Transcripts For SFGTV Health Commission 20221108

Front. Commissioner giraudo. Present. Dimiss anyone . Im sorry. Me. Right. Commissioner. All right. Thank you. I have a script to read. You need a mask. Do you have a mask . Welcome to the november first, San Francisco Health Commission meeting in hybrid in person and broadcast live on sfgovtv via web ex or listen by calling. The access code is on the good afternoon remind you present approximate attending in person today that all safety protocols adhered to. This includes wearing a mask. Covering mouth and nose any time you may speak. Adhere to the rules approval from the removal of the room. We appreciate your cooperation with the rules and requirements in the interest of everyones health and safety. Note that hand sanitize are stations at the upon entrance of the room. We welcome will participation during Public Comment. There will be an opportunity for general Public Comment in the begin and an opportunity to comment on each action item on the agenda. Each comment limited to 3 minutes. Public comment in person and through call in. The commission will take it first from here in person and then people attending remote. Those in person requested to submit a card to the Commission Secretary and remote on page 4 of the meeting agenda. City policies with state and local law present discriminatory against employees and others. Will not be tolerated. Comment on the jurisdiction of the Health Commission. Folks on the line those of you who wish to make Public Comment i urge to you raise your hand by pressing story 3 to make sure you get your hand up in time in case have you a delay on your end. Press star 3 the begin if you go intend to comment. Thank you for joining us be patients we learn and grow with our hybrid systems. I have the privilege of reading the land ocknowledgement. The Health Commission acknowledged we are on the unceded home land of the recommend ram the africanamerican inhabitants. As the indigenous stewards with translations the recommend ram never ceded, lost or forgotten their responsibilities as care takers as well as all people who reside in their traditional territory. As guests we rescue noise we benefit from live and working on their Traditional Home land we pay respects acknowledging then cest tors of the Ramaytush Ohlone community and affirming their rights as first people. November is american inldzian and alaska native heritage month. It is time to celebrate and acknowledge the rich culture, tradition and histories in addition to the important contributions of native people temperature is an opportunity to educate the general public about the challenges native people faced and the ways which the communities worked address these challenges. This year the Health Commission ash rude 2201 addressing health of local American Indian communities written with local American Indian lead and acknowledge the experience by the communities. Resolution directs the department of Public Health and the communities to identify recommendations to address this. And honor and privilege to acknowledge this month on the first day of november. So. The next item is the approval of the minutes of the meeting of october 18, 2022. Are there additions or corrections to the minutes . I like to add a note on the minutes under the closed session there was a member of the public had questioned the electric of Public Comment taken on your actions regarding disclosing or not. I wanted let you know i checked with the City Attorneys Office they confirmd that the practice of not take Public Comment on that portion of closed session is alined with law and practice of other commissions and noting that the closed session has several portions and will take comment at the beginning. It is one item. I want to close this loop for to you know i checked and the process we are currently enacting can appropriate. Thank you very much. Secretary morewitz. Are there corrections to the minutes . Okay. Is there a motion to approve. I move. Second. I will check to see if well is public upon comment. Folks on the line we are on item twot approval of the Minutes Press story 3 if you like to make comment on this item. Okay. No Public Comment i will do a vote. Commissioner guillermo. Yes. Commissioner chung. Yes. Commissioner green. Yes. Commissioner chow. Yes. Commissioner giraudo. Yes. Minutes are passed. Thank you. The next item is the directors report. Good afternoon. Commissioners director of health with the report i will summarize items and happy to answer questions from the commissioners. First item is San Francisco ended Public Health emergency to mpx on october 31st. The case slowed less then and there a case per day and 27,000 people are vaccinated. The Community Support for Critical Resources such as vaccines coupled with early action drove San Francisco to successful response and enabled to reach this mile stone. San francisco proactive about health and protect themselves and others. [inaudible] 3 months of the declaration it is important to that mpx is circumstantial lit nothing communities and is a concern. Work must continue. D ph will focus Public Health resource where is they can be effective and address health despashities in communities. Vigilent in responds to out breaks, monitoring trends and keeping the community inform when new issues arise. Health systems and clinics cites will offer vaccines, tests and other resources. Also encourages people to be proactive about screenings other infections can present similarly and require medical care. New tools to prevent disease should be considered when promote. A trial conducted by d ph at city clinic and ucsf and d ph the Health Program and the university of washington found this a single dose taken within 72 hours after sex reduce infections. It is the first prevention drug effective in to the rited reduce infections. Promise to decrease rates of syfilous in San Francisco the highest in the country. Syfilous is the sti the highest potential for severe disease the eyes and nervous system. New guidance to be used among men and trance women when had an sti in the past year and oral sexual contact with one male or transfemale partner. Anyone with a history of syfilous receive it. They will support and participate in research hapromotes the health of the communities we serve. You will seat links to information. I wantedd this is an example of Research Done within the department with Academic Centers ucsf and university of washington take the findings and with a positive result. W to implement the findings in the field as quickly as possible and scaling up operations to meet the needs of our community. Next is the china town Child Development center. We cell brits the 50th anniversary. A Health Clinic in china town. Center served needs of children throughout china town since 1972. D ph established it to serve children, youth and families providing Mental Health Services Accessible and culturally appropriate. Ccdc integrates a Behavioral Health model for all eligible focus asianamerican communities. Provides by a team of providers. Dc also works with Community Members throughout the parents to address the stigma and associated with accessing health service. Through educational learner train and robust language services, ccdc credits a supportive environment to over come these challenges. Next is code lavender launches. [inaudible] in the sfgh foundation. Code lavender a crisis tool Health Care Workers can now call when incidents impact staff wellness occur. When staff called a code lavender a Team Responding with a stress diffusing mech niche. Wellness and next steps. It is piloting expanded hours in the emergency department. Next is with regard to uniting for u Grain Program the Community Health and prosecute motion newcomers Health Program. San francisco Tb Prevention Program and the Sf Health Network are collaborate to welcome and support ukrainian in san pran when fled due to the war. Many are joining sponsors to say in the u. S. Temporarily under the program enentitles them to employment and medical conferage after leaving their home. Since the u noticed for Ukraine Program start in the april. The team supported ukrainians from ages 4 months to 86 years of age. They are a collective effort and shout out to the staff for welcome and patient centered care y. There are additional announcements Training Opportunity in the directors report and i will go on to the am covid update with if they could come up on the screen. Commissioners you see here that in terms of our cases per 100,000 in San Francisco this is the larger it graph on the slide. We continue to plateau in terms of cases very much reflecting the u. S. Trendses shown in the insert. Next slide. And in terms of hospitalizations our hospitalizations have been stable over the last few weeks. Were averaging between approximately 40 and 50 people in the hospital with covid. Once again these are people who may be hospitalized do you to covid. Or 19 hospitalized for other conditions and have covid on admission this includes oust countef transfer residents you see that our Health Care System in terms of firefighter acute care remains robust. In terms of vaccines you see on this slide we continue to have high rates of over all vaccineful coverage in the city 0 to 4 year olds are less vaccinated compared to other groups a third of the age received a dose in a fifth an initial series this is higher than the National Rate and the same time it lower than we would like to see in terms of adequately covering that group. And then we have an mpx slide this is look at cases per day and case reenforce the fact we are very low numbers over case per day and you see case over time have levels off. Next slide. And with less than one new mpx case per day, we have ended the Public Health emergency. Sf covid rates are stable and Hospital Capacity is adequate. Booster dose added to sfgov. Org dash board in the next week we will have updates on the. Biveilant roll out. We do believe that increasing this full and winter lead to increased covid cases and encourage people to be prepared. Using the steps in the bullets on the slide. And we are working with the state to coordinate for the end of the california state of emergency which the governor announced in official 23. And i believe this is my left slide. Happy to take questions. Thank you. Thank you for the report and the progress we see in so many areas. Is there any Public Comment . I will check. Item athlete directors report if you like to comment about anything in the report do so by pressing star 3 to raise your hand. I see no hands wrochl commissioner questions or comments . I see a hand . Yes. I got it working. So. Director colfact im please period you [inaudible] the [inaudible] Child Development center it is an excellent [inaudible] the forefront of continuing to bring Mental Health to our children but to all our population. I know that the area and [inaudible] or a significant amount of [inaudible] may not feel enough. I wonder as you are talking about them moving into the china town Public Health center. Glad to see we are work on that. Im wondering if there is enough room that were not shorting them [inaudible]. Thank you, commissioner chow. Just with regard to the question administered by the team at ccdc that the renovated center can, comidate the ccdc alcohol be located on the third floor of the c ph c. Okay. Thank you. And appreciate this report. [inaudible] china town and [inaudible] of the choina town Public Health center. Thank you. Any other commissioner questions or comments . Okay. Thank you. And seeing none the next item is general Public Comment if you like to comment about manage not on the agenda of anything that is not on the agenda. Press story 3 if you are interested in making general Public Comment. We will wit a few seconds. I see no hands. Commissioners. All right. Then upon the next is the fiscal year 202122 Fourth Quarter Financial Report. D ph chief Financial Officer. I will be sharing my screen. Good evenings. Throughout chair jenny Financial Officer for department of public healing im pleased report the Fourth Quarter Financial Report for the year this close in the june of 22. This is the spoil spoiler alert the Fourth Quarter financials the final balance after the routine beens we do at the Controllers Office there is significant variances of the close of the fiscal yeesh. The positive balance of projecting in this and all other quarter low reports required off set the fund deficit. I note we had above budget ref now from one time and temporary source. The Controllers Office made a one time adjustment of 18. 7 million to repay a prior with drawl. This is was of something that addresses with drawl from several years agos. And was directed by the Controllers Office and City Attorney top do. Operating funds does not include any of the covid19 expensep spngs project. It is reported separately. Controllers office does make a 9. 8 Million Dollars transfer to address the short fall in q3 this is similar to what the Controllers Office done for part of of all city departments and Covid Response. Genetics big picture bottom line when we see over all is we will ends the year with 129 Million Dollars surplus in ref now and detail out what is driving some of this increase. It it is unusual amount off set in addition we have 13 penalty 4 million of savings and those 2 combined result in 142 million over ending fund billions of commissioners know we have a management reserve. We made 9. 2 million a deposit in previous quarter and it is update to the 2224 budget we increase the cap on the reserve and allows you to make 10. 6 million. Department expects ending balance positive of 122 million. I will note i had questions about 13 penalty 4 million savings. It it is a large amount of money. I will note that percentage wise when you electric at offering budget of 2 billion, 245 million. It reports. 6 . Of our operating budget over all. In terms of upon variance from a percentage wise, it is in the as significant but we recognize there is 13 penalty 4 million unupon spent dollars in our budget. Commissioners sought slide in the Third Quarter the numbers again is our estimate as we look at some of the formula changes that happened overnight last year. Not to support public healing system. Estimate about 94 million of the 1 twine million is related to the policy changes. Should take the numbers grain of salt a lot are formula rate changes. Layered upon volume change this is is an analysis i had the team do to give a sense of what is the main one time drivers of the revenue. Sorry. The new item that we did not see in the prior year was 4. 9 million, funsd by the federal government part of the american recovery act. And used to support Public Hospital systems in the efforts to address the covid19 pandemic. Commissioners remember prior we received 23 million over all from multiple phases of the revenue starting in 2020. And we released received a final dispursement of 4. 9 million in the current year. We expect that this will be the left disbursement of relief funds from the government. In addition to the net increase approximate following the submission of the prf claims reports for the 21 ref now prior fiscal year close the trf revenues were realign in the our budget to match claiming suck mission. Revenues work the city received the dollars in advance of submission of i claim. We made our best guess where to budget them and rescue noise them. But once we got the final reporting determined how we best to claim to maximize ref nows for the city. We adjusted ref nows to really identify where they were you will see positive and negative dont worry they are not losses and revenues. It is the alignment of dollars. Remaining changes the 3. 27 million for the extension of the s map. Which is matching percentage under the Public Health emergency 8 opinion for behavioral, 3. For you for laguna honda. We have one time thresh hold payment under groebl Payment Program of 38. 5 million. One time state grant for Public Health care. And 9 penalty 4 million of one time Behavioral Health settlements. Diving in the details San Francisco general this is where we see the significant revenue and our largest division. Net patient ref nows 70 penalty 9 million the matching s map. Medical 8. 6 the net of the 38 opinion 5 the payment plan increase. We also of the 29. 2 million prior year settle am the net impact is 8. 6 million. Quality and Center Program is expected to perform better boy 4. 9 million and the Educational Program continues with 9 million. Tation ref nows of 4. 3 million and Quality Insurance was 7. 4 million. Minor negative variances of 600,000 on salaries. 900 jobs and nonpersonnel and approximate 1. 2 on supplies as a result of covid19. Laguna honda hospital received 10 million in sniff rates includes some of the formula changes in our rates. But it is off set boy 6. 1 million of cost we rely on other divisions to reflect the cost report. Expenditure side 1. 4 million savings and minor savings and materials and splice. Fringe benefit savings a result of one time upon delay in hiring that we dont expect to continue the last 45 months we have been doing a push for hiring at laguna honda and primarily facility staff. I dont expect this level of savings to continue. Am i know the commissioners had question the contracts for consultanters coming oust budget and, yes. Thank you j. So the contractless we are have set up additional to support the recertification efforts. We were notified of the decertification of laguna honda mid may, we did set up a contract part of the be ending of the fiscal year we had 6 weeks in the year and did in the have the contracts start right, way. There are minor expented tours reflected for year ends 21twoochl i xmentd export bulk to hit on july one and beyond. I expect welsee those impacts in the Financial Statement and not in the prior year. Behavioral health projecting 29. 4 million in additional revenues. Patient revenues related toy medical billing driven by match and percentage. Minor increase in medicare revenues 4. 1 million the prior patient revenues. Alignment of 16 penalty 5 Behavioral Health [inaudible] 4 huh that you knowed and [inaudible] am Substance Use of 200,000 off set by losses state revenue of 700,000 of delayed claims with the School District and a million related Substance Use. On the expenditure side the salaries are variance of 300,000 and nonpersonal, this is reading 4. 5 and not 3. 2. This is related to one time prior year close outs of purchase orders that were held part of past report settlements we are expecting to close with the accel ritted settlements we saw we can close out the peers we are holding in the caves additional costs we may need to incur to finalize the settlements. The drivers on our nonpersonnel side. It is manage we have seen in prior years special condition to look for and work with Behavioral Health to project their contracts. In primary care, there is we project a short fall 4. 3 million. There is a prior Year Adjustment related to the adjust item as well as a 5. 5 million. The other patient revenues 400,000. A positive and negative on medical and medicare this. Is our ability to perfect low predict how pier sources off set each other minor short fall and a positive increase recognized of 800,000 for provider funds. And 15 some salary savings related to one time hiring delays. Of 900,000 will small savings in personnel and materials and supplies and equipment work orders. With jail health, and health at home 1. 1 million of improved patient ref now in addition to minor [inaudible] approximate for the Health Network, commissioners seen the adjustments the last 3 quarter and we adjust whered the current year budget. We will be seeing many of these observe but there is short false of 21. 3 million in revenue related 700,000 short falls in the medical activities billing. As a result of staff this are being code toward Covid Response and in the drawing down in the 2 sources. The health plan settlement of minor short fall 200,000 and recognition of short falls and healthy San Francisco emmrooi ployer fees and 400,000 related fees and licenses. The other revenue where we assume 6 million city option funds vs not recognized them in the past several years that remains a short fall. We did receive will positive revenue of 900,000 for california Child Support services. 1. 1 million for provider relief funds. Thats a double count the total should be accurate. For of the expenditure side, fringe savings 700,000 on nonpersonal savings 2. 2 primarily on contracts and the small amountol interdidntal work orders. And i mentioned earlier. The Health Network services receive the one time budget adjustment 18. 5 million to repay the prior year with drawls and neutral you dont seat variance but something i wanted to provide. On the Population Health side 4. 3 million short fall related to 700,000 in medical and billing 1. 7 patient revenues. I think it is primary low a make reduced activity of the some of at our travel clinics as well as we are looking at epic billing issues moving forward. That we hope to resolve. EnvironMental Health fees. Of 2. 8 million. The rust reduced activity as well as some adjustments where we are delaying recognition of some payments to support small businesses. Coordinated with the larger city. Other revenues a baptist provide are fund adjustments as well as 300,000 for agricultural prevention for weights and measures program run oust the environMental Health that supports the weights and scales you see. Expenditure side minor variances 300,000 and 7 00,000 in nonpersonnel service. Public healing add striegz straigz. Recognize mel medical activity there is do you to some reduced time study billing related covid. A short fall of 1. 8 million. And short fall or this should be a surplus in vital records of 200,000 and then recognize 8. 4 million of provider relief funds. For expenditures. Upon 700,000 savings infringe and 2 million of nonpersonal Services Related delay and issuance of debt delayed and pushed out the debt payment to a future year. Minor savings and billing from interdepartmental work orders. The Covid Response side, the projections remained primarily the same as you see here. Terms of the revised budget the Controllers Office did adjust can revise to be 170 million to match projections actual is 10899. This is a continuing fund, we are we are noting that the other pending charges ruled over in the following year about 40 million. We expect will be charged for services this were rendered in the prior year. We are expecting those acountries to hit post june 30 time frame because of the nature of how the Controllers Office treats funds tell be rolled over and expect that to be for prior year services. We have a 5. 7 Million Dollars inventory adjustment and will this was tricky for mow to show i gave it its own column here. It reflects the requirements for treatment of prior year purchases. Result of rescue noising the have you of an asset and used and deducted from the Balance Sheets in the year it is ewe likewised. So, when we factor in adjustments the projected spending part of the covid project leaving 15 opinion 7 million. Part of our budget process this february and may, we assumed that we would have savings in Covid Community line item to continue our contracts throughout end of the calendar year. We were expecting the 13 Million Dollars surplus to continue and will be applied services this year. There is an available balance of 2. 8 million. When the project is commreechlt in terms of highlights of the variances in addition to the adjustment. Hotel savings and funding throughout d. Homelessness and Supportive Housing and room key program. We were able to charge cover the cost of hsh and not apply to the covid budget of short fall in Quarantine Hotels due to expansion of rooms and the contracts i mentioned, testing which over budget is we were aware of duce to demand during omicron surj and vaccines reducing the need for services on our end. So finally with the Revenue Management reserve, want to update you as of the Second Quarter had made the deposits for our manager reserve, which is capped at 5 of the 2 year budget of budgeted revenues. With the adjustment and adoption of the new 2 year budget increased revenues, therefore making an additional deposit of bring the total reserve 123 million and full emfunds the reserve we have to buffer against fluctuations in revenues moving forward. I think those are all my presentation i know there were other questions outside of the Financial Statements. And i want to make sure that i get to them. So there is a question about how medicaid redetermination will impact capitation ref nows and the states changes to capitation as well as the impact to healthy San Francisco. This is a hard one. To predict the impact. First the redetermination of medical benefits again for commissioners background. The state paused disenroll am in the medical program. Basically if youor medical you stayed on and you were not disenrolled. With the states announcement tell end the Public Health emergency in february that program will sxenldz they will begin this redetermination press to determine when is eligible and not for medical. We expect this to be phased in. And so we are not sure if there will be an Immediate Impact in the current year it is one we will watch and dependses on the reasons for people disenrolled because am income eligibility. Received employment to qualify for employer coverage ownership geographic, where they moved out of county or the state and not eligible. And so it is hard to tell, like low result in a reduction in our enrollment. But this will is off set by expansion of medical benefits that started in may of this year with the 50 plus group that will now be eligible for benefits regardless of documentation status. And this will expand to the full Adult Population this following may. We expect this would be anup tick in capitation enroll am and reduction in healthy San Francisco. Tell is too early to tell but this is a question that we will looking at part of our budget. And will be try to understand the impactless the next months. And then upon last i had a question about in prior years would we or in the future years in 2324 would we expected to being on target to meet general fund targets . We have balanced the prior year the mayors helped us will issue a budget instructions in december this year. So i think we will get updates on whether what the general fund targets electric like temperature is too early to tell the impacts. And then lastly, commissioner chow note thered were 2 lines the end of each Financial Statements around Carry Forward in and outs. We automated our reporting we used to update the financials manualy. We now have ann credible way to pull the dad in through the spreadsheet this is Additional Data that shouldup sxhoeld should not have included. Ignore these lines and we correct it moving forward. With that im happy to answer questions the commissioners may have. Thank you so much. You have incredible ability to take this amazeingly complex information and not only distill it and understand the memo of each memo is stellar. I dont think we would be able to understand much of this were not for the way you are able to simplify and explain it in clear terms. There are Public Comments . Person on the line on item 5. Fourth quarter low report of the Financial Report if you like to comment press star 3 now to raise your hand. No hands. Are there commissioner questions or comments. Commissioner chow . Thank you for your again always clear report another line item the continuing fund says what do you mean by those . In lines 39 and 40 . Sure what we do on the Financial Statements report on operating fund basically anything on surplus or deficits balanced went current year. The controller treats the continuing fund system unspent funds rolled over in the following year. Fundses that include this are usually often capitol projects they span years and get one slug of money to fully fund the program and than i are allowed roll over dollars as the project is implemented over multiple years. Another example is our covid19 project put in a continuing fund enabling us to roll over dollars. In the part of the data approximately we are showing the balance in our continuing funds. And so such as the capitol and covid19 projects the funds balance themselves because the Controllers Office go in and the match the budget to the actuals they reduce unextend budget. And then roll it over and so for million upon statements to match, the system, the basically the system balances out the continuing projectless. Rolls it over they look balanced the budget and annuals match and show it as matching. There is no variance to be reported the balances dont get released and recognized as part of the citys beens but carried forward part to continue the support project. Okay. More detail. So, if we had a 10 million calf project in this year we only spent 6 Million Dollars of it. And expected to roll it forward when you will see is a continuing project of what were you see in the financials 10 Million Dollars budgeted to begin with. But year end the Controllers Office will balance and show 6 million of budget and 6 million of expenditures to match and take those dollars the 4 million is not available balance but roll it over in the following year. To be available to complete the project. In the subsequent years as planned to which gift Spending Authority for this 4 Million Dollars we need to reduce and balance it out. In the continuing unlsd if year end they will always balance to recognize the constant roll over and adjustment of the appropriation over the course of the years. Okay. Im sure you understand that. Thank you. All right. Any other commissioner comments or questions . Thank you, again. For this comprehensive report. And we will look forward to surpluses and good news hopeful low in the future. Thank you, commissioners. Our next is fiscal 202223 approval for administration of laguna honda gift fund. This will be [inaudible] chief Financial Officer of laguna honda. Hi. Commissioners. Lilly laguna honda chief Financial Officer. Good to be here. I will present the gift fund laguna honda resident gift fund budget for review and approval. So i am start by reviewing the prior year similar format but you will notice i have received questions from you we have the gift Fund Committee has done an alignment with the budget based on spends in prior years. There are changes this year versus the prior year where it was the same. I will start by going through line by line of the prior year to explain what changed and why. So, just a high level of the budget for last [inaudible] [bad audio] [very fuzzy audio] i will start from the top. I got a question about this one. Low last year and typically the activity line item for [inaudible]. So we have not done those the past few years. This is low. The gift fund optimistic we hope may be to bring in some of this this year. We can put funding there but lower than the prior year. Why art with Elders Program this resumed and going strong that it is year over year and the next one is focus community a few other of the small are budget line items ones part of the 3 alignment not that we are not allocating funds but we are rolling them up in the more general funds line item like miscellaneous when you funds them it it is a larger event or cultural event or resident wide event. Make its difficult when you have small line items to fund them. [fuzzy audio]. This is Older Program [inaudible] several years ago that no longer used. Again not to say we are not funding Behavioral Health but we are not doing it with a specific program. Covid related support, this is did not have spending left year but we left it in the budget. We charged the support for another program supposed to launch last year but had delays in the program and hope to launch it this year. 2 page card program that would give cards to residents [inaudible]. Hope than i get that going this year. Gift card pol the communities per of this programful ends of year hospital wide programs. We reroll third degree in the [inaudible] that was a duplicate reduced the wish list. This will successful and we increased those to do one round of wish lists per year but now doing multiple rounds increase the budget for this one and the hell day gift program i had a question about this one that was why would this increase if there is reduced residentses and there are 2 reasons. One stuff costs more than it d. We are seeing price increases on things and the types of things we would befor the Holiday Program and also such a Successful Program wore improving the catalog of items we are purchasing as far as the program. We increased that one this year. Hospital wide special events the same latin voices choir we are not using that. We removed it. Medical clowning and memory care the same. And miscellane us for patient benefits there is know increase to off set the reductions i talked about earlier. And Palliative Care and positive care we are consolidating. Rehab slight increase and one cool thing about rehab line is we have been seeing some spending on some molly fund a donation we received and for assisted technology. A lot of the requests come through rehab and an interesting program. So glad to see spending there. And special toed and beverages a slight increase for that one to off set the other dksz. A lot of information hopefully that answered some or most of your questions. And then the next page is just cleaned up budget for the concern fitsical year of 23. And the budget is similar to left year and you know we hope to as we come out of covid increase the programming and bring that spending back up from last year. But im happy to answer questions you that may have. About the budget or left years spends. Thank you for clarify andancing our questions. Is there Public Comment on this item . Person on the line if you like to comment on item 6 laguna honda gift fund. Press story 3 now. Story 3. No hands issue commissioners. Why are there any commissioner comments or questions on this item . Commissioner chung . It is just a very small question. I think this is the first time i noticed it. So many years like read thanksgiving. What is medical clowning project . So wham it sounding like. There are clowns who come and provide upon entertainment and walk around and chat with residentses and i see them in the cafeteria sometimes and it is a cool program. Therapy and coordinates that and has units a few times a month. Thank you. Interesting. Yea. I dont see other hands. Director colfax . You had comments thank you, Vice President green and i wanted thank the gift funds for you w this has been done there and laguna honda goes through a challenging period and we move forward toward recertification just to emphasize that these programs are really help with the spirit and demonstrate how the culture of laguna honda is parent centered and focusd and creativity this supported through the fund. Wanted to acknowledge that and thank the laguna honda team for the great programs. Why thank you. Thank you. I realized we have to have a motion to approve the request. So is there a motion to approve the 2223 gift fund . Motion to approve. Second. Roll call commissioner giraudo. Aye. Commissioner chung. Yes. Commissioner guillermo. Yes. Commissioner chow. Yes. Commissioner green. Yes. The item passes. Thank you y. Thanks. Thank you. Next item the off with city and county of San Francisco land lord and San Francisco General Hospital foundation tenant lose of the 25th street [inaudible] San Francisco, california. [inaudible] [. Good evening, commissioners. Director colfax and staff. Im mark prim at capitol oversight advisor and with me in person is jeff from the department of real estate. We worked on the most complex city lease in the history which is the ucsf Research Academic building. Took 6 years . Hes got a well rounded knowledge. Joining us virtual secfo gary chow. Ceo kim meridith. Our ceo susan erlike and jason zuk the project manager at zukerberg. I know there were questions so i think between jeff and i we will address those inside the presentation. The background on how we discovered the loses that were upon on campus were so out dated or did not exist with the Research Building. So at that time, director garcia asked us to look at everything on campus. And so thats what we were able to do. And one of the loses was the foundations lease. Which really updated quickly in 2018. With a year lease just to get it going. And then jeff and his team worked on the longterm lease which extends a 20 Year Base Year with 2 options of 10 years to extend. And [inaudible] 13 to 15 leases on campus. So, when director grsia asked us to electric we locked at everything. The first step you do which it is looking at an updated current market condition is jeffs department does an appraisal. So in some case some of the ucsf lease paying 9 dollars a square foot. Because the lease was 2025 years old. Thats step one is to get a barometer when your valuing the property. Second step is other credits that the leasee made to the space. Or is there other credits as in ucsf built a roadway between building five in the Research Building worth 3 billion dollars. Am the other christmased they us was of the deposit of 10 Million Dollars for transit common lawed management. Jeff and his team applied the credits against the values of property and foundation zeros it out. Because of the robust aim of fund raise hag kim will get into. So the lease space is about a doubling. 2,000 square feet to under 5,000 that is 2789, 25th street and improvements that the foundation made as well as the city made to make that safe expanded, the h vac, change out windows and other improvements. I think that i will turn it over to josh. Good evening. Im jeff im with the city and county of San Francisco real estate division. And america said, i worked with him with the deputy of Public Health on many of their lease this is is one on going. This is for the sudden front General Hospital foundation. Second floor of the chn build nothing 2789, 25th street. And approximately just under 5,000 square feet. Mark said, this is what in the city does a number of these there is in charge lease because the benefit received by the department in the sthae out weighs the cost and value of the lease in there it is a mes metrics we look at. Now in the lease we included in the packet to you all, there were a couple of error. I apologize we had one question around the base rent and we have language in there as if there is base rent and there is a sentence this says there is in charge for the rent of this it is in there for the City Attorney. And that is the conscience within the agreement with the foundation that if there their mou were to be changed dramatically, there being be a change in the rent. And so we leave this in there so that we dont have to would not go back and make the changes in the future. We had a linkage error that are has to do with related to the same thing. These are unlike low to ever occur but they are in there just so we have the everyoneses to there. You know to what happened to the event if the rent is unpaid. Given the rent is zero. It does common sense thing that make its electric like it should not be in there. I believe tr was a request to the exhibits b87 form this. Is something we fill out the end in case the lease which process through commissioner approval and board of supervisor approval goes through any changes. Thats a new form that has been added as of 2021 boy the government and county standards board so that when Television Government agencies report a lease it is done in the had same format as the Financial Statements. We have that check list to make sure it is in there. We will wait until we have the final form before we complete it and sends it out. So unless you have questions for real estate i will pass this to gary chow who will speak to how we found the Public Benefit out weighing the lease values significantly. Thank you. Tell be kim meridith the ceo go over the per inship. Hello. This is kim meridith im virtual. Grit to see everyone. You could move the slide deck forward to slide number 6. That would be outstanding. Terrific. So hello im kim the ceo of the San Francisco General Hospital foundation. Im honored to be here today. Our mission at the foundation is to fund and support patient care and innovation at the General Hospital. Why . We believe in Health Equity and he access to care for all. Our goals are alined with the true goals of the [inaudible]. And doctor susan erlikes team. We have this incredible partnership and this year were celebrating the 150th anniversary. August 28, 1872, the city and county hospital opened. And the following year, in 2023, will be the 150th anniversary of the ucsf and this partnership together. Clearly through pandemic, booms, busts. Earth quakes they have been there the wonderful expertise and physicians. This Incredible Connection with the 2 of them. And the 2 have found Additional Needs to support patient care and innovation at the dsfg the Public Hospital foundation was create in the 1994 or 95 timing. We will be celebrating our 30than verse row in the near future. Fascinating when you think about most patriot hospitals had a foundation for year and wonderful it has been to bring in private philanthropy in sudden finish to support Public Health. Raised the largest gift for a Public Hospital initial low. Our mission is, lined with sfg heart and commitments there are and of course we also care about not only our service to team and the community. 20 of San Francisco depoland everyier for care. When you look at the acute Care Hospital and the out patient hospital, 20 of all San Francisco all the time the largest pediatric clinic. Largest family Health Clinic. 30 of ambulance there. The place for people low income. Medical, medicare. Homeless, uninsured. We are prud to support that with our Health Equity lens. The next slide 7, talks about our priorities. Approximate. We created fiscal Year Strategic Plan with 4 areas to fund in terms of programs and [inaudible]. We have med a commitment to raise over 250 Million Dollars in those 5 years between fiscal 22 and 26, 250 Million Dollars, which it is what has been raised in the past 30 years. It is expectancyive, it is needed in order to support the work that fgment its prosecute void to the community and whether capitol or prioritiesure around transforming in Behavioral Health and have a funds for that. Trauma, clearly the Level One Trauma Center and Healthy Families i said, it statute learningest birthing center and the largest pediatric clinic. And then know finally wellness. As a human right. You think about the adult care and chronic needs in individuals who have not had access to health care their entire lives now do have access. As a result of the incredible work and support that the city and county of San Francisco gives to Public Health the leadership and hopeful low the role we play as the foundation. We are very grateful prosecute for your wellingness to provide office space. Im in the new office space now. We cleaned it up. It is still stark. It has been a wonderful investment and we are honored be your partner in this work. Thank you. And i will hundred it over to jason. Good evening. Everyone. Jason executive project manager csfg. I believe the next slide should be mine. If this is a didnt translate that well. Before. These are before and after shots of the space of foundation occupied. I the add that of that 4500 square feet or so that included accessible upgrades to our Public Restrooms in this building and also path of travel upgrades. Benefitted all of our staff and everyone that guess in that building. So also in addition to the mark mentioned up gridded the mechanical system as well. That serves the foundations as well as accounting office. More cohesive um sharing of resource between the foundation and the city. Um thats about all i have unless you have questions. Commissioners i think if you have other questions or if we did in the answer the questions this were submitted, we are here to answer them. Thank you, so much for the presentation i think it is wonderful something dry as a leaf has enabled us to show case the incredible work at the general and how important it is and how the Foundation Supports so many programs. It creates improved health for all of the citizens of San Francisco and delighted you are in a bright shine [inaudible] and the hearts of the picture it is symbolic of everything you do in the humanity you express in the work you do. Thank you all, everyone for the fundation to [inaudible] and all of our facility people who made this possible. Is there Public Comment. A person on the line weer item 11 the lose with the city and sfgh foundation. If you like to comment press star 3 now. No hands. Are there commissioner questions or comments . All right. Seeing none i believe we need a motion to approve the lease. Move. I second. Roll call. Commissioner giraudo yes commissioner chung y. Yes. Commissioner chow. Yes. Commissioner green. Yes. Thank you it is approved. Enjoy your new home. Thank you. All right. The next is our resolution making findings to teleconference meeting under code section 54935 e. This is the statement you passed i think 9 or 10 months that allows to you operate in the hybrid meetings. It is changing the dates. And so we are seek approval so you can meet. Right. Is there Public Comment on this one . No one on the comment line. Need a motion . I heard a motion from commissioner giraudo. A second . Second. I will do i roll call. Commissioner giraudo yes commissioner chow yes commissioner chung. Yes. Commissioner guillermo. Yes. And commissioner green. Yes. Thank you, that passes as well. So item 9 is the finance and Planning Committee update. Commissioner chung. Thank you, commissioner green. There are 2 parts to todays meeting the first part is to go over all the don tracts in the report and xr going over 2 contract to [inaudible] and those contracts [inaudible] on consent. I want to go in details. And then we also have discussion about the [inaudible] [cannot understand speaker] the Financial Consultant fee manage we are following closely. And both commissioner chow special i and have expressed like our disappointment. This institute that the bailo place. Would be in this kind of dilemma now. So but it is good to know that health right would taking over 2 of the fall programs they are plan to close and i think we will have more follow up in the future meetings. Then we adjourn. So i guess any questions or comments . I think we have the consent calendar, right . Next. Yes. And a quick note commissioners the Financial Planning members from did ask for updates and one of them the bake are place prc may come or the full commission. You will hear more regardless as the situation moves forward. And the next item is consent i need a motion to approve. All right. So sxefrn there is no one on Public Comment y. No one. So everyone reviewed the items on consent . I dont need to read them. Is there a motion to approve . Second. I will second. Roll call vote thank you. Why commissioner giraudo. Yes commissioner chung. Yes. Commissioner chow. Yes. Commissioner guillermo. Yes. And commissioner green. Yes. Great. Thank you. Passes. All right. Next other business. Is there other business anyonement its bring to the floor . And no commissioner giraudo has something to say. Great. Follow up to [inaudible] [cannot hear speaker] no audio. People here commissioner giraudo comments. Her microphone is not working i did in the know. She mentioned the heart event in february and more information will be coming as that event is planned is this appropriate commissioner giraudo . Which it is a fundraiser for the foundation pigging backing on what you just approved. Thank you. Thank you for reminding us. So, i guess we are ready for item 12. Which is the joint conference and report. Will do the meeting of october 25 of 22. Commissioner [inaudible]. It is october 25th meeting, thank you. From chair you add to i think essentially continues our work in review of different hospitals, services and departments emergency room and is and its diversion rates and continuing to be partly to the [inaudible] staff shortages. And work with the city ambulances [inaudible] 60 it close to their goal of 40 to 55 . And in our medical report, we heard an excellent report on the surgical department. Should be noted that 94o surge row is one of the world class departments we have that actually is changing emergency diameters throughout the world. In trauma and the Trauma Service. I recall having the key role and probably service before he [inaudible] and our current programs carry on in this tradition and are actually at the forefront. [inaudible] which continues to support all [inaudible] as they showed today x. Final low, open session we reviewed the protocols for one changing they are interested for wonderful for [inaudible] physician assistance. Physician no. Nurse track practitioners [inaudible]. It is so excellent i think this both commissioner green and i we are struck by not only detailed scientific backgrounds and one time it locked like they were copyrighting and told this in fact it is in the going to be copy writed after they have review today and they have it [inaudible] public, robea for anybody else who wants to use this algorithm. We can private low what the next [inaudible] and in closed session reviewed the [inaudible] program and Financial Report and [inaudible] needed to do our Due Diligence on behalf of the Health Commission this is my report. And saying commissioner [inaudible] you can add. Thank you very much i think you emphasized when were rable the surgery, organization and work the Trauma Service and that algorithm that just shows how certain [inaudible] and how important it is at the [inaudible] has everyone practicing the top of license using all the resources to gift best care to the citizens of San Francisco. It was wonderful. [inaudible] no Public Comment. Any commissioner questions or comments . All right. Then the next item is the october 18th 2022 community and Public Health committee update. From october 18th. Commissioner giraudo thank you. The first item this we heard was the environmental healing Emergency Response team. And the one of 30 promise was the hazmat team. They are 24 7 focussing on hazardous materials. Conception 19 aint with an incident on the bay bridge when it was shut down for 11 hours the materials could not be identified. There is they have a gap of at that point lack of Trained Personnel lead to the d ph unit formed. So this is a proactive group. The basic is 45 members. Now there is 2 members because of thaik vacant positions somebody is on duty 24 7 the trin suggest continual the employees operate under the sudden fran Fire Department structure. And responsibilities include ppe, sampling of different materials, disposal and transport of hazardous materials. Decontamination. Common incidents we asked them is abandoned hazardous waste. Environmental release and spills, suspicious letters and packages and special events such as the superbowl. It was interesting. And then the seconded item was the acredited which is every 5 years. Measures the Health Department performance against national standards. The benefit to the department is continual improvements, plans and reports are reviewed. There is 10 essential Public Health domains that are reviewed butt center is all for all of the domains is equity. So the the creditation for our group is on track for march 202223. Both other than informative reports. Director chung. Joy would like to say the Environmental Department you know at that group [inaudible] not in my [inaudible] and [inaudible] we dont get this year about their work often. [inaudible] their w is very important. Thank you. Thank you for this report. Very interesting. Any commissioner questions or comments . All right. The next is motion to go to closed session. I must have to go in closed session. Second. I no opinion comment i will vote commissioner giraudo yes commissioner chow yes. Commissioner chung. Why yes commissioner guillermo yes. And commissioner green. Yes. A second vote on the agenda and it is to vote on whether to acert Attorney Client privilege in relation to the closed session. We mead motions and a vote on that as well. Motion . I move. Second. Dot roll call. Commissioner giraudo yes commissioner chow. Why yes. Commissioner chung. Yes. Commissioner guillermo. Yes. And commissioner green. Yes. All right. Give us a few minutes to transition to closed session. No one on the line in case you see it know we will be back in open session in closed session the public cannot see or hear us. We will be back. We will close the meeting out. Second. And commissioner, please consider motion to disclose or not disclose what was held in closed session. I move not to disclose. Second. Okay. I will there is no Public Comment. I doll a vote. Commissioner giraudo come. Commissioner chow. Yes commissioner chung. Yes. Commissioner guillermo. Yes. Commissioner green. Yes. And there is a second action on this motion to report actions taken in closed session it is different then and there discussion. And again to the same motion the same action that you all dont share actions taken in closed session but need to vote. I move not to disclose action