Secretary any other questions, commissioner . Commissioner chung. Commissioner chung i keep click the wrong button. Thank you for the presentations and i, too, appreciate hearing those who are in the endstage, you know, of their life, get to spend that with the family. Instead of like dying alone because like this whole covid19 created a very different way for hospital assistance, which also caused many patients, you know in other hospitals, that ended up dying alone. So i think thats really important for tows acknowledge. You mentioned face time and a video visit, which prompted other questions i have. How well have we been utilizing telehealth since some of these like inperson doctor visits, it is not possible. Could you guys hear me . Secretary could you raise your hand, dr. Hathaway. Its very hard to hear her. Theres an echo and we sure do want to hear this. Dr. Hathaway could you hear my better . Yoasm like im yelling. So here at laguna hospital, were not utilizing telehealth, telemedicine, the same way that the community is using. So remember this is a very unique facility and we function very similarly with [indiscernible] as an inpatient hospital. So our providers actually see patients facetoface. We do not utilize any sort of devices that rely on a third party because a nurse or a pca to visualize the patient. We actually still seat patient and assess them as if they were an inpatient facility. Now, there are some instances in which i can do Remote Access for our cubicle or from our offices but its more of a chart review process. Any service situation where a patient needs to be examined, a physician will examine them in person. Does that answer your question . Commissioner chung yes. Thank you much. Dr. Hathaway youre welcome. Secretary any other questions, commissioners. The team is already lit up and on video. We continue on with the laguna honda item and go back to the staff report. Is that okay, commissioner bernal, with you . Okay. Great. So then well move on. Well move on. To 9, which is laguna honda Regulatory Affairs report. Just one minute. I am the [indiscernible] for laguna honda hospital. Im going to share with you the regulatory report for the month of may. For the month of mai. Laguna honda hospital submitted a total of 19 facilityreported incidents to cdc h. You have the break down there on your report. There were also 7 anonymous complaint. To questions that were provided by commissioner green, just some quick follow up. So there was a change in staffing so this has caused a delay in followup in some of the investigation items so this is the roughly 15 investigations that you see have not been started here at the hospital just yet. 7 of which are [indiscernible] cases. Additionally, follow up with over 40 cases during this covid time. So the surveyors are not visit visiting all the facilities. Its a great time for them to catch up on some of their pending cases and theyve been doing that. The Management Team has been extremely busy, providing followup documentation to over 40 cases and over 15 impenlding case that is we an tyes prit documentation comes. There are concerns in term n terms of the penlding cases. I would say, not at this time. Of course, theres an opportunity they might be substantiated, there might be deficiencies. But in terms of other penalties or other deficiencies that the facilities have seerntion that is not a concern, as all those cases of course closed ow. Thank you commissioner green for your thoughtful questions. I hope that addresses some of your thoughts. In addition, i think one thing thra is really something to celebrate. Is that we are back in compliance. I just want to highlight it again. To get the facility back in compliance with participation. This was shared with us on may 7. The so that was very exciting for the team here, as we were in the midst of covid, they accepted our plan of correction with a table review if their office after submitting documentation. Clerk let secretary anyc comment. Theres no Public Comment at this time. Secretary thank you, any questions, commissioner . No comment . All right. Im not i zoo seeing any. We can move on. To the next item. Item 10. Laguna honda wide policies and processer. Thank you very much. Ill continue to present this item for you. Nawzaneen we have three hospital wide policy that is have been revised. These are three of our Infection Control policies. All the revisions are related to the laguna honda hospitals covid19 response and wanting to update our policies in line with the protocols we have put in place with the facilities. There are three departmental policies from nursing. These are related to epic workflows. The department has updated workflows. The rehabilitation has one policy up for revision and this is in terms of their commission to medical. Secretary do we have any Public Comment for this item . We do not. Secretary any questions, commissioners . Okay. President bernal do we have a motion to approve . Vice president green so moved. President bernal is there a second . Second. President bernal yes. Vice president green yes. Commissioner chow yes. Commissioner chung no response . Secretary commissioner chung . President bernal commission. Secretary let me make sure she had no trouble with kexese connections. Im going to give her a call. Please hold, everyone. Please be patient. Thank you. This is a vote on item 10. The other three commissioners have already voted and we need out record. Commissioner chung yes. Secretary thank you, laguna honda team. So as you know, first were going to go to dr. Horton closed session first, so i will email you, and i will also test you dr. To make sure when its time for to you sign it in closed session, i will do that through that communication. In the meantime, please turn your camera off and thank you much for the report. Dr. Horton, are you on the line . Dr. Horton i am and im so sorry for the glitch i had earlier. Secretary okay. Great. Youre o. Dr. Horton im you cant see me on video. This should be fixed next week when i join the dph ranks knead and we have a different Microsoft Teams. But my apologizes about that. First, for my chief of staff report, thanks so much for attending and for your wonderful words of encouragingment of med staff that are virt yom, this year, our virtual med staff dinner, our handle meeting we had a good time, even though actually we could not actually have a dinner. We had a number of interns from the various departments who won a [indiscernible] award, and always a shout out, as that particular award focuses on their dedication and hard work on behalf of our very vulnerable patients and zsfg in particular. The nominating committee for the med staff had met and proposed a new chief of staff, and it was voted on at the dinner we are delighted with anyone who is not familiar with dr. Winston, she is the head of Infection Control, at zsfg and is vice chief the of the internal medicine department, the Largest Department at dsfg, so shes played a Critical Role of operations, mostly on the Inpatient Service but shes very knowledgeable in the out patient services. Were really happy shes been willing to step into the role, and sleel be keeping her Infection Control hat but passing on her chief of medicine hat, sort of getting a lot of bang for your bucks there. As she knows more about than almost anybodyel at the hospital. Im really thrill body that and i leaked a couple of new atlarge members. One is the vice chief of the Pediatric Department and the medical director of pediatric clinic. The other is vice chief of Community Family medicine and also is the Program Associate director for their residency. Really, wonderful people. The other thing we focused oat the dinner, but also at one of our med expect Committee Meetings is of course, the issue of Racial Equity. Theres been a lot of involvement and concern about these issues, not only before the death of george floyd and Brionna Taylor and all the other events that have happened, but really a lot more light being shed on all the advocacy going on in this area, and all of the work that we have put in for Racial Equity. Im very appreciative and prepared a list of resources as well. She is the head of ourstra teenlic planning for equity at the hospital and some of the metrics shes followed and some of the work beef been doing to advance Racial Equity and both she and some of our trainees, who have taken leadership role in the roles for black lives Matter Organization at ucsf, has been carrying a lot of resources about how the med staff will get involved in that and i really appreciate all the work going on there. The final in my chief staff report, we have taken a bit of a break from our division reports because everyones been scrambling around to reconfigure their services but were back to service as usual. And we had a great report and they did some tremendous work at the help. And complexity, chief of services they also do it with very little, they have 1. 8stes for attending time. And someone point d out. Dr. Russell hearses seems to be doing 1. 5 herself so she wears a lot of hats and answers all the econs, does a lot surgery and they have a wonderful residency class and i have three action items can i go through all together. Or call for a vote or we can vote individual lee. But ill let you know what they are first. So the first, we have revision to the standard procedure. Fortified nurse. Midwifes, and it allows them to be first assist for csection. The reason for this is because like all services, there has been the ob gyn service and the residents are not always available we had a discussion about this. And the committee had a discussion and the commit i recommended some revisions. We wanted to make sure that there were actually two surgeons in the room. And so that one of the surgeons could actually be overseeing and teaching and watching the words of the nurse midwifes, so that nursemid wf can learn and be proctored and be signed off on the first assist rule, in order to perform that adequately. Secretary any questions, commissioners. Do we need to take them as individual items. Secretary on mass is what you normally do. President bernal all right. Thank you. Secretary go ahead, dr. Horton. Dr. Horton okay. Great. So the next is an an thesia st. So the reason for this youll r youll see a lot is in there. We have had a pain clinic for a while now, where we have had nurse practitioners, working in the pain clinic. But as you all know the way our system works. You were supposed to have an st. And so we modeled this, or we didnt, but the cipd committee and dr. Wood, who is the medical director of pain clinic, mold thd on our sp, so it follows similar guidelines, in terms of proctoring automatic all of the nurse practical tigdzers, working in pain clinics, are credentialed at the hospital and are covered under some st, they were not specifically working on an st for pain clinic. Prior to this. Any questions about that. We also have an update and that is we are removing the central line placement in the tunnel catheter procedure so this is for the attending nephrology, and the [indiscernible] need to be proct ord or are proct ord from attending other departments who hold those privileges. You have questions about that . I think our questions and Credentials Committee was a little bit of a surprised that our Nephrology Center is not doing procedures but we were reassured, the people who are doing procedures, they are getting adequately proct ord and signed off by those who do have those privileges. Secretary before we go to the commissioners for questions, lets just check and see if theres Public Comment. Being currently done. Just taken out then . Into these circumstances in which the spiftist nephrologist has in fact been doing . I mean, i dont know [overlapping speakers] dr. Horton [indiscernible] [overlapping speakers] but they are not retaining the priviledge . Commissioner chow by eliminating t. Even though they are not doing it right now. Commissioner chung in the future, its potentially possible. They dont have residents. Yeah, i did wonder that myself. Even if no one currently is doing it on the attending level, it is possible someone would want that joined in the future. I do know more are, replaced by i. R. And the attendees do not take overnight call so its really an overnight call to come in and place those. However, im also happy to take this back from the chief of neverseenbefore iology and they dont want retain t but a lout current nephrology. Privilege. Commissioner chung its an optional privilege and its fine if youre going to take it back to them, just for review and we can go on right now if they think it might be good to retain it, they can put that in. Dr. Horton okay. That sounds very reasonable. Secretary commissioner green, do you have a question as well . Vice president green im confused about in many of these situations. In terps of new criteria. There are highvolume things for things that are realliesome and lowvolume needs for those that are complicated. audio distoargses in the background [indiscernible] some kind of consis isies, for how they address the complexity, procedures, compared to highvolume procedures, when factoring, when creating a new procedure but there is some variability in them because they are all created by their own department and i dont so far, i dont think we have of we have plan a comprehensive overhaul of them, but what we have planned is more of a procedure where the entire st has gone over, at least every two years and we are right in the process you of beating the drums for that and trying to get departments to do that. When covid hit. But i think the new chair of the commit severy interested in doing that. Now that things are calming down again with covid they still made sense and you correctly pointed out arks couple of sessions ago, that they had a procedure in there that im sorry, this is for the attending privileges but they had a privilege in there that was no longer done anywhere and i think that goes to under score your point which is all of privileges, really should be reviewed. R rs, at least every with a certain period that we can count oso we have a more comprehensive review. So i dont know if you have a comment about those specific procedures now, in which case im happy to take it back to the Ob Gyn Department and im happy to [indiscernible] to the chief of staff and ann swager and allen gield and the head of the cidc committee [indiscernible] our efforts around regular comp henlsive review of the s. P. s is a good idea. This is dan, so yes, im on the phone. Noted. Inld you dont know the extent to which it applies to multiple specialties as well. I think what happens is, people get kind of stuck in a situation for proct org whether its for an initial a payment or a reappointment. Low volume. Hi complexity procedures are opportunities to view them, but theyre the most title for proke omplet were having this discussion. Pretty often enough, where we need the peed i mean, you really have to know what youre doing and yet, we dont have to int bait that many kids per year. So its hard for everyone to maintain their competency in lowrisk, high volume situations and thats really true we continually discuss that. Secretary before we go to a vote. I miss today, for the nephrology, is that going to be included in this vote or are you going to be take ting back and trying to address commissioner chows question . The way the call is set up and other way the Current Department is set up. I think it would probably be best to vote to approve to remove them but i will take it back to the Nephrology Department, this conception that, you know, if going changes, we will get it back with a special procedure right away. I think thats the best way. I didnt have the direct conversations myself with the Nephrology Department and there may be additional considerations and its not going to leave anybody doing the procedure without a privilege assist at this time. S i understand. So my question is more for [indiscernible] with thindanind. Are the nephrology privileges still on the action items for a vote today . Okay. They are. Okay. Great. The standard procedures in the nephrology procedure list. Do we have a motion to approve. So moved. Sefnlgtd. President bernal yes. Vice president green yes. Commissioner chow yes. Commissioner chung yes. Secretary great. And i believe im sorry. I understand dr. Ehrlic has some things she would like to say. Dr. Ehrlic yes, thank you, commissioners for the time. I want to take this time to recognize dr. Horton for her service as chief of staff. Dr. Horton has just been a tremendous leader in this role. Shes been in the role for an unusually short period of time but shes really packed in a lot action during that year she worked with us on epic and going live and she is Pretty Amazing in her efforts in dreationz faculty and trainees, coming out of that epic go live, she was very involved in the ambluetory demain, in helping them get back on their feet. And no senior we got things semisettled with epic, but we went into a pandemic and dr. Horton has been an incredible leader during that tie. I have so enjoyed havingler on the executive committee. Shes been a great contributor. Shes creative, incredibly intelligent. Shes got a great cents of humor. Sense of humor. I regret shes had to cut short her time as chief of staff. But the good news is, shes going to be the chief medical officer for the network and well all get to keep working with her in a new and enhanced role. So im looking forward to that. Thank you very much, clerc. Youve always been so thoughtful and informative when you come to the commission and we have just really enjoyed having you in this role and wish you the best, knowing that youre not going too far and that well continue to see you. Dr. Horton oh, my gosh. Thats so nice of everyone. Youll probably see more of me than you want to. But i adopt to take a moment i really enjoyed working on your executive team. And its been real pleasure to work with all of you, the commissioner nirs and about mark and this has helped me so much how this commission and the department functions. I am completing my original twoyear term, but it is true, i was planning to stay for a third year and then [speaking away from microphone] secretary before closed session, theres item 11 for other businesses. Just checking other things that have come up. Any Public Comments about the item. Theres no Public Comment. Secretary thank you. So commissioners, consideration for going into closed session. That requires a vote. Is there a motion. So moved. Second. President bernal yes. Vice president green green. Commissioner chung yes. Commissioner chow yes. Secretary okay. Everyone. Please, remember, im going to close this meeting out. You have to go to the next link if youre opening up the email i sent you, or can you go to your Microsoft Teams and click on the closed session link, and that will take you to the meeting. I will see you hopefully, in a minute or two. Wrack brack close [closed session in progress]. . [connection difficulties] i need your voice, sir. You were muted. Yes. Oofnlgt great. Commissioner chung. Commissioner chung yes. Vice president green yes. Commissioner chow yes. And the last thing is consideration for adjournment. Move to adjourn. Second. Okay. Great. Commissioner chung yes. Vice president green yes. President bernal yes. Commissioner chow yes. Secretary thank you all. Thanks for this meeting. Have a lovely meeting. Be safe. Thank you. San francisco is surrounded on three sides by water, the fire boat station is intergal to maritime rescue and preparedness, not only for san francisco, but for all of the bay area. [sirens] fire station 35 was built in 1915. So it is over 100 years old. And helped it, were going to build fire boat station 35. So the finished Capital Planning committee, i think about three years ago, issued a guidance that all city facilities must exist on Sea Level Rise. The station 35, Construction Cost is approximately 30 million. And the schedule was complicated because of what you call a float. It is being fabricated in china, and will be brought to treasure island, where the building site efficient will be constructed on top of it, and then brought to pier 22 and a half for installation. Were looking at late 2020 for final completion of the fire boat float. The historic firehouse will remain on the embarcadero, and we will still respond out of the historic firehouse with our fire engine, and respond to medical calls and other incidences in the district. This totally has to incorporate between three to six feet of Sea Level Rise over the next 100 years. Thats what the citys guidance is requiring. It is built on the float, that can move up and down as the water level rises, and sits on four fixed guide piles. So if the seas go up, it can move up and down with that. It does have a full range of travel, from low tide to high tide of about 16 feet. So that allows for current tidal movements and sea lisle rises in the coming decades. The fire boat station float will also incorporate a ramp for ambulance deployment and access. The access ramp is rigidly connected to the land side, with more of a pivot or hinge connection, and then it is sliding over the top of the float. In that way the ramp can flex up and down like a hinge, and also allow for a slight few inches of lateral motion of the float. Both the access ramps, which there is two, and the utilitys only flexible connection connecting from the float to the back of the building. So electrical power, water, sewage, it all has flexible connection to the boat. High boat station number 35 will provide mooring for three fire boats and one rescue boat. Currently were staffed with Seven Members per day, but the Fire Department would like to establish a new dedicated marine unit that would be able to respond to multiple incidences. Looking into the future, we have not only at t park, where we have a lot of kayakers, but we have a lot of developments in the southeast side, including the stadium, and we want to have the ability to respond to any marine or maritime incident along these new developments. There are very few designs for people sleeping on the water. Were looking at cruiseships, which are larger structures, several times the size of harbor station 35, but theyre the only good reference point. We look to the cruiseship industry who has kind of an index for how much acceleration they were accommodate. It is very unique. I dont know that any other fire station built on the water is in the united states. The fire boat is a regionalesset tharegional assete used for water rescue, but we also do environmental cleanup. We have special rigging that we carry that will contain oil spills until an environmental unit can come out. This is a job for us, but it is also a way of life and a lifestyle. Were proud to serve our community. And were willing to help good morning, everyone. The meeting will come to order, welcome to the june 29, 2020, meeting. Im supervisor hillary ronen, chair of the committee. And with me is vicechair, Catherine Stefani and supervisor gordon mar. And our clerk today is victor young and id like to thank sfgovtv terror staffin for stas meeting. Mr. Clerk, do you have any announcements . Clerk the board of supervisors legislative chamber and Committee Room are closed. However, members are participating in the meeting today