Transcripts For SFGTV Health Commission 20240707

meeting of the president bernal is taking a well deserved day off with his family as his director colfax. we will start by calling the meeting to order. and taking the roll call. >> sure. >> i will start with commissioner chow. >> can you hear me? commissioner giraudo. >> yes. >> commissioner guillermo. >> present. >> commissioner green. >> present. >> commissioner chow. looks like he is not having that. let me me call we cannot move forward without. >> hello it seems like you can't hear me. commissioners, commissioner chow is going to sign in again. hopefully he will be here. i can read the land acknowledgment. >> thank you. we will do that. >> the san francisco health commission acknowledges we are on the unseed home land of the ramaytush ohlone who were the original inhabitants as stewards of this land and with their translations. the ramaytush ohlone never seeded, lost nor forgotten their responsibilities as caretakers and all who reside in their traditional territory. we rescue night we benefit from living and working on their home lands. we wish to pay respects knight honoring the ramaytush ohlone community and affirming their sovereign rights as first peoples. >> thank you. >> next is approval of the minuteses of the health commission of june 21, 22. are there any corrections to the minutes? >> is there a motion it approve >> i move approval. >> i second. >> okay. >> and unfortunately we have to wait for commissioner chow in order to finish that action. we have not done this commissioner green i will check on the line we have folks on public comment. >> i'm not sure. folks on the lightweight if you like to comment on item 2 the approval of the june 21st minutes press star 3 so we can recognize you. as a tip, unless you would like to comment, it is best if you do so when the item begins. press star 3 so you show up. i will wait about 20-30 seconds to get you it is easier if we do it that way i believe commissioner chow just joined us. >> i did. >> i see no handos public comments for this item. and commissioner chow, there was a motion to approve the minutes. >> i did have a correction to the minutes. mostly and i will will read it here i have them before me. page 6, in the second paragraph on item 7. you have comments of mine, which i believe belong to item 6. >> okay. >> i will rectify that i apologize. >> that's my only correction. >> all right. so if we accept that correction, then can we take a vote on the minutes? >> yes. >> commissioner chow. >> yes. >> commissioner guillermo. >> yes. >> commissioner girl oddo. >> yes. >> commissioner green. >> yes. >> the item passes. >> next is the director's report and deputy director of health bobbet will stand in for director colfax and do the report as well as covid-19 update. we will give her the floor. thank you. >> thank you, commissioner green and welcome commissioners. i just for director's report i want to highlight the covid and monkey pox updates separately in terms of the director's report i highlight nasummer rise opened this . is a drug soaper center that is located in south of market. and that people who are intoxicated with opioids or methamphetamine can come and get connected to services as well as dignity provided by bathrooms, showers and meals this . it is a long time coming. we are excited have this center open. tell be open for walk in's and connected to other street team usa including our own d ph teams like street crisis. and the homeless out reach team usa temperature is a big addition to how we are approaching drug use on our streets. >> the second item i wanted to bring to attention is our environmental healing branch. our hazardous materials. emergency respond service a team within that take calls 24/7 and respond to incidents. i had to call them during -- and testify that they are a really important resource for the department. as part of preparing for any type of hazzard material response, they did participate in an exercise that occurred 1 a.m. and 5 a.m. and the simulation was there was along that on -- public transport. these are always important for us to prepare and responds because minutes mean a lot. again, really thankful for our team and all the work they have done. and finally, i wanted commends dsfg for the successful lab survey sufficiency unscheduled. joint's commission survey with anatomic pathology on tuesday june 21st they only had 8 findings. the surveys can be difficult and the team did an excellent job. and final thing i wanted mention is former commissioner guy health commissioner guy was recognized by the metafund for her role as an fluential leader for the lbgtg + movement. and how she dedicated her life to social justice championing rights of women. lbgtq +, immigrants, people with hiv, indigenous, black and elders for decades. she has been advancing policy around homelessness. community health and incarceration and poverty. i will stop there and happy to take questions. >> thank you very much. is there public comment? >> if you like to comment on the director's report. press star 3, star 3 so we can recognize you. i the wait to make sure the viewing catches up with our live meeting. i see no hands. >> what about commissioner questions or comments? >> i don't see any on the panelist list. if i missing? >> i see none. >> oh , i actually can't do it. my only comment was i wanted to add my congratulationses to former commissioner guy. so well deserved. she worked so harvard for many years. most i think everybody here knows her and it is wonderful, extend congratulationses from the health commission make the president and vice president can convey our congratulations to her for her fine work. . thank you very much, for saying that. when i first came on the commission she met with me 4 times i see heads bobbing. she was generous with her time and informative. shey may be second to you knowing as much about the history in this city than anyone and having that resource. generous with her time and so willing to help in any way she can she is a remarkable corrector and exemplary of who leads the organization. i concur. one question i had about can you talk go how the tenderloin linkage center and the soma rise structure will interface when the 24 hour a day summer rise will be available and how we transition from one to the other given the funding changes the end of the year. >> great question. commissioner green, and i will say that in terms summer rise has been planned for arc while. it was part of our methamphetamine task force a recommendation coming there will be additional dwrug sewnering that our current is focused on alcohol to have a place where people that may use or you know, use drugs outside of alcohol could come and get connected to care. the line linkage center is different in response to an emergency and meant to not just for drug sobering but anybody in the tenderloin that needs service. i think that you know we are still and doctor and her team are think burglar what the future state of the tenderloin center and i'm sure when the talks get to an appropriate place of having an idea we are happy to come back and provide that information. >> thank you. and there is a sense that summer rise can assume some of the programs and responsibilities that have been at the linkage center this point in time and moving from one to the next part of the plan or we are think burglar that? >> yes, that's correct. there will be the potential for summer rise to take on clientele that have coming to the tlc. >> wonderful. if there are no other questions or comment i think we are ready for the covid-19 update. >> all right. i wanted say that i will be providing the covid-19 update as well as a monkey pox update and doctor philip system on the line to help answer questions. in terms of case you see the case rates peeked 58.2. it was sloping down gifrn with the current circulation of ba4 and 5 there , is potential to plateau and you see a slight increase in cases we are following this closely at the local level and obviously the state and our national partners are following this. >> next slide. covid deaths you know, we had a small increase over time. you see where the dates of the deaths occurred. next slide gives you more data f. we can go there. >> this is our desk by month. we -- this will get updated because deaths do lag every month or every few weeks you see january -- both years is where we peeked. but as of now our death rates continue to be around half of what they were in january. are lower. and in terms of case rates by vaccination it continues to offer protection. where you see the unvaccinated have a higher case rates than those who received their initial vaccine series. next slide. hospitalizations. these have creeped up a bit. we are watching this. and -- there have been large increases with large decreases philidelphia by large decreases temperature is difficult to tell if people are getting admitted and have incidental covid and different things versus admit the for covid. >> next slide, police. >> and in terms of vaccination rates they remain high. you see the numbers of 75 and above and 90%. where all residents seventy-four % of residents are boosted. 5 to 11 year olds. 81 percent have a dose and 75 compleaded their initial series. doctor chow, i know you asked about fourth dloes last commission. we don't have the denominator but know it is begin out 122, 862 boosters throughout the city. you know the 6 months to 4 year olds got approved and that data should be coming in the next week as well. next slide. so boosters by age. you see that am the vast majority are 50 and above. we want to make progress. boosters are important in protection against hospitalization. and that's it for covid. i will quickly talk a bit about monkey pox. so in terms of the update, currently globally there are 6, 924 cases in theus there are 460 case. total confirmed and probable in california are 95. and total confirmd and probable case in sf were 40. globalally we are seeing what are sf what is happening globally in the u.s. and california a vast majority of cases in men who have sex with men. >> in terms of vaccinations. we did update our vaccination eligibility late last week. san francisco eligible include those referred by contact investigators they have been in close contact of somebody who had not had monkey pox and people who self upon are the of contact of someone diagnosed with monkey pock or notification of potential exposure through a venue and lab workers who handle monkey pox samples should get vaccinated. we are using the vaccine for monkey pox. as you have heard the vaccine is in short supply. to date received 580 doses. we have given about 227 and 45 have been begin outside of d ph. we are working with the major health system, community and private provide torse establish a vaccine system. kaiser is offering vaccine to those exposed. and it is a 2 dose vaccine. currently the guidelines of to use all of the doses in hand because the expect agsz there will be more for the second dose coming months. out reach and communication this remains the vital areas for our successful response to monkey pox and a lot of work done here. there is on going presentations every week this week there is presentations at the access providers. at brother's esteem and hiv help c providers and updating collateral as new information come in like eligibility criteria. they will be found on our website. we are working with our cbo's to get the information out to the most impacted communities and where we know well is a high risk. we have social media and coverage and the chronicle covered monkey pox and a monkey pox awareness campaign and reaching out to venues associated with sexual gathering a potential risk of exposure and transmission. so -- really -- hoping they are able to out reach to their client toll discuss this issue. and in terms of resource we have our sfgov page, city clinic and a number of phone lines that are available for people to talk about or call about monkey pox. the health systems we met with last week were interested and supportive of improving the out reach on monkey pox and they are also willing to take on vaccine for those that they take care of. and i think that's my last slide. yes. happy to answer questions and doctor phillips can answer as well. >> thank you so much for that presentation. i believe there are probably people in public comment line. >> yes. thanks for checking, commissioner green. if you like to comment on the covid update and monkey pox update press star 3 now. i will wait 30 seconds to catch up. there are 15 or 16 folkos there. press star 3. and i can recognize you. i didn't fwring home i don't have it with me. folks on the line if you want to make comment the comment needs to be about covid and or monkey pock. each item you make comment on the comment needs to be about that item. general public comment which is next can be anything not on the agenda. >> so i don't see hands. commissioners, how about if we go to your comments and questions and i will monitor this and go back. that way we manage time best. >> all right. are there commissioner comments or questions? >> this is doctor chow. commissioner giraudo. >> you can do this. [laughter]. my question to doctor bobbet is i have seen initial out reach and so called marketing for the 6 month to 5 year olds. will how long will your the let's call it marketing and media campaign continue? i guess my concern is this is the summer months. and -- when kids are going back to you know preschool, j k, et cetera, is also will it continue during that time? through september? >> thank you for that question. i think when we talk to the vaccine team and get more concrete answer us bring up a good point. as people go back to school that is a good time to remind getting ready for school includes vaccination. we expect the covid-19 team to continue to have funding for this year to do that. the expectation is that would happen and we have a school's person that can do that out reach. i will get confirmation and get back to you. >> i'd appreciate that and my understanding and if you could confirm it, if -- a child is at you know needs other vaccinations this can be given at the same time, am i correct? >> i believe that is correct doctor philip, did you want to? >> confirm or weigh in? >> good afternoon, yes, thank you. yes, that is correct there is no need to wait or have a separate visit which will be helpful and an effort with the health system partners as well as schools to work on catch up vaccinations for other vaccine prevent amable diseases. it is a good opportunity to talk about covid and other vaccines that children may be due forace well. >> great. i appreciate that. i hope that is part of the media campaign. i know at our clinic, we upon don't give vaccines but we had a lot of inquire and he questions from families about that. so, i think to include that in the out reach would be wonderful. >> great. thank you. >> commissioner chow, you have the floor. >> thank you. i was going to inquire from doctor phillips how we are doing with immunity. i saw the other day as i was driving that the front of the muni bus carry mask recommended. but the next muni bus carry go warriors. that was after the warriors had won. i was wondering if they are starting to want to say recommend masks it would being nice they did that instead of condition continuing to support the warriors that it is a step they could take. >> thank you, commissioner chow, yes, my understanding and i will need to check back in with colleagues at mta and in the mayor's office on disability. that was an intermeadiat step they were take to make clear with signage on the outside of the buss and trains and inside as well. and so i believe those are steps they are take to reminds it is public whchlt we have an opportunity to talk to the public we say masking can recommended now as it is in the rest of the bay area and the state where when now that rates are higher. >> so. another question is, well, you have put out that masking is recommended, in indoors it does not sort of specify how large indoor or specific. it might be you are all thinking that -- the public will remember what was said in the previous public announcements i wonder if one should be more specific again just to help reemphasize may be in larger groups and a meating. and are we recommending it for large out door upon eventses as versus smaller. i no pictures of pier 39 yesterday did not show a lot wearing masks but had more mask in new york and washington. these are large groups are we recommending in large groups out doors and -- that is perhaps more true indoors? >> yes for out door we are not making a general recommendation. what we said is if people are concerned because of their own health or of who they live with then masks can be a good idea. but not a general recommendation for people out doors regardless of the size of the group. people can make those decisions based on their comfort level and health status. indoors if people are indoor which are rowded or -- locations where there are lots of people they are don't know and in public space that, that's where there is a strong recommendation. to wear masks and we have said that. i take your point that we need to remind people of the scenarios and when it could be most helpful. how are we gathering this data? >> this is for covid, commissioner green? >> yes. >> yes; yes, that's correct there is a feed that go in the state and we can pull down if you need to understands what the vaccination is happening in san francisco. >> we get it by zip code of the individual vaccinated and do it with children so a uniformed access for all age groups through the state? correct. >> wonderful >> thank you. all right. well, i guess we -- actually there are many public comment requests that popped up. >> thank you. >> for being patient. folks online, i have a timer each you will be unmuted for up to 3 minutes and you are able to comment. once your 3 minutes is up the timer guess off and i will mute you. know if you are able to finish ahead of time that would be appreciated but you have a full 3 minutes i will start with the first caller. >> please let us know if you are there? caller? i hear you, are you there? am i unmuted. >> i had raised my hand and it did not work i check in the via web ex. sorry about that. there are others who were raising hands but not visible. i'm organizer at senior sablt action i'm asking to you bring back indoor mask requirements i was looking back on my notes from several weeks ago request 10% and now 15%. am you said you would bring back an indoor mask requirement if cases increased and we had more dangerous variants all of those happen exclude where is the mask requirement t. is not requireod muni or buses. the fact that it is strongly recommended makes no difference to member who is are not able to take transit because of your failure to institute a policy that make its safe for high risk people. and i hear doctor phillips saying that people should make decisions based on own comfort levelism want to ask what about the comfort level of members who can't leave the apartment because of masks are not required because of g ph's inning 11s what about the comfort level of a member who pulled their child out of summer camp and explained why she can't attend summer camp with friends because their parent could die from covid these are examples of your policy. bring back indoor mask requirement. >> thank you for your comment. caller you are unmuted let us know you are there. >> yes, i'm here. i'm shauna reeves a social work and mother of a small child. i'm calling to ask you to bring back san francisco indoor mask requirement. in the chronicle today accord to a study of 5 and a half million parent patient repeated covid infections set us up for risk of ked neil, cardiovascular and mental health problems. 40,000 parent who is had 2 or more covid inincitement of insurrections risk of death do you believes the omicron 5 accounts for 54% of infections more evading and means we'll not see an end to the surge any time soon including the 15% test positivity rate what can we do to fenldz the infections that put us at risk of long covid? masks. be on the right side of history by requiring masks indoor. people are not hearing your message they hear they are not required. this puts us at high risk of contracting covid over and over again. this is not okay or moral. when we look at the time in history tell be hard for to yous explain the common sense actions we refused to take. dot right thing. bring back the mask will requirement for san francisco so we can all have a fighting chance at staying covid free. thank you. thank you for sharing your comments. >> i've unmuted you. >> can you hear me. >> yes i'm putting 3 minute on the clack for you. i'm calling to urge san francisco count tow reinstate the mask man days. i listen to the health director casually go over. increase in hospitalizations oh increase in case its really disturbs me how casual it is and a true lack of concern about what is going on and not treat it with urgency it deserves. like to reiterate that the previous caller said. ba4 plus 5 is making up 52% in the united states. it is [inaudible] and transmissable. evades prior immunity and evades vaccination. our own the doctor bob who is the doctor wrote a recent upon "washington post" oped piece talked about his wife double boosted and healthy has long covid from an initial mild case. as much as you try to negotiablealize masdz infections they want matter. 5 to 30% of covid survivors go to develop long covid. 5% is the conservative estimate for boosted people and people young and health and he have mild cases develop long covid months after the acute infection. we need to take the life health consequences seriously and it is criminal the government's negligence at all levels including sf county act being like they don't have to do anything major. strongly recommending mask system a cop out. as another previous caller said, people don't wear masks when you don't require them. you guys are yourself benefitting from mask requirement not to the county. i like to point out doctor bob said besides long covid. there are -- people who had covid have significant increase in heart attack and blood clots a year from time of infection it is ridiculous we don't have a mask mandate during a surge 50% in sf at the peek of omicron it was 19% we are energy the people omicron if you took public health seriously you would institute indoor and out door mask requirements because people are getting covid out doors. time for to you stands up again for public health and dot right thing and if you can't do it or work for the people and protect the people you need to resign you are not doing public health. thank you for your time. >> thank you. . i have unmuted you. >> can you hearment me. i'm starting the clock at 3 minutes. thank you. >> i'm [inaudible] professor and pedestrian nandz complex institute and cofounder of the world health network asked by the community evercommunity and addressed masking requirement in san francisco and public health messaging on risks and 15% bunkhamity rate ba5 the growing variant and has higher transmiss. [inaudible] the vaccine [inaudible] mask requirements are needed to make it safer for high risk individuals including immunocompromises. disabilities and seniors and all to access public spaces and essential service. universal masking lorers the risk infection and more effective than one way masking. this is similar to an individual's risk when drinking and driving and being in the car with the driver who is drinking and driving. rapid tests north report under counting make its difficult to a sesdz the risk well is growing information about long covid. it is critical to know that long covid is present in a third of infected individuals and long-term serials impact on brain function and ij immune system damage and damage to other organs including liver, lungs and kidney. everyone is vulnerable to long covid including healthy adults and children. gifrn the health impacts the current conscience the have affects on the public and the workforce. preventing infections addresses health, future health costs and addresses the economic impact on the city and workers. i like to add the monkey pox out break should be taken seriously. effective public communication and rapid case identification are necessary. transmission proof of contact and bedding and surfaces dominant but strong evidence it is air born. i recommend mask requirements more information on mum pull topics at world health network. thank you. >> next caller you are unmuted. >> hi. good afternoon will i'm -- beth kenny and i have spoken before in this commission and shared greueling affects of the mask requirement its had on me and my family. the average november san francisco of case system 501. this is a significant under count it does not include at home tests say go with the 501 a day in san francisco. that is 501 people a day who are doubling risks for a pulmonary embolism. and a long covid and -- we are going to say -- we are okay with that. that we are okay with 120 people possibly insurancing disabling conditions for a month to, perhaps lifelong. that is short sided not about public health. a lot of things have to do with public health. the menial health impacts of masking on children it is debunkd and ignores the children who have who are immune compromised and high risk. ignores the people who have family members that are high risk and ignores the children who lost family members to covid. it ignorse the children who have long covid and the number one way that long covid shows up in children. mental health anxiety and depression you perpetuate that by not having measures like masking. having kids eat outside at school. these things don't cost a lot but will save lives and will protect the health of our community. there is no reason not to do it other than it is politically inconvenient. what point are we going to say, we want our community to be protected. we are department of public health not department of personal health. personal choice leaves me and everyone vulnerable. thank you. thank you for sharing your comments i'm alissa, i find the health commission's we fuse am to mandate indoor mask mandate a wrong and confusing decision. 2 reasons can in to mind. one, you don't track data showing sf p.s. positive rates are 15 rates and rising. and you don't read newspapers. or 2, you are under enormous pressures to recommend but not reinstate masking. i think you track data and read newspapers. would be a health commissioner's duty to follow scientific news. and for pressure against reinstating the mandate it would seem as public health commissioners you are sworn to advocate for public health. your own website states the mission of the san francisco department of public health is to protect and promote the health of all of san francisco. the mission of the mayor's office and that of the board of supervisors is more generalized. and not specifically focused on protecting the health of the people. please do your specific job and reinstate the mask mandate to protect the public health of our city. i watched the documentary on joan us [inaudible] and the development of the polio vaccine and left me in tierce because a whole country was backing public health. a whole country was pulling together to keep people safe. i would love to see that happen starting in san francisco. where we all pull together to protect all of us. thank you very much. >> thank you for sharing your comments all right. i have unmuted you. are you there. >> i'm here. >> commissioners pay attention to what i have got to say. first and foremost. public comment trickle was not work. i had to call the board twice to call sfgov3 times in order to fix the problem. why am i bringing this to your attention? because if i had not done that all the speakers who spoke before i spoke y'all would not have got their comment. all the astutely speakers. this is san francisco. what y'all are doing, commissioners is kick the can down the street. and that's. despicable. we all need to wear the mask. am we all need to wear the mask. and the children we need to love our children and take care of them. it is our duty to protect the public not deal with politics. i remember early on, when some link was spots by you guys and i'm not blaming you per se, and link could not be activated hi to activate the link and work with [inaudible] and travel nurses. i had to contribute over 10,000 vaccines to the citycounty of san francisco. why, because i unerstand. this is a pandemicch and the doctor who just talks you know in a very general manner i believe phillips or something, she is not paying attention to imperical data. she has no emathy. am doctors have to have emathy. do you know the difference with emathand he compassion? look it up in the dictionary. too many frail people in san francisco are catching covid. because this virus are dangerous. this virus are dangerous. and you commissioners have to pray to god so that from your heart you do the right thing. and not the wrong thing. from your heart you do the right thing. your heard has to be in the right place. don't get caught up in the pop ticks of this very, very, very corrupt city and my name is francisco decosta. >> thank you. that concludes public comment. commissioners. thank you all for your comments. >> thank you. so much. for the comments is there anything that our -- staff want to add or follow up with. >> yes. commissioner green. i wanted to acbuilding and thank the members of the public whom have taken the time to call in am and express their occurrence. of course, we want to hear everyone's concerns across the board and take all the comments seriously in our thinking. >> thank you for acknowledging some of the issues that have been brought up specifically to the callers, thank you for calling >> on behalf of the commission i associate myself with the comments as well. >> our next agenda item is general public comment. and is there anyone on the general public comment line? >> let me say, folks, general public comment is for issues and items not on the agenda. so for instance since covid and monkey pox have been addressed in an item. this will be a time to discuss something else that is not mentioned. if you like to make comment on something not on the agenda press star 3 now and we will give you a few seconds for handses to show up. we know there is a delay. upon i will put 3 minute on the clock. i will stop you if it is about an item on the agenda. because there are places on every item where you can comment. let's see. commissioners i'm sorry it is clunko my home computer i apologize for the delay. caller, i have you unmuted let me know if you are there. >> i'm here and my sister was raising her hand during the covid comment. yea. >> i raised my hand and not called upon. you have 3 minutes. >> great. >> you might hear an echo. i'm sarah and i will start my comment by quoting doctor suzanne philip herself she gave today to a local paper. people should not forget about covid. it is a challenging time case remain high. she mentions the new variants ba4 and 5 which are increasing at proportion of virus sequence in california. the covid test positive rate in sf is 15% which is likely an under count typeset is more like 20. doctor phillips repeats the line of hospitalizations. hospitalizations and death are important as a disabled person during of disability pride month i feel like a prone record. long covid is rig nord and down play today is used as an excuse to not reinstate the mask mandates an important protection in reducing transmission. the more we decrease transmission we protect our community members. to quote a disease doctor, lack of community mitigation signs everyone up for infection. one way masking can only take you so far if everyone is getting infected including those you live with this . is too much to expect of individuals and little of leaders you are our public health leaders i expect more of you. i say, lead. that's all. >> thank you for your comment. >> is there anyone else. >> there are many. person on the line i unmuted you. let us know you are there. >> hello? >> hi. that was me. raising my hand. thanks. person on the line? i have unmuted you. >> hi. >> can you hear me. >> yes , i got 3 minutes on the clock. thank you. i'm brandy i'm a public school parent live in richmond and asking for reinstatement of the mask mandate. >> i'm sorry i just mentioned that the covid item is the time to make comment on covid. i'm sorry to be rigid. okay. thank you. i'm sorry that otherwise we have this runs on and on. >> okay. >> thank you. >> caller i have unmuted you. let us know you are there. >> gone. sorry, commissioners i don't see -- caller i'm unmuting you i'm not sure if you spoke before. >> i don't know why i have been unmuted twice. >> not when i wanted to speak. thank you. >> commissioners, that is all the comment all the hands i see. thank you and callers i apologize it is difficult on seat hands i than is not enough but we are doing our best. i believe we can move on. >> thank you. the next item is the resolution regarding access to reproductive care as a public health issue. >> so -- secretary moore were you good to read the resolution. >> i am happy to read the resolution. i will not be reading all of the arc did you understandum but the body of the resolution and commissioners, i sent this to you earlier, commissioner green offered amendments i will note as we g. ~age sesz to reproductive care as a public healing issue. the american public health association recognized abortion and commissioner green add suggested add the word access as a public health concern in 1970 and access to the full spectrum of sexual and reproductive happy including boorz is fundsamential. and where as follow sexual and reproductive health entails pregnancy support and preconception and miscarriage, labor and delivery, post part and up take out interconception care and add gynecology care. time between pregnancy. abortion can be conducted through a surgical procedure or taking medication. latest data from the cdc and the national center for health are maternal mortality due to illegal abortion system.41 per 1,000 procedures. where as in the united states the opportunity to obtain a range of reproductive health service including abortion varies by race, income, health certains. immigration and disability status, age. sexual orientation. and laws restricting access to surgical or medical abortions impacts people of court reporter, younger people. low are income and queer and transgender people. turn away study followed a thousand women on boorz including some for you care to find gestational [inaudible] they south care and some at 3 weeks past the age limit and turned away. study found restricting abortions associated with worsening of living conditions for vulnerable women. women turned away from having abortion and gave birth increase in household poverty lasting 4 years relative to those who received one. among women with existing children that sought abortion 4 years later the existing children live in postcompared to those who received an boorz. years after abortion denial women were more likely not likely have enough monfer food, housing and transportation. denied an boopgz associated with lower credit scores and negative public public records. women turned away stayed contact with a violent partner. well being of children negatively impacted the united states supreme court struck down roe v wade removing protection for boorz in all states and many states passed abortion laws in preparation for the removal of federal protection. boorz is now illegal until some states and restricted in other states. some of the state lutz make it a felony for a person to leave the state to get an abortion and for providetory perform surgical or medical abortion or the other text that aid a person in getting an abortion. additional laws allow people to sue the law whom assisted the person getting the abortion. women with financial means able to obtain an abortion by private doctors or travel to other counts reals. poor women and women of color suffer and death due to unsanitary abortions provided illegally and using poisons and coat hangers. and 1974 the abortion rate for women of color was double that of white women. american indian services for native american women experience higher rates of sexual assault and unintended pregnancy. transgender seek abortion service face barriers economic hardship and stigma. sexual and reproduct of health care language and lack of provider understanding of transgender and nonbinary people and people facing psychological freedom of movement experiencing intimate partner domestic violence or human trafficking may need health services including abortions. the governor and state legislator are attempting to pass legislation and policy to make the state a sancts iary for people seeking abortions in california from other states and the commission supports the right for every pregnant person to have reproductive health including abortion available by trained left lanesed professionals and the san francisco health commission mayor reef for efforts to work with the san francisco of status of women to prepare for an influx of pregnant people visiting san francisco for abortions and the san francisco health commission commends sashgs san francisco public health for reproductive health services to meet the needs of diverse individuals. >> thank you very much for reading is that. is there public comment. >> well is. folks i will put 3 minutes on the clock. >> i have a person on the line let us know you are there. >> i'm here. thank you. commissioners, san francisco has always embraced human beings who are in need of help. the technicalities must be set aside right now. we have the best minds, attorneys who are dealing with the right type of language and working with the city department. as women come to san francisco at our airports or taking the bus or whatever other modality, we have to go a little bit deeper into offering them ambassadors who can help them and put them at ease. that is important. when we get to technical. we forget to think about the plight of a woman who is stressed coming from another area. and if she is a person of color then its -- doubly encum ban upon us to do what we are known for. embracing those who need help most. commissioners, we are looking for you. looking toward you, working we are looking forward to you uplifting us to uplift you to uplift those who most need help. this is critical. and i then and there because i have been involved with crisis all overnight world. not only in san francisco. for example we have to stress on having emergency personnel of the caliber of a commander. not safety officers. this will be needed. we need a commander who specializes in emergency services. we need those type of people to put everything in place. thank you very much. >> thank you for sharing your comments i think there is one more, commissioners. >> hi caller. i unmuted you. let us know you are there. hello? that's the only person. >> all right. are there commissioner questions or comments about the resolution? a reminder this is ray discussion item. this will be voted on at the august seconded health commission meeting lots of time to put in comment in case there are none today >> commissioner chow? >> i thought that commissioner green's additions to the fine work that our secretary has put together as the resolution was helpful and i think it would be useful to continue to work on is that and my at the moment i have comments which i will forward later but i thought under the data source we should put date in as to when those documents were or for example, there is no way of getting women using indian health service facility. those are and i have added -- on the appendix, i -- i'm wondering under the medication abortion. that while it speaks about medication abortion as a broad category and i think useful category. not a lot consider the use of medications as an abortion process in the same way the public used the word, abortion. i ask commissioner green in her professional expertise one drug is name is that the own drug that is being used? i thought i read somewhere there were 2? they are in item 33. it is one years ago ru486. and cyto~ tech those other 2 medications that ar in item 33. that's what is on my copy. item 33. third liven item 33. n is for people and color and so fourth. medication abortion and make i have an old copy here. >> my item on 36 included your comments were medication abortion an approved and does not actually name them. may be we can straight then out. think we should name those 2 i thought i had seen it before one thing the one comupon ponent the former ru46 is doyle opsdpan by physician offices and clinics and not a prescription someone can pick up at a pharmacy. the other is widely available from pharmacies. that is has been traditional low the barrier among the 2 drugs. miso profital helps the utrus empty. that's his role and the other slows the growth of placenta tissue. that's what the 2 drugs do we will clarify that for sure and make sure we have the numbers right. >> okay. just seemed to me that probably under that what i see as paragraph 36 beginning with medication abortion. might be a good place to put in what medicines were since later we talk about the difference of the medication if you take a look at that we should try to be more explicit if there are these 2 medications and the difference that would be helpful and in appendix, otherwise. i'll send a few comment in. mark, why did it go to august and not the next meeting. >> the health commission leadership with doctor colfax prioritized laguna honda updates. >> yes. >> only items on those are items that need action we are trying to this is an important thing but this is something you can take time to develop over time. and commissioner chow, the 2 medications are listed on that first not they want to take more time in that same photograph on the first you understand medication abortion. >> we can look at that again. may be i'm not reading correctly. we are in agreement the 2 should be liftd and the difference with the 2 that is educational for people. >> thank you for your comment and i say, secretary pull third degree together with all these dast in short order. i think you know high praise is due to him for not only get thanksgiving information and having the accurate. as it is and well referenced as it is. many thanks and -- we appreciate your additions and comments commissioner chow and in august we will pass this resolution. all right. thank you, everyone. the next item is resolution making the finding to allow teleconference meeting under coat 54953e. >> and commissioner this is is the same resolution brought to you the beginning of every mont allows you to give yourself permission to hold hybrid meeting this is is from the city and mayor's office this is something you passed many timers over the past year. >> any public comment on the item? >> if you are raising a hand the comments is about the resolution to hold hybrid meetings. i will unmute a call and see -- caller, are you there? there is no public comment. >> questions or comments from the commissioners. >> commissioner chow. >> i -- obviously this is a resolution we looked at. comment the date needs to be changed on the day we pass it. it says june 7. yes, i changed the copy online. i think the one you might have printed out i did change that i will make surety resolutions are current. >> okay. otherwise, then. i would like to move the resolution. >> and is there a second. >> i second. >> >> great. commissioner giraudo. >> yes. >> commissioner jarmo. >> yes. >> commissioner chow. >> yes. >> commissioner green. >> item passes. >> thank you secretary. we pivoted from hybrid to now online to the need this is week that turned it upside down for you i appreciate your efforts and flip flopping the ways we manage the meetings. >> you are welcome. >> next for discussion is the city option funds and out reach updates. and00 autodirector of managed care will talk to us. are we red to go. >> go on, stelea, thank you. >> good afternoon, commissioners i'm stelea chow. the director of managed care. i'm here with from san francisco health plan. [inaudible]ing add administrator for the city option's program to provide updates on achievement and activeities, this is an item we promised we would come back in 6 months when is approve in the january. the policy was approved early this year. after the new year. and when we -- when we presented this the proposal proposed policy. at that time we were projecting we should be able to start the shipment in october first. now there is a delay for a few months we are awaiting for confirmation. we are expecting the first shipment in 2026. because of the 3 years requirement and the other requirements by the state law. >> so, in january, we projected that -- becausest accumulated amount for 13 years we protected that the first in shipment will -- be over 100 million dollars. and then -- after that, we project it is 38 million dollars-14 million dollars to be on an on going basis. this is also depening on the out reach between now and then. next slide please. here is a high level lives deliverables we completed we have been working on since we met in january. one of them is -- we are working with the -- controller's office. the also the -- treasure and tax collector's office. as well as san francisco health plan to initiate the planning of transfer the funds to the city treasurer. without the funds arrive nothing our ash count we cannot start the process. this is of the starting of the clock. you know, we completed an mou with d ph and treasure and tax collector. i will refer to tgx. and from there we are also -- drafted the memo to the responsibility that we are expecting our san francisco health plan to do for this new policy. this will is still a draft. and then we are still actively working with controller's office to set up that account to move the money over. and the related policy and procedures. that,llows san francisco health plan to after the transitions still continue timely to pay the employees mra. reimbursement claims and venders. in addition to the process we are also actively more aggressively doing communities out reach. our goal is to maximize the equalization of the [inaudible] benefit. upon when come in 2016 that reduce a lot of the funds to be [inaudible]. because the goal of the program is to make the access and health insurance affordable. health expenditure. here is a summary of our activities. between january and now. updated the website. . of course, the website is translateed different languages. but we have improved the functionality and -- as you see from the memo we attached a few. sample there is. we placed them with the city to improve program krell based on our research. the collateral marketing materials we redesigning and making more readable and lower reading level and doing more aggress and i have on going out reach to reminds people to enroll and reminds those that enrolld and not use fundses to use funds. this will be on going. last question. what else i want to say? the out reach efforts this is something on our website we have not spelled out the shipment where they have a way to search whether hay have funds left or not. we don't have a day to [inaudible] this is pending for the controller's action to create that account. but commissioner green, we hear you that was a great suggestion this is what we have been think burglar in planning meeting. so i will pause here this is will quick. will but -- i will be happy to take questions you may have. thank you. and the memo was superb. made it clear what your thinking and plans are. i wents to the website and thought it was terrific. is there public comment on this item? i not see hands. commissioner comments and questions? commissioner chow? yes, thank you for the update and i guess every 60's months will be more than it expects. . i was only interested in the fact that under your recap you had 104 million projected a 13 year accumulation. and then you are projecting 38 million annualy and increase in the number of people using this program. i'm not sure where the 38 million almost a third behalf it took 13 years to accumulate is based on? i can answer that for you. this is sumi. it is that. because the program is so big now compared to what it really was in the first 10 years. the most dramatic i will i think from our memo in january, we did a bit of a degame how we got to nanumber. it is a relatively small percentage but it is because we are getting over 100 million dollars in deposits compared to the beginning of the program you had small participation as it was ramping up 3 million-5 million and it is because that size and i would say you know our goal is to not meet that 38 million. it is trying to get it lower. to try to get more people using but it is really an an a testament to the size of the program now and how many people use it. >> so you are using 7.6%? >> no. gave you an estimate of like what the how much that is of the total a accumulated. i think our estimate is a little over the 7.6% but i will tell you what the actual is. il have to look back at the january memo. >> that's fine, >> thank you. >> amazing growth and certainly the work done to bring this about and to reduce that is -- vanish commendable. thank you. >> commissioner do you have your hand up? you have the floor. >> thank you. commissioner green, i wanted to comment thap i thought that the new form with the city seal and the language was great. very understandsable, and i reality appreciated the reading level. as well so -- i wanted to comment that i thought you really makes will make a difference in understanding the process for one to access it. thank you. >> yea. >> it was excellent. any other commissioner questions or comments? all right. hearing none. next item is the finance and planning update. is commissioner chow doing that. mr. chung is out? >> very good. you have the floor. >> yes. thank you. this was a very busy committee that met 2 hours before. it went through about 13 contracts which were on 19 pages you all saw that in the packet. . the and i'm going to thank commissioner guillermo helping me go through this large segment. a large number of the contracts are actually based on renewals of a 5 year or so initial contract. and we are a continuation of such. with the -- a -- a score in their evaluation that allowed them to continue, for our commission just to reminds them we did approve having 10 year contracts and thought we should not just have 10 year contract review and the most we should review is a 5 year contract with a 5 year renewal. many are that. we did explore there were a number of contracts that fell under your committed units of service and informed that due to staffing problems. this was a real problem. rather than just simple low patient reluctance. and that -- a number of the staff being staff, the staffs from the nonprofits were used during the covid contact program. and that a number of those actually joined the department of the which just exacerbated the problem in nonprofits. they are working on a program to try to assist the nonprofits to get their workforce up to par. within the 13 or so contracts there were -- 2 contracts that are actually new contracts but older providers. one that is worthy of mentioning, the san francisco study center was brought forth. by doctor bennett. and in participation using that as the contract allow for flex believability and health equity we many approaches and be that the san francisco study centers would actually be the third party administrator that it the flexibility to do a number of different opportunity that the department felt would be helpful in trying to get communities rbi put in megan ecwitted. i thought this was a fine contract to really then put dollars where we had been talking about. we are looking forward to seeing the results of this pilot. a second new contract actually was from family services. a new contract because the original value fell under 500,000. and to remind the commission that it would be a contract over 500 thousand dollars that the finance committee reviews. so. the new contract now is over 500 thousand dollars. continue services in the past and are for services for the deaf. we are recommending that also. there is a contract that would be a part of a discussion we will have in a few moments to bring you updated. in regards to the positive resource centers. which is part of the baker place positive resource center. you recall last time we brought this to your attention that is a contract for them in terms of the types of services they were doing and the beds we needed. een though there were financial issues between, because of the well. there are financial issues may be partly related the merging of baker place and resource centers. we were told that this contract for the same reason should be approved. and that -- if this became a problem and necessary to move it, then they would have the flexibility within the contract to do that. so -- that we will explain where they are now. and that in fact we asked the commission gets an update on this after some of the questions or -- posed to -- the -- the chief operating officer about these contracts. some of you read in the newspaper it is where then the board actually -- gave the contractor about 1.3 million dollars for the over run and on their payrolls that was going to put them in financial jeopardy. we'll have a discussion on that before they go back to the board of supervisors with findings and i will describe that in a mobile home or 2. so -- within that is a contract report that the committee is asking for approval. there were several other types of approvals that we are asking for. one was -- an approval for a list of contractors that are used as needed by the department for certain items that need to be done that dpw has agreed could be done as outside contractors. we see that list year after year and this is a list of the 12 contracts that are related to a number of services used by the d. there is a review that we did of a new contract with west com. west comand tv incorporated are is the provider for nurse call system at laguna honda. this is to put annual contract for service in place rather than ad hoc. we are going to be recommending that also. we reviewed a sole source contract report thap goes to the board of supervisors we all passed an ability for our executive secretary to approve individual sole source requests. after having -- reviewed the new governors and policy that the business office wanted use to save a number of months in terms of paperwork. the sole source contract report -- that is eluded to here and in your packet. is that which goes to the board of supervisors but is begin to us for annual review behalf has been done. on the individual basis moremented to assure us that his work is to sign off this was a sole source that appears to meet the criteria. but that then just continues the process of allowing contracts to be created and those do come before the commission so -- this was a nice review we had of what the whole process is in terms of contracts and that new sole source process should then reduce a number of week in terms of contract -- approval finally am were they have come through the commission and/or the board. >> lastly, many of you may have seen in the papers the question of baker place and positive resource center. we brought this up briefly a mont ago. and mr. wagner gave us a presentation. you have the slide. there was a short fall on payroll and the board of supervisors closed that short fall through july. and will be looking at -- the results of the -- inspect consultant brought in to baker place. to try to understand the basis of the problems and what could be done. mr. wagner you said they were working for the last several monthses already. on what had been a short fall but that the payroll short fall was a surprise and that's what they had to bring to the board in order to keep the doors opened. the very important services and -- things like the residential licenses that were at stake if in fact they were to close and wield have to the requalify those. those other same reasons the last mont we passed. we are asking for to you pass in one. number of steps taken bite department included going on to a cost basis rather than fee for service. and also looking at other solutions but those were not have actually resolved the acute problem of the short fall newscast pay role this is what the board did give about bont 3 million. and we'll hear the remainder of the report. prior to that we asked the committee mr. wag merand his staff before us as a full commission in order to understand after their studies here what will be their proposals in order to rectify this. we have asked them to study in commissioner green brought the same questions. to them and we did bring that up that -- it am a larger question might be how large should large be for the commission's contracting here with -- over 10 contracts held by this -- joint bite combination that has not been cull monated yet but all in the same entity, i guess at the moment even not formalized. it does create a problem if one of the contracts were in jeopardy just as this was in one of their detox units it seems to create a problem with the series of other services renders by that entity that sets up a question of, well, trying to solve the larger problem might be an issue when it could have been a small problem in a small organization. but anyway, that type of discussion that -- commissioner green brought forth again in her note and commissioner chung who was unable to be at the meeting today has brought up a number of times in the past for discussion about the large contractors we asked be discussed whether within that context of this particular problem or upon perhaps later depending on what is seeing best but -- certainly very small agencies are a problem. it appear we should have review of very large agency now. so. that -- actually was a very full agenda and it is committee asked for your approval of the monthly contracts and the several other items that we have under looks like items 4 through 5; right . happy to answer questions. or commissioner guillermo if you wish to add it was an extremely busy and -- quite informative meeting. the only thing i want to thank you commissioner chow for an excellent summary of very complicated, i think, and difficult, i think, situation that a lot of nonprofits are facing and what the department is doing to both preserve the ability for san francisco to provide these services as needed for the vulnerable population and the same time, you know hold organizations accountable for performance. in not with standing and -- mitigating circumstances over the past 3 years with covid and with other external precious like inflation and labor costs and so on. i want to commend the department on being creative and flexible. and understanding that you know coming down with the hammer is not the way to resolve issues but the same time it it is something that it can't continue in the manner in which things have been presented. i look forward to us being able to work or at least help -- over see and guide and provide support to the department to -- you know, folks like michelle and greg wagner and the staff there on trying to figure out the best way to resolve a number of thorny problems. that we are facing. so, i guess -- we ask for public be comment on this. >> no we have not yet >> is there anyone on the public comments line. and personals online if you like to make comment on the consent i will mute you. first on the line, are you there >> yes, i'm here. >> commissioners. police pay careful attention to hai'm saying. the matter of our 2 nonprofits came before the budget committee. and when we the constituents who stands for accountability and transparency were paying attention, the person who came there before the second time was lying. and the issue go to 2017. so -- we should not have nonprofits trying to do something without accountability and transparency. and then using as a ploy or bait that we cannot pay the employees. you have too many nonprofits who cannot do a need's assessment and we have a commission you can ramble about a situation. anyone can ramble about a situation and you do other thing you have to know what you are talking about you cannot lie. you cannot just demand 5 million dollars without providing the necessary imperical data to the legislative budget analyst. that's a shame. and was not present and another general member is present and you were trike to [inaudible] that is about the nonprofits. i lived in san francisco for a long time. do you know commissioners it is a shame and we call ourselves a first class city allow certain nonprofits to provide services in a tent. i challenge you commissioners to go to the united nation plaza and see what is happening. in stinky conditions. that's the same thing that happened at laguna honda. you knew and with intent dumped [inaudible] in a place that provides skilled nursing to our seniors. you cannot mix addicts 45 year old men prisoners in jail birds mixing with the seniors. that is a shame. commissioners, it is time you wake up. as i said. we embrace everybody. but we have to embrace of everybody with standardses. don'ts make knews the 2 nonprofits this and the other one they lied. >> thank you for your comment time is up. >> are there any other commissioner questions or comments? well, then we should entertain a motion to approve the consent calendar items. is there a motion. >> so move to approve the consent calendar. >> i second that. >> commissioner guillermo. >> yes. >> commissioner [inaudible] >> yes >> commissioner chow. >> commissioner green. >> yes. >> sthk, approved. >> excellent. >> the next item is other business is there other business to discuss? is there public comment on other business? i don't see hands, commissioners. >> all right. >> then the next item is the report from the sfg joint upon conference committee from june 28, 2022. and commissioner chow has the floor. i lost my papers on it. >> commissioner chow i e mailed you i'm happy to read it and you can fill in. >> why don't you do that. >> i'm sorry. >> no, i apologize i'm not feeling limp everything was done. >>you are being very heroic today. >> okay. i will read. june 28 the meeting committee reviewed reports in open session including the roll report you human report and medical staff hospital. checking on the status of complaintses and follow up survase the hospital did well on a lab survey, the committee discussed prohibits agsz on financial steward should new measures to enable managers to understand their budget and how operations fit western it is budget this . is a goal of the health commission. during the medical staff report the committee approved the urgent care rn procedure you cans surgery list and anesthesia privilege list. approved credentials report and report of the [inaudible]. >> anything else to add commissioner's green or chow? >> no. soundses like a great summary. thank you. >> excellent summary and impressive the way they did on the lab survey 8 out of 900 something and the new financial modeling which i think the tools nay give to managers to be able to budget and better manage resources in what is becoming an increaseingly resource challenged area is excellent. it was they have come a long way i thought it was excellent. they are working together. >> all right. i guess. that's my report. >> any public comment on the report. >> folks on the line if you like to comment on the report. press star 3. i don't see hands. questions or comments on the report. seeing none. we have to then move to closed session to do credentialing approvals for new physicians so -- is there a motion to go in closed session. >> so moved. >> do we ask for public comment, mark. >> we do. >> f commissioner guillermo. >> yes. >> commissioner chow. >> yes. >> commissioner green. >> now we are at adjournment commissioner green had a thought. >> i think it would be wonderful to adjourn for roma guy and the contributions she made to the health of the city of san francisco and to helping the health commission in guiding us in every way. >> i move to adjourn in honor of roma guy. >> second. >> second. >> all right. commissioner guillermo. >> yes. >> commissioner chow. >> yes. >> commissioner >> yes yoochl commissioner green. >> yes. >> thank you. i believe the meeting is over. >> thank you, mark for your leadership and help today i know you are under the weather you have done great. >> thank you very much >> thank you. >> i love teaching. it is such an exhilarating experience when people began to feel their own creativity. >> this really is a place where all people can come and take a class and fill part of the community. this is very enriching as an artist. a lot of folks take these classes and take their digital imagery and turn it into negatives. >> there are not many black and white darkrooms available anymore. that is a really big draw. >> this is a signature piece. this is the bill largest darkroom in the u.s.. >> there are a lot of people that want to get into that dark room. >> i think it is the heart of this place. you feel it when you come in. >> the people who just started taking pictures, so this is really an intersection for many generations of photographers and this is a great place to learn because if you need people from different areas and also everyone who works here is working in photography. >> we get to build the community here. this is different. first of all, this is a great location. it is in a less-populated area. >> of lot of people come here just so that they can participate in this program. it is a great opportunity for people who have a little bit of photographic experience. the people have a lot, they can really come together and share a love and a passion. >> we offer everything from traditional black and white darkrooms to learning how to process your first roll of film. we offer classes and workshops in digital camera, digital printing. we offer classes basically in the shooting, ton the town at night, treasure island. there is a way for the programs exploring everyone who would like to spend the day on this program. >> hello, my name is jennifer. >> my name is simone. we are going on a field trip to take pictures up the hill. >> c'mon, c'mon, c'mon. >> actually, i have been here a lot. i have never looked closely enough to see everything. now, i get to take pictures. >> we want to try to get them to be more creative with it. we let them to be free with them but at the same time, we give them a little bit of direction. >> you can focus in here. >> that was cool. >> if you see that? >> behind the city, behind the houses, behind those hills. the see any more hills? >> these kids are wonderful. they get to explore, they get to see different things. >> we let them explore a little bit. they get their best. if their parents ever ask, we can learn -- they can say that they learned about the depth of field or the rule of thirds or that the shadows can give a good contrast. some of the things they come up with are fantastic. that is what we're trying to encourage. these kids can bring up the creativity and also the love for photography. >> a lot of people come into my classes and they don't feel like they really are creative and through the process of working and showing them and giving them some tips and ideas. >> this is kind of the best kept secret. you should come on and take a class. we have orientations on most saturdays. this is a really wonderful location and is the real jewel to the community. >> ready to develop your photography skills? the harvey milk photo center focuses on adult classes. and saturday workshops expose youth and adults to photography classes. >> you are watching san francisco rising. a special guest today. >> i am chris and you are watching san francisco rising. focused on rebuilding and reimagining our city. our guest is the director of financial justice in the san francisco office of treasure to talk aboutw

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