Transcripts For SFGTV Health Commission 20240713

You have the directors report in front of you. I am going to highlight our covid19 coronavirus response. Dr. Aragon will have more details. I wanted to acknowledge the Department Staff who have been working for over eight weeks in terms of our preparedness and our response in terms of dealing with the coronavirus. Last tuesday i am pleased to announce that mayor breed declared a state of emergency in the city, which was transformative in our ability to better prepare for the response. It allowed us to activate the department to be more focused on the response, coordinate better with other city departments. This is a shared responsibility in terms of our response doing that. We were able to also be eligible for potential federal responses within an emergency response. We were also able to position ourselves to better educate the community and the public about how best to prepare for coronavirus and when coronavirus does arrive in San Francisco. A key part of our message is that everyone can be a Good Public Health hero in this response. That includes not going to work or school if you are sick. Stay at home or seek medical attention. Avoid coughing into your hand. Cough into your elbow or sneeze into our elbow. We recommend to not shake hands, but do an elbow bump instead. A key piece moving forward. And also a reminder to get a flu shot, and a flu shot does not prevent coronavirus infection, but it prevents symptoms similar to a coronavirus infection. Get a flu shot to prevent getting symptoms. And, very importantly, wash your hands or use Hand Sanitizer frequently, especially after being in contact, close contact, with others, touching your face and so forth. Regular hand soap for 20 seconds is one of the most effective Public Health strategies that we have as well as Hand Sanitizer. Hand sanitizer is available outside with the commission materials. We also need to focus on the outcomes. Our department is working with other Healthcare Systems and other departments to focus on the most vulnerable. According to the w. H. O. Those include people over 60 and Additional Data shows people with chronic medical conditions, especially diabetes, kidney or renal disease, people who have autoimmune disorders and are on medications. Were focusing on those populations. Im pleased to say as of yesterday San Francisco has started testing for coronavirus covid19. This is a big step forward for us because until now weve had to send tests to the c. D. C. That turnaround time can be as much as seven days. We are now, because of our Laboratory Leadership who worked very hard to scale up and to be ready for testing, we started yesterday and that turnaround time is now between one and two days. We do not have a newly diagnosed case of covid19 in San Francisco diagnosed at this time, but i just want to emphasize that given the situation that were seeing in terms of Community Transmission in our surrounding areas, i think its a matter of not if but when. When there is a case, the departments will report it as quickly as possible to both you and of course the public at large. I will also emphasize that as we continue our collective response in this epidemic, we need to ensure that were following the science. Part of that scientific literature is that stigma discrimination and xenophobia is very much bad for individuals, its bad for community, and its bad for Public Health. We are working with communities across the message to ensure that stigma, discrimination, and xenophobia will not be tolerated and we must address this disease together using the best Scientific Evidence as possible. As part of that effort, we are having numerous communications, meetings, and engagements. Those efforts are being coordinated with the department of emergency management, which is leading all the areas of the response that are not directly Public Health or clinically related. Thats my focus on the directors report today. I am happy to answer any questions on the report. With regard to covid19 response, i would ask dr. Aragon to address more details in his report, which is the next agenda item. Thank you. Commissioners, before we go on to dr. Aragon, you had received the report previous. Are there questions on the other areas of the report that he has given us today . Most of these are areas to which are matters of interest. The joint commission is at zuckerberg general. Were actually going through the full survey at this point. Let the commission know if you had not seen that point sent to you earlier. Likewise, on workforce violence at zuckerberg we did address that during our joint conference committee. The information here in the directors report is very substanti substantial. We are continuing to address this message in a very serious matter, also at the joint conference. Commissioners, if i may add, i meant to say we have Public Health leadership here for the specific agenda items today. I have excused many as the executive staff who would typical be here because they are working on the coronavirus covid19 response. I want to acknowledge that fact going forward, but per these agenda items, we have the leadership that needs to be here today. Thank you, director, for the update in where we are. I think we will now hear dr. Aragon, who will give us further information as to the status in the city regarding our response and what the science is today. This is item 4. Good afternoon. My name is dr. Tomas aragon. Things are moving at a fast pace. Im going to try to complement the things to dr. Colfax summarized. As he mentioned february 25 mayor breed declared a local emergency. I want to clarify that its called a local emergency versus a local health emergency. So local emergency is more encompasses and gives us broader powers and more authority to mobilize resources for the city. So thats really important to say. The other counties are asking us why we didnt declare a health emergency, and we said no, were declaring a local emergency which gives us more power and authority. On february 26 Solano County announced the first case of communityacquired coronavirus. As of today the chronicles are reporting we now have 12 communityacquired cases. Each day the number is picking up. If you imagine, if you have 12 cases, theres really an iceberg of people who are infected. We know that most people have mild illness. So that means that infection is circulating in the community. He also mentioned that on february 29 the first death was reported in Washington State. The number of deaths now in Washington State is up to nine, and six of those are connected to a longterm healthcare facility. So theres been a big pivot in the way that were now focusing on the epidemic. This week has really been a big transition week for us. So we have three highpriority areas that were really focused on. Dr. Grant had mentioned number one is focusing on the most vulnerable, medically fragile persons. We know with what were seeing is especially with people who are older and chronic medical conditions that we saw in those longterm care facilities, that the mortality rate is high. The second one is protecting our healthcare workers. Healthcare workers have a unique situation that their cumulative risk of infection is higher than the general public because theyre seeing lots of patients that could be infected and those are the ones we need to protect from becoming ill. The third is focusing on mitigating community spread. There the focus is on how do we interrupt transmission so we can reduce illness and severe disease, thereby reducing demands on our Healthcare System and also reducing the social and Economic Impacts of our community. As of this afternoon, the c. D. C. Is reporting a total of 60 cases across the country. The chronicle is reporting a total when you look at the whole area including travellers. And as well the community acquired, there is 12. The total number in the bay area is 29. San francisco continues to have zero cases at the moment. Santa clara county is up to 11 cases and berkeley just reported a case this afternoon. By focusing on the most vulnerable populations, were asking people who plan large events or Mass Gatherings to really think through about the most vulnerable populations, to really take that into planning and to consider how they can adjust. Just to let you know the Health Department did adjust project homeless connect. Were going to make sure when we bring it back that we address the issues so that people are safe. The c. D. C. As well as d. P. H. Just released our longterm facility guidelines so we have a real rigorous focus on protecting persons in longterm care facilities. Within that, we have the focus on condegree gat settings. Today dr. Baba met with the s. R. O. Committee to focus on what we can do around s. R. O. S where we have a high concentration of persons who are not just older but share facilities. Another major area were making progress reason is dr. Colfax and dr. Baba are working through the Hospital Council to identify and mobilize resources and figure out how the city will handle medical surge, but not just in the system, but if the systems get overwhelmed, do we end up designating specific hospitals to take over where care can be provided. As already mentioned, we have started our testing in San Francisco. I understand that the testing is going to be increasing dramatically at the national level. Unfortunately the c. D. C. Was very slow initially, but thats changing. Two more things i want to mention. Just this afternoon, the California Department of Public Health just got permission to release from the stockpile that they have, its in the millions, its a large number of n95 for healthcare workers. So thats really good news. So were going to have n95 res pirators for our healthcare workers in california. Thats important for us to recognize. The last thing i want to mention is for Community Mitigation which is interrupting transmission in the community, we think of personal measures. Dr. Colfax mentioned the personal measures because they are critical, its the foundation. The community measures, i mentioned the issue of how to think about Mass Gatherings and large events. The third area is environmental measures. Thats really cleaning and disinfecting our environment. And dr. Colfax referred me to olga miranda who is a union lead for the porters in San Francisco. And i believe its 5,000, a large number of porters that we have that clean all the buildings in San Francisco. So i mention this because they are really the they are part of the frontlines of fighting this epidemic and they need our support because theres a lot of issues around their working conditions that we can work on together to make it better for them. So i do want to mention that. I do want to thank dr. Colfax for referring me to her. Its an area where we would not notice it if it werent for the epidemic. They came to us. I think its a great opportunity for us to have a strong partnership. We dont see them. Theyre cleaning at night. They make a big difference in keeping us safe. I do want to acknowledge them and to thank dr. Colfax. Thats the end of my report. Thank you, dr. Aragon. Commissioners, questions of dr. Aragon. I think its important to acknowledge how hard the department has been working and the fact that much of our usual staff who was at the meetings to help answer some of our questions are not here because they are busy, as dr. Aragon described, doing all the different work that will be necessary in order to respond to whatever happens with this as we move through this Community Phase of the problem of the infecti infection. So i do want to express on behalf of the commission the gratitude for the very fine work that were doing, which is not only protecting our city, but also being able to address the anxieties of our City Residents as to what it is that this virus is all about and what needs to be done. I think the success so far of the information that you have put out is indicated by the fact that people are appropriately using the techniques. I notice that hand wash materials are actually very squares to find in scores. And even though it appears you cant really buy a mask out in the public areas for the fact that the city does not have everybody wearing a mask i think indicates that i think weve heard the message. Its important to have that if we believe that we have some sort of infection, but that very importantly that Health Workers need it because of the exposure that theyre going to get. I think your last information that Health Workers are going to be able to access this is very importa importa important. I believe that we want to once again express our thanks to the department and the mayor for actually getting ahead of this. Although, i guess it was in the hour that the government also declared with the c. D. C. That there was a real need on a nationtonation basis to be mobilized. We were there also to mobilize the city. Our timing was very good. I described it to a coworker. Were like riding a wave and were on the right part of the wave, not wiping out but just ahead of the curve. I feel confident in what were doing. Commissioners, some specific questions that you may have. Thank you, dr. Aragon, for your report. I want to add my thanks to commissioner chow for the swift action and the comprehensiveness of the work thats being done in riding the wave quite well. I had a question about the testing. The test kits, the c. D. C. Tests, are they state tests or what the current tests that were sent out came from right as of today, all the testing are c. D. C. Kits. So the state Health Department has them and then selected local Health Departments got some of them. We got just over the ability to test 100 people. That still is limited to people who meet the requirements for testing. The f. D. A. Just approved the ability for hospitals and private labs, as far as they can meet the full laboratory requirements, they can go ahead and start testing. I think over the next week or two youll see a lot more positive tests. Can i also state and reinforce the fact that current testing recommendations are to test people who are at highest risk for coronavirus infection. Theres no ondemand testing in San Francisco. Im not aware that theres anywhere at this time, but just to emphasize that. The test has to be if people are correspond, they need to discuss this with their healthcare provider, who will contact the healthcare department, and they will make an assessment with the c. D. C. Guidelines whether a test will be done. Thats correct. Thank you as well. My question is of all the cases reported in the United States, are any of them children and adolescents . None are children that im aware of in the United States right now. I know from china the number of children involved is really, really small, very small. Thank you. Commissioner green. Thank you so much. I was wondering if you could elaborate on how youre interacting with Hospital Councils. I work in the sudder system and most of what were getting is from sudder corporate. So many of our hospitals are getting things systemwide. Im going to refer to dr. Colfax because thats an area hes spending time with. If you could elaborate with, that would be great. Using the Hospital Council, we have brought together the Healthcare Systems to have shared conversations to make sure we have the best understanding of how we are preparing together, focusing on the same priorities and the same populations and also ensuring that we are potentially being able to share resources, particularly with regard to the medical staffing and staffing up in the event we need more capacity to respond to an epidemic. So lots of planning going on on an ongoing basis with regular and structured calls, on a regular basis to ensure that point people are identified, leadership is activated, and that were moving forward as consistently and as rapidly as possible. Thank you. I did want to thank dr. Aragon also for responding to my question last time in regards to the s. R. O. S and that the d. E. M. Is working with them in order to be able to help respond to another vulnerable area which i think especially in this city is very pertinent. Commissioner, if i may add something else. The most uptodate information on coronavirus and local guidance, sfdph. Org and then the c. D. C. Website also has uptodate information. Given there are multiple sources of information, some are more reliable than others. I want to encourage the public to go to sfdph. Org for the most uptodate information. Thank you very much. Thats information, then, dr. Colfax, that will be for laypeople also or for yes. Okay. In multiple languages for San Francisco. Okay. And that would be through the departments website . Yes. Okay. Very good. Okay. Any further questions . If not, once again the commission is very appreciative of all the hard work that youre all doing and we look forward to the report coming up well, we dont look forward to it, but we will then be receiving your report at our next meeting again. Thank you. Clerk commissioners, item 5 is general Public Comment and i have not received any requests for that. General Public Comment would be on a topic that is not listed on the agenda as an item. Still none. We can move down to item 6 which is report back for the finance and Planning Committee. The finance and Planning Committee met earlier today. We had a couple of items that have added to the consent calendars for our approval. The first is the contract report and there are three contracts in that report. One is San Francisco Public Health foundation and that is for in a contract came back to us for amendment because there were more sundays added through the text. So they have to adjust the contract figures. The second one is the San Francisco aids foundation. Due to the supervisors at that, they also have some additional fundings that they need to amend into the existing contract. The third one is the Mission Neighborhood health center. This is actually a renewal contract. So the last contract ended in december 31, 2019, and this one this contract is for the period between january 1, 2020, to june 30, 2023. We also have a new contract with talemed and it is to provide nurse registry personnel to San Francisco health network, zuckerberg hospital, and laguna honda. This is the contract that we are approving for, just to make sure we do not get short staffed at any point in time. In addition to that, we have two discussion items. These items actually also would come to the Commission Later on today and the programs themselves would the contract would be coming back to the finance and Planning Committee meetings. These two contracts are first theres the hummingbird respite in 1156 valencia. The other one is the project 180 which is the methamphetamine Sobering Center on 180 jones street. We have received a lot of Public Comments for both items. For the hummingbird respite, we get fairly positive support in the feedback that they really support the program. Hopefully, this will help to alleviate some of the highcost services that folks needed, such as going to the p. S. Or other emergency services. Instead, they would have this detox respite that they could go to. The other is the project 180, which is a methamphetamine Sobering Center. It has 15 beds. It is going to utilize one of the citys property which is currently a parking lot to set up a tent for these 15 beds. It is scheduled to go for a year. After that, that space would be used for Affordable Housing development. We have a lot of Public Comment from both sides. Some supports and some concerns about the process, but in general from what we gathered earlier is that nobody is opposing this kind of program from being implemented. You know, the concern is more about the timing and the process of it. Im pretty sure that some of these members of the public would come back and speak on that later on our agenda as well. Thank you. Are there any questions . I think well take questions on the contracts, questions on the other two parts of the committee hearing. Well actually defer to our own hearing because we will be hearing those two subjects here at the Health Commission very shortly. My apologies, i should add a little bit is that we didnt have to approve any of those contracts because we have rescheduled them to come back to the finance and Planning Committee on march 17. That way, we could also meet the actual requirement for posting it and for the Public Notice and which needs to be 30 days. Right. So to get into those items, well discuss what the process in and what well be doing in terms of taking up the two subjects and action on them. So i would accept questions on this point to commissioner chung regarding the consent calendar if there are any questions i should say in regards to the report and then well move on to the consent calendar. If theres no questions on the report, well move on to item 7. Clerk item 7 is the consent calendar. The consent calendar is before you. Are there any extractions . Seeing none, well adopt that and move on to the next item. Clerk item 8 is the proposed Program Review of 1156 valencia hummingbird respite, a Respite Program to be located at 1156 valencia street. This is a discussion item. Yes, once again, as we take up these two items, both items will be for discussion for the public to put their input in. The commission then will request the department in certain follow up if any occurs from the testimony. And then the final action on these two items will be taken at our next Health Commission meeting. So well proceed with the presentation on item number 8 now, please. Arrow up because i think its at the end. Good afternoon, commissioners. My name is Kelly Hiramoto and im the special projects director for the department of Public Health here to talk to you and give you a brief overview of the proposed hummingbird respite at 1156 valencia street. So identifying the need for a hummingbird that is in the neighborhood, we know that many people in the neighborhood know the people we aim to serve and the need to support them locally. We know many of them as well. We want to create a safe place for them to rest and consider their options. Its also important to note that the neighboring district 9 has 661 people at the january 2019 point in time count. There are 317 people experiencing homelessness in district 8 according to the same point in time count. A known group of atrisk individuals are in the mission upper market and delores park corridor and they could be served by having a place closer. We know clients are more likely to seek out shelter from a nearby location with welcoming staff and activities that will keep them positively engaged. Were aiming to serve praerls Homeless Individuals who are not engaging care. Our goal is to have recovery programs to maximize each individuals capacity and quality of life. Why 1156 valencia . As you know, San Francisco real estate can be challenging, so we were fortunate to find this building in an area where the need for services is great. Just as we were looking for a new location to expand the successful hummingbird place mod model, we were looking for an innovative way to serve people experiencing homelessness in San Francisco. Its also important to note that Salvation Army is making this an affordable site for the city. It is the right size to serve a population in the hummingbird model. It has the right features, existing bathrooms, Large Community spaces, ability to support laundry and meals. It is close to delores park and corridors where the need is great. The project itself is going to operate 24 7, 365 days a year. It will have 30 beds for overnight stays and up to 25 dropin daily participants. We dont just mean people who will just drop in. At our current site about 70 of the population are people who have stayed at the program before and are coming back but just to stay for the day. A lot of folks come and stay during the daytime and rest during the day so they can stay up at night because they feel at risk in the community. Low barrier means were always open, you dont need an appointment, you can bring your partner, your pet, your belongings. Inside, you will find trained, compassionate staff, access to activities and also Substance Use treatment. If people are not able to get to our center, people will come to the site to do the paperwork and intake. We will offer individual and group counseling, laundry facilities, meals, connect to healthcare, link to social services, help sign people up for Services Like s. F. I. , and help escorting people to their families when needed. Weve talked about the kinds of people we hope to serve at 1156 valencia and now we are going to talk about what it would be for the neighbors. First, we encourage people to engage so the people in need are not vulnerable. Neighbors would notice 24 7 security on site with staff escorting clients when they come and go. The captain from the San Francisco Police Department mission station is committed to partnering with p. R. C. Baker with the onsite security. Anyone experiencing homelessness in the vicinity is not in need of this type of support but needs housing. D. P. H. Is exploring a partnership with the department of homelessness and Supportive Housing to help the community. D. P. H. Convened two Community Meetings about this proposal about you today. We held a Community Meeting on february 10 and we had a followup one on the 17th. Neighbors will be provided a phone number to report any issues 24 7. A Community Meeting will be convened six months after opening. We are having conversations with the neighbors and the community. It may be that well hold further Community Members if thats necessary as we launch. We targeted for six months because we want to give the program time to get off the ground and have some structure to it before we have conversations with the community. The program will work with the community to provide referral to services. These referrals will come from Many Services in the area. The goal is for the majority of referrals to come into the program to be from a known source so were able to have escorts in and out. The good news is that we do have treatment to offer clients who are ready for it. Clients who participate in this program get expedited access to these providers. Because Mental Health Treatment Programs are also offered, it is a straightforward way of fast true and accurating folks into those programs. We also partner with the crisis service. Salvation army also as a Substance Use social Detox Program and residential Treatment Program. Well be having tight relationships with them. We also have relationships with Additional Community treatment providers such as Friendship House or mission council. Well continue to make sure we have warm handoffs. Those referrals can go in both directions. It may be somebody is having a tough time in the Treatment Program. Rather than having those individuals discharged into the community, they can come to the hummingbird site to have a moment to think about it. We have included some data from our current existing hummingbird place. Our average length of stay for the fiscal year of 201819, our shortest stay was less than a day. Our longest stay was an individual with us for 220 days p. Right now our average length of stay is around 17 days. Thank you new site, Tipping Point community is funding because theyve studied the model and recognized the need for more Services Like it. We also collect data about the d. P. H. Programs. Here is Additional Data about the program that launched in august of 2017. Our efficacy is measured in a few ways. For clients not really for treatment, willingness to keep returning. For those who come in, success is going to the program. And for those who leave, having 30 days or longer without a return to p. D. H. At our first hummingbird site, many of the clients did not return after a departure from the site. In our last fiscal year we increased the number that exited residential treatment to 34. Were Getting Better able to understand the population that were serving. To give you an example of some of the clients weve served, t. M. Had a long history of homelessness, alcoholism, and other issues. He was using a wheelchair. He used the Emergency Department so frequently that the Emergency Department Case Management team stepped in to help. At hummingbird, he was able to maintain sobriety and get regular follow up and emotional support. He continued with his medical care and with time no longer needed the wheelchair and was able to graduate to use a cane. He continues to remain sober. Here is another example. He completed a 90day program, and moved to his own place where he continues to do well. These are good examples that we do have success and how were engaging clients and moving them into a Higher Quality of care. I wanted to take a minute to allow p. R. C. To talk about their program, what their history is, why were partnering with them to do this program. Here is the c. E. O. Thank you, kelly. Commissioners, good afternoon, director. I quickly ran home to walk my dog max and found out that joe biden won virginia. I have no dog in this race, but thought i would report that. Its a busy day in the United States. I am Brett Andrews and i am the c. O. Of p. R. C. This was formerly positive Resource Center. In 2017 we merged positive Resource Center and baker places, a center that you all have been supporting since 1964. I think this is all teed up. I just put on the screen our executive leadership to include myself and a chief operating officer, finance, clinical, programs, strategy, and our information officer. I have joe here who is our c. O. O. In the back and our director of Property Management Jeremiah Gregory who is here as well. P. R. C. Has been around since 1964 as a combined entity with baker places since 1964. Our mission is to help people affected by h. I. V. And aids, Substance Use and Mental Health issues to better realize opportunities by providing better integrated legal, social services that address the broad range of social factors that limit wellness and affect potential. We stand on our values of diversity, inclusion, and respect, to name a few. I think ive skipped ahead a little bit. Our headquarters are on 179 street. We just had the opportunity to merge the three organizations and of the 270 staff that we have, almost 100 of them are at 179 street between mission and howard. That was formerly the operas Costume House that we were able to take advantage of. Were glad to provide Legal Services there, workforce development, housing Case Management, emergency financial assistance, and peertopeer counseling. Our staff is a total of 270 and we have a budget of about 31 million. In addition to our hummingbird facility that we have on pretrero, we have another facility across the city of 100 beds of residential Treatment Programs and 114 beds of transitional and permanent Supportive Housing. This all speaks to a continuum of care and i know youre going to be later talking about 180 jones street. As we think about lowbarrier services, allowing people to step into services where they are in a Harm Reduction model with a level of dignity and often in a homelike environment, this is San Franciscos innovative way of introducing hummingbird as a Behavioral Health respite and allows people for many times, for the first time, to think about what is the next best right step for them. In a lot of cases people are going to go from the Sobering Center to hummingbird and stabilize them and into treatment and care and living a life of wellness and recovery, something that San Francisco as a value has been standing on for years. Kelly talked a lot about 1156 valencia. I heard a lot about the process. I understand its important to get feedback in the community process. We want to hear from the community while we are moving forward with this hummingbird and potentially if there are other hummingbirds. I will say as person who had a has been in the work for 17 years, i have seen those in the streets and watched our clientele become sicker, older, and darker. There will be a spot of individuals who we will never be able to save if we dont do anything. I would like to thank the commission for taking big and bold steps in this. With that, im happy to answer any questions you have. [ indiscernible ] public speakers, which we will call before we go on to questions. Actually, commissioner, if i may. For those of you new to the commission, my name is mark, the Health Commissioner secretary. I have a timer and everyone will get two minutes to speak. When the buzzer goes off, please stop and let the next person speak. Many of you are passionate about the topic. If you would like to say the same thing, use your hands like this so we can keep the flow going. There are six people who have asked to speak on this item, so i will call each of the names. You dont have to be in this order, but be prepared to come forward. Come forward into the aisle and take the next spot after the previous speaker. Each speaker has two minutes. Hi, commissioners, director. I am the policy director at Compass Family Services and were a member of the treatment on demand coalition. I just want to speak in favor of this proposal. I think we need projects like this and so many more like them in order to offer people, as brett was saying, the lowbarrier dignified care they need to access recovery and maintain their own wellness over time. Its tough to go first because im not really responding to other perspectives, but as a family provider i want to say we shouldnt underestimate what it means for families to provide these spaces for people to be. Its extremely important for our families and our children that we move people inside in a dignified way that gives them safe spaces to be. And i think this project, like other projects, theres certain other refrains that we hear in the community in opposition to the project. While i acknowledge that those arguments are out there, i think the argument is always that we want this but not here, if that is the argument, were never going to bring the projects online with the frequency to mitigate the cases of homelessness and Substance Abuse that were seeing in San Francisco. We need to also assess the goals that are laid out. With that said, we support the project and thank you for your time. Thank you next speaker, plea please. My name is anthony crosco and i work with marykate over at compass services. Im not sure if you all have siblings, but i think its similar how siblings can look similar or different. I have a very big family, about seven folks in my family. One of my older brothers named donnie, hes about 6 foot5 and he has curly hair and he looks just like johnny depp and you couldnt tell them apart or he looked like him. I havent seen him in 12 years. During the time in which my family navigated the obstacles of homelessness, my brother developed a drug addiction and was incarcerated and hes been incarcerated ever since. I would not wish on any of you or anyone you care about the pain of losing a sibling. I cant tell you with scientific certainty that a program like hummingbird would have made it so that my brother wasnt taken away from me, but i can tell you with scientific certainty that with programs like hummingbird families can Stay Together and siblings wont have to grow up without their parents and without each other. That is something that is true. So i appreciate and im very, very grateful for all of your commitment to programs like hummingbird. Im grateful to the mayor for her support of programs like hummingbird. I can just tell you that i hope that this project finds great success. Thank you. Next speaker, please. Good afternoon, commissioners. Im sara short. I live at 1042 valencia. So its just the adjacent block to the proposed site at 1156. As a neighbor, i just wanted to express my genuine support for the project. I see these folks in my neighborhood. I know some of them. Ive become familiar with their stories. I also to some extent see them day after day for month after month. So im really familiar with how important this resource is so that rather than many childrens and families in my neighborhood like any other, rather than have those children see suffering on the streets and see a city that doesnt care about people in crisis, i would like the children of my community to experience the knowledge that theres a facility where theres care and healing and treatment being provided to those folks. So im really excited about this facility and i know that this wont be the only one. Thats the other thing that im happy about is our neighborhood being a leader, that if its successful, hopefully we can replicate it. We already know its been successful because weve had a model over at general. To do it in the community now is the logical next step. I just want to say that as a resident, ive heard a lot of my neighbors express fear and concerns and such and say we really, really support this project, but not right here and now. Im saying, yes here and now. Please, thank you. Thank you. Welcome former commissioner guy. Thank you, current, daily, president chow facilitating the meeting today. Commissioners and staff, including our director. Today i just want to im smiling because i didnt come to complain, which is what you usually anticipate, so relax. Even though we have this virus that we know is coming. So i want to really support the lessons that weve learned as a community from the first Navigation Center that was opened in the mission at 16th street. I just want to give credit to the staff leadership over the years. Thank you. And also, the second point is part of the success of this is that the silos began collaborating. So you have housing, the department of Public Health, you have the community, even when we brought our criticisms. So this Community Collaboration is part of the achievement, including the financing and people who run for office now. That was not true four years ago. Also, thank you especially for linking homelessness and incarceration because this is the first time that weve begun to do this. I just really want to thank you that all the Navigation Centers are open to people where theyre at, having them come back to the Navigation Center rather than being recycled at p. B. S. And the jail. Thank you for this success and also thank you for showing that the Navigation Centers and others will not be afraid of the public, that we come to you and organize regular Community Meetings for feedback and learning more lessons. Thank you. Thank you. Hello, im lidia branston and im coming to talk to you of a child that goes to school two blocks of the proposed hummingbird site. Im wearing a hummingbird in support of the site. Im here also with the support of my child. She has grown up understanding that people all deserve respect, that theyre inherently dignified, and sometimes as a society we need to give them that respect to remind them of their inherent dignity and their right to have a dignified life. One of my kids friends parents said, watch out, here comes a tomato and they were having an episode that was involved with drugs. My daughter was horrified and she said, you should talk to their mom. When does a person become a tomato . The dehumanizing aspect of stigma of people who are struggling with Mental Health and programs like hummingbird, like the 180 project, show our children that we have a society that actually cares for all people and that all people deserve respect and treatment. Thank you. Thank you. I think i had one more also, lauren khan. Hi. Thank you so much for the opportunity to be here. Lauren khan representing health 360 and also myself as a citizen of San Francisco. I just want to say the need for expansion of the Hummingbird Program and more programming like this could not be more acute in San Francisco right now. So really appreciate the work that many have done to advance this and to want to encourage the commission to do everyone in its power to move this forward. Thank you. I think that ends public testimony unless somebody has not turned in a slip. Yes, please. Thank you for doing updates. Bernie sanders won vermont. Im amy wise, the founder and director of the San Francisco homelessness challenge. Our focus 2015 is to end the crisis conditions of street homelessness through essential needs activism and also creating safe, organized spaces of stewardship, belonging, shared agreements, cultural enrichment, and participatory management. Ah, that sounds good, right . One thing i want to mention to you, i support this project. I live im currently housing unstable, but one of the places that i stay at sometimes is just two blocks away. As a neighbor, i say, yes to in my backyard. One thing that our organization has been pointing out for a long time is that we need safe exits from the Navigation Center. Originally what was the beauty of the Navigation Center, one part of it in addition to partners, pets, and possessions was that people got to stay there until they got housing. And i understand theres been different policy changes, but ive seen the impacts of peoples lives and having to get evicted for 30, 60, or 90 days. When youre talking about this, please think about a safe exits program. Guess what, i have a solution. We dont have enough beds inside buildings. We dont have enough beds and shelters, but we can create safe, organized spaces on land that is underutilized right now. Think about that, safe exits, so were making sure that people arent returning to the streets. S. F. Public press just did a report on the amount of people that go through the healthy streets operation and go through a na. V. Center and go back to the streets. Thank you very much is there any other Public Comment . Seeing none, though, before we go to the commissioners, i would ask director colfax to make some comments. Again, i would add to your comment, director chow, that this is an ongoing expansion of our behavioral work. This is another step in lowbarrier opportunities for people and this is really in the larger picture the efforts of what mayor breed has said with Mental Health reform and Mental Health s. F. This is another key step going forward. As we continue to invest in Mental Health s. F. Efforts, what i would like to communicate to the commission and the members of the public is that this would be one step forward, but over time this would be one of many of those types of opportunities for people who have Mental Health disorders to get the care and support. And then the exit strategies that support them and the community to do better. Thank you. Commissioners, questions to any of our presenters or to dr. Colfax . The presentations have been so outstanding that i have not actually remembered when the commission didnt think that they actually wanted to question it. I will take that then as an intent for us to then close discussion on this particular item, reminding the public that we will be taking this item up again for final discussion and action on march what is it . The commission will vote on the contract for this program on march 17. On march 17, okay. Commissioner chow, if i may. Kelly, one of our key staff who has led the hummingbird concept, i want to acknowledge her leadership in this work. This is hard work to do and she mobilizes us enables us to get her. I want to acknowledge her here today. She has been doing a lot of work for a lot of years. This must be one shes feeling satisfied about in terms of being part of the exit. Shall we move on, commissioners . Yes, please, shall we go on to the next item. Item 9 is the proposed Program Review project 180, a new drug Sobering Center to be located at 180 jones street, San Francisco. This is a discussion item. The contract will be forked at the march 17 meeting. Dr. Martin. Good afternoon, commissioners. Some of you are going to feel like its groundhog day. So my name is judy martin and im the medical director for seven Seas Services for the city and county. Im going to be presenting some slides for project 180 along with my colleague from health 360. First i would like to call another colleague dr. Anton nigusse bland who has had a lot to do with this project. Thank you, dr. Martin, and thank you, commissioners, for the opportunity to present this information and our proposal for a drug Sobering Center in the tenderloin. The drug Sobering Center was the foremost recommendation and it was cochaired by leaders from the department of Public Health. Over six months this group of individuals, including healthcare providers, policymakers, safety officials, members of the judiciary, as well as most importantly members of our community who have lived with the experience of methamphetamine use, committed to inquiry and develop recommendations for how our city can best move forward in response to the growing methamphetamine epidemic. Today im pleased to join with our team members in presenting this proposal. Over the past several weeks, ive had the opportunity to listen attentively to concerned Community Members and directly driveways their concerns about the drug Sobering Center. What i hear mostly in these conversations is trauma. I want to acknowledge and spaes for the experiences of inequity and i also want to acknowledge as your Health Systems attempt to improve, we must allow for our experiences of inequity. What we cannot do in the face of inequity and in the face of rising deaths and other harms linked to methamphetamine use, which disproportionately affects people experiencing homelessness, what we cannot do is wait. The mayor made it an urgent priority for city agencies to work collaboratively and partner to create the first drug Sobering Center. Our aim for this program is to increase safety for the Tenderloin Community and the many children who live there. As the department of Public Health previously did when placi placi placing syringe boxes, we will continue to request the advice and insight from concerned Community Members and incorporate their feedback into our programming. Our hope is that as we continue to build relationships in the Tenderloin Community, the community will feel a difference, continue to thrive, and people will receive the care that they need with dignity and respect. With that, ill turn it over to dr. Judy martin and kathleen stokes. I wanted to start by saying this is noticed under chapter 79 a of the code. If commissioners have questions, my colleague is here to help answer questions. The drug Sobering Center is a recommendation of the Methamphetamine Task force and the other 16 recommendations are in your packets. This one was the number one recommendation. In october when these recommendations were presented, mayor breed said the city would implement the top recommendation and then in february announced that a proposed opening of a drug Sobering Center at 180 jones street. The Methamphetamine Task force was informed by focus groups that included people with lived experience using methamphetamine and experiencing homelessness. It included residents and merchants from various neighborhoods and included healthcare providers. Between april and september 2017, the task force convened four public meetings, studied best practices, compared our situation to other countries and state states, and weighed Public Comment at those meetings. The two words that they used in this initial recommendation that we used is trauma informed and Harm Reduction. I just wanted to point out that trauma informed means that our care for people takes into account all kinds of previous trauma, current trauma, et cetera. The approach which is to care for physical, psychological, and emotional safety for clients also includes the same for providers and neighbors. Harm reduction is something that San Francisco has led and has been a shining example for many years. Its been our policy, weve had a Harm Reduction policy for 15 years or so. The Harm Reduction services help to mitigate the dangerous effects of drugs and alcohol use and is not predicated on coming into treatment. So syringe access is a good example of this. Were good at opiates doing Harm Reduction. I wanted to point out in 2018 there were over 1,800 bystander reversals. So the community is very well aware of these efforts and sophisticated about protecting each other. So this geo map, sometimes called a heat map, represents some of the challenges of the tenderloin neighborhood. The darker the blue, the higher the over dodose rate. You can see that the darkest of all is in the area where this Sobering Center is being placed. We also wanted to mention that the Homeless Count in 2019, the single day count would look fairly similar with 3,659 people experiencing homelessness counted in district 6, which is 10 times more than the neighboring counties. I mean that in district 6. So the effects of methamphetamine are a challenge for the neighborhood and for the people who use methamphetamine and for this system. The hospitalizations have increased dramatically since 20 2013. Psych emergency visits have many of them are related to methamphetamine use, including people walking in for help to psych emergency. Were hoping to help some of those people at the Sobering Center. Also there are also a lot of arrests related to methamphetamine, and 55 of those occurred in tenderloin and south of market. So this project is meant to provide an alternative to being arrested or going to the emergency services. And a more appropriate response. So a drug Sobering Center, the word Sobering Center comes from the alcohol ones, like the ones we have in the city thats been successful for many years. Some of the learnings we got from that program we used in designing this one. Drug Sobering Center is focusing on other drugs, most importantly methamphetamine. Its a place where people experiencing homelessness and who use drugs in the street in the open can come in and their needs be addressed by professional staff who also are caring and trained in traumainformed systems. The monitoring for health and safety is especially important to notice. So part of the triage and evaluation is the risk for overdose. So people at higher risk would be monitored more frequently than those who may be at lower risk. The Sobering Center includes needs for people who are stimulated and want to walk around and do things and also for people who are crashing and need to rest and sometimes stay overnight. So the site selection, one of the things i mentioned earlier is the tenderloin in general, but this particular site, part of the reason for selecting a site that was immediately available to the city and owned by the city is the urgency of this issue. The location at jones and turk was also good. It was sited for Affordable Housing starting in the fall of 2021. That makes this a temporary project. Were looking at it as a pilot that will further inform the development of other Sobering Centers in the city. One of the commissioners was asking what we will be looking at and how that will inform. Were immediately looking at how does it flow. Where do people come from, how many people come back twice. How are the warm handoffs in the community, which is one of the most interesting parts of this project that i think is brilliant and is going to work well is to meet people in the community and walk them back, how much that works. Whether the screening or triage process works. Can people stay, are we picking the right people to be there or should some people be in the hospital. Were looking at that. Depending on the results of the pilot program, we might tweak some of the other proposals and even this one. Were hoping that this one will continue in a more permanent site in the tenderloin neighborhood. Its meant to be embedded in the tenderloin and working in other tenderloin agencies that serve peop people. So people will not be bused in from other parts of the city. Theyre already in the tenderloin. Many of them we expect to come from referral partners that serve the neighborhood programs in the area. One of the commissioners asked too what other programs are in the area. So we attempted to make a list, an initial list. St. Anthoninys hospitality house, boys and girls club, glubio project, drug users union, larkin street, antonio manner, compass, guide. Lots of programs can use this. Curry Seniors Center is another place and might be using this if someone is compensating. The calls will come from the tenderloin area. Were not screening people at intake like saying, where did you come from, whats your address . Were more trying to get referrals that only come from the area. Health 360 is probably going to speak about that more. Where do people go . Well, we have other programs that address clients experiencing homelessness. 90 of the residential treatment clients are experiencing homelessness. Many of those use methamphetamine. One obvious potential warm handoff on referral would be a residential Treatment Program. We now have finetreatmentsf. Org that lets people know daytoday the open bed count of these programs. So well probably use that as well in referral. We wanted to say, though, that were supporting people, regardless of whether they choose a Treatment Program or not or just Harm Reduction services. We want to recognize that even coming to that site is already a commitment to health and the beginning of a relationship. So we are committed to Community Engagement and well be active with Community Partners in the tenderloin. We recognize that the community wanted to be involved before the announcement of this proposal in february, and we apologize for not gathering their input sooner. Were committed to repairing those communities and rebuilding them in the future. What we found is most people approve of the service and see the need for it. So were hoping to work with other issues that people are raising about the location. So im going to turn this over to my colleague kathleen silk to talk about health 360 and how they see the program. Good afternoon, commissioners. Thank you for having me again this afternoon. My name is kathleen silk. Im a licensed marriage and family therapist. I specialize in Substance Use disorder and trauma treatment. Im also currently the managing director of Behavioral Health services at health right 360 in San Francisco, overseeing 200 staff over a dozen Behavioral Health programs in San Francisco, which include outpatient recovery services, detoxification, as well as transitional housing and criminal justice programs. Im also a native of San Francisco and live in the civic center area. Health right 360 is one of the Substance Use Disorder Treatment centers. The agency is the result of a merger of two San Francisco nonprofits organizations waldon house and ashbury program. We currently provide an array of services here in San Francisco aimed at integrated wholeperson care. Those include street outreach, primary health and dental care, and social supports. Underlying all of our work is the belief that everyone has a right to access healthcare. The way we practice that value is by Offering Services that are nonjudgmental and affordable. We serve people who are uninsured, experience homelessness, and are socioeconomically disenfranchised. We love the people that we serve and we love the work that we do. Were deeply concerned about the increasing dangers and harms for those experiencing homelessness in San Francisco, particularly the growing risk of overdose and death. I will describe some of the major features of the proposed program we hope to open. As was mentioned, the top recommendation from the Methamphetamine Task force was to open a traumainformed drug Sobering Center. This is a Neighborhood Pilot Program focused on serving people in the tenderloin who are intoxicated by methamphetamines and other drugs. All stays are voluntary. The program would be built on the principles of Harm Reduction and care. As a result of the Harm Reduction approach, we acknowledge that harms caused by Substance Use can be numerous and Impact Communities in vastly different ways. In this proposed program, we would meet participants where they are motivated to engage. Some people may stay for only a couple of hours, while others will be invited to stay overnight. Some may only accept a few resources on their first visit, but we want to create a space where they will feel comfortable returning. We would have staff at this program 24 7, included registered nurses, Health Workers, supervisors, van drivers, and safety monitors. We understand that the harms of Substance Use are not just ones that impact individuals, but whole communities. Our goal is to be a positive influence on that corner. One way we will do that is with staff encouraging a sebs of stewardship for the area as an extension of our program. The program is based on a few key elements listed here. As i mentioned, we believe in treating people without judgment and with compassion. We care deeply about people who use drugs seeking our services and we want to minimize barriers to engaging in our program. The services would include self referrals, community organizations, the department of Public Health, the Street Outreach Team and street medicine. Our warm handoff process was referenced that were working with the tenderloin substation to facilitate, which would include our van or outreach workers walking or picking people up in the community. This will be particularly important, as there is no 24hour service in the neighborhood and this is something that we know that an overnight shift of Police Officers would be able to utilize. We will have registered nurses on staff aroundtheclock to provide medical assessments and refer out as necessary. They can provide first aid, educate people on their medications, and assist in linkages to healthcare providers. The layout of the program would be at the lot of 180 jones. Its enclosed by a perimeter fence and would be with a large te tent. We want to be able to use this temporary space while looking for an alternative space in the neighborhood for this project. While we have this chance, we are working with the department of public works to have a weatherproof, as durable as possible on this timeline tent and make the most of the space. So that includes outdoor spaces for walking and pacing, a pet area, as well as baths and a shower. People can present with various features. Were hoping to create a space that can provide flexible accommodations for people in those states and help people feel better. We will provide an offer to rest, be active, as well as places for medical assessments. Underlying all of our services is the prioritization of safety of our participants, our staff, and the surrounding area. Health right 360 has 50 years of experience running 24hour facilities. We have learned a lot of lessons on running facilities where participants have traumatic histories. We account for traumatic experiences in peoples backgrounds. We make an assumption that people react from a place of vulnerability and fear and need a safe space. We hope there will be a sense of calm and familiarity. These principles are also underlying our staff training which include nonviolent communication, restorative justice. We also want to be responsive to the community that we serve, given that we are aiming to serve those in our community who need help. Our safety monitors may become the most visible in our neighborhood, as we hope to have them work in the areas surrounding the program. Partnerships are very key in the development of this program and its success. We recognize that building a strong evidencebased Community Engagement component is also essential. Health right 360 is going to partner with the ucsf center on a formal evaluation of the impact of this project and the engagement of the community in the tenderloin. The goal is to learn lessons and what we need to improve upon. We have begun the process preliminarily in engaging some community stakeholders, including people who work in the t. O. , use drugs, and other participants. We would also like to create ways for immediate and Community Feedback partners. Many of the partnerships will be Major Players into the referrals for the program. The program will be for providing transportation on leaving 180. We also plan to partner with many amazing organizations to create more linkages to refer back and forth and to coordinate with the services we offer. We have also received honest and generous feedback from many partners about specific considerations for that corner. This includes concerns that this program would be a negative presence in the area. Our hope is to be a positive presence with 24hour staff on hand. One consideration we would want to follow up on would be the ins and outs of safe passage and school sometimes. Another partnership we hope to build on is with the community of people who use drugs in the tenderloin. This program should have the voices and expertise of people who would use the services built in the structures and practices. We plan to formally engage in that process if this Program Moves forward by creating Community Feedback forums and other mechanisms. Ultimately this program is for them and we hope they would be able to guide its success. Thank you for nowing me to describe this program and please let me know if you have any questions. We have a number of speakers. I will call out five at a time. Hello, i live around the corner from the site. I am here on behalf of myself and many of my neighbors. We oppose the application. The families and children living and going to school nearby are already facing persistent Traumatic Stress and by diminishing their voices and concerns, you are continuing to oppress an alreadyoppressed population. The city has done a horrific job of disseminating information. When i spoke to an administrator at city academy, it was the first the administrator had heard of the site. The disregard and disrespect shown for residents in the tenderloin is infuriating. We have been given no concrete answer where this will go. Only the potential options. 6. 8 million is an outrageous amount of money for a 15month tent and that doesnt even meet the recommendations of the Methamphetamine Task force. Two of the recommendations were that it should be a calm environment. This is a 15bed tent on a loud corner surrounded by openair drug dealing. There has been littletono transparency regarding the budget or the position selection. I would like to request we are given a Second Public meeting in a room large enough to fit everyone with translation. The first meeting wasnt large enough to fit everyone and didnt have a spanish translator. Thank you for your time. Good afternoon, commissioners. My name is joseph inervera. I am representing local 2. Our home for 13,000 members has been at the corner of golden gate avenue and living worth for 42 years. My family and i also live in the tenderloin since 1990. A block away from the proposed site of the methamphetamine Sobering Center. Local 2 strongly urges you to postpone any vote on the 180 jones facility until concerns regarding the proposed sites are addressed. More details regarding our concerns are contained in the letters you received from us. We are not opposed to this type of facility in our neighborhood, but you must work in partnership with the community to make it happen in the right way. Thank you. Thank you. Next speaker, please. Thank you, commissioner. Rose mcguy. Were a member of treatment on demand also, part of this whole process. I just really want to add the major criticisms. You know, we can work with health right 360 to better the program, to make it unique to the program, et cetera. Thats not the problem here. The problem is that, again, the department did not bring the community in to design and have a discussion about what would be appropriate in this alreadytraumatized community. In the previous discussion about the Navigation Center at valencia, weve learned that youve got to take people where theyre at and build on it and problem solve. That didnt happen. It just didnt happen and now we have spilled milk that we have to try to put back in a bucket and it aint working. Whether its a delay which we would support, we have to problem solve at another level. You want to do equity work in a community thats been traumatized over the years of sending people from the avenues or whatever, trauma, trauma, trauma for the community. This has not been considered and its really bad organizing. I just really think that the department of Public Health has to learn its lesson. As dr. Bland said, this is an equity issue now that doesnt look good. Really, could you please Pay Attention to this and problem solve at this level. Thank you. Next speaker, please. Good afternoon, commissioners. Just quickly, i actually live over in the Mission District and just wanted to say that my wife and i 100 support the proposal for the hummingbird space there. I work for st. Anthoniny foundation. Weve been on the corner of golden gate and jones for 70 years. We really wanted to emphasize that weve had many conversations with folks from the community. We understand theres some anger around how this process went through, but that said to us this is an issue of urgency. People are dying in the street every single day. Many of our staff respond to overdoses, medical emergencies, see people die on that corner, in that corridor. We would welcome help from the city, department of Public Health, health right 360, glide. We believe the right people would be in place for that corner for people to get the help it needs. I know theres a lot of talk about postponing and i want to reiterate there is so much urgency around this issue. People are overdosing and dying every single day. Thanksgiving day i got off work and walked down the street and saw another person dead on that corner. I dont know how many more people have to die in the city before we take this absolutely seriously. As has been said before by paul, the reality is there is not a place for folks that are going through issues like this around methamphetamine use as a provider. We have nowhere to take folks right now and we would welcome any help to be able to bring our guests and our neighbors to a place that could help them on any level. Thank you so much. Thank you. As we have one more speaker called, i will call more. Im robert hoffman. I was called in the first round. I work as a director of the syringe access and disposal program. I have also lived in the neighborhood of the tenderloin for over 12 years. I see the people that could benefit from this program are part of this community already. They are already here. We would need multiple lowthreshold Services Like this pilot to serve the need that already exists in the neighborhood. I understand that there is a lot of fear to move forward with the project. I know people get concerned about the idea of moving people in from other neighborhoods, but we already have an urgent need to help people who are dying and who are suffering and are marginized in our neighborhood right now. So i fully support this project. In my position at the San Francisco aids foundation, we would partner to try to make this the most success we can with all the support that we can provide. So i guess thats what ill leave it at, but i think we need to move this forward, not postpone it. Thank you. Thank you. Next speaker, please. We support the project. Again, the argument is always that we support the project or that it shouldnt be here. Clearly theres repairing of trust that needs to be done between the department and the community. Im optimistic that can be accomplished with some Community Education and outreach, having the right conversations and the right meetings with the right folks at the table. I think the providers in this case are extremely experienced. The agencies that provide services in the area, compass being one of them, we see these problems every day. We see that people are suffering and dying in the street. Delaying is not going to solve the problem. We need solutions right now. We have to focus on biggerpicture issues, how were going to coordinate to solve the issues of homelessness and Substance Use. We need more interdepartmental coordination and roll out the vision thats been part of the Mental Health s. F. Planning. So from that perspective we have so many things to talk about and solve and delays and opposition are really getting in the way of providing people the care that we need today and also building the system to serve all of the people that need help. Thank you. Thank you. Next speaker, please. My name is anthony. I work with mary kate over at compass. Time and place, its the right place and its not the right time only because it should have been a while ago. Earlier it was brought up before this meeting started, some folks have communicated again like mary kate alluded to, why the tenderloin, we have so much drugs in the tenderloin, we have all these drug dealers in the tenderline. Why dont we open this thing up on Alcatraz Island or in Golden Gate Park and have people basically have to make a trek in order to have a place to sleep at night. The best location is the tenderloin. Thats where the need is. You all know that. Thats where the Service Needs to be. The time, again, its already too late for so many who have died and a delay is unconscionable. Its an emergency. We already know its an emergency. When its an emergency, you dont delay things like this. Of course from now until the 17th, there will be dialog from now until the 17th. There can be conversation between now and the 17th. There can be collaboration, but not a delay. If theres any entertainment of a delay, thats a clear statement that this is not an emergency. When it comes to it, if theres a fire in this place, can we have as much consultation as we want . No. But we have to get out if we want to survive. There are folks who are in a place where they need to get the support now. So again, you cant deny that this is an emergency. A delay is unconscionable. Thank you for your work and please keep working on this project. Thank you. Thank you. Next speaker, please. [speaking spanish] [speaking spanish] [speaking spanish] [speaking spanish]. Good afternoon. What i would like is another Community Meeting where the community can actually vote as a gro gro group, one that involves interpreting for all languages, one that actually reaches out to schools and organizations and families because were all part of a community, a community that has been traumatized. What we would like is for our voices to be heard. We are families of young people, of children, of elderly, of adolescent adolescents. Since were talking about it, where is the budget for families that have been through such horrible things that we cant even explain to our own kids how someone can end up like the people were seeing. So were in favor of this, but we want to do it as a family and we want to have compassion, but we want to be able to explain this to our children and as a community. I feel my heart broken, but i need to ask for compassion and justice to be done. I would like us to be one community at some point, the people that are homeless, the families, the doctors, the commissioners. So im asking for another meeting with us. Thank you very much. Next, please. Thank you. My name is randy orovelo. I think i have a keen perspective on this. Not only am i a former methamphetamine user, im a pure navigator at glide. I go into the community where people are actively uses and try to get them to help get services. I sleep at that corner. Every night i set up my tent and every morning at 6 00 i take it down. Every night on jones, there is a whole row of tents. People are dying. Other drugs are being used. This cant be delayed. It needs to be done now. I help people in the community, but i also am part of that community. I am on the street literally. We really need to get this thing off the ground and going. As were waiting for the next speaker, ill call the next five. My name is lidia brampton. Thank you for allowing me to speak again. I would like to address the gentleman who just spoke. He said something which i think is really valid to this conversation, and that was that he sets up his tent every evening. He sleeps outside st. Anthoninys, and in the morning at 6 00 he takes it down. Why 6 00 . Because we have a Community Agreement. We have a Community Agreement with the community that lives both in houses on the 100 block of golden gate and on the street of golden gate. We came up with an arrangement with gubio project where they open up earlier, where if people want to continue resting, they can go into the church. We wash the streets at the end of the day and in the morning. We keep the environment clean not just for the pedestrians walking by, but also for the people who are sleeping on those streets. We can do the same thing outside of this program. That street right now is unsafe for the people having to live on it during the evenings, in their tents, on a cardboard box, barriers that keep getting put up. D. P. W. Comes and takes their stuff. People dump their trash on the street which ends up back into the community. We come up with Community Agreements to make this street better, not just for the people who need the service, but the people who live around the service. Thank you. My name is rose juliano. I wanted to voice support for the 180 project today, but also to say from my own personal experience at the Reduction Center that we low that lowthreshold Harm Reduction Services Like this work. There are no 24hour services for folks living on the street in the tenderloin. There are Many Services for folks using opiates, but really nothing for folks using methamphetamine. This is a great step in the right direction for folks who are out there. I want to say thank you and we support the project. Thank you very much. Next speaker, please. Good afternoon, supervisors. My name is joe. I live at geary and jones and im fortunate enough to work at st. Anthonys foundation at golden gate and jones. I see this problem all the time. I was struck listening to the opening conversation on what the city is doing to prepare for the coronavirus. Its fascinating to me that all of this money has been freed up and resources have been rearranged to deal with something that may be coming in some form we dont understand. Right now we are in the midst of an epidemic. I live right in the middle of it. Why do you put a temporary tent up in the tenderloin . Because you meet the crisis where it is. You dont build a permanent building where a tornado is hit. You put a tent up and get the crisis workers in there to deal with the issue. I see children all the time stepping over needles. I see them pointing and crying at people that are frankly in the midst of methamphetamine addiction. Theyre taking their clothes off, theyre screaming. It is traumatizing. If were worried about those things in the tenderloin, lets remember right now the city is currently rebuilding a playground across the street from a strip club. So im sure that there are more than enough awkward conversations going on in the tenderloin. There is a sex club on jones street that shares space with afterschool programs. Children are exposed to a lot whether we want to be comfortable with that or not. I think getting people into a Sobering Center so they can come down off the high and be exposed to other options in their life is a god send for a community right now that is constantly traumatized. I just want to add that i lost a friend who died of an overdose right there on jones and geary. That would have been a few blocks away from this center. So i am very much in favor of it. Thank you. Thank you very much. Next speaker, please. Amy fairwise with the st. Francis homelessness challenge. 180 jones, just the name of it, elicits such love in my heart and mind and you might wonder why. Thats because weve spent hundreds of hours there with our organization when supervisor haney and someone from st. Anthonys told us maybe we could use that site as an interim use. We started to do the work at the site and engaged with the sheltered, unsheltered, and housed neighbors around that area doing that work, hundreds of hours. I dont know if you know we did an r. F. P. Process, did everything we were asked to do. The Mayors Office made the decision to stop that process at the very last minute and put in this project. Now, thats egregious, thats terrible planning. Everyone here agrees. That was the Mayors Office. That wasnt department of Public Health, health right, glide, it was the Mayors Office. Now, you would think, oh, they took the place where you were trying to do your work, a safe, organized space at no cost to the city, by the way. Ours was fully funded and we wanted to activate it months ago, talk about crisis. The Mayors Office decided to do this. Were not opposing this, were supporting it. I think with paul and glide and health right 360 doing this, its going to be a Great Program and its actually going to alleviate a lot of the concerns here, so i want to reiterate that. Its a big price tag, 6. 8 million. One thing that were asking is we have done interviews and have organized lots of the unsheltered people that live in that area. We would like a small part of that budget, 50,000, to go to peer organizers so we can do the work in the neighborhood, to partner with dr. Anton nigusse bland and others to do that. There should be 10,000 for a community council. And i want to say People Living there on the street have all been offered Navigation Center. Thats a really good thing. It took this project happening before the people i have been working with for a year got offered services. The city should do everything all over because people will be offered services. Thank you. Next speaker, please. As we get to the remaining speakers i will call john shoulder and jason alverson. I want to acknowledge amys activism and commitment to the community. I want to say i believe in this project this project gets my endorsement. Ive got 20 years in the tenderloin so i feel like i know what im talking about. At glide ive done 10 years of community building. I walk the streets. I do syringe sweeps and i see whats happening on the ground and i work with the partners. Even the folks who disagree, i want to commend the tenderloin for not having a kneejerk reaction here. Theyre saying you didnt include us enough. As we move forward as this project happens, they will be included for sure. We build with community, not just for them, but with them. This is an asset for the community. This will be a 24hour center where people will be taken care of, thats what were talking about here. I dont even know if this exists in the country yet. The location is always going to be complained about, but when you talk about wanting trau traumainformed responses, thats what this is because of the situation. I dont want to play one house versus another game, but people are dying needlessly because we dont have centers where they can come and be safe. This is a center that will immediately reduce the impact on people. Its not just people coming in and having a bed and a tent, this is a bridge to multiple services and an connection of lots of collaborations that will have the regard for people who use drugs and their health and wellbeing. Youll see a healthier tenderloin having this asset. Do not wait this muchneeded asset. Thank you very much. Next speaker, please. Good afternoon. My name is john shoulder. Im the night manager for 249 eddie tndc and we have a sister building right next store. I also volunteer in the community with street soccer u. S. A. And work with youth in the community. Someone was quoted earlier as saying after the last presentation that they were really excited about the last presentation because the silos began collaborating. Theres been no collaboration, especially with the community. Im embarrassed if this is the best our city can do. During the one and only Community Meeting i was called as a spanish translator after the meeting already had begun. Not only was there no translators, there wasnt sufficient space for those who wanted to attend. And the leaders abruptly ended the meeting without hearing the voices of those in the room. If they cant run a Community Meeting, how can we trust them to run a program of this magnitude. If its an emergency and another emergency is created, its allfornaug allfornaught. There was no voices from the neighborhood. The location selection which one of the leaders said the reasons being selected, number one, is the urgency. Given this presentation we just saw, that shows the proposal and process is embarrassingly unprofessional. One of the leaders from this project is hoping to work with the community and i plead that you delay this vote to my neighbors have a chance to be heard. [ please stand by ] this is an illness, methamphetamine use, that is profoundly isolating and profound profoundly destructive. It potentially destroys or it can destroy people. In the 1970s, we said that speed kills, and this does more than kill. It kills the self, and it kills the ability to be a part of the community. To engage with these folks who are strung out, who have no other options, who are meth dependent is completely necessary if were going to consign a segment of our community to disability, to mortality, and to psychosis. There is no choice. This is engagement, this is where it starts. This is the beginning, this is where, deep down, the spirit meets the bone. I urge you to vote yes on this proposal. Thank you so much for hearing me today. Thank you. Are there any other speakers that i didnt call or perhaps they i didnt pronounce correctly . Hi. Im colleen rebecca. Im the director of community policy, organizing, and developing for tenderloin development corporation. I just wanted to come up and make sure that its clear that everyone knows that t. D. C. Is a company that doesnt have a position opposing or supporting the center right now. Part of that is because the community process, if we can call it that, that has happened so far regarding the center has been so poor that it has actually taken a lot of our residents and Community Members who were supporting things like the like Safe Injection Sites and other things and has turned them into opposing just because of how disrespectful how the city was in presenting this to the community a few weeks ago. And we have a lot of constituents and stakeholders that are really concerned, and we also have a lot of people who see the need for this type of this type of program in the neighborhood. Speaking only so because we havent been only to reach concenab concensus within our community and the different stakeholders in the organization, were stepping back now and trying to listen. And hopefully this this delay will allow us to have another Community Conclusion that can include more people and can also address some of the Unanswered Questions about how this program will run, ensuring that were not dumping people back onto the street after theyve been in this program, because that is not a good model, and some of other issues that were concerned about. Seeing that this is really a program that that works on a Harm Reduction model, and thats respectful to people that use drugs. Thank you. Thank you very much. I have no other public speakers at this time. Before i go to colleague questions, ill ask dr. Colfax for any statements or comments. Thank you. I just want to say with regard to the recommendation of the meth task force, at mayor breeds request, i chaired this task force along with supervisor raphael mandelman, and its certainly in keeping with the recommendations with Mental Health reform and in the broader context of Mental Health s. F. I do want to express regret for the community process. We are certainly committed at the Health Department to improving that work. One of the as ive listened, i think theres a lot of things that we can do together here. There are actually a number of of ideas proposed that i think we need to have further discussion on. Perhaps here, but in another Community Meeting. We will be scheduling that Community Meeting. We will be doing our best to find adequate space and interpretation. I think that thats very key. I heard that, and really committed to not only listening more but being responsive to to as many of your concerns as possible and also recognizing that were committed to the integrity of the program and working to do that in partnership with the community. So we will schedule that meeting prior to march 17 to get more to have additional conversations and input from people here and other stakeholders who may not have been able to be here tonight. Thank you, dr. Colfax, and thank you for, you know, speaking about the need for the meeting, which i believe its quite clear that such would be very important before we actually go onto a vote on the contract on march 17. Commissioners, questions at this point . Let me go to commissioner chung, because she had some questions from our previous committee, and it was deferred to now. Well, thank you, commissioner chow. So the first questions i have is because of the uniqueness of that neighborhood, because theres a whole corridor of other, like, social services, you know, like Health Clinic and tndc. How are you working with these organizations moving forward . So id actually like to call up paul harkin, the director of 360. Hes worked in the tenderloin for decades and has some really nice ideas about how to do that. So yeah, the tenderloins at good with partnerships. And in my work at glide, i was involved in partnerships with st. Antonys, the sheriffs department, naloxone reversal. I partnered with the agencies like homeless coalition, people that have been involved in many different initiatives that are improving the wellbeing of marginalized folks, particularly with people with Mental Health issues and experiencing homelessness. So i do not see any reason that this, if it gets selected to go on forward, wont utilize the is partnerships that are wont utilize the partnerships that are available because it is beneficial to have this up and running. And once people get the trust back with the way the process worked, i certainly believe that it will be seen as a model and an arrangement that can be replicated in other districts, in fact, other jurisdictions because theres nothing like this right now. Everything has been opioid focused, and opioid treatments are incredible. But meth treatment is very little because more people are dying of meth overdoses than opioid doses in this city. And what really caught my attention was the Police Department can be a referral point, as well, like, thats kind of, like, unusual because, like, for the Police Officers, they have two different ways of handling these situations, right . One of them is bring them to 850 bryant, and one of them is bring them to emergency services. So this seemed to, like, open up, like, tools for the Law Enforcement to use. So are you planning to train the officers around that . I think, you know, if you look at the l. E. A. D. Model, where we have Law Enforcementassisted diversion, where we dont want Law Enforcement bringing people to our building because weve got a traumainformed care building. Were seen and coming and liberating that person, so its, like, do not go to jail, come with us. Similarly, we dont want police to rile up and drop them at the door. Well probably be sharing with them some of the criteria. We would say this comes here, versus someone is an extreme health dangerous, this is where theyre not going to be coming because were going to have a sweet spot of folks that were going to meet with. I have meet with the tenderloin substation, and weve talked about training the midnight shift, when this is going to be the only service open and interesting a team ready at all times, like First Responders for the teams to be able to call for the warm handoff that paul just described. Future models may include also training hsoc officers, but right now, were just focused on the tenderloin substation. Thank you. I have some other comments, but ill let the other commissioners for now. Thank you. [inaudible] i just want to say that as a native san franciscan, i spent my late 60s and early 70s in grade school and high School Every Day in the tenderloin at my fathers barber shop on hyde and turk. I have a very personal interest in seeing that the neighborhood returns back to the kind of neighborhood where a tenyearold can take the bus in the tenderloin, play in the streets, and feel safe, so this is not just questions from a commissioner on the commission. And so i at the same time, however, as i have a personal interest in not delaying a response to this crisis, which has actually been a crisis for a long time. I also spent my adult years as an advocate for Community Input and process, and i feel that we cant ignore the voices. That even though expediency is important in this, wanting to respond quickly to the need, i also feel that oftentimes, the voices that are most impacted in the community who cant come to meetings like this because theyre either working, or theyre at home, back at home, taking care of their kids, or theyre trying to find some transportation to meetings, we dont get to hear from them, or we hear from them by proxy. So i feel very committed to making sure that there is additional opportunity for community voice, and im very glad to hear from director colfax that there will be. This isnt going to be something thats going to be solved as easily. As much as we want smiwift action, we have to make sure that the program is successful is a surety. I just want to let you know, as a member of the commission, this is something we have to consider carefully and consider the right solutions [inaudible] thank you. Dr. Colfax, thank you for requesting another Community Meeting. My only concern is our next Commission Meeting is in two weeks, and im not complete sure that were going to have enough time within this period to notify the community of the next meeting so we can plan and have the input. So id just like to raise that as a concern because i do believe that the Community Input is extremely important. I do know that the school had not been notified until a couple of days ago. And from the feedback, i have heard from a number of organizations that work with the kids that neighborhood which, of course, there are ten of them there is a big safety concern. And i know youre addressing with the time of discharge, and i am hoping that you have done enough homework to know that the discharge of the kids from the schools is at various times, anywhere from 2 00 to 5 30. I know the underlying issue is not to support the center, but its safety. Im hoping that you would be able to bring back to us a much more significant and detailed safety plan for the center before we go forward. Thank you. Commissioner green . Yes. Well, i wanted to thank everyone for their presentations, and the elegance and compassion everyone is here with. Everyone is here to solve a problem, and with these issues, i think theres universal pledges, and im truly moved by many of the comments that people have made here. Im wondering by the next meeting you could give us more information about community safety, and what you plan, visavis, Community Input. And, also, when we might receive reports. Im hearing it should be far greater frequent and with far greater detail that already go in there. What im hearing is that children in this community and adults in this community have experienced trauma of their own, seeing whats going on in the streets. And im wondering if thats part of your program and how you plan to address that. I can speak a little bit to that now. Health right has already spoken with the tenderloin to do an Impact Program that dates back to the start of this, which weve heard has been really messy, to include that, to take seriously the concerns that have already occurred, and also, see going forward, if some of our attempts can do that. Also, well be conducting evaluations of thissum practice. I think to begin with, were going to be doing weekly reportouts, so that would be in conjunction with the department of Public Health, and you are right. It would be much more frequent and more detailed than the Hummingbird Program. We can go into more detail about this at the next meeting, accountability going forward. We at health right are committed to that, and we do take our integrity seriously, and weve been a provider in a lot of different neighborhoods and have had similar experiences on both sides, and so we really understand and appreciate that you all are advocating for that, and i appreciate the personal story behind that. I feel that, too, and were very committed to that, so we can absolutely provide more detail on that at the next meeting. Thank you. Commissioner chung . So thank you for the presentations again, and thank you for all the input. Like i mentioned earlier, you know, in the committee meeting, you know, this is really actually personal for me not just because i believe these programs work. Its because ive worked in the neighborhood on eddy street. One of my clients died in his room without the ability to get services, and ive also worked along the corridor, you know, doing outreach services. Knowing where that corner is and whats going on right now, i think thats actually pretty much a really good place. Youre almost putting, like, a Crisis Center at, like, the epicenter where the activities are happening. And ive also been working in the Substance Abuse services before. I still remember, like, referring folks with, like, alcohol withdrawals to alcohol centers. Thats a while ago, and theyre willing to just stay on the floor, waiting for the bed to open. Thats how scared some of these programs are. And thats the first time that ive heard were going to do anything for methamphetamine users. I dont believe theres anything like this anywhere in the country, am i correct . Thats my understanding, as well. So it means the whole world is looking at us, how we respond to that and how were going to continue to develop this program. And i appreciate you saying, you know, that theres going to be regular report back. And part of it, im sewereous because the neighborhood seems to think theyre not being informed enough. How would you engage them and allow a space im serious because the neighborhood seems to think theyre not being informed enough. How would you engage them and allow a space for them to find out . I know the commission has ways for people who cant be here for meetings to submit comments, so figuring outweighs to do that. Also, making sure that staff and leaders are known in the neighborhoods, that they know they have a contact that they can reach. Those are just a few things. And again, part of the model is outreach into the community to gather participants, and so really being a participant in that way. Yeah. So what ive heard from the Public Comment, its not that anybodys opposed to anything like that being implemented, but its more like how to engage them in this process and find a way to build that relationship. I think its pretty clear that the you know, the main thing that, you know, people want to know. So i appreciate you saying that and appreciate all you adding all that transparency to that. But it also looks in the timeline that you havent set a date for that to open yet, so thats kind of, like, flexible. So it doesnt affect how we plan to move this forward. So we can approve the contract for the services. The rest is going back to director, your court, and to healthright 360 in terms of, you know, how to plan, you know, the program itself and how to continue to engage the nake neighborhood. So, yeah, i think thats what i heard, and i feel pretty comfortable. Thank you. Thank you. Any further comments . If not, i think ill try to sum up where we are. Were very grateful that the input that the community has given and the time that we were spent. Many of you were here at 2 00, and it shows a dedication and importance of this topic, one in which everyone here has said they want to help resolve, and i think, then, the departments offer to at least begin with that second meeting well, the next meeting of the community, and this time, with the appropriate people there and clearly, schools need to be there, the people who are actually right on the scene, some of the partners that health right is talking about, all of that so we could receive answers back to what we have all heard and feel comfortable about it. This does not preclude that future meetings, obviously, would not be needed, and a solution doesnt have to really come out of just one single meeting, but the beginning of looking towards a way will take the immediate problem, which everybody has greagreed is an emergency, and working with the neighborhood. I think someone told us that everybody in the tenderloin had worked off times when the kids would be off the streets and went back i mean, those types of arrangements are important to be able to Work Together and yet answer the very important need. For the commission, we will take this up as a potential item on march 17 as calendared. On the contract . Yes. Well consider a vote on that . Yes, as a topic in regards to the contract. Obviously, it does reflect all of the discussions of today because the performance of the contract is very dependent upon us understanding how that is going to be. Commissioners at that time, then, can decide on what it would like to also understand in terms of are there further actions after that, and it will be an action item for the commission, so i would ask that the commission think now at this time during the next several weeks, also, our homework is to how we can figure out how to make this an Effective Program to answer the great need that we have all been expressing today. So with that, i believe that, again, we really thank all of you who have taken the time to help all of us and help our city to find a solution, one solution that we are facing with our homeless, with those that are actually needing help, and with our communities, also. I believe that commissioner chung has something to say . Yes, commissioner chung. I have two things. One is for clarification. This seems like two different things, right . One is to approve the contract because, you know, that is what the Mayors Office had set aside for this initiative. The other is helping facilitate conversations between the community and, you know, the department and, like, healthright 360, so its not the same. No. Obviously, approving the contract is quite different and has to do with the services that the contractor had. How the contractor does that, however, is pertinent, and how what you said, how it would work with the community and with those in need, all of that is pertinent and makes sense. And i think these questions can wait until next time for answers because, like, we as commissioners are, like, very mindful of general funds. Like, were trying to make sure that outside of general funds, there are other resources that will fund this as things move forward. So the next time when you come to do the presentations, it would be good, you know, to know what what that part is, you know . Is this, like, a oneyear deal or is this something that has already been planned, you know, with kind of a vision moving forward . Thank you. Right. And i appreciate that, commissioner chung. That goes, also, to that question that was out there. If this is the temporary site, what is it that were looking for, and what type of approach . And either that comes from our department or others that tracks how this program ultimately will be successful. Any other comments or questions from our commission . Okay. Then again, we thank the public for the time that you have spent. We hope that you would also engage within the Community Meetings to actually have additional dialogue, and at our next meeting, we will hear some of the results of that. And with that, well go onto the next item, please. Id like to also thank our d. P. H. Translator who assisted during the meeting today, which shows just how important translation can be. Clerk so item 10 is other business, and commissioners, ill note to you that your march 12 meeting is at 10 30, not 10 00, as we had originally thought, so make sure you have that in your calendars. Item 11 is a report back from the csfjcc meeting. I think the majority of those i did report back on the directors report. We otherwise did the regulatory report at j. C. C. , the c. E. O. S report, the h. R. Report, and also took on the medical staff report. And the presentations included the quality measure update on the true north scorecard. These are all on track or else somewhat behind partly because of epic in terms of trying to get the right measures with the right types of data in order to actually use that. So we understood that has a problem. In open session, we approved ophthalmology and cardiology changes, and we had closed session. So dr. Green was part of that meeting. I dont know if she wants to add anything . I think well summarized. Thank you. Clerk and commissioners, now youre at motion for adjournment. So motion for adjournment is in order. So moved. And a second . Second. All those in favor, say aye, and none opposed, and we are now adjourned. Thank you. [gavel] mayor breed thank you. Welcome to chinatown. Thank you, supervisor peskin to allowing us to come and hang out with you today. I am San Francisco mayor london breed here with many members of the board of supervisors, state officials, sf travel, wow, a lot of people here. We all know that one of the Biggest Challenges that we are facing not just here in San Francisco but in this country and throughout the world is the threat of the coronavirus and how it has not only impacted people and Public Health but how it has, unfortunately, impacted our economy. When we first heard of this virus in january we launched the Emergency Operations center. What we noticed during that time and supervisor peskin can attest to this. We didnt get support and people visiting our community in chinatown and other places and as we can see as this develops, this virus is not discriminating based on race. This is impacting people all over the world and has impacted a number of people right here in San Francisco. As of today we are up to 14 cases. I am really proud of the work that has been done with the department of Public Health to be proactive and making sure that we are prepared and making sure that we keep people healthy and safe and looking at the vulnerable communities, seniors and people with illnesses answer challenges and providing resources and support and being aware we have a vulnerable Homeless Population and making sure we have places for people to be quanteened and in case there is a situation that we as the city we are prepared to handle it. I want to be clear we cant live in fear. We have to make sure we are doing everything to keep ourselves, our families, our communities safe but we also have to make sure that we are addressing some of the other challenges that have happened as a result of this issue. That brings us to the economy. We are definitely going to feel impact. We are in china town because we know the businesses in this community have probably felt the impact, the Economic Impact more than any other community in San Francisco. We have been working together, my office and the state and, as i said, a number of the board of supervisors, we have worked together to come up with a number of immediate things to do now. We will be coming back with other things that we can definitely do in the future. We want to provide immediate relief to our Small Businesses. I wanted to make an announcement today about some of those things that we plan to do. Working with our treasurer and other city departments, we have been able to identify a number of ways that the city can provide immediate assistance to small business. To begin with, we are allowing Small Businesses to defer the next round of Quarterly Business taxes to next year in february of 2021. I know that is going to provide significant relief for Small Businesses. We will also be delaying a collection of our unified license bill for at least three months. These bills include charges for restaurants, food trucks, bakeries and smal small busines. Our time is to delay those fees. We are actively looking at other ways to delay more fees for our Small Businesses as they deal with this challenge. We also understand that our communitybased organizations or nonprofits wonder what is going to happen to us and our work forces specially those who may stay home to care for a child or sick parent with no sick leave. We will work to make sure all communitybased nonprofits that receive funding from the city continue to receive that funding. We want to make sure that you know that in todays Emergency Declaration that i signed it was a revision to make sure we are able to support our Small Businesses through this situation. We are also establishing a fund to provide immediate relief with 1 million in the fund to provide at least 10,0