Not a case was report and they trusted 67 of the clients and none came back positive. On august 6th ut doctor and saying he wasnt on board with even the states cutting people outdoor policy because he had seen quote no evidence end quote, that salons were spreading this as fast as other businesses were in allowed to remain or reopen and to have them lumped in with bars and restaurants is always seemed just misguided. One salon and perhaps this person will be on the phone but one salon in San Francisco, who also owns a shop in austin, texas that has been open, reports over, this is maybe two weeks ago, a week ago, about 3100 clients in zero reported cases. I know my time suppose. Fair enough. Thank you. Great. Commissioners, i believe that is all. Let me go. Theres another hand but i believe give me one second to try. I believe thats all. Press the button to raise your hand. I do not see any. I will raise two questions. On your last slide its encouraging news we see our reproduction number below one at 9. 3. Recognizing that our early success in containing the pandemic involved close coordination with the other bay area counties and with work that you and our Health Officer had done with them. Do we know or do we believe the reproduction number is also following the trend in surrounding counties and it may be below zero in those countries . Thank you, commissioners. So, when is interesting in looking at the rate around the surrounding counties is theyre leg than San Francisco right now and we dont know exactly y one thing that happened is their rate increase before our reproductive rate did and so we may be behind. In other words, they went up faster and we were behind them in the increase so hopefully our decrease is lagging so were watching that. The other cause for concern is that we are a much denser injuries diction than most of the other surrounding counties so, it is plows able because of our sense tee and because of the high level of virus that without greater adherence to the social distancing, the masking and good high queen we will continue to see a relatively higher rate than the other surrounding counties and thats my response, thank you. San francisco is the second densest jurisdiction in the country. I believe. My second question goes back to case demographics you mentioned we were putting into place our adaptive testing strategy with mobile teams that are sent into neighborhoods in the city with higher prevalence and do we expect that result in a higher percentage positive number in our testing because were being more work would community and let people foe there is Testing Available so were in the process of on what day and well look at the data evaluating whether we are in deed going where the virus is and based on those Positivity Rates and before we can draw conclusions about what the data are showing us in terms of how we may need to adjust. It may be the report and to understand and if we do see an increased Positivity Rate and it could be a better targeting our testing events that are most infacted. There are reason and if were being more more precise about where we need to test, that would mean we could have at least initially a higher testing rate. If our prevention interventions and our testing sat rates, we would expect to see that Positivity Rate to go down unless the numbers continue to go up and we continue to focus on basically the increasing cases going up as a result and reproductive rate so theres a combination of factors that could influence the Positivity Rate Going Forward and our goal is to basically look at our Positivity Rate our Testing Programs and the Positivity Rate at the mobile sights in conjunction with the reproductive rate as well as our Contact Tracing Positivity Rate and that Positivity Rate has been from two to three times above average of our over all Positivity Rate so that starts to go down its a good sign that were basically saturating the groups with the highest risk for covid19. One more question. You mentioned that we are doing a much better job in our resulting time for testing. What are we looking at for our resulting testing and is there a difference between the time for getting results between our publichealth labs and private labs or private providers . The most recent data i have is that our large scale testing labs and lab course so i have lab core turn around time is 2. 2 days now dramatically better than it was. And its a huge advances there and with our city test sf site and oir publichealth lab results are available within 24 to 48 hours with a possible outside window of 72 hours. Thank you director colfax. Commissioner giraudo. My question is about the increase in the rate of children that was up rather significantly it seemed and if you have any information on the root of the increase in this population of camps . So there are a number of consideration thats have been taken into with regard to that rate of increase. The most basic one is the outbreaks are more widespread and occurring in multi generational households and adults who are essential workers and working are essentially infected bringing it home to the households and kids are becoming infected as a result. The other plausible explanation is were six months into shelter in place and the kids are just getting out more and interacting more with other kids and perhaps other families and there may be increased transmission there as well. Thank you. You dont see an increase in the Daycare Centers . Specifically. I will check. Were not seeing a sustained increase in the centers that im aware of but i can report back to you on that. Thank you. Oh, yes. Thank you. I had about throw questions. One was first in terms of the data coming in i thought i had understood previously that because the reports also came directly to the department along to the state that we werent going to be impacted to a great extent so is that still true or do we feel that actually a number of things slipped through and they never got to us and they got to the state and when do you then expect that the data would be aligned correctly within the week or give us an estimate if you can. Yes, commissioner, thank you. So we do get some data directly locally but a significant preportion was set up through the system and sent back locally so we do expect some disruptions as a result. For instance, this weekend we got 45,000 test results that were backlogged and not reported into our system. So were now repopulating those test results based on when they were drawn and resulted so that will probably influence our Positivity Rate on some dates. Almost all those test results were negative. So if anything our Positivity Rates should go down. Rather than go up. And im being told by our data team we expect provided the state is accurate saying they fixed everything that they that was malfunctioning at the state level, we should have a pretty we expect to have this resolved over the next few days and certainly by next week. We would be able to see what was there before versus once the state has repopulated the state data has gone out so that we can see the difference the two. Ive asked the team to track that. Yeah. That would be helpful in terms of understanding the impact and as you said, if these were negative it would lower our rate. If i could just clarify. Our reproductive rate wont change because its based on hospitalizations and those hospitalizations are local data so the fall function did not effect our hospitalization numbers and the reproductive model would still hold. I see, thank you. That is a very good clarification. Second good evening i have and theres a publicity at this point in regards to flu vaccine and does the department have been put out advisory about when people should be getting. Theres some data that says thas people should get it earlier and versus the usual period of time where additional device is said because here in california we normally see it in december and january you should be closer to october or november but others are now saying it would be useful to get it earlier so it doesnt confound the symptom apology that may occur with a potential covid surge. I dont know if the department is looking that in terms of it offering officers our residents. Thank you for the question. Dr. Horton, we have been working on killing our flu and ensuring that gets out and people are aware of the importance and i dont know if you can share with the commissioner some Additional Details or certainly we can provide those at the next meeting if necessary. I can speak to that. This is how good afternoon commissioners. We have had our commercial meeting can you hear me ok . Yes. Weve had our initial meetings with ucsf and commune i canal disease putting together a strategy for the flu season for immunizing as many people as possible. Dr. Chow, i cant speak exactly to how it will workout the timing. Its still part of the discussions but i will say that our approach is going to be a one of removing as many barriers as possible to immunizing the public. We expect well have a good supply of flu vaccine this year and were interested in speaking outside the box and really getting as many people as possible in vulnerable populations and immunized as possible so we can prevent what everybody is concerned about which is the double pandemic. We have a team now from the dph that is working with folks in the public command center, across the network and with other systems including ucsf on our approaches here and taking it very, very seriously and if you would like, we can have that team come report or send you a written report after this meeting. This is claire and im sorry i had trouble unmuting but just wanted to echo this is a top priority and its a top datadriven and well track throughout our system as well to make sure that our stable Patient Population as well as the other patients and people we are treating throughout our system get the flu shot this year. Im thankful for the response and i think because its urgent, when you do come to a conclusion about how to roll out the campaign, some of us are being asked about this even though personally and professionally and it would be helpful for all of us if that information is available its also passed on and it would be helpful. I have one more question, which was more trying to understand because as i understand that you know were in a city in which schools are not going to be inperson was were on the watch list i think. Can we get an understanding as to what is our position on schools . I know that there have been some orders and issued but theyre not really quite clear and that would be in regards to the primary and secondary and then what are we doing about universities . I mean, are they just on their own and its up to city college and sf state or usf or are we also giving advice at this point . There are two types of questions, the schools and advice and what happens with the upper Higher Education . So were in a situation where the state will not permit inperson learning until were off the watch list for two days and the exception of that would be any waivers with the Health Officer so our Health Officer is in the process of drafting a letter to School Administrators detailing the process that would be required and the criteria required to be even considered for a potential waiver. So, the plan is for us to ensure that the environment in which schools are open is safe and we adhere at a minimum to state guidelines with regard to social distancing and good hygiene and to keep children and staff as safe as possible and as you know, i think commissioners San Francisco Unified School District has dedded not to open inperson a learning until next spring at the earliest and so right now, our focus is on schools that many wish to be grant aid waiver to reopen and welcome to the state for further guidance when were off the wait list in terms of what the criteria would be from the state level and this is something that dr. Aragone, along with our pediatricians and other experts including collaboration with ucsf are looking at the National Situation and looking at cases where School Offerings have been detected and what are our criteria going to need to be Going Forward so that schools can open as safely as possible and we have the authority with regard to hire education and learning and dr. Aragone is working with institutions of ire learning as well to ensure that if they do meet criteria and the guidelines are as concerned by the Health Officer. Thank you. Thank you. Im doing my best to take commissioner comments and questions in the order that hands were raised. I see commissioner green and after that commissioner christian. Thank you for all this excellent information. I was wondering if you had anymore detail on some of our hoppization lengths of stay and whether that is trending in anyway and also, the demographic of the patients who happen to be hospitalized as we see the case percentages in younger populations increasing. Are we also seeing changes in the demographic of hospitalizations and how we have data that are the ethnic backgrounds of our tested patients along with began you lar that patients that passed away but do we have the subset of people who are hospitalized and another thing that have we got any plans to offer flu shots at our testing sites, especially our mobile testing sites . So thank you for the question. Our length of stay of hospitalization appeared to be going down in may and june which may have been evidence of less disease severity and the latest information that length of stay has gone back up again so i can provide more details about that length of stay in a update to the commissioner earlier and drr advance planning officer, has a lot of details on the hospitalization data and we can certainly share that before at the next update as you request. Weve also been able to work with hospital zoos that the detailed data on patient demographics is going to be made available across the system before now weve only had in sight into the hospitalizations at sucker burg San Francisco general so that data system is on its way to being developed and we can report that to you on a timeline in terms of when we can report the demographics of the hospitalizations over all. Its been a lot of high work on part of the hospitals across the city and i want to thank them for their collaboration and cooperation and this is ensuring data across our systems and including systems that dont have our systems so theres a lot of work and a lot of good collaboration and it will help us better plan Going Forward in terms of our Hospital Capacity and the needs of the communities of people who are being hospitalized. I just wanted to answer part 2 which is the here now group is that has come up an as idea is going ahead and vaccinating as we swab them. Many of many ideas that is no yonge door to the flu vaccine. Great. Thank you. Commissioner christian. Just adding onto the questions weve had about the flu. I was wondering whether one of the things that will be considered in expanding access will be pushing out the termination date for the flu vaccine. Dr. Chow mentioned theres been information that, here in the bay area it doesnt peak until december. And so, i also know that in the past, it is difficult toward the winter to get a vaccine so i wonder if that also might be a part of what changes to make it more fatigued against us. And so, no need to answer that now obviously. My other question touched on one of my other questions touched on what commissioner giraudo asked about the demographics in kids and dr. Colfax you said one of the hypothesis was related to essential workers and People Living in larger households and bringing the virus home so are we seeing the same disproportionate rate of infection rising among children in people of color and the black population and lean tino. I dont know whether its accurate or whether or not you can see that yet but do you have any information about that. We have the information i can share with the commissioner. That is my understanding. Yes. Ok. And, obviously whatever strategies were looking at will address that attempt to at lea least . What information can you give bus what were seeing happening in the Residential Care facilities for the elderly, the rcfb versus places like laguna honda, the Nursing Homes . Is there anything that the city has control over given it may be, i dont know a lot about these facilities but i imagine some of them are private and not city run. So we do have a team thats been working with the rcfce since early on in the ep dem spick we support them with resources, guidelines, inform and guidance and information about where people can get tested and certainly if people are symptomatic and they need tested we support it and so we n report back in detail but its a focus of ours since the beginning of the pandemic. Is it voluntary to adhere to the guidelines you suggest . We provide the guidelines. Weve not required its much les. The over all risk to the population is lower. Certainly, we have the inform and guidance that can provide more details to the commission and to you by the followup. Thank you. That would be appreciated. Thank you so much. Thank you, commissioners, before we move on, i know i did that commissioner chung did have a question and shes not able to be with us today but related to soji data and the end of july i believe. But looking at data [please stand by] [please stand by] we can move on to general Public Comment. Please press star three and ill give it about ten seconds and everyone please know that were someone knew at webex. Speaker i feel like were kind of abandoned here and my main concern is theres a big inconsistency between the rule for opening churches and restaurants. I dont know why because were under a much more serious height restrictions and i havent gotten a clear answer from anybody about that. And its quite frustrating, especially we got rained on yesterday and as the winter comes in were very worried youll shut us down again and we cant go indoors to have our worship services. Weve been waiting months and months and months and we can safely go inside and we wear masks and wipe everything down. Speaker i just want to echo some of the things a couple other people said and one of the things i would like to request, i guess, is that you consider taking us off the highrisk list because its keeping us from opening any time soon. Were trained anyone Infectious Diseases and we take courses in bloodborne pathogens and our clients are wearing mansions andmasks and alot of the peoplen francisco are small and sometimes its one client, which seems very minimal risk and as the earlier caller said, theres data showing that we are not the place that is the vector of spread with unemployment highly inaccessible, theres an entire industry that could go back to work that could help with that and San Francisco and california is having less benefits to take care of and i think that the risk is very low as a cosmetologist, i wanted to throw that out there and be another caller to say, please, consider childrewhen youre looking at te businesses that are risky and cosmetologists, we dont gather in huge numbers. So, anyway, thats just what i wanted to say and hopefully you will consider that. Grocery stores are far more dangerous to go in and thank you for your consideration. So to discuss the proposed updates to the patient rates for the department of Public Health, for background, especially for those who are not on the commission over the past couple of years, we charge, we have a charge master that is our patient rates for services that we provide in our hospitals and clinics and we periodically propose updates to those rates an. In ago decision to not coverg the cost, the remainder of the cost to the patient, to the insured individual. We have about six of our patients who are commercially insured and within that six , about onethird of the six was covered by health plans that were potentially in this category of legally being allowed to do this balance billing where theyll cover a portion of the charge and the balance will go in a bill to the patient. And this is a practise that is widespread and kind of known through press coverage and that sort of thing, but it became increasingly clear that a lot of our patients were negatively effected by that practise. That was out of character with our mission and how we want to approach our relationship with our patients and it was in 2019, april of 2019, we brought a package of proposed changes to the Health Commission which the Health Commission approved and designed to limit that practise. Were creating a new policy if youre commercially insured you will only pay what you would at an innetwork hospital. We will simply say, tell us what your Insurance Plan is and charge the coinsurance or whatever it is under your insurance but not that additional cost for being out of network. Secondly, we established out of pocket maximum payment at all income levels and it does vary by income level and that ranges from zero for those who are below 138 of the federal Poverty Level up to a maximum of 4,800 who are at a thousand percent or more of the federal Poverty Level and those out of pocket caps are available to all patients and in addition to that, we put into place a lot of changes in our administrative policies about how we communicate about Financial Issues and how w and significans to the patients at our department work. And im describing all of this history, particularly because at that time, another one of the pieces that we exite committed o doing was to benchmark or charges and our patient rates against peer hospitals. We wanted do that just to assure ourselves and assure the commission and other interested parties that our charges were within the realm of what other hospitals and consistent with the industry. And so weve done that and, ill talk a little bit about what we found. I do want to emphasize, though, because of these protects that e put in place, the out of pocket maximum is the case that theres very little remaining relationship from the perspective of the patient between our rates and what theyll pay for care. Its primarily becomes an issue between the department and commercial insurance which is one of our cares, particularly at the zuckerburg General Hospital. So we did go through this process to analyze our rates much more rigorously than we have in the past several years before bringing them to the commission and we hired delight consulting to do a peer benchmarking study. They did that, selected a number of hospitals, compared our rates to those. And made recommendations on how we ought to adjust our rates to be more aligned with the industry standards in california, Northern California in particular. And so, they evaluated 15 peer hospitals, made recommendations for areas where we are above the norm and below the norm and we applied a threshold where we are adjusting our rate so that well be within the 75 percentile of that peer group. Thats higher than the median but that reflects the fact that San Francisco is a higher cost in our study group and it keeps us it takes that into account while keeping us in mind with the industry. And so weve proposed some adjustments in the rates here and there are some areas where the rates are proposed to go up and some proposed to go down accordingly and you can see that in the memo attached to your Commission Packet in a table at the end of the memo. And there are two areas where weve proposed to phase in those rate changes over time and those would be in the Emergency Department charges and trauma activation charges. Ed charges would have gone down according to the trauma down. What were proposing to do because of the financial situation around covid is to hold those rates flat and allow them to catch up as industrycost inflation occurs and that we would then be within that benchmark period over a period of three to five years as a opposed to making that change immediately in a single year. And so those are the modifications. Taken together, these proposed rates would increase our revenue by about 2. 63 million versus the last approved rates ordinance and thats an increase but a lower rate of increase that we had then we have proposed over the last handful of patient rates ordinances. And as i discussed, it would be variation and whats going up and whats going down in those categories. And so that was a lot of talking, but i wanted to make sure to remind and connect this patient rates ordinance with the previous discussion that we had at the commission and how we followed through on our promise to do this analysis and this study prior to bringing you a new set of rates to approve. Im happy to take questions and we have the team from our outpatient Financial Services and reimbursement groups here, as well. Folks, if you would like to make a Public Comment, please press star three. I dont see any hands raised commissioners, i dont see any hands, so you can move on with any questions or comments you have. Commissioner chow. Yes, thank you, mr. Wagner. It was a very good explain expln as to the events over the last 18 or so months. I am only looking at i think technically, on your page two of the ordinance, i think its a typo that since well be passing this, i just thought that we should at least take note that in your column or medical, surgical 2021, you actually have it has 9796 and i think you meant 9769 because the next year, it is 9769 and that would go along with your thought that you werent raising rates. You put an extra 30 there and you can let me know why. I believe that you are correct, dr. Chow and thank you for catching that. I think that has two reverse numbers and intended to be 9769 and we will clean that up. And right, that was all that i wanted to comment on so that we can have an odd rate going through. Thank you, thank you for that catch. Thank you. Otherwise, i saw your explanations to commission grange and she may have some questions but im fine, thank you. Now. Thank you. I just wanted to thank you for the extensive answers to the questions, they were clarifying and i congratulate you with the things that were troublesome to the public and very much appreciated the work, yes. Thank you, commissioner and im sorry that i got the ann answero you last minute. Perfect, thank you. I would like to move to approve if were at that point. One second. Do i have a second . Second. I will do a role call . Actually, im noting to amendment needs to be made for the correction commissioner chow has made and well make sure that is taken care of. Role call, commissioner chow while youre on the screen. Yes. Chair car role call . The item passes, thank you. Thank you, mr. Wagner, and your team. Well move on to the next item, the laguna honda hospital and the gift fund budget for fiscal year 20202021. Hello, commissioners and good afternoon, commissioners and dr. Im william frasier. Currently im a dsw worker in outbreak management, and so thank you for having me on your Meeting Agenda today and thank you, mark, for your excellent work in facilitating this meeting. Laguna honda hospital seeks your approval of the 2021 fund budget. We are putting our budget together in the spring before the fiscal year and this year we faced a bill challenge determining what life was going to look like at the laguna honda and how best to meet the needs of the residents through our gift fund budget. Our approach was to go at it with the hope that things would return to normal sooner than later. Of course, that doesnt seem to be the case, but were hoping that well be able to pivot and adjust. And an example of this is early on in the Public Health emergency, we use gift fund monies to purchase 20 ipads im sorry, 50 ipads, to facilitate video messages between the residents and the families and friends. The gift fund remains a a wonderful resource to help us meet the needs of the residents. And so, im going to take you through the budget and just point out any variables that you may be interested in and i will let you know that theres been some reorganization and you will see for the first time we have an item called discharge support previously undermiscellaneous and were ramping up to prove the success of the discharges to the community and were using the gift fund to provide residents with items like toiletries, clothing, luggage, and things like that that would help them be successful in their discharge. And some other variables that you should be aware of that there are some expend tour expee related to purchase orders in the Previous Fiscal Year and there will be well, actually on the 14th, those charges reverted back, but i had to have this information in on the 13th and so, i would say that the total expenditures for the gift fund budget, you can see at the very bottom as of the 30th i would probably would estimate theres another 15 to 20,000 that will be reverted back to the Previous Fiscal Year. But just going through the different line items and the variables you may be interested in on. First on Behavioral Health, i want to explain the increase. Increase. Our Behavioral Health program, specifically what we call our laguna premiere club acquired a special computer system, especially designed to meet the needs of the ederly and disabled residents. We got that through the wish list and that comes with a 3,000ayear subscription for the content and its a great, great resource for that particular items going up. And you can see that weve also added covidrelated support. Of course, well need to address those needs, but we received 13,000 of donations, specifically to benefit the residents. And that is our practise, is to acknowledge and to try to meet the intent of the donors. Then theres discharge support and i do want to explain the friends of laguna honda wish list. Weve been working with the friends to kind of line up our fiscal our years. They work in a calendar year and we work in the fiscal year and weve been working to kind of align those so that theyll Work Together, but you may remember i came to see you maybe well, i came to see you in 2019, asking you for an increase in that particular budget and we have to go through a process of having their donation accepted through you and the board of supervisors and a number of issues, including covid19, prevented us getting that through the board of supervisors before the end of the fiscal year so we were unable to spend that. So we were carrying that over and the 90,000 reflects what laguna honda committed to donating this year. The only other item that looks variable is the memory care program. Theres about 5,000 worth of expenditures that will be reverted back to the previous budget and will be eventually reflected there, but that also represents plans on the part of our memory care programs to up the acquisition of century stimulation equipment. And if there are any other items there that you would like an explanation for, i would be glad to give them to you and i would glad to answer any questions that you may have. Before we move on to commissioner comments and questions, secretary, do we have any Public Comment on this item . We do have at least one. I will remind the public if you would like to make a comment, press star three now and ill unmute the one call theyre i see. And i will put two minutes on the timer. Are you there . I see commissioner green. Is that a leftover han raise from the previous item . I think thats a lefton the other hand hand. Thank you, commissioner green and do we have any other comments or questions from commissioners . Can i just express my appreciation to mr. Frasier for the completion in the work that laguna honda are down as representing by mr. Frasier and in the overall Covid Response . This is an intersection and i just wanted to add that laguna honda, weve had a total of 82 total covid cases, 60 among staff and 20 among residents and so far, right now, weve had no dennings among the residents due to covid19. And we have no active cases among residents. We have ten active cases among staff, which we attribute to the increasing community spread. But just to reinforce that this is supported by the gift fund are more important than ever given the covid19 pandemic. As the commission knows, laguna honda has been severely restricted because of the covid19 pandemic and just i want to reinforce how important it is that the residents get the support that they need, especially during this extremely difficult time. Thank you. Thank you, director. And i also want to add to directors word, thank you, mr. Frasier for your work and the work from all of your colleagues and laguna honda and your adaptability in your personal work and everybody there. Laguna honda is a model for the nation in responding to potential covid outbreaks and its work on the ground, as well as cooperation with it federal government, the cdc and i know there are many Lessons Learned that dph has applied with other longterm care facilities in San Francisco. And so that is directly attributable to the excellent work thats being done at laguna honda and thank you for that. If we do not have any other questions or comments from commissioners, we can entertain a mission to approve. please stand by . Im not hearing him. Ok. Well, i guess what we can do is he is in the next office over. We can mask up and carry an with our presentation. Thank you very much, this is just a special report from our Covid Response dr. Brown is on our office right now. Good afternoon, commissioners. This is a special report of our projects that we have been doing with the covid19 response. Weve been activated since day one towards the end of january and been very busy both with Covid Response and also running the 911 system. Weve been wearing multiple hats and i just have to do a big shout out to our staff theyve been working tremendously hard on creating innovative projects and not complaining and just doing a fantastic job. Is without them we wouldnt be in the place we are right now as far as our projects that were doing and also the 911 system. So, just to give you an update of our presentation summary were going over some of the projects that weve been working on. And i think the commissioners did receive a dictionary of were start with the mow chalk dr. Brown will go ahead and give his presentation on this. Can you hear me ok, commissioners . Yes, we can. One of the major functioning is acting as this medical operation coordinator or mohawk and we are a link between the San Francisco as a city and county which is called Operational Area so were looked for coun tease in our region which is region two of the state the bay area going up to the oregon border and and through that region to the state, so when theres a need that we cant fulfill within San Francisco, either by the normal functions such as a hospital purchasing to their supply chain or obtaining through their hr process personnel, then we go to the region with the request and if it can be filled by our coun tease in the bay area, that will be done and if not it will be brought up to the state level. So, some examples of the functions that were doing coordinating disaster medical Health Resource and patients distribution and medical evaluation and inpatients Emergency Care provider around clarifying regulations, getting a scope to practice established that type of thing and then, assist ing the establishment of field Treatment Facilities and these are examples what weve been involved with so far. Were now up to 64 resour request examples of these range for large items like a federal medical station which is the basis for the sites up in the practice seed yo to cleaning supplies such as wipes disinfect apartment rapes and it depends what we are unable to we have helped out other communities in the drug during a phase of their illness. Its closely allocated by the state to the difference county and the different cities and counties by their hospitals Covid Patients burdens. We saw dr. Colfaxs presentation its dynamic. By the time the allocation is received by the hospital, they no longer need it or they need more. When we tried to exchange within the city we do it through our Hospital Unit here at the covid19 command center however when we dont have that ability we need some and well go outside the county and so we have helped out slano county that needed an emergency transfer. Thats an example that came through the mohawk. Coming in and out of the county most recently you are aware from Imperial County and the surge they had down there and from the difficult outbreak at san quinton, San Francisco is still receiving some patienc patientsk when this started in february or so we had the grand princess cruise liner that came in with several patients that had to be distribute today the bay area counties and participated in the distribution of those patients determination of where they went to. Weve been helping with plans on the dph side and board and care facilities utilizing a blended ems providers and emergency providers from hospitals and from the field care clinic. We have responded to request mainly for information from the state office of Emergency Services and then weve been working with dr. Luke john day and the group of chief medical officers from all of our hospitals on the distribution of the medication. Were now getting weekly allocations and theyve been increasing in size. When this first started, we were getting them every two weeks and it was a much smaller number. Were trying to respond quickly and pivot quickly as our needs change when we dont need the medication we try to make sure it goes to other counties that need it and when we need it we get exactly what we do need. Next slide. Thank you, dr. Brown. The mohawk program is something that is on going. Its not necessarily due to disasters but its a program that is constantly in the background and so early on, were test come up with a based on very Little Information knowing that there was a pandemic pending and it looks like historically there was a big push on the 911 system and those patients would end up in the hospital and we looked at it and we came up with our ems search plan for the system and we followed the same color coating and it means the Different Levels of search weve had. Our expectation is we would surge just like the hospitals were but what we found out, up until a week ago is the 911 system actually dropped about 25 in call volume so for the last five months, the call volume, the 911 call volume has been down about 25 and up until about two weeks ago, were back to normal levels. Our ems surge plan is based on a lot of different factors or triggers and each one of those triggers represents a response that this system will automatically kick in from green to austere care out in the community when things the system overwhelmed and we had this in place and its our working document for when or if a surge happens in the 911 system that its pushed over to the hospital system. Along with that, we developed a transportation and communication hub. We started out with one dispatcher and in our Conference Room at 90 van ness into a fully functioning interactive dispatch center at bill graham. We have multiple people 24 hours a day running a, basically a Transportation Service and part of that service is we do the inter facility transports from the shelters to the hospitals. We do street to shelters, greet to hospitals and we also support the 911 system. We provide support to the publichealth Services Field testing unit on top of that and we have partnered with a lot of different people the publichealth nurse and nor cal ambulance and amr ambulance and theyve been very, very beneficial and the success of this program as you can see our volume is has up and down and theyve been steady and increasing and the need and transportations and we have about 15 paratransit bands on a daily basis and five ambulances for supporting ambulances and theyre there basically from 7 00 in the morning until running those calls and we have another based out of there which is the program which dr. Brown will talk about in a few minutes and its a very Robust Program and its been very successful and weve also just started a new program from a Health Officer order to test in the communities and we have a unit that will either go out on site and test someone that has passed away or we will go to the funeral establishments and test and take this gust and to the publichealth and finding out about that did have a cove and and up to date, along with that, we felt with all the shelter sites and place and we decided that one of the things is a safety of the individuals that are at the shelters, we developed a aed and external and and Training Program so we purchased the defibrillators and were currently scheduling training to train the staff at all the sites and the use of the its been a year and a half in the Development Process originally envisioned starting last doing a better level loading or matching of capacity for the system with their new hospitals coming online and for San Francisco central begun for helping with the diversion. We realize quickly in the development of this program we have a lot of input and thanks to our partners commercially and who went through three test of concepts and assimilation, pretty large scale and helped us to define the Program Parameters so were getting some data and looking at some specific outcomes that im about to discuss and should we experience levels of surge in the system and we have not, were very fortunate and being done on the preventative side and should we have that we will be able to absolutely maximize the ability of the ambulance fleet to find every single area of capacity in this system and have utilized every capacity with available rather than overload some areas and under utilize others. So this program is operating 24 7. It operates out of the health that you have just seen. Its staffing models its either a paramedic supervisor plus a emergency physician with base hospital training and base hospital means that physicians, Emergency Physicians that workout of San Francisco General Hospital who are trained in contacting and working with ambulance crews on a regular basis so every day there are calls to the base hospital from the ambulance crews or advice and for certain protocol items so theyre working with the county supervisors and when not available we have two paramedic supervisors that are again looking at the over all system and the hospital and and theyre able to factor in such items as icu capacity if that is limited and its been the biggest change that weve seen in issue weve seen around Covid Patients. Look at number that is 11,600 calls in three months and in our system to give you a sense of perspective, we have 50 to 60,000 destination calls in a years time and these calls they are the code two calls and redirect patients that are critical because its important they go to the nearest facility regardless of the capacity issues and then were also not trying to direct Specialty Center patients that theyre not directed by the caddy pilots and individuals who are on duty at the caddy system. Briefly listed are the goals of the system and in the first slide in the center daily transport average daily transport to static Emergency Department capacity. What this means is, if hospital has a 20 Emergency Department bids, then they are getting 20 ambulances over the course of the day. If they have more than that number of ambulances the ratio is getting to be greater than one and if theyre getting less than that, they are getting a ratio and the same 20 beds they were getting and 30 ambulances a day a 1. 5 ratio and five ambulances a day, so were trying to get this ratio this is all data post cove because its important to remember Emergency Department volumes have dropped by 35 city wide since the shelter in place order and ems has dropped 25 . Were not taking data before the pandemic, that would not be a good comparison. Were taking pandemic data before the Program Start and after. Were seeing improvement are goal being to get one the large number you see in the lower is the compliance rate of the crews with the programs are targeted here with 80 comply bans because from are exceptions and the crews cant communicate very well with caddy due to technical issues or other extenuating circumstances you might not call in and its present in hospital. We are finding that some things have been improving and other things staying the same and other things have not been improving. Theres been a total decrease in diversion which is part of our goals but were trying to analyze is that do you to the decrease volume in Emergency Departments and due to both. Were also seeing a little bit of a trend in off load time which is the delay that patients might have when theyre in Emergency Department getting were following up with hospitals with higher levels of diversion and longer turnover times and seeing where those might be cause be and whether or not theyre causing problems for the system. Thank you, doctor. One of the things that we have really looked at is the pre load of the hospitals or the front end of the hospitals. Were also with the communication hub. West ambulances there to help on the off load of the hospitals so for patients that are needing to be discharged to free up room for patients that are sitting in Emergency Departments waiting from a bed to free up. These ambulances and units can be used to move those patients out to sit by the sites or where they can do for a step down error. The other program that i talked about earlier is the testing unit. Just to give you an idea of where we are. We started out in june, late june, when we looked at our data in july, we only were at the 55 test and as of today, were at 230 tests. So fairly busy operations in coordination with the communication hub. One of the other things that we looked at in our surge plan is cardiac arrest. The potential of the exposure to the providers and doing cpr because were doing cpr you are pushing down on someones chest to compress the heart but you are also pushing the lungs which then air comes out which could be droplets so what we tried to do is create some programs its an assist program and if its a mechanical compressor so it simulates or does mechanical chest compressions we have less chances for exposure. We have 12 devices and four on the rescue with the Fire Department on 24 7 and one each on the amc supervisor and one on the marine union exit we have a few back ups. We did a lot of training and we did train the trainer and along with all of the Covid Responses, we had to stay on top of our policies and procedures and being thinking more towards what is coming next and preparing for it. We have the new protocols on mechanical cpr devices, the lucas device. We had to redefine our protocol on respiratory pandemic so we dont use certain drugs for ar solation of medicine and increase providers in an enclosed space in the back of an ambulance taking care of a patient. We looked at assess and refer things where we respond and 911 searches where someone might not need to go to the hospital so a 911 unit will go out there and assess the patients and refer that to another source of care. And we also looked at Airway Management policies and other than a designated and emergency room and i work with the state to allow us to take those patients as needed through other sites through the field care sites at southeast and we can take them to a couple of other sites and pick them up and and we used the basic lifesupport ambulances in the 911 system through the communication hub or or well do a memo that allows other providers to provide els ambulances in the system when it becomes very busy. We have changed our local optional scope of practice that allows ems providers to do testing and also weve allowed our ems providers to work in static healthily facilities like the field Care Treatment Centers or Skilled Nursing facilities in they run into staffing issues. We have looked at ems providers to assist in giving injections and and to make sure the crews have that information and they can proceed with monitoring their own health and falling over there occupation we have cooperation from systems and we have some holes in the system and were working and weve had about 316 positive notifications for ems contact patients than weve contacted up to 10 or 12 individuals because it depends if its a ill patient and there was multiple ems providers on site doing resuscitation and we want to be sure they have that information followed up with their providers. One of the last slides that we have is not only are we really deeply involved in the covid at multiple levels, so the Covid Response, we have our regular ems business that we have to attend to and running the 911 and they went out on july 1st. We have all the providers signed and were still waiting on one. Hopefully its coming soon. Weve instituted a new ambulance audit tool which helps us evaluate new Ambulance Service thats would like to come in and work in the city so that is up and running and we have one in the process currently and we have to do emt certification and accreditations and both emt and paramedic and we also had to move like i said earlier and the program, weve moved from 90 van ness to 25 van yes and this is a temporary location and well be moving again and probable february of 2021. I just want to give another shout out to the staff, they have been in absolutely an incredible humbling experience working with some fine, dedicated individuals and we would not be as successful as we are currently without their dedication and involvement and i just want to say thank you again and that is the end of our presentation and we will answer any questions that you might have. Do we have any Public Comment on this item . Do i not see any but if you would like to make comment on this, press star 3. Well give it a few seconds to make sure we catch anyone who raises their hand. Thank you dr. Brown for your detailed presentation even outside of a pandemic and services requires a great deal of precision and planning so thank you for bringing this presentation to us and for all the fantastic work you and your colleagues have done. We have a comment from commissioner chow. Thank you. I certainly echo president s comments and concerning this division and agency and im a very impressed with the caddy project. After so many years of looking at ways of trying to help the different adjust and and, i think that as we look at the future, and its not and under which if its someone elses work we would look at some of the previous benchmarks that had been established in terms of response and where we are now in regards to that and either in a local and comparison to either region or a national levels. In a couple of areas, we are continuing to monitor the situation and i think we have not seen any deterioration and improvements so two examples are, weve participated in the cares response and survival data base and National Project and 20 to 30 of the ems systems in the country, including all of california, and they provide over a two hospital discharge with good neurological outcome are in the high 30s range and that is good in the sense got continuing however, its not our goal. Our goal is to get into the 50 range its been a longterm coal so were not satisfied that were not sliding backwards. We need to continue to improve there and so aed project you heard about is one small component and we hope when we get into phase 3 of this pandemic well redeploy those devices to areas of the community that are under populated since the whole southeast corner of the city has very few aeds per person as opposed to the Financial Systems in north beach. We want to try and apply that and to get more survival because its clear rapid cpr and defibrillation are very important part of life saving even more so than the response times and its what we measure. Our response intervals are still not where we need them to be. Were trying to reconfigure how we evaluate them and to be careful were applying a National Standard that were taking the same times everyone else in the country and another area which is our lifesupport therapies that the paramedics are refield we are trying to adjust our protocols that follow what is the best practice that the paramedics are providing so for instance, we made a change where were favoring the over and the because its more successful in the field and we want the most successful therapy to be applied that were using in the community and we want our rate improve and we want to get them off the National Standard theyre in the 60 frame so the Fire Department has a program and to implement video learn which is the type of technique to improve that and therapy and working with dr. Crayon that well be leave evolved in the training and the roll out so that we get up to the National Standard in that area. While we are not backsliding we moved from one emphasis of one therapy to another and we want to get up to exceed and on our website and the commission devise and i think in the past sense either quarterly and metrics and i think we would be happy to continue to do so. Thank you. Well be introducing new dashboards january 1 to reflect the standard. The other thing that were doing as far as cardiac arrest, we have developed a very Innovative Program that looks at com operation rate and a quality of chest com persions and its nowhere else in the world that theyre actually looking at it and at the level we are according to a lot of Industry Experts and they have a keen eye on the work that our staff is doing and creating that program where we can actually analyze the quality of a single com operation. With rate and release with the hopes of increasing cardiac arrest outcomes with quality chest compressions. I thank you very much for actually getting offer to bring black information and i know how busy its been during the transition with the department and all the challenges at covid we dont want to interfere with the great work you are doing and you were able to create the caddy project which had been something that was dadly needed as we looked at our different institutions and the issues of diversion or rightly getting patients to where they building. So i suggest working with the Commission Secretary and president to find the right time to begin again a reporting back our success as we tried to move our own numbers back in terms of response and the goals that you are saying so we can appreciate the work that you are going to be continuing along that line and i would leave that with our officers to find the right time to do that. Thank you. Do we have any questions or comments . If not we can move on to our next item. Can i just want to acknowledge and thank Patrick Brown and the incredible work during covid and the epidemic they were engage and involved and i think that the work theyve presented speaks for itself and just to say that the pandemic has brought the best forward in our ems system and the work that theyve, the foundation that theyve laid for the last few years in terms of the ems roles and responsibilities really shined brightly during the Pandemic Response so just acknowledgment of their leadership across the department and the city as a whole. Thank you dr. Brown and jim. Thank you director colfax and we associate ourselves with your remarks. Moving onto the next item for action. Resolution honoring Maria X Martinez. She passed on july 15th. She was highly respected both within the department and large and we all mourn her passing and were grateful to have dr. Hale hammer before the commission acts on it and i would like to hand it over to secretary mor morewitz and dr. Hammer. Thank you very much commissioners, dr. Colfax and secretary morewitz. Its a honor to introduce this resolution recognizing maria x. Maria x, as many of us knew her was a trusted colleague, mentor and friends she served as our director of whole person care so this resolution before you is well primed with our hope and care act which will follow. When i think of my dear friend and colleague, maria, the four words i think of are commission, wisdom, vibrant, and ex h again. She left a mark on the department of publichealth in San Francisco in the programs that she helped develop which served people experiencing homelessness and think the latest of these programs but its really a tremendous honor again to radio introduce this spirit and the work she did for us over her 23 years. Im going to turn it over to mark. So you all can hear and the public can hear, honoring Maria X Martinez. Whereas, she served the city and county of San Francisco as a devoted San Francisco department of publichealth and staff member and leader for 23 years and whereas, during mrs. Teen he is tenure, she served in the following leadership roles. Deputy director of community programs, senior staff, director of health, chief integrity officer and and whereas the highlight of her career at the dph was her role and extra care and aims to improve outcomes for adults and experiencing homelessness and San Francisco and to enhance care coordination and they solidified among dph the department of homelessness and Supportive Housing and bringing them together to wrack in ways they had been under her leadership envision San Francisco adopted a Population Based approach providing housing and Human Services to adults experiencing homeless. It highlighted care coordination and inner agency data share to identify and problem soft and street to home plan with whatever it takes approach. She helped build initiatives and Public Policy and for the past 15 years she was an active board member of the Chicana Latina Foundation where she developed the Leadership Institute for relationship recipients and she died on july 15th, 2020 surrounded by a loving circle of close family and friends now be it resolved that that San Francisco Health Commission honours maria x martine he is for her lifelong commitment and dedication to improving the lives of others through her service and thoughtful leadership. The San Francisco Health Commission conveys its heartfelt condolences to ms. Martinezs daughter and other family and colleagues and friends. Thank you dr. Harmer and thank you for mark i would like to say and in addition to the remarks offered by dr. Hammer in reading true this resolution there are so many words that just pop out that remind us of her fantastic work, partnership, vision, problem solving and its all things we knew to be closely sewated with maria x and her work. We would approve this resolution and its though we can take this on whole person care both as a tribute to maria x and her leadership and our contributions because this is such a deep and strong legacy that shes left not only within the department but serving the entire community in San Francisco. I dont see any Public Comment before you all move forward. Thank you, mark. Commissioners, do we have a motion. Comments or motion to approve. So moved and i would echo your comments, so. Thank you. We all inaudible and she was always wonderful. Everyone she touched was someone that seems so personal to her. It was just amazing. Thank you. Thank you. Second. Great. Yes. Commissioner ger add owe. Yes. Commissioner christian. Yes, commission gren. Thank you, the item has passed. Thank you and i know i wish we would be seeing maria x for this next item which we will now bring up the whole person care update. Ive given you permission to present and im not sure if you are the person that will share your screen i need to do a special it looks like you are, great, thanks. Can you see my screen . Yes. Great. Thank you very much and i did want to add that well have another chance to celebrate her life on september 3rd. Well send out an announcement about the event we are planning. The whole person care team is working with the family and looking forward to a beautiful event to celebrate maria. Ok, so, i have the pleasure today of producing amber reed who is the acting director of whole person care and our medical director for whole person integrated share and edge under care and amber will present the update on whole person care and the last time we presented this update was maria and me presenting to the Health Commission and there were some followup items we were asked to come back and share and thats what were doing today and i just want to let commissioner green know that we received your questions and they should be addressed in the talking points and if not well be happy to address them after the presentation. So, with that, i will hand it over to amber. Hello, everyone. Can you hear me . Good afternoon commissioners, im pleased to be here giving you an up update this afternoon and thank you for your kind remarks about maria. Today, we are going to be level setting on our program goals, providing an update for our data sharing solution and Care Coordination Services and discussing sustainability for whole person care beyond the 2020 waiver. So as a reminder, San Francisco whole person care is focused on people experiencing homelessness and we have a twopronged approach. First is innovation and technology and second innovations in service and we talk about a datasharing platform that will allow us to share comprehensive, integrated Health Hazard and benefits data for shared clients. The innovations and service, care coordination and structure to care for the highest risk and utilizing clients across the citys echo system and services and its unique its an inner Agency Partnership also. Weve taken a humancentered design approach to identifying and understanding opportunities for improving the homeless system of care. This is a map of our discovery work and theres a lot of detail here and we dont expect you to read through it. Its an example of a whole person care client and theyre run by different departments and different locations. What this highlights is the opportunities we have for improving coordination and communication between these programs. Its during these times of transition between and wore optimistic our inner agency data sharing will facilitate Better Communications between providers and staff. Next slide, please. Are you able to go to the next slide. Through whole person care were implementing the inner agency data sharing solution and ill walk you introduce the component. Were care coordination functionality to the current installed and this means and shared cool set and care coordination and working together and we will make the data in information more accessible to providers. This will also help us to identify people experiencing homelessness who enter the system of care through any door and so if they come in through hsh, the shelter system or dph or through hsa well be able to identify them and locate them more easily. Were expanding access to non dph teams to epic and were excited about this because this means that teams like ems6 who provide Critical Services to people experiencing homelessness who will also have access to that shared care coordination tool set, and this will facilitate better coordination and this is possible because of the groundwork that weve been putting in place for the last several years is data sharing agreements and implementing protocols to allow this information to be shared. Next slide, please. Our work is positioned us to be a key source of data and specifically attempt to mitigate the impact of the pandemic on people experiencing homelessness and our Data Infrastructure is built on longstanding relationships and partners between agencies and because we have this data and understand how were able to use it, we were able to quickly develop a Risk Assessment methodology based on cdc guidelines enabling us to locate and identify individuals rapidly and individuals who are at highrisk for complications analysis of this has helped inform policy and Planning Decisions as well as were able to provide a daily census report for people in the shelter in place hotels and isolation and quarantine sites and provide that to providers which facilitates targeted outreach and linkages to Necessary Services and then finally, because we have this Data Infrastructure in place well be able to more effectively evaluate our interventions in the future. Next, please. So, i want to give you an update on the shared priority project which you all heard about in october. Just to remind you, last summer an inner agency group of stakeholders came together and through this project dph, hsa and hsh came together to take a populationbased approach to provide in the health, housing and benefits. The goal of the project was to create street to home plans and then to identify and problem solve system barriers that arose throughout the process and those system barriers that we were able to identify and problem solve for and not just the 237. So an interim evaluation of the or progress update for the project was conducted with take stakeholders in february and the evaluation of the process is on going. Some of the things that we heard from providers during that initial check in was the shared priority label is effective and Opening Doors that wont be open. That shared Party Project is helping teams to be creative and flexible and carrying for vulnerable clients and individuals are getting help that wouldnt be if it werent for this project. So the shared priority project Team Continues to meet weekly and we report on on going progress through by by weekly dashboard. Can you go to the next slide. So this is an example of our by weekly dashboard from august 11th and the dashboard exclusively follows the original 237 and it highlights our progress and the difficulty of the work. Since we kicked off in october of 2019, from the 237 clients, 126 are currently housed and 35 are ready and awaiting and ununits and they have all the document this is place just waiting for the unit to open up and 117 are connected to dph Case Management and 184 is received Housing Navigation or Case Management services through hsh. Sadly, 13 are deceased, which confirms that this is a very Vulnerable Group of people. This is a living situation overtime since october. You can see along the bottom is the green is the placement into a permanent Supportive Housing. Our goal is to provide services to all 237 of these individuals in the cohort and support their Journey Towards recovery wellness and housing and we are continuing to work on that project. I want to turn it over to the doctor for the next couple of slides. Thank you. Thank you, everyone. Thank you commission for the honoring maria x. It is very strange to be giving this presentation and very hard to be giving this presentation without maria here and her work is absolutely inter woven into all the work weve done. I want to talk about a few things. This is the clinical arm of whole person care. At the onset of the covid pandemic, we had quite a lot of knowledge and monday evidently quite a lot of anxiety about what the effect on people experiencing homelessness would be knowing that much of the Homeless Population was in categories that were highrisk for acquisition and categories that highrisk for complications and death from covid19. We also understand that outside of the effects of the virus the Homeless Population historically is our high users of Emergency Departments and high users of acute hospitalizations and we wanted to do everything we could could be ready for the surge and cope these people kept out of the hospital out of the hospital. And we were aware that the interventions meant to prevent spread of covid would have great disruptions on resources for people experiencing homelessness and related to sheltering and dropin centers and all the other services. The goal was to design a response to mitigate these risks and the work that was done through whole person care through our experienced with the shared priority project and made this i think i can say, made what would have seemed to be impossible a couple years ago feel like it was in the realm of possibility. Because we have data that we had never had before and we had relationships between departments and among divisions that we never had before. And that was an incredible gift, really, to be prepared that way and prior to cove. When cove started and the smelter in place were ramped up we were able to quickly work with Human Services Agency Department of homelessness and Supportive Housing and on having a mold of care that would work and didnt require hours and hours of plan tag it would have required had we not done this Work Together previously, im very aware that looking at dashboards is, they look very good and in the real world and this has really made it a big difference for us in being able to develop these systems quickly and provide care. Next slide, please. I also want to talk about our response to unsheltered people experiencing homelessness and during the covid period of time. We started this spring and late last winter planning for an expansion of a high intensity care team related to shared priority. We took the existing ems6 model and said what do we need to add to it to be able to be the outreach arm 20 hours a day for the shared priority project. And we were well way with planning that although not particularly implementing it when covid hit. We were able to say, we need this team to be up and running. We need to be working closely with ems6 and with sf hot and we were able to reach out both to the shared priority population, to the ambulance and 911 system high user population which were the original populations but we were able to expand to unshelter people at highrisk of highrisk of harm and develop a daily model in which we have street medicine staff working with ems6 and nsf hut on a seven day a week basis. Planning that would have taken many months that was compressed into a period of time of days and it was greatly helped by the work we had done before. Among people experiencing homelessness weve had a few cases of cove diagnosed and very few deaths. One death recorded of a person experiencing and although we believe that persons death was related to an oohed medical condition that were identified as also covid positive. Weve seen a big increase in homeless deaths during this period of shelter in place and we have no way of knowing, its certainly seems to me that increasingly in homeless deaths would be much greater had we not implemented these interventions and work with what we had built on with home person care. I wish that we had the epic care coordination module implemented already and its very easy to see how that module is going to be very helpful to the on the groundwork that were doing when it is developed and goes live. Back to amber on the next slide. Thank you. I want to wrapup with talking about the sustainability and the whole person care work. Over the next year well focus on sustaining that work. The whole person care team will be integrated into the clinical arm of whole person incompetent greated care which well talk about on the next slide. Well continue with the optimization of the care coordination tool set through our work with inner Agency Partners and well foam us on new homeless Health Resource center on track to open in november 2021. Next slide, please. In the future the whole person care team will sit back in the whole person integrated Care Organization and this is a simplified chart of that. As a reminder, whole person integrated care is and weve identified Behavioral Health Service Leaders that will bridge between and and inner agency and collaboration. And i am very please today introduce our new director of whole person integrate care dara and its coming to up from the Supportive Housing and shes here with us today. She will start in august and august 22nd in her new role but shes been a member of our team for the past three years so were very excited that shell be taking on this new and important role. Thank you, dara. I want to wrapup with an image from the project Design Workshop late last spring and you can see Maria X Martinez and to her right, and Maria X Martinezs vision and commitment to the vulnerable population and on our project the department approach to serving vulnerable populations and our team is so proud to be here today and thankful for everyones support bringing this important work to fruition. Thank you. Next slide, please. Before we move forward, do we have any Public Comments. I dont see any hands raised. Ill give it a second. Do you want to make Public Comment on this item, press star 3. All right, no comments, commissioners. Welcome to your new and very important role. Thank you dr. Hammer and dr. Zevin and ms. Reed for this presentation. Before we go to commissioner comments or questions, id like to recognize director colfax. Thank you, commissioner bernal and i just wanted to thank dr. Hammer and the commission for dr. Hammer for her introduction of the resolution honoring Maria X Martinez and just to reinforce that maria was a beloved colleague in the department and a mentor to so many of us. I was able to work with her very closely during my prior tenure at department and was just incredibly i am so grateful for being able to have done that and be training as a department and seeing what she was building and what she developed and with all the kindness and guidance and commitments that is shown through in everything she did so just acknowledging that and supporting the words that have already been spoken and her spirit and we all feel her spirit with us here today. Thank you. Thank you, dr. Colfax. Commissioners, any questions or comments . Not seeing any questions or comments, thank you again for your presentation and for giving us an update on this critical work. I just personally i particularly appreciate the slides showing the journey of someone who is receiving care and their experience and how we can provide services to them. It helps visualize and understand what the experiences from sort of a client perspective so thank you for that as well. Commissioner christian raised her hand after you began speaking. Thank you president bernal and thank you mark. I just want to say thank you and how grateful i am as a person who lives in San Francisco and someone who works in the criminaljustice system and has spent a number of years working with the population that people who need and and seeing up close and firsthand what a difference it makes to have these great emphasis on providing the care that the person needs and a coordinated way in a way that is collaborative with who do work closely with some people in the population and i wanted to know, i know there would be written 237 in the i dont know if you call it a pilot originning thor theinitiative what about bg in more people and how do you know what the capacity is that you are going to aim for . Im just curious to see what work goes through there. Amber, do you want to take that . Sure, i guess i consider this was a Pilot Program to better understand what it will take toktoeffectively serve this population and we heard to be successful, we need to ensure we have adequate staffing to support inner agency care coordination its a high touch work and we also need a shared tool set and so were really excited about the implication of the ethic care cor din module because its all od and better identify and cohort and groups in the future should the department chose to carry on this work in this way. Thank you, i cant imagine the circumstances we would not want to expand this work. For only people outside of the publichealth system and you know, ela person to the system and you talked about it being high touch work and seeing how high touch it is and seeing it does give result and it can work and its not a trajectory or always up and always down its up and down and its the way of life for human beings and please note your work is experienced by those of us who see it in another realm as experiencing working thank you. Thank you very much for your important words. We really appreciate it. Its great to hear that. She will keep in that mind as a model for this work. Thank you. Thank you, commissioner christian. Thank you. Commissioner chow. Yes, thank you. And i want to thank everybody for their wonderful presentations. Im looking at the future chart and im trying to understand because youve already developed an entire system that seems to be working so well and does it mean that whole person incompetent greateintegrated cae people. How much better can you get and what does the full person emigrated care have to what you are already doing with the 200 238 or some odd people. Are we meaning to add more people or Additional Services or just trying to understand our next steps that you are talking about. So ill address that. So, whole person integrated care is a constellation of Clinical Programs and youll of which serve primarily serve people experiencing homelessness so these are programs interested in the Health Department and in different areas and until we hold them together, and started to integrate the program they did not all work in a coordinated way with each other. By having one organizational structure a director to a medical director and really coordination through the ccm module and ep dick and case conferencing and cross Training Staff and we hope that we can do a much better job of taking care of this essentially a larger than the 237 who are in the shared Priority Group and its really all people experiencing homelessness who touch our systems and provide these services and the Health Department. So, none of these is a new program and the Newest Program is actually in care so thats the data design and quality increasement program that came about because of the current medical waiver and now its a waiver that is ending and wore bringing it into whole person integrated care as the data and design team for these Clinical Programs. So, i hope that answers your question. Im really excited to have them all come together and i think we addressed, it was really signed of fast tracked this work of coordination and synchronizing our work with covid because we had to come together and say how does cheap medicine and how do we work with the Care Coordination Team for transition and our Respite Group in terms of comment how can we elaborate our work is much more integrated and coordinated and the epic work wore doing right now is the culmination of that. If i may just try to understand the followup, our current whole person care is a wonderful example to try to draw these agencies together as you depicted here to try to work on everybody that needs this beyond the 237 and will the 237 stay in this pilot then and a group or is that going to really transition so that the 237 might be 500 or 600 within the whole person integrated system . Amber was correct in how she addressed that the commissioner and its a pilot and we really learned a lot from it how much you can came by coming to the table together and across agencies with Human Services agencies and the department of homelessness and Supportive Housing with services and focus on the population that we can find as being highest needs and where we can really make some progress focus on a defined group of people. The boundaries around that group will fade away as we implement this module and epic as we figure out how we continue those cross agency work after the end of the waiver which was ending at the end of next year as we continue to see the benefits of cross Agency Collaboration, in our care of these complicated population. Not just 237 but but really the whole the with complex Behavioral Health medical, and psycho social needs. In terms of sustainability, our new homeless Health Resource centers that you heard of referred to that would be opening in november of 2021, that will be a sustainability plan for this because well be co located and staff will be co located with hsa and hsa team and well have a place for people to come to access housing benefits and healthcare as weve envisioned in our homeless and care work. Thank you for helping to amplify further and we can all look forward to the build out of this future. A great legacy for maria x. This is definitely her vision and this Agency Collaboration and data sharing was her vision. Thank you. Any other questions or comments . Thank you for the great presentation and we look forward to hearing back the next time. Thank you. Well move on to the next item which is other business. Commissioners have any other business . I believe we can move on to the next item. Which is closed session. Did we have a motion to enter into a closed session . Moved to enter. So moved. Ill do a roll call vote. [ roll call vote ] all right. So thank you to everyone who is not going in the closed session. Ill turn a function to cut you off and thank you to the public who joined us. You also will be cut off from this portion but you can stay on if you like and join later. To see what happens. Commissioners, give me 30 seconds please to turn on the extra. Commissioner chow [roll call] thank you for a great meeting. Thank you all, great to see you. Thank you. Great to see everybody. Good night. Today we have ma mayor london breed, Health Director grant colfax. Director of the department of Emergency Management Mary Ellen Carroll and abigail here do you to the bad air quality due to the wildfires. You can submit up to two questions by chat only. Submit them as clearly as possible and include your name and outlet. Well do our best to take your questions in the order received until the q a begins. Well be happy to take your emails. Welcome, madame mayor. Thank you, very much and good afternoon, everyone. Fire season unfortunately has begun in the state of california. And with that here in San Francisco comes challenges with our air quality. In a normal year wed be able to focus entirely on the air quality challenges but as you know we are not in normal years. Were living in covid. Even as we have been focussed on responding to the covid Public Health emergency, we havent lost sight of the need to respond to other emergencies. Whether thats an earthquake or air quality event due to wildfire smoke. In San Francisco we know we have to be prepared. Now, i want to start first by recognizing that while our air quality here in the city is a challenge, we have to focus first on those communities that are being impacted by the fire. When peoples lives are at risk and their homes are at risk, that has to be the top priority. We all have friends and family all over the bay area in california. Our communities are connected and we are there to support each other during these very difficult times. As weve provided hospital beds for counties overwhelmed by covid, San Francisco is proud to offer mutual aid for other jurisdictions battling fires. Recently we sent the San Francisco Fire Department to assist with the river fire and we will send the personnel wherever we can in the weeks ahead. We do this because we care for our neighbors and we know that when the San Francisco in the eye of the storm, theyll there be for us. With that being said, we are still 100 focussed on keeping the people of San Francisco safe and healthy. Unfortunately, weve been through this before. In 2018, following the camp fire when our air quality was severely impacted for days, i issued an executive director to strengthen San Franciscos response to future air quality emergencies and other weatherrelated events. As a result, we revised and improved our air quality emergency plan. This plan includes specific strategies to reach out to our most vulnerable residents especially our seniors, including working with existing Community Networks to get the word out and make sure people have the information they need. We all need to look out for one another and make sure our residents know what to do to stay safe. Right now, our air quality is red, which means the air is unhealthy. Que know this can we know this can shift and we will continue to update the public as things change. The best thing you can do is avoid smartphone to outdoor air by staying indoors with the windows and doors closed. And for those unfortunate enough to be able to work from home, please continue to stay home as much as possible. It is important both for the slowing of the spread of covid19 and minimizing your exposure to poor air quality. We know not everyone can stay home and we need to take steps to protect our unhoused residents. The department of homelessness and Supportive Housing will provide an update on what we are doing for our homeless residents but we are prepared to do everything we can to keep people safe. As with covid, our ultimate goal was to keep the public informed. When we have information to share, we will share it. The affects of Climate Change are already being felt and sadly we know events like these are only going to become more common with dryer weather and hotter temperatures. But we will do everything that we can in this city to keep people safe and healthy. Well be providing updates throughout the day online and will continue to notify the public in the coming days and weeks with more information. If you have questions and concerns and dont have access to the internet call 311 and id like to thank the people of San Francisco for continuing to listen to our Public Health guidance. To be clear, were still on the state watch list around covid. We anticipate hopefully tomorrow we may no longer be on the state watch list but in the midst of these wildfires and everything were dealing with, we have got to use common sense and Good Behavior if we want to beat the virus and make sure we make it through this challenging time with this poor air quality. Please, dont forget, wear your masks, keep your distance, cut back on your social engagement, make sure you are taking care of yourself, your family and your community. We all play a role in ending covid in our city. And now id like to take this opportunity to introduce dr. Koufax who will talk talk more specifically about the facts of covid as well as air quality. Dr. Grant koufax is having technology difficulties. We can take another update for now. If someone wants to start the video im ready to go. Thank you so much and thank you madame mayor. Today, as weve already stated were experiencing poor air quality with smoke and ash visual throughout the city. We have faced hazard after hazard in this year in 2020 and the city has been prepared to respond to the incident we faced during this time of covid. In the past seven days weve dealt with a heatwave, rolling power outages, rain, thunderstorms and now poor air quality as a result of the wildfire. We have been and will remain prepared to tackle multiple hazards while continuing to respond to the global covid19 Public Comment is closed. San franciscos Covid Command Center will lead response to the multiple simultaneous hazards. The air quality will vary depending on the amount and impact of smoke particles in the air. If the situation gets worse our response will increase. Weve been fluctuating between earning and red air quality levels index just today. Red is considered unhealthy. That means we already initiated city wide coordination for widespread Public Information and messaging through our social traditional media and our Emergency Alert notifications, alert s. F. Through the incident well continue to push out messaging to the public so everyone stays up to date on the risk level in the city and knows how to protect themselves. If the air quality in San Francisco remains unhealthy or gets worse, were prepared to respond by protecting the most vulnerable and ensuring the public gets the information they need to stay safe and will issue personal protective equipment as the air quality continues to be healthy were distributing n95 respirators to the unhoused and those in shelters. Well evaluate our officering outdoor operation our existing outdoor operations. If we reach the high range we may pull back some of our outdoor operations such as Neighborhood Outreach and distribution of door hangers and sliders. Well activate respite sites. If we reach an air quality level of purple, which is considered very unthe, well activate unhealthy well activate centers. The locations will be based on a neighborhood approach that focuses on the areas of highest need and promoted through community use. We will keep the public informs. Multiple times a day well issue updates on the current status of air quality in San Francisco and the actions the public should take to protect themselves. This professional will be conveyed through our Emergency Notification system and alert sf and our traditional social media outlets. We prepared due to planning and we have learned lessons from previous heat waves and power outages. After back to back years of devastating wildfires and resulting poor air quality, we embarked on a regional effort to make sure each area, city and county were coordinated in our response for air quality. The resulting effort ensured we are all communicating with the same health and safety guidance to our residents. Im proud of our regional efforts as they have laid the groundwork for successful response in San Francisco. Were also better coordinated because city departments and our partners have been united in our fight against covid19. Here at the Covid Command Center we overcome the challenges of the global Public Comment is closed. This helped us in times of additional challenges like air quality and extreme weather. Finally, please remember whenever smoke is unpredictable as weve seen today were going back and forth between air quality index levels and residents should be aware. If you smell smoke, keep windows and doors closed, if possible. Stay up to date by signing up for for instance emergency text alert by texting the zip code where you live or work to 888777. The department of Emergency Management will continue to share information via these alerts and alerts to sf72 dot important we all know people from San Francisco are resill interand have taken care of each other during the Public Comment is closed and i know no matter what emergency is layered on top of this one, well get through this together. Thank you. Thank you, dr. Mary ellen carroll. I present to you dr. Grant koufax. Director of Public Health. Im director of health for the city and county of San Francisco. Thank you, director carroll for your cooperation and collaboration and leadership during covid19 and now during the speak events. Theres smoke events. Theres multiple fires burning throughout california including in Northern California and santa cruz county. Today, for instance is experiencing unusually hazy and smoky air as a result. The air quality index is currently at level red which means unhealthy. In other words, everyone may begin to experience Adverse Health effects and members of sensitive groups may experience more serious affects. That includes people with lung disease including those who have asthma and copd and asthma and children. These groups are particularly susceptible to elevated air pollution levels and should take extra precautions to avoid exposure. These individuals should avoid prolonged or heavy outdoor exertion and people should limit Prolonged Health guides. If you have an respiratory illness, chronic or acute make sure you have an adequate supply of meds and contact your health care provider. People should be cautious when they choose to go outside and wear a mask and always be aware of whether youre having an challenges breathing. The air quality in our area changes daily and throughout the day as it is dependent on wind speed and direction. Air quality may improve at times or worsen very quickly and weve seen that even today where weve varied between levels of red and orange. Now we must manage both air quality in the context of the covid19 pandemic and as we said with regard to covid19 for many months now the best thing you and your family can do, if youre able to, is to stay at home. Even during days of poor quality conditions we must protect our community from covid19. During poor air quality condition and covid19 the intersection of these concerns, the healthiest thing for everyone to do now is avoid exposure to outdoor air and the virus by staying indoors as much as possible. If you must leave your home and go outside for essential activity, remember to bring your face coverings and socially distance from people outside your household to protect yourself and your community from covid19. We continue to live in unprecedented times and air quality is another challenge to address as a city. Please, again, stay at home if you can. And through social media please check on your friends, family and neighbors and,0 those pregnt or have respiratory illnesses these are people at risk and should take precautions to avoid exposure. The reality is that as we enter whenever season and changing wind patterns well be living with both the intersections of covid19, poor air quality and likely heat events for some time. We must stay vigilant and resilient as we take all actions to protect ourselves and our community from the elements. We continue to find ways to protect each other and our community and we will continue to rise to the occasion as we continue together to work to slow the of covid19. Thank you. Now the director of homelessness Abigail Stewart kahn. Thank you for your partnership and leadership through these complex, multi faceted events. We have learned for instance has heart. Weve always known this and we as a city need to continue to pull together to be nimble, compassionate and responsive. Civil servants and many are rising to the occasion today and for that we are grateful. As you heard covid is still the number one priority for all of us in Public Health. We need to ensure were caring for those most vulnerable due to covid, heat, air quality and other in clement weather events. During our heat emergency our Homeless Outreach team who were heroes even before the pandemic have been activated for their lower level extreme heat response. At this level that activation included increased wellness checks, providing appropriate resources and guidance on how to stay safe during covid and the heat. We continue that support. Our department is working closely with the command center to monitor air quality and as director carroll shared we strongly encourage everyone, housed and unhoused to activate your alerts because it is changing by the moment. As you heard from the experts, we are partner at red level of air quality. Based on this and pos policy decisions distribute nonmedical grade n95 masks and water and other resources. This is in addition to look for those most vulnerable to covid and bring them indoors and continues to partner with hsoc and well didnt distribution of n95 masks so have access though theyre such a scarce resource. San francisco is living its values by dedicating these resources to unhoused neighbors where we all know every Civil Servant at mayor breeds leadership wishes everyone to be inside the shelter in place. I want to pause and particularly this many the members of the Homeless Team and hsh and providers for adding work on top of work to take care of those most vulnerable in our community. The city is exploring what to do and the next stages should air quality deteriorate further. The Services Agency is responsible for mask care and shelter and evaluating alternative sites where people may come inside if we reach higher levels of air quality challenges. As you can see, many departments, many Civil Servants, many leaders and many citizens are coming to the aid of our unhoused neighbors. While you should stay inside if you are housed, if you are outside and encounter somebody who is sheltered, encourage them to mask and ask them how their day is, say good morning and good afternoon. The Homeless Outreach team we hope will be there soon to provide mask. Well continue to provide updates through our boards, governance authorities and website and encourage all of you to stay connected through the various ways to get up to date information. Thank you to mayor breed and the city for continuing to find another year in which to keep san franciscans safe and cared for. Thank you. Thank you, director stewartkahn. Well now begin our q a portion. The first set of questions are for dr. Colfax. We are not currently planning to close any covid19 testing sites at this time. Were assessing the situation and obviously testing and identifying those infected is and remains a top priority. We will continue to assess the air quality as things go forward with regard to changes in our testing sites but at this points our Testing Centers will remain open and we will provide updated information if that changes. A followup question is what is the threshold for making such a decision and how close is s. F. Air quality to that point now . Again, we are assessing the situation, testing sites remain open and if there are any changes well certainly make sure people know that. Thank you. The following question is for maryellen carroll. If the city opens respite sites how will they mitigate the risk of covid at those sites . We will follow all the social distancing guidelines that already exist. We will see an Additional Health screen for anyone coming in many other jurisdictions having high levels of temperatures have been doing this and we have a plan and feel we can do it safely should we need to. Thank you very much. It seems there are no further questions at this time and this will conclude todays press conference. Thank you, everybody, for your time and please stay safe. Hi. Im Chris Mathers with channel 19, and youre watching coping with covid19. Today, im going to be talking about exercising during the pandemic. First, im going to tell you what ive been doing, and then im going to be checking in with some friends and family. Ive been riding my bike. All i take is a pair of gloves and a mask if i come into contact with anyone. I try to ride my bike during the time im sheltering in place. I try to ride for at least 30 minutes. Surfing is my other regular outdoor activity. California state guidelines recommend you dont drive more than ten minutes for a spot to exercise, and although im close to ocean beach, im a bit wary to go there, so im using the time to do some maintenance. Filling in gouges and dings, and sanding it down. Im also repairing holes in my suit. Fellow sfgovtv producer chris took his first yoga lesson a couple of years ago and used to go to a class regularly before the lockdown. He and his wife set up a space in their garage for exercising. This routine is from an online class by power yoga. Deann and andy have been using the ping pong table that they bought off craigslist and set it up in their back yard. Ellie has been using this home gym to stay fit. It has everything she needed. And lastly, if the weather is bad outside, you can exercise your mind by doing a puzzle, sudoku, or just by reading a good book. Heres a quick recap. Since i started this episode, the guidelines have changed. For instance, jack may be able to go golfing with some restrictions. Go to sf. Gov to get the most uptodate the meeting comes to order, the august 19th, rescheduled budget and appropriations meeting. Im sandra lee fewer and joined by the Committee Members, supervisors walton and mandelman and ronen and norman yee. Our clerk is miss linda wong. I thank sfgovtv for broadcasting this meeting. And also, supervisor walton will be joining us a little later. Can we have a motion to excuse him for the first beginning part of the meeting. So moved. Chair fewer thank you very much, can i have a second, please. Second. Chair fewer could i have a roll call vote please. Clerk yes, on the motion. [roll call] there are four ayes. Chair fewer thank you very much. Madam clerk, do you have any announcements. Clerk due to the covid19 health emergency, the City Employees and the board of supervisors legislative and the committee room, and the members will be participating in a meeting remotely. This is for the local and state and federal orders and declarations and orders. The meeting is through Video Conferencing and participate as if physically present. Public comments are available on each item on this agenda and channel 26 and fo sfgovtv. Org e streaming the number across the korean. The opportunity to speak during Public Comment period are available via phone call by calling 1 415 6550001. Again, 1 415 6550001. And meeting i. D. , 146 347 6022. Again, 146 347 6022. And then press pound twice. When connected you will hear the meeting discussion but you will be muted and in listening mode only. When your item of interest comes up, press star, 3, to be added to the speaker line. The best practices are to call from a quiet location, speak clearly and slowly and turn down your television or radio. And alternatively, you can make Public Comment in any of the ways, the budget and finance Committee Clerk at. And if you submit Public Comment via email it will be forwarded to the supervisors and will be included as part of the official file. Finally, items acted upon today are expected to appear on the board of supervisors agenda of september 15, unless otherwise stated. Chair fewer thank you very much. Good morning, everyone. This weeks hearings are focused on the reductions that the Budget Committee would like to make to the department budgets. A few things to note before we begin before calling the departments this morning we are going to hear about the trailing legislation first and then come back to items 1 and 2 which are budget items. My office will release an updated list of requests which now totals 364 million in year one. I will also be releasing a proposed spending plan to focus on key priorities which are posted online and my office will distribute to offices. Again, what im putting out is a conservative spending plan for 20 million since we do want know how much the board will have to allocate. The hears are noted separately, but this is all one meeting. Well recess, not adjourn, at the end of every day and picking back up the following day at 10 00 a. M. This means that theres one continual meeting for wednesday, thursday and friday. For that reason there is no Public Comment this week on the budget. Which is items 1 and 2. All Public Comment on the budget will be heard on monday, august 24th beginning at 10 00 a. M. Theres no other business on monday except for hearing Public Comment. The budget and Appropriations Committee will recess at approximately 12 30 or 1 00 p. M. For a 30minute lunch. As much as possible well hear the departments in the order listed, but i want to recognize that we sometimes need to accommodate scheduling conflicts and call out of order. And today were hearing the following departments likely in the following order controller, city administrator, retirement, technology, public works, general city responsibility, human resources, library, rec and park, children, youth and families, Mayors Office, city attorney, elections, board of supervisors. With that, lets get started. Madam clerk, can you please call items 3 and 4. Clerk the resolution concurring with the controllers certification that Department Services previously approved can be performed by private contractor for a lower cost than similar work performed by the city and county employees. And item 4, resolution concurring with the controllers certification that Department Services can be performed by private contractor for a lower cost than similar work performed to the city and county employees. To call for Public Comment, 1 415 6550001, and i. D. , 146 347 6022 and then press pound twice. If you have not already done so, please dial star, 3, to line up to speak. And wait until the system indicates that you have been unmuted and you can may begin your comments. Chair fewer thank you very much. And today we have reesea sandler from the Controllers Office and she can introduce everybody else. Hi, lisa. Hi, good morning. Im reesa sandler from the Controllers Office and just back with the continued two items for previously approved prop j resolution and not previously approved prop j resolutions. There are Department Staff on hand if you have questions. I am happy to answer any questions myself. Chair fewer any comments or questions from colleagues . Seeing none, can we take Public Comment for the items. Clerk yes, madam chair. Operation, checking to see if theres callers in the queue. As a reminder this is not a general Public Comment on the budget that occurs on monday august 24th. If you have not already done so, press star 3, to be added to the queue. For those already on hold, wait until the system has you unmuted. Are there any commenters on items 3 and 4 . Madam chair, theres no callers in the queue. Chair fewer thank you very much. Public comment is closed for items 3 and 4. I want to mention that i really singled out the prop j contracts just because i think that this contracting out should be really looked at. Year after year were asked to approve these prop j contracts and after next year, they should look at this and with much more scrutiny. And even more so if we are experiencing layoffs of our City Employees. With that, i would like to make a motion to send this to the full board. Could i have a second, please . Second. Presiden chair fewer can a roll call vote, please. Clerk yes, on the motion [roll call] there are four ayes. Chair fewer thank you very much. Call items 8 and 9. Clerk yell 8, ordinance authorizing the execution and delivery of certificates of participation in one or more series from time to time evidencing and representing an aggregate Principal Amount not to exceed 97,500,000, to prepay certain certificates of participation that financed and refinanced various Capital Improvement projects. Item 9, the ordinance disappropriating 4. 6 million of series 2010a refunding certificates of participation prior reserve funds and appropriating 02,136,200 of refunding certificates of participation series 2020r1, including deappropriated funds and 97,500,000, one or more series of refunding certificates of participation proceeds for fy20202021. If you want wish to call, call 1 415 6550001 and i. D. 146 347 6022. Please wait until the system indicates that you have been unmuted and you may begin your comments. Chair fewer today we have anna, and the office of public finance. Good morning, supervisors, and thank you. Im luke, with the office of public finance. And im going to share a quick little slide with you today about our upcoming proposed refunding certificates of participation. These are we have identified funding candidates here in finance which can be refunded as soon as october 2020. And we estimate that it will produce savings depending on Market Conditions, and gross savings to the fund of 13. 8 billion, based on an estimated Interest Rate of 2. 6 or approximately 1 million annually. Which on a net value basis is 11. 2 million or 12 of the total outstanding principal. We are seeking the approval of the ordinance to authorize and the supplemental ordinance appropriating the 2020 r1 funding proceeds, not to exceed 97. 5 million and the final is october 30, 2023. Are there any questions . Chair fewer yes. Any comments from my colleagues . President yee im sorry chair fewer go ahead, president yee. President yee is this refinancing simply that would be for 13 years . Or what . It would be existing certificates of participation that were looking at, the final maturity of those, the existing debt is 13 years. So we will match maturity to final maturity of the new refunding certificate. President yee any reason that you want to keep the length of time the same . So certificates of participation are a lease back structure and because of that we tend to try and to match the term of the lease closely with the term of the original asset. So the term of this being 2033, would have been 30 years from the time of the originally anticipated completion of the county jail number 5. At that time they gave it a 30year term just based on useful life, which is typically 70 years for jails. President yee and what happens to the when we say 1 million, does it go back to general funds or where are the savings . So the savings these two pieces are in that way, according to the mayors budget office, that we communicated, those savings are to go to the general fund. President yee okay. So is that an indiscernible back . The savings need to be realized first before they can be programmed, in case the bond Market Conditions change. The market is pretty volatile right now and were looking to get in before the election, but, you know, the rates could move quite a bit. So we dont want to program anything just in case the rates spike up and were not able to close the financing. Should the rates continue to be as low as they are now, hopefully well get even better savings than were currently estimating. President yee okay, thank you. Chair fewer any more questions or comments . Seeing none. Madam clerk, can you please call for Public Comment on these items. Clerk yes, madam chair. Operations are checking to see if theres callers in the queue. Let me know if there are any callers that are ready. If you have not already done so press star, 3, to be added to the queue. For those already on hold, continue to wait until the system indicates that you have been unmuted. And if there are any callers who wish to comment on items 8 and 9 . Madam chair, there are no callers in the queue. Chair fewer Public Comment is now closed. I make a motion to move items 8 and 9 to the board with a positive recommendation. The Board Meeting of september 15th. Could i have a second, please. Second. Chair fewer roll call vote, please. Clerk yes, on the motion [roll call] what are we voting on . I am sorry, i just logged in. Chair fewer on items 8 and 9. Aye. Clerk there are five ayes. Chair fewer thank you. So, colleagues, i miss that there is a b. L. A. Report for items 8 and 9, so if you would like to refer to it, i apologize that we didnt call for the b. L. A. Report. But i am assuming that you all have access to that report. Lets move on to can you call please items 5, 6 and 10. Clerk yes, madam chair. The ordare draft ordinance amending administrative code, section 8. 14, to adjust the office of the chief medical examiners fees to add postmortem investigation services, remove obsolete services, and update to all amounts to fy20202021. And item 6, ordinance amending the administrative code to authorize the department of Administrative Services to impose a fee for reproduction and Notary Services provided to the public. And item 7, ordinance amending the administrative code to update county clerk fees to current amounts and to authorize the county clerk to impose a Digital Signature fee. And item number 10, hearing to consider the release of reserved funds to the office of the city administrator, placed on the budget and finance committee reserve by ordinance number 16919. The public that wishes to comment on these, call 1 415 6550001. Meeting i. D. , 146 347 6022 and press pound twice. And if you have already done so, press star, 3, and line up to comment. And wait until the system indicates that you may begin your comments. Chair fewer thank you very much. I think that there are representatives from the city administrators. Are you here . I am. Chair fewer great. Lets take item 5 first, please. Good morning, chair fewer and the members of the budget and Appropriations Committees. The deputy city initiate your. And amending the fees charged by the chief medical examiner. Its primarily deleting fees that we no longer need for doing this, and as well as updating a number of these and adding some new fews from our Forensic Laboratory who is who are now able to do some outside testing as needed. And so one of the hopes that when the new office of the chief medical examiner was built a couple years ago, and we now have a Forensic Laboratory, is that the lab, once it developed full capacity, would be able to provide services and potentially provide additional income into the city to support its operations. By providing the services to outside agencies. And so the keys established here allow for the outside entities to be charged for that work if its developed in the future. Its that work that were currently doing but were just allowing for it to happen in the future. And then finally, the fees are adjusted by the c. T. I. Increases that are allowed. And before you today is actually the amended version of what was originally noticed and advertised and that was due to the fact that the version in the original packit and part of the original notice does not reflect the c. T. I. Increases that were allowed. And that were authorizing in legislation. And so with that, i will take any questions. Chair fewer thank you very much. There is no b. L. A. Report on this item. Is there any comments or questions from my colleagues at all . Seeing none. Could we take Public Comment on item number 5, please. Clerk yes, madam chair. Operation is checking to see if theres any callers in the queue. Operations, please let us know if there are any callers that are ready. If you have not already done so, press star, 3, to be added to the queue. For those already on hold, continue to wait until the system indicates that you have been unmuted. And operations, let us know if there are any callers to comment on item number 5. Madam chair, there are no callers in the queue. Chair fewer thank you very much. Public comment for item number 5 is now closed. And there is an amendment i believe, madam clerk, that we need to approve, is that correct . I make a motion to approve the amendment. Could i have a second, please. Second. Chair fewer roll call vote please on the amendment. Clerk yes. On the motion [roll call] there are five ayes. Chair fewer i would like to make a motion to move this as amended to the budget and finance Committee Meeting on september 2nd. Could i have a second, please . Second. Chair fewer roll call vote, please. Clerk yes, on the motion [roll call] there are five ayes. Chair fewer thank you very much. Madam clerk oh, now lets hear item 6 and 7. Yes, item 6 is to provide new fees for Reproduction Services through repromill. Its an internal Services Department and it provides reproduction and Mailing Services for other city departments as part of the new feature, we are creating with the new permit center at 49 south van ness, we want a center for the members of the public if they brought in items and they needed updated versions of their plans or other things printed there, as well as any signage they would normally to have to go to the department. And so this through legislation establishes fees to award those services for the public. Chair fewer thank you very much. Any comments or questions . There is no b. L. A. Report on these two items. Any comments or questions . Seeing no one in the queue, can you open up Public Comment for items 6 and 7. Clerk yes, madam chair. Operations are checking to see if theres callers in the queue. Operations, let us know if there are callers that are ready. If you have not already done so, press star, 3, to be added to the queue. For those already on hold, wait until you have been unmuted. Can the clerk let us know if there are callers to comment on items 6 and 7 . Madam chair, there are no callers in the queue. Chair fewer thank you very much. Public comment on item 6 and 7 7 are now closed. I make a motion to move this to the full board with a positive recommendation, to the meeting of september 15th. A second, please. Second. Chair fewer roll call vote please, madam clerk. Clerk on the motion [roll call] there are five ayes. Chair fewer thank you very much. And now item number 10, mr. Bor cowski and we do have a b. L. A. Report. And first hear from you, and then from the b. L. A. . So item 10 is a request to release the funding that was placed on budget and finance committee reserve during the 1920 budget discussions and so at that point in time because the b. L. A. Agreement had not been finalized, the Labor Agreement was not finalized, it was not clear when to have enforcement of that agreement. And that agreement was it was finalized and went into effect on july 14th of this year. And so we are now requesting that two of those positions and the funding related to two of those positions be released from reserve so we can move forward with the work needed to support the agreement. Chair fewer thank you very much. Can we hear from the b. L. A. , please. Hello miss severn. How are you . Good morning, chair fewer and members of the committee. This could be released, salary and fridge benefits for two conditions that were allocated for the project Labor Agreement which went into effect in july of this year. On page 10 of our report we show the salary benefit costs, and we recommend approval of the release of these reserves. And im available for any questions. Chair fewer thank you very much. Any questions or comments from my colleagues . Yes, president yee. President yee are these positions already occupied . No, theyre not. They were so the release of reserve means that theyre filled as of october 1st. Chair fewer okay. Go ahead, president yee. President yee are these positions crucial or something . They are crucial if it is desired for the Labor Agreement to be implemented, yes. President yee its crucial then, okay. Chair fewer i have a question. So its my understanding that there was another position, a third position, and a contract compliance officer. Is this f. T. A. Still needed . Because i actually am interested in exploring the elimination of this position. Because i think that there were three positions originally put on reserve. And youre asking for the release of two positions but there was a third position also that was in reserve. So is this f. T. E. Still needed . Because i am actually looking at eliminating this position for one year. We made the conscious decision that we did not need the f. T. E. As of october to begin the implementation. But that left open the possibility to come back to the board during the fiscal year depending on the work that was coming forward and making a request for release of reserve funds for that other position. I also have pat mulligan here today, the director of the office of enforcement, and he might be able to provide some additional detail or response to that. Chair fewer sure. Mr. Mulligan . Hi, pat. There i am, sorry. Thank you, supervisor. So we are anticipating with the rollout of the project Labor Agreement that theres a lot of Capital Projects that are in flux right now. So we feel confident that we can handle the implementation, which is two positions, at least through the first 12 months, the first fiscal year cycle. And then were looking for maybe next fiscal year to see if that position was necessary. And also depending on the budgetary constraints in the following fiscal year. Chair fewer okay, thats great. Because i think that we can probably eliminate that third position for the first year. But keeping open for the second year just in case, and construction and we dont know how its going or anything. But i think that would happen actually when we actually talk about your budget which is coming up, correct, right . Yes, president yee . President yee since this is for the money in reserves, why do we need to wait until we talk about his budget . Chair fewer because we would president yee we could free it up from reserve now . Chair fewer is there someone who could give me advice on this . Chair fewer, supervisor yee, the release of these reserves covers the cost of the two positions. The third position, the way theyve written the reserve, all of the moneys that were on reserve would not cover the third position. I think that what could happen during the discussion of the Administrative Services budget is to place the salary and Fringe Benefits of that third position to actually basically increase attrition savings for one year to cover the cost of that position. So that i believe that would be about 215,000 and i could give you the exact number to be considered during the actual deliberation of the budget itself. President yee okay, thank you. Chair fewer, and excuse me one of the things we want to confirm is that actual full Salary Amount is included in our budget as was just mentioned. Whether the reserve amount that was set aside covered the cost of that full reserve. So we dont have sufficient money budgeted to cover that full reserve and you cut that total amount then youre overreducing our budget. So i wanted to make sure chair fewer so we approve item 10 now and then later when we have budget discussions were able to take that salary and Fringe Benefits for first year. Right . Got it. Okay. Having said that, lets open it up for Public Comment, madam clerk. Clerk yes, 345 madam chair. Operations, checking to see if theres callers in the queue. Operations, let us know if there are callers that are ready. If you have not done so press star, 3, to be added to the queue. And for those on hold, continue to wait until the system indicates that you have been unmuted. Please let us know if there are callers who wish to comment on item number 10. Madam chair, there are no callers in the queue. Chair fewer thank you very much, Public Comment on item number 10 is now closed. Id like to make a motion to file this hearing and could i have a second, please. Clerk thank you, madam chair. The request to release reserve funds . Chair fewer yes. Yes, thats the action yes, you can take that action, absolutely right, thank you very much. Clerk is there a second . Second. Chair fewer roll call vote, please. Clerk on the motion to release the request reserve funds and to file the hearing [roll call] there are five ayes. Chair fewer thank you very much. So, madam clerk, can you call items 1 and 2. Clerk yes, madam chair. Item 1, budget and appropriation ordinance appropriating all estimated receipts and all estimated expenditures for departments of the city and county as of july 31st, 2020, and ending june 30, 2021, and june 30, 2022. Item number 2, annual salary ordinance enumerating positions in the annual budget and appropriation ordinance for the years ending june 30, 2021, and june to, 2022. To give Public Comment, call 1 415 6550001. Sorry, there are no Public Comments on items 1 and 2. Chair fewer thank you very much. So before we start, i just wanted to say to our Department Heads that are listening that this budget process is set up to be somewhat adversarial. You have budgets and the mayor has a proposed budget, and then the board of supervisors comes in with the help of the b. L. A. To help us to find waste and also where we can actually then tighten up the budget. I know that the Department Heads, i have heard from many of them, fighting really hard for their departments. So i just wanted to begin this conversation by thanking all of our City Employees and our hardworking Department Heads. I know that you are fighting for your budgets to better serve the people of San Francisco. And i just want to say thank you. You know, i think that people i mean, those of us that serve on this committee take this job very seriously and that we find efficiencies because this money is earne earned on the hardworg backs of san franciscans. But we also recognize that as Public Servants you serve them, and we could not operate the city without you. So before we start, theres a series of sometimes contentious conversations, and i just wanted to acknowledge the fine work of our Public Employees and the honorable and respectful work that you do every day to serve the residents of this wonderful city. And with that, well start with our controller, mr. Ben rosenfield. Good morning, chair fewer and members of the committee, ben rosenfield, city controller. And thank you for the kind words. And i would like to thank the legislative analysts for their work to review our budget. We are in agreement with their recommendations that you have in front of you. Just to highlight the followup question that the committee had for us last week, we have eliminated our general fund travel in our proposed budget, at the recommendations before you, eliminate the Nongeneral Fund travel for the coming fiscal year as well at the committees request and were in agreement with that. Im happy to answer any questions. Chair fewer any comments or questions . Seeing none, i would ask that are we sort of in general agreement where just a nod, Committee Members, that were in agreement with the controller and accepting things and thank you very much to the Controllers Office. Take note of the committees attention to accept the b. L. A. Recommendations for this department. Thank you very much. And the next department that we have is the city administrator. And is mr. Pocowski. Hi, ken. Okay, yes, what do you have to say . We, chair fewer, we are in agreement with the b. L. A. Report before you today. Chair fewer thank you very much. And then this is the added one f. T. E. That i think that the b. L. A. Has recommended that since we could place this as part of attrition, im thinking with the salary savings, right, and the benefit and salary that comes to about 215,000 for the first year. And this to add back to the pot, also, is that correct . That is correct, chair fewer. Chair fewer thank you very much. And mr. Pocowski were in agreement with that so the request from the b. L. A. And then also theres one position for the fiscal year, the first year, we are in agreement . Chair fewer, i can confirm the understanding. So the f. T. E. Remains in the budget, the attrition is adjusted by the 212,000, the exact amount of the position value. Chair fewer is that correct . I seek general agreement among my colleagues to accept these cuts. Please then, mr. Controllers office, can you take note of the committees attention to accept the b. L. A. Recommendations for this department. Thank you. Chair chair fewer yes, madam clerk . Clerk i just wanted to note that president yee would like to speak. Chair fewer im so sorry. President yee . President yee are we just do we have other cuts that we want to do to talk about it or what . Chair fewer yes, i believe so. Are there other cuts in the city administrators budget that youd like to bring to our attention . President yee well, i dont know how it fits in, and this is it may not be this department. Im trying to figure it out as im looking at the reports. So theres a b. L. A. Report on the indiscernible that we use and i dont know whether or not these vehicles are controlled by the city administrator or the departments themselves. So its a little confusing for me right now and i havent had time to absorb everything. Chair fewer president yee, we are also able to call the departments back if you would like also more time. But, if not, why dont we ask our b. L. A. Right now. Mr. Goncher, we heard from president yee that hes interested in the efficiencies around the leasing of vehicles and whether or not the vehicles are leased through just the Administrators Office or leased through the individual departments . Chair fewer, the legislative analyst office. I believe that the Lease Services manages those vehicles. But they are budgeted in individual departments. We have reviewed all of the equipment requests, including all departments that we are reviewing this year. And we have made recommendations within each of those department reports. Chair fewer okay. President yee president yee so so this is not about cutting, actually. I know that you dont want to hear it, chair fewer, but when i looked at the report, theres one of the things that is needed is somebody to monitor all of this stuff. And theres nobody assumed to be responsible in terms of the leasing piece of it. And we need to get reports. And the other issue is where theres inefficiencies and disputes and things that shouldnt happen when city drivers drive these vehicles. And, again, we could save money in terms of gas and everything else, but it takes somebody to call it out and say and to actually try to get the departments to focus on on where the efforts to reduce these types of inefficiencies. So what im seeing is a need for somebody chair fewer oversight . President yee yeah, to do some oversight on that. Chair fewer sure. President yee so im just sort of um, putting the seed out there, or planting the seeds right now, to have additional staffing, okay . Chair fewer no, no, i was just wondering how we could do it. Im just thinking that if a deeper analysis and just a supplemental for a position later on to fill this position. Thats great. Yes, mr. Powcowski. Two things. One specifically on that topic raised by president yee, we are happy to work with his office and we have not seen the b. L. A. Report referenced in this mornings paper and but we are happy to work with the office and to figure out ways to play a coordination role and any resources are needed to support that. We do not manage them for the departments in any way. Second, i wanted to say that my budget officer just texted me to say that the funding for the salary for the position that we were talking about, defunding for the current year, we still have 226,000 on reserve, and the funding that we would request or maybe wed have to come back with a followup request for that funding to be taken off of reserve. And that would be provided as part of the budget savings. Chair fewer why dont we why dont we have you come back for that. Would that be the citys admiAdministrators Office, or, mr. Controller, do you have a recommendation . I was going recommend, chair fewer, that the committee could actually release that reserve as part of your final actions on the budget next week, if that is the committees desire. Chair fewer okay. Lets do that. To add that to the list for next week. Chair fewer okay, well add it to the list for next week. And i see that we have general agreement with the city administrators, agreement to take these cuts. So the Controllers Office, take note of the committees intent to accept the recommendations of this department. Thank you very much. And lets move to the next department, retirement. Good morning, supervisors. Chair fewer good morning. As i didnt have an opportunity last week to present to you, i just wanted to give you sort of an update on the status of the retirement system. I want to assure you that we even though we had very difficult financial climate over the last year, we did well. We did not earn 7. 4 , however, we believe that when we get the final valuations of the Market Portfolio that well come in around 2. 5 as a return. That would still be within the top quarterile of all Pension Plans in the united states. And more importantly the plan remains very well funded as the valuation. And we indiscernible which is extraordinary for the public Pension Plans in the united states. Since we didnt earn the 7. 4 , we expect that will probably take a couple Percentage Points on the valuation in july of this year. But, again, i wanted to just assure you that were doing the best that we can. The Pension Trust at the end of july was 27. 4 billion. Which is nearly 1. 5 billion more than it was last year. And that is in addition to paying nearly a billion and a half dollars in Public Pensions over the year. So with that, as far as our budget, when we resubmitted it we certainly focused on our travel budget. Travel, as you know, is currently prohibited. And we dont know when or if it will ever become safe or necessary to travel again. Our Investment Team has not really skipped a beat and they continue to conduct their Due Diligence and their meetings with managers remotely. And so i think that were well prepared to go forward. Sort of indefinitely as we all are, assuming that we were going to need to conduct all of our Due Diligence and all of our meetings remotely. And we with that ill be happy to answer any questions. We certainly well, i shouldnt say certainly. We accept the recommendation from the b. L. A. Office and we certainly thank the Mayors Office and the b. L. A. For the work that they do. Chair fewer thank you very much. And i know that i join my other Committee Members to say thank you very much for keeping our Retirement Fund sound. President yee and i will be drawing from it in the future. So we wanted to say thank you very much for those successes. And i see general agreement with my colleagues. So, mr. Controller, can you please take note of the committees intention to accept the b. L. A. Recommendation from this department. Thank you very much. Thank you for your work and thank you for joining us today. The next department that we have is technology. Hi, good morning, chair fewer. Chair fewer hi. Hi. I am the c. F. O. Of the department of technology. We are in full agreement with the b. L. A. Budget report this morning and ill be happy to answer any additional questions that you may have. Chair fewer thank you very much. I see no question question or cs from my colleagues. This is the department of technology. I think that general agreement with my colleagues to accept these recommendations. So, please, mr. Controller, please take note of this committees intention to accept the b. L. A. Recommendations for this department. Thank you very much. President yee, yes . President yee can you sort of highlight the justice portion of your budget a little bit . The recommendations. We are all holding by 1. 25 more f. T. E. S for additional attrition savings as our director durrell mentioned in her presentation last wednesday. Theres currently 41 vacant positions and we are currently holding 23 f. T. E. S vacant to bid on our original attrition target and additional attrition savings target as we identified together with the budget analyst. And then we also identified some savings that, you know, in our justice program. And also security contract and license. We are able to realize Additional Savings as we have some budget Carry Forward to next year. I think that is pretty much what we have identified. And i know, chair fewer, youre very interested in everyones travel budget. I just want to mention that we have already in the first original budget review, we had already reduced our total travel budget by twothirds in the first round of the budget cuts. Chair fewer president yee, any other questions or comments . No. Okay, great. Yes, its too bad about travel. All of us like to travel but it is what it is. Okay, so mr. Controller, can you please take note of this committees recommendations for this department. Thank you very much and thank you for joining us today. Next we have public works. Good morning, chair fewer. Chair fewer hi. And to the members of the board. Im the acting director of public works. Public works is in agreement with the recommendations from the b. L. A. Chair fewer thank you very much. Any comments or questions from my colleagues . I think that we are in general agreement. Mr. Controller, can you please take note of the committees intention to accept the b. L. A. Recommendations for this department. Thank you very much. Thank you. Chair fewer lets go on to general city responsibility. Good morning, supervisors. The Controllers Office. Chair fewer hi. Many thanks to the budget analysts for this work and we are in agreement with the recommendations. Chair fewer thank you very much. I have a question. Is that with were looking at you have quite a bit of reserves here. But i see that one of your reserves is 5 million for the Housing Authority when we dont have really the Housing Authority anymore. Can you explain why that is still we still have a reserve of 5 million for the Housing Authority . Supervisors, that was a contingency reserve that the board approved in last years budget and in the budget that is proposed before you, that is one of the contingency reserves that has been consolidated into a Covid Response and fiscal effect reserve. Chair fewer so this is has already been included as part of the 500 million reserve . Thats correct. Chair fewer and looking at your other reserves for example, you have a reserve for the Affordable Care act reserve. And you have a reserve from also state and federal revenue risk. And this is im reading from the b. L. A. Report. And that so actually, i am proposing that maybe we skim off a little bit from each of the reserves as is the b. L. A. Says this is considered a policy matter for the board of supervisors. And so i am wondering, i am going to propose that we actually take half a Million Dollars from each of the reserves. If we took half a Million Dollars, it would leave the Affordable Care act reserve fairly intact with 99 of the revenue for this purpose. And 500,000 from the federal reserve, it would still be over a 39 million which leaves it 98. 75 reserve intact for this purpose. Would you like to explain further . Sure. Chair fewer, as you stated, these reserves are unallocated and unappropriated reserves that are set aside. Again, the Housing Authority reserve, which i guess that has been consolidated with the Covid Response has 5 million. The Affordable Care act reserve with 50 million. And the federal and state revenue risk reserve has 40 million. We wrote in our reports on page 14 that this action would be considered to be a policy matter for the board of supervisors as it consists of unappropriated reserves which would require agreement with the mayor to increase the fiscal year 20202021 budget by an equivalent amount. Further, we added the use of these reserves would reduce the amount available to address the risk in the proposed twoyear budget with 270 million depend end on the renegotiation of the labor contracts, 300 million dependent on the voters approving a ballot measure in november. And federal and state reimbursement of covid19 expenditures and continuing revenue impacts of the covid19 emergency. As you did state, our recommendation is for very small portions of each of these reserves, 500,000 of the Affordable Care act reserve would still leave 99 of the reserve intact. And 500,000 from the state and federal reserve, leaving 98. 75 in that reserve intact. Chair fewer any comments or questions from my colleagues . Any response from the general city Responsibility Department . No, just only to echo what was said that it does require agreement from the Mayors Office to decrease the size of the budget if you wish to do so. Chair fewer any comments or questions for us . I would just want to comment that, you know, at this time, you know, given the risk that weve been talking about and the need to hedge for reserves, you know, i cant agree at this time to grow the budget by using additional reserves. But im happy to have the conversation over the coming week with the mayor and you, chair fewer. Chair fewer okay, thats great. So why dont we first just accept the committee i mean, accept the b. L. A. Recommendation for this department and then next week lets talk in the meantime well talk with the budget director about skimming off a little bit of money, not a lot, so leaving it pretty much intact. Its a Million Dollars but a Million Dollars can go a long way in our budget. So we will table call this department back next week when we have deliberations. And i just wanted to put it out that we are looking at this money. Controllers office, accept the recommendations for this department. Thank you very much for joining us today. Next we have human resources. Good morning, chair fewer, and Committee Members. Happy chair fewer hi. How are you . Yes, thank you. So Mickey Callahan here, resources director. I wanted to thank you, chair fewer, for your kind words about the City Employees at the beginning of the hearing. Many of them have worked very hard to deploy the disaster workers and to provide Invaluable Services to the city right now. And i want to thank severn campbell and our budget analyst cody, and we are in agreement with the budget analyst recommendations. We have made reductions to the travel budget in line with your comments at the first meeting. And we have added attrition savings for delayed hiring and our Employment Services in our divisions. Chair fewer thank you very much. Any comments or questions . General agreement with this . So mr. Controller, please take note of the committees intention to accept the recommendations for this department. Thank you, miss callahan, for joining us. Thank you. Chair fewer and next mr. Librarian, how are you . Im wonderful, thank you, madam chair. Chair fewer yes. Good morning, supervisors. I want to begin by thanking sev severn campbell and the board analyst, mary, for working with us. The library is in full agreement with the board analysts recommendations. Thank you for all of your support and im more than happy to answer any questions that you may have. Chair fewer thank you very much, mr. Librarian, and thank you for your service. Chair fewer, if i may make a couple comments on the Public Library fund report. You all should have received an updated report a few minutes ago. There are no changes that the department is not aware of. We just theres one recommendation that missed the cutoff, so that is included in the updated report that was sent out. And theres only one i just want to highlight that recommendation that was not included in the original report but was intended to and its included in the updated is a policy recommendation. And its recommendation number 10 in the Public Library. And its a policy recommendation, its to reduce the work order with the Police Departments, between the library and the Police Department, by 75 in fiscal year 20202021. Due to the Public Librarys reduced need for security. The Public Library has a separate work order with the Sheriffs Office and the Library Staff noted that it meets the needs of the department. And since the budget year has begun, this would allow for the continued overtime billing until the interim budget expires. And we consider a policy matter for the board of supervisors, as it would result in savings to the library fund at the expense of the discretionary money from the general fund. This work order is prohibited as an overtime line item in this budget and a discretionary afford cost with the library baseline. And its for general fund if the board of supervisors accepts the recommendation number 4, in our Police Department report, which was issued last night. And its included as a policy recommendation in our report with the Police Department. And so that is a policy matter for a total savings indiscernible for that recommendation would be 196,850. Chair fewer okay. Colleagues, any comments or questions for mr. Librarian at all about this . So, yes, supervisor ronen . Supervisor ronen i noticed supervisor mandelmans name. Do you have questions . Chair fewer supervisor mandelman, there you are. Apologies. Superviso supervisor manded them addressed prior. Supervisor ronen so can you explain to us what the police do at the library and how many there are and where they are . And if you believe that theyre needed . And the same with sheriffs. Thank you for the question supervisor ronen. The work order with the San Francisco Police Department has evolved over time. Previously we relied on the San Francisco Police Department to supply a sergeant to oversee our salary benefitted Civil Servants, our buildings and ground patrol officers. We have moved away from that model. And we have our own safety and security manager position now that is part of the librarys management team. And it provides a more expansive role for Emergency Preparedness and all aspects of health and safety considerations for library operations. And then the remaining sfpd work order has allowed the 10b shifts, the overtime shifts, for sfpd officers to earn extra money and patrol the perimeter of the main library tha. There was also some enhanced security for the Eureka Branch valley library. We feel that we no longer need those services moving forward. Our buildings and grounds patrol officers are providing security for the main library and the branches. The Sheriffs Department work order is a Different Service for the library. We do feel that we need this continued partnership with the Sheriffs Department. As you know, the Sheriffs Department provides security for the entrances of all municipal buildings and the civil center, and we do have a work order agreement with the Sheriffs Department to provide that service in the atrium, the first floor of the main library. In addition, having the Sheriffs Department here on site at the main library, they help us with emergency response. And they are also an added security measure. The main library has the largest concentration of employees at any given time. And also, you know, precovid, 4,000, 5,000 visitors per day. So having the Sheriffs Department on site will provide us with support in the event of a catastrophe, like an active shooter event. So we do see a delineation between the sfpd work order and the sheriffs work order. And we we need that partnership with the Sheriffs Department to continue. Supervisor ronen okay. And then to dan, the additional recommendation im sorry, i didnt have a chance to look at the updated one so youre suggesting eliminating the entire work order for sfpd . Yes, so were eliminating the entire work order for the second budget year, the year 20212022. Supervisor ronen what is the first . And the first is because were already into the first year. So we our recommendation is for 75 to allow for the phase out of that work order. The board, you know, i dont know if the library has the current billings, there might be a delay, i dont know if they would have the updated numbers already. But we wanted to give a cushion for billings that might have already occurred in the current fiscal. Supervisor ronen can you speak to that, are we able to eliminate any additional anything that is left of that work order . I think that for all practical purposes that we are