you should introduce a motion today and second it to postpone taking any action on laguna hondas license until the lawsuit is appealed. I dont understand how if the decertification of the hospital is overruled, why cms would force you into accepting the two patient per person room because they had not decertified you, that issue should not have come up theoretically. You urge City Attorney and the mayor and our congressional delegation to keep pushing on this issue in challenging the notion that cms could getaway with imposing a rule if you had not violated cms rules in the first place. It wouldnt be a topic for discussion. Thank you. Thanks for your comment. Next caller, are you there . Yes, thank you brenda. Sorry, my car is noisy. So, what i would like to say is i hope that while were talking about laguna honda at this particular moment, it is clear because i know people that are on that have Family Members on that waiting list. There still needs to be some other option and i hope the department of Public Health is looking into another option, some sort of overflow, smaller hospital or something where you have enough beds so that everybody who need help can get it. Thats it. Okay, thank you. All right. Next person, please let us know youre there. Hi. Its dr. Teresa palmer again. I really think its important to hold off from delicensing the 120 beds until the outcome of the lawsuit. It doesnt make sense at all. There is a waiting list at laguna honda. Theres not enough medical nursing home beds in San Francisco. This is the size 120 wes is the size of two regular Nursing Homes. Its crazy to cut them. And i would urge you to resist the final delicensing by any means possible. The other thing is i havent hear any assurance that laguna honda staff will be able to freely refuse unsafe admissions have San Francisco General Hospital and inappropriate admissions and the complaints i hear about laguna honda are from the subset of folks who smoke, who run around and cause trouble who dont want to be in a nursing home and would be much better placed in a Treatment Facility that cater to them. And this needs to be funded. Laguna honda patients shouldnt have to be put together with folks that dont need to be there and dont want to be there. And i heard no reassurance youre going to stop the flow project. No reassurance youre going to give the laguna honda staff and nursing staff back the power to independently and freely refuse unsafe events and services at General Hospital. I would urge you to look at alternative placements for hard to place San Francisco general patients who are not appropriate for nursing home residency. The benefit of this will be for free the bed for san franciscans from other hospitals and from home who truly need a nursing home bed. There is a waiting list. It has always been hard to get in but now its impossible. Please do your best to do this. I would also encourage no patient should be discharged who is who is nursing home eligible, should be discharged at all even if San Francisco has to bring the funding. The deaths that will occur are not worth the money saved. Cms may pull the funding for the two months, two month bridge until recertification but theyre not insisting that the nursing home close but just pulling the funding. Please, do not kill anymore people. Thank you. Okay. Thank you. Next caller, please let you know youre there. Commissioners, youre very fortunate that in San Francisco we have an attorney like rayne who is going to clear this mess. But commissioners, anyway you look at the situation, as the previous person alluded, it was a crime to send drug addicts and mix them with our seniors. I repeat, you do not mix drug addicts with our seniors who are suffering from dementia. You know that but yall did that to save money. And thats a crime. Now, our attorney reyna will reveal a lot about cms. They keep indiscernible us and you commissioners cannot stand tall and represent because yall know that youre not innocent. So, laguna honda is wellknown all over the world, let alone the nation. And this problem started with the drug addicts who should be about out in the old building or maybe put on al camacho traz and we shouldnt tolerate nonsense. If anybody has trading with the mill military or disciplinary, they will not put seniors in harms way. Thats what you commissioners are done. You have to have a Standard Operating Procedure rather than this long procedure. A standing procedure and orientation given by the consultants who you all are paying 5 million plus so yall know how to maintain standard. Each and every one of you commissioners should get an orientation. And it would be nice for our attorney rene and i think shell be willing to come and give her presentation as to how shes going to be dealing with cms who has been bullying us and you commissioners do not have that ability. Thank you, your time is up. This is the last caller, commissioners. Hi caller, please let us know youre there. Yes. My name is art and im an sf grade panther and interested member of the public. Watching with dismay the laguna honda hospital closure and patient transfer debacle can consequences for its residents and this is the result of ridge squalid and mindless Regulatory Compliance with rules that let commonsense and compassion and the net result in the unnecessary deaths of residents is a process that is bent on the destruction of San Franciscos rare and valuable public longterm care facility. Whats been going on at laguna hospital is a failure of government and local state and federal. When an institution like this has problems w he we owe it to ourself to solve the problems ask allow it to morph on and function and continue to meet the needs of San Franciscos vulnerable elderly and disabled residents rear than put them at risk but unnecessarily transferring them to inappropriate substandard setting that dont meet their healthcare needs result nothing trauma and even death. We need to keep laguna honda hospital going rather than shut it down according to inflexible counter protective and blind rule thats do harm. We call for a stop on Public Institution. Many questions ask concerns remain much we must stop 120 beds from being cut and force discharges to nursing home stops until recertification in january or february of 2023. Two questions, will laguna honda staff will be able to refuse unsafe admits from San Francisco General Hospital . And finally, will alternative placements for hard to place San Francisco general patients be funded . We got to resist the delicensing, solve the problem and keep it going. Keep lhh going to allow it to take care of elderly and disabled who need a nursing home bed. Thank you. Thank you for your comment. That was the last hand, commissioners. Great, thank you everyone from the public for your very passionate and thoughtful remarks. Are there any comments and questions from the commissioners . I see commissioner giraudos hand. Thank you, vicepresident green. I had a couple of questions. The first one being around the reduction in beds that was discussed and information shared about that. It would seem that the timing differences between and i guess the processes between the litigation and the deadline that we may have around recertification is something that we should keep a very, very close communication both with the public as well as, you know, with the commission and im just sort of i dont know what the mechanism for that might be but if we could sort of clarify them. Im glad to hear we have not yet applied to rely sense a number of beds relicense beds because i think that needs to be an opportunity to think about other options or at least to continue to dialogue in the arguments with cms around the impact of that in the particular situation we have at laguna honda, so i wanted to just make sure that as things develop that there is a good information flow and an opportunity for the public to hear what the developments may be as long as they are available to be made public. The other question i had to do with the thank you, roland for your presentation on the very involved and detailed process that laguna honda is going to get to recertification. And i had a question about the critical element pathways. And you know, i just i know this is something that a lot of attention is being focused on it and it appears as if theres widespread sort of owe moat cajun and the certification we have to do. Im wondering how the ceps might or might not have played a role in the past around previous surveys . The other and we know the delay on cms and deph on the facility related incidents was delayed, i think in some cases up to a year and a half, almost two years. We werent able to get a lot of the information about the kinds of things that needs to be improved. Is there a relationship between that and the critical element pathways that we are now charging to put together and to, as you say, bake in into the process of recertification and the future of improvements around laguna honda . So thank you for those questions, commissioner commissioner guillermo and ill start with the facility reports. The hundreds of incidents where laguna itself reported unusual occurrences or situations to the state and where the state had not for up to, as you have mentioned, a year or a year and a half havent come out to do those investigations. That is not directly tied to the cep through sales but its a significant issue in terms of our ability to, you know, make corrections. You know, in spite as we try to identify and catch everything ourselves, if someone has information about a deficit and we dont know about it, then you know, we dont know what to fix. So, you know, the good thing is over the last couple of weeks, the state has now come back out onsite to clear up many of those long outstanding reporting and so, you know, hopefully there well on their way of clearing up their backlog so we have seen them in few weeks looking at many of those cases and in terms of the cep in terms of how they may have affected or whats the relationship between the cep and our previous surveys and behaviors, the best way i can sum it up is that prior to our consultants, particularly the hvac group coming onboard in may, ceps were not on the radar at laguna honda which is, they were not something that had been to the best of my knowledge really incorporated into how the facility worked. And an analogy would be that, you know, weve talked before that one of the findings that laguna was structured more like an acute Care Hospital, so laguna really focused on, for example, the state of california title 22 un indiscernible for acute hospital so the per for znswer was driven by the title 22 regs and thats okay if youre a gen laguna is a Skilled Nursing facility. Like San Francisco general, they utilize title 22 general acute Care Hospital guidelines and the joint Commission Guidelines as their pathways towards Regulatory Compliance. So, while laguna wasnt a joint commission survey, but its a state of california license so it had been using title 22 and not using ceps which are the standards for Skilled Nursing facility and laguna wasnt using them but now we are and so, one would hope, one would think that perhaps had we been utilizing ceps in the past, perhaps, the facility could have been more in line with Regulatory Compliance and were moving forward to put that in place because now weve learned and been educated that ceps are what high performing Nursing Homes use to maintain their compliance developed by cms. Thank you, mr. Pickens and then the question about the communication around the bed reduction and the timing issues between the, its requirement for recertification as well as the litigation. You may not be able to answer that directly but it is something in terms of communication information, i think its really important. Absolutely. Obviously, any actions of communication will be done through consultation with the laguna honda jcc, first of all. Secondly, i think its important for me to clarify that 120 beds issued, there two things, theres how many beds are in a license verses how many patient was in a room. Were definitely, as ive mentioned, moving towards making sure theres no more than two patients in a room. We havent taken steps to change our license to reduce 120 beds. Again, working through City Attorneys office, you know, the litigation will have an impact on that, we dont know. Thank you, mr. Pickens. And thank you for bringing up the really important topics, commissioner guillermo. I see commissioner chows hand. Thank you and thank you mr. Pickens for a very clear explanation as to the medial work going on. First, i think that its important for us to appreciate that the administration and the mayor and City Attorney and particularly the public have, i think, finally made an impact on cms as to the consequences of this action. . Of which would seem to be actually related to in part to the technical problems that occurred in terms of the run up to our decertification which now is part of the lawsuit from City Attorney chew. And we hope that has a very favorable outcome and therefore it wasnt appropriate to decertify us and therefore wed like to make the corrections that are needed. I think mr. Pickens explained quite well in all the years that many of us worked at laguna and followed and monitored, we were following to a great extent the state surveys each year and seeing that we were in compliance with state surveys, which gave us our license and obviously we were also giving, i think, very good medical care as a Skilled Nursing facility but we seem to have had bypassed or i guess it went by us that in the many years that laguna has been there, that in fact, the federal government were developing different guidelines for Skilled Nursing facilities and therefore the existence of ceps werent even mentioned within our context of making sure that we were in Regulatory Compliance and we were always in Regulatory Compliance with the state on their annual reviews. And and so i think the hma and atec consultations have been very valuable to us because also then expanded our vision that not only should we just be meeting compliance with the state but we should be extending and expanding our services to our residents and activities, so that while these are federal guidelines, they were related to the fact that longterm resident Needs Service and respect and were learning to provide better than before. So i think coming out of this, laguna will be a far better place. So, i did want to commend the administration for having brought in two wonderful consultants and i think the work they have done shows in the presentations, the details they have gone into have been amazing. The course of action that they have put together, i think helped us feel more confident that we should come out, whether it be a recertification or correction of deficiencies that we can do it because they have identified even greater than surveyors may in fact identify and im hopeful that you know, this will be the next beginning, as you might say, the next iteration of laguna which will be better for our residents so i just wanted to take that to say that, in reflection over the last several months to have had so quick a response on the part of our consultants, a response then by our administration for putting this all this into operation and moving quite quickly that i think this is a pathway that we can take as confidence as we can that we are trying to respond to the issues that have been raised. So, thank you, mr. Pickens and thank you to the department for, actually, bringing these resources together and for everybody trying to work to make sure that laguna continues for another one hundred years, thank you. Thank you so much, commissioner chow for those really eloquent comments and you know, i would like to not only associate myself with those comments but also say that you know, over the years weve seen a lot of differences of opinion under aspects of Public Health but theres no question that everyone in this room, everyone in this San Francisco Community Wants to see laguna honda stay opened and to continue to serve our most vulnerable residents, not only today but well into the future. Ruma guy told me and quizzed me ask said do you know who was president when laguna honda opened and the answer is Abraham Lincoln so theres that tremendous history and its our privilege to continue to improve and keep this institution strong and continue to give the kind of humane and Compassionate Care that families and residents receive. I think we should also acknowledge how tragic this has been for the laguna honda residents and their families. You know, its great we have gotten two months more of time for our corrective action plans but all of us on the commission agree this is what we wanted to have had happened months ago and it really has taken not only the unanimous but the vocal support of local officials and members of the public and Legal Advocates and Union Members to get to the point that where we are today and on one hand, its really encouraging to see you the unity but its unfortunate the consequences that come as a result of this urgency that was put upon us by our regulators and those on the commission and the joint Conference Commission have been chosen involved in this process. I cannot tell you how impressive it has been as commissioner chow mentioned, the speed as with the department of Health Department leadership deployed our best and brightest in an effort to address this threat to laguna honda but also how quickly the staff who themselves are really traumatized, have not only embraced every one of these recommendations but come forward with such enthusiasm and eagerness. They loved the residents and they like us want to see this institution thrive. So i just wanted to reassure the public that we as a commission are very involved, were involved daytoday. Were involved in between meetings and we have the greatest confidence and respect for the staff and members of the department of Public Health working diligently on this problem and i think we feel confident that well be able to not only achieve recertification but also continue a better standard and cultural of excellence on to the months and years to come, so we really appreciate everyones input and everyones support for our beloved laguna honda. I dont see any other questions or comments, so i think in the interest of time, if its okay with the other commissioners, we might table items 8, 9 and 10 because theresish quite a few issues in closed session and if theres no objection, it may be best to table those to the next meeting. Is that your recommendation, secretary morewitz . Yes. I just feel like otherwise, this meeting is going to until midnight and i know thats not what you all were prepared for today. Those items wont be cancelled but deferred so the report can come in at the next meeting. Great. All right. With that in mind, we will go into, well entertain a motion to go into closed session and members of the public, im not sure when well be back. Is there a motion to go into closed session . So moved. Mark, are you can you hear me, this is glen levy with City Attorneys office. Theres two separate things that has to happen to go into closed session. Its a change in procedure but because were going into closed session and one is quality related and litigation related. We have to vote on both different basis to go into closed session. You didnt give me a chance to say it, but thank you very much. Sorry. And we also need to take Public Comment before we do the votes and i see a hand up, commissioners. Folks in line, if you want to make Public Comment, were jumping into closed session, item 11. Let us know if you would like to speak by pressing star three. The person on the line, let us know youre there. Its patrick, since youre going to take two votes, does that mean i get six minutes to make two separate Public Comments about each section . You have three minutes but please use the three minutes wisely, go ahead. Youre asking me to be wise. Thats good. So one of the things that the Health Commission and the full board of supervisors need to start considering is in the event that youre forced into this two bedroom per person maximum, is whether the city im cutting you off. That topic is not about the closed session. Anyone speaking on this item, its about the closed session. So thats the comment for this. Commission, im going to go to a vote. This, if you look at your agenda, were talking about 11b and c, so this vote is whether to hold a closed session. Well take Public Comment. Im sure ill hear about what i just did. Youll vote on a closed session, asserting Attorney Client privilege and this vote is closed session. Commissioner chung . Yes. Commissioner gr. Yes. Commissioner green . Yes. Commissioner guillermo. Yes. Commissioner chow . Yes. Now, please consider a motion to assert Attorney Client privilege in relation to the closed session discussion. Ill move to assert the Attorney Client privilege. I second. All right. Well see if theres Public Comment. One hand. All right. Please let us know youre there. I am. Its patrick. Im trying to suggest that part of the Attorney Client privilege conversation in closed session should include a discussion among the commissioners about alternatives for remodeling laguna honda hospital to keep the number of beds constant even if you have to float a bond measure or certificate of participation to remodel the facility to keep serving an equal number of san franciscans in county. You guys have got to discuss that as a policy issue whether in closed session or on a future agenda item or perhaps a joint session with the board of supervisors that that conversation must be had. Thank you. All right. Thats the only Public Comment on that item. Commissioners, well do a vote and again, youre voting on asserting Attorney Client privilege in the closed session. Commissioner giraudo . Yes. Commissioner chung . Yes. Commissioner chow . Yes. Commissioner guillermo . Yes. And commissioner green . Yes. All right. So im going to take us into closed session. Folks on the line, well disappear from your view and your hearing but if you want to wait, well be back and i believe closed session will be an hour, hour and a half, im not sure and folks in the room, actually ill get us in the room and well go over there. Thank you again to the members of the public. [closed session]