Patients and staff are able to function within the confines of our Delivery Services so thats a real key piece. The last piece is as an equity issue, Disaster Preparedness is key because we know that population thats suffer from the greatest health and equity of chronic diseases are the most at risk in disaster for Poor Health Outcomes so dr. Gurly has been a real champion across the department. I want to thank her and her team for that leadership and thank you in terms of how we have moved from a less frequent execution of these duties to a frequent one. Ensuring the department and the commission is aware of these and that we prepare accordingly. Thank you. Thank you. Next item, please. Item 11 is other business and the counter is before you and its just a reminder the august 20th meet be will be held at the chinatown ymca at 5 00. Anything else . We can move on to item 1. The report back from the july 9th, 2019jcc meeting and i believe commissioner green attended. Yes, the laguna honda hospital the committee discussed the following items. We heard the administrators report discussion of the patient incidents and change of hospital leadership. We reiterated our sadness and our commitment to support current leadership to ensure the safety and quality of care of patients at laguna honda hospital and necessary changes are made. We heard the Regulatory Affairs report. We heard about their ethic implementation which was fantastic and they in deed had a lot of green dots that were red a week earlier. Added congratulations to you and we approved a policy and procedure manual that was quite extensive and very well done with a lot of great updates. A consider for close the session. I have not received Public Comment for that item. Is there a motion to go into a second. Second. All in favor aye. Well go into closed session. Thank you, consideration to disclose are not disclose. Consideration. Motion to not disclose. Is there a second. Second. All those if favor. Aye. Any consider for adjournment. Looking for adjournment. So moved. Is there a second. Second. All those in favor signify by saying aye. Aye. Meeting adjourned. Thank you, everyone. We spoke with people regardless of what they are. That is when you see change. That is a lead vannin advantage. So Law Enforcement assistance diversion to work with individuals with nonviolent related of offenses to offer an alternative to an arrest and the county jail. We are seeing reduction in drugrelated crimes in the pilot area. They have done the program for quite a while. They are successful in reducing the going to the county jail. This was a state grant that we applied for. The department is the main administrator. It requires we work with multiple agencies. We have a community that includes the da, Rapid Transit police and San FranciscoSheriffs Department and Law Enforcement agencies, Public Defenders Office and adult probation to Work Together to look at the population that ends up in criminal justice and how they will not end up in jail. Having partners in the nonprofit world and the public defender are critical to the success. We are beginning to succeed because we have that cooperation. Agencies with very little connection are brought together at the same table. Collaboration is good for the department. It gets us all working in the same direction. These are complex issues we are dealing with. When you have systems as complicated as police and health and proation and jails and nonprofits it requires people to come to Work Together so everybody has to put their egos at the door. We have done it very, very well. The model of care where police, district attorney, public defenders are communitybased organizations are all involved to worked towards the common goal. Nobody wants to see drug users in jail. They want them to get the correct treatment they need. We are piloting lead in San Francisco. Close to civic center along market street, union plaza, powell street and in the mission, 16th and mission. Our goal in San Francisco and in seattle is to work with individuals who are cycling in and out of criminal justice and are falling through the cracks and using this as intervention to address that population and the Racial Disparity we see. We want to focus on the mission in tender loan district. It goes to the partners that hired case managers to deal directly with the clients. Case managers with referrals from the police or city agencies connect with the person to determine what their needs are and how we can best meet those needs. I have nobody, no friends, no resources, i am flatout on my own. I witnessed women getting beat, men getting beat. Transgenders getting beat up. I saw people shot, stabbed. These are people that have had many visits to the county jail in San Francisco or other institutions. We are trying to connect them with the resources they need in the community to break out of that cycle. All of the referrals are coming from the Law Enforcement agency. Officers observe an offense. Say you are using. It is found out you are in possession of drugs, that constituted a lead eligible defense. The officer would talk to the individual about participating in the program instead of being booked into the county jail. Are you ever heard of the leads program. Yes. Are you part of the leads program . Do you have a case worker . Yes, i have a case manager. When they have a contact with a possible lead referral, they give us a call. Ideally we can meet them at the scene where the ticket is being issued. Primarily what you are talking to are people under the influence of drugs but they will all be nonviolent. If they were violent they wouldnt qualify for lead. You think i am going to get arrested or maybe i will go to jail for something i just did because of the Substance Abuse issues i am dealing with. They would contact with the outreach worker. Then glide shows up, you are not going to jail. We can take you. Lets meet you where you are without telling you exactly what that is going to look like, let us help you and help you help yourself. Bring them to the Community Assessment and Services Center run by adult probation to have assessment with the department of Public Health staff to assess the treatment needs. It provides meals, groups, there are things happening that make it an open space they can access. They go through detailed assessment about their needs and how we can meet those needs. Someone who would have entered the jail system or would have been arrested and book order the charge is diverted to social services. Then from there instead of them going through that system, which hasnt shown itself to be an effective way to deal with people suffering from suable stance abuse issues they can be connected with case management. They can offer Services Based on their needs as individuals. One of the key things is our approach is client centered. Hall reduction is based around helping the client and meeting them where they are at in terms of what steps are you ready to take . We are not asking individuals to do anything specific at any point in time. It is a Program Based on whatever it takes and wherever it takes. We are going to them and working with them where they feel most comfortable in the community. It opens doors and they get access they wouldnt have had otherwise. Supports them on their goals. We are not assigning goals working to come up with a plan what success looks like to them. Because i have been in the field a lot i can offer different choices and let them decide which one they want to go down and help them on that path. It is all on you. We are here to guide you. We are not trying to force you to do what you want to do or change your mind. It is you telling us how you want us to help you. It means a lot to the clients to know there is someone creative in the way we can assist them. They pick up the phone. It was a blessing to have them when i was on the streets. No matter what situation, what pay phone, cell phone, somebody elses phone by calling them they always answered. In officebased setting somebody at the reception desk and the clinician will not work for this population of drug users on the street. This has been helpful to see the outcome. We will pick you up, take you to the appointment, get you food on the way and make sure your needs are taken care of so you are not out in the cold. First to push me so i will not be afraid to ask for help with the lead team. Can we get you to use less and less so you can function and have a normal life, job, place to stay, be a functioning part of the community. It is all part of the home reduction model. You are using less and you are allowed to be a viable member of the society. This is an important question where lead will go from here. Looking at the data so far and seeing the successes and we can build on that and as the department based on that where the investments need to go. If it is for five months. Hopefully as final we will come up with a model that may help with all of the communities in the california. I want to go back to school to start my ged and go to community clean. It can be somebody scaled out. That is the hope anyway. Is a huge need in the city. Depending on the need and the data we are getting we can definitely see an expansion. We all hope, obviously, the program is successful and we can implement it city wide. I think it will save the county millions of dollars in emergency services, police services, prosecuting services. More importantly, it will save lives. Thank you all for being here today and for your patience. Im london breed, mayor of San Francisco, and i am joined by president of the board of supervisors, supervisor norman yee as well as the director of the department the department of Public Health, dr. Grant pulled koufax and other members of the department of Public Health. We are here today because there was a very unfortunate situation that has occurred at laguna honda pick laguna honda hospital is a place that has taken care of so many vulnerable residents, people like my grandmother, were so many years. My grandmother suffered from dementia and she was at laguna honda for many years before she passed away in 2016. I want to say that the chair and the support and the compassion from so many of the employees at laguna honda meant a lot to me personally and meant a lot to my family, but these particular acts that have occurred, by few individuals will be addressed. Dr. Colfax will provide some of the details in terms of what has happened and we are already taking swift action to address those issues and i want to thank him and his department for being steadfast in the work to address these issues, in addition to providing new leadership to make sure that this doesnt occur again. We are better than this. We are committed to restoring the trust of the families and the patients of laguna honda and we thank you thank you all so much for being here, as well as, as i said, many of the folks who are part of laguna honda, we have work to do and we are committed to making sure that situations like this that have occurred dont happen again. At this time, i would like to ask president of the board of supervisors, norman yee to say a few words. Laguna honda is located in his district. Thank you, mayor. Im kind of speech list when i found out about this situation and im super i am super outraged with what has occurred. Like mayor breed, this is personal to me. I have had family members who stay there. I still have friends whose parents are being cared for. So for this to occur under our watch, i dont have the words to express how upset i am. When people send their loved ones there, they trust, they would like to be able to trust that they will have the best care. For the most part, at laguna honda, i would say that they have received that, but for these few Staff Members that have perpetrated these incidents , i am with dr. Colfax, this is a very quick, quick reaction, not only to find out what happened, but what is more important is that we really need to figure out how to prevent Something Like this from ever happening again because again, when one sends their loved ones there, they want to feel comfortable. They care. They do care what happens, and they have to trust us, and we should do the best we can. Because of that, we are going to call for a hearing at the board of supervisors to find out what exactly happened and what are the measures that will guarantee that this will never happen again. I want to thank the mayor for acting quickly and i want to also thank dr. Colfax for what he has done so far. Thank you very much. Thank you president yee and now dr. Grant colfax to provide more details about what has occurred. Good afternoon. Thank you madam mayor and thank you president yee and thank you all for coming today on such short notice. We are here to report something difficult, disturbing, and disappointing to the people of San Francisco. In february of this year, while investigating and unrelated Personnel Matter, the department uncover the possibility of patient mistreatment at laguna honda hospital. We immediately started an internal investigation and found evidence to substantiate our initial submission suspicions we contacted the San FranciscoCity Attorney to help us conduct a more formal and comprehensive investigation. We reported our evidence to the California Department of Public Health and to the San Francisco police department. And we just we dispatch the quality and safety Team Together all the relevant facts and to make recommendations. We know want to the people of San Francisco to hear directly from us about our findings and what we are going to do about them. We discovered that 23 residents were affected, dating back to 2016. Six Staff Members were involved in they are no longer employed by the department of Public Health. The misconduct we discovered included sexualized conversations with residents, verbal and physical abuse, neglect, privacy violations, medication errors, and the administration of nonprescribed substances to some residents in an attempt to pacify them. This behavior is not something we will tolerate. This behavior is not something i will tolerate. As a caregiver, i am outraged and heartbroken. There are patients that our patients were treated this way. I apologize to them and to their families. In response to our findings, we have immediately taken steps to ensure patient wellness and safety. We have removed the chief executive officer and chief quality officer of laguna honda hospital. We have notified all affected patients and their decisionmakers or their conservators. We have thoroughly examined all affected patients to make sure to ensure their health and wellness. We have informed all relevant regulatory Law Enforcement agencies, we have retrained staff in prevention and preventing patient abuse and we have improved drug security, dispensing, and testing practices. There is no evidence that these abuses continue to pass january of 2019. An extensive investigation and interviews with staff confirm that these abuses were limited to two units of the hospital and to a minority of patients in those units. Today, we are confident that laguna honda continues to be a good place for patients. Especially in the areas the patient care and safety. We want to ensure it continues moving in the right direction, so these circumstances never occur again. Our acting c. E. O. Will lead to the process of recovery from these incidents and we will fully engage our hospital staff and recommending and recommitting to our mission, values and work. We will continue to work in close collaboration with the California Department of health and our cooperate and are corruptly cooperating fully with their investigation. Additionally, the Health Department wonder take a turnaround plan for laguna honda , informed by external experts in longterm care and working in partnership with the community, patients and their families and Health Department leaders. Well submit our plan for moving forward to the mayor, to the board of supervisors and to the Health Commission within 60 days anyone with concerns about patient care or staff conduct is asked to call the Confidential Department of Public Health compliance hotline at 8557296040 855 7296040. Now, the director of the San FranciscoHealth Network and i will answer a few questions as there are still ongoing investigations, we may be limited in what we can say at this time, but we thought it was important the community hear from us directly and that is why were we are here today. Thank you. [indiscernible] all six employees have been removed from employment. There is an Ongoing Police investigation. [indiscernible] they have been removed from those positions and we have a new c. E. O. It is a Personnel Matter and i cant specify any further than that they are removed