Transcripts For SFGTV Board Of Education 20240712

Or whatever the processes would be, for a more permanent way of making sure that hiring is really more effective as you have shown . Thank you, commissioner, for that question. Just so you know that part of what we did is that we dismantled some of the norm processees that we used in hiring. But even with that, if you looked at just the nursing, for instance, that theres some things that we did which we can keep as we go forward. And im hoping that it will also blend and lend into the rest of the type of hiring that we do. With the directive from the mayor we were able to bypass some of the Civil Service rule processes in terms of hiring. But what we did specifically is to start looking at with the nurses and hiring without having to wait for the supervisor who is doing the clinical work to do the interviews and the processing. And h. R. Took control of that. And those are some of the things that we can do and to look at in the future as we start in our hiring process. One of the key things to make that work is to have a strong background in terms of the qualifications when you are putting someone on an eligible list so that we can just go down the list. And we dont have to really start looking at interviewing. If theyre qualified by the minimum qualifications, those are the things that will be when you create that eligible list, anybody on there is ready to come on board and we can just go down the list. Those are things that we can work in on the process. But we have to rely on the nurse managers to give us the right information on what were creating to create that list. We have not done that. I think were about 10 years or so before looking at the m. Q. S so theres a bit of intertwining and working that we need to do and working with d. H. R. And thats still in the process for the long run. Some of the lessons learned, we can also look at trying to expand it to other classifications other than nurses. What we were able to do this particular time is because of the directive from the mayor and we can look at old eligible lists and hire people. Were not able to do that in the normal process. But we can use other things in terms of expediting the process and making sure that we have eligible lists that are going to be available or doing examination processes that will be more expeditious in terms of creating an eligible list. Those are things that well look at in the future and whatever we can come out from this process and try to extend it so that we dont have long periods of 260 days for hires, yes, to me that is unacceptable. And hopefully were not going back to that. Commissioner chow i think that as we progress we should know that were going to be putting those in, you know, some of the things that will then help to reduce to a reasonable hiring plan and well just continue to monitor the work that youre doing. Thank you very much for getting the staff on board. First of all, thank you for this presentation and thank you to our colleague, commissioner green for the thoughtful questions which she had asked and your responses. Im just looking at the data that you have here specifically as this and looking at the division indiscernible and the patient eligibility. And just wondering what the impact is of that on the ground in terms of providing services . It seems that these might be positions related for example, keeping capacity for a potential surge. So i guess that is all to say are the divisions on which theres more people on leave are they necessarily people who, you know, wouldnt have as heavy a workload now because of the capacity of keeping open or is it creating an issue on the ground and in being able to perform the work . So in some of these areas like e. V. S. And food, Nutrition Services particularly, we know that theres been impact because based on now what the requirements are for the porters to have to clean, i think that it takes double the time. So since based on the leaves and the expectations and the surge from this, we have hired temporary covid related porters. I believe that we hired close to 80 porters across d. P. H. I think that our goal is 10 more, which is 90. And those should be completed processing by the end of this month. So across d. P. H. We have an additional 90 that is covid related. And the same for food Nutrition Services. We dont have 90 but were working on about 20 positions to support the leave issue for zuk areberg. And those zuckerberg. And those should be filled by the end of this month. President bernal thank you for that clarification. Clerk any other questions, commissioners . All right, thank you very much to mr. Brown and miss hill. We appreciate your information. Thank you. Clerk so i lets see, the next item is item 8, the resolution authorizing the department of Public Health to recommend to the board of supervisors the assessments of 125,652 to the l. H. H. Gift fund from the friends of laguna honda. And mr. William fraser should be on. William i see and hear, can you unmute and get on camera . So what im going to do is to pause for a second and put on the Public Comment line i was testing as well to say, you know, to add that we needed resources in order to sustain this. Clerk so youre on the microphone so make sure that you mute yourself. Is anyone on the line with laguna honda who can try to get William Fraser on . All right, so since im not hearing anything, with your permission can we move to the next item and try to come back to this . Is that okay, commissioner bernal . President bernal yes. Clerk okay. I see you. So, everyone, well move to item 9 which is the laguna honda c. E. O. Report and hopefully mr. Phillips is on. Yes, i see you. Thats great. And, mark, before i begin id like to take the opportunity on behalf of the comeation to welcome Michael Phillips as youre presenting as the laguna honda hospital c. E. O. For the first time. Welcome. Were looking forward to your presentation. In addition we would like to acknowledge and maggie racowski as the acting c. E. O. At laguna honda and during an important time and as well as the work that you have done together, both of you, to sunday t respons pandemic. And really putting laguna honda on solid footing, compared to where we see other longterm care facilities. So thank you to both of you for your fantastic work and welcome Michael Phillips. Thank you very much, commissioner, and thank you to the entire commission for allowing us to present to you this afternoon. I am pleased to be here. And im going to try to do an abbreviated report to just allow sufficient time for questions and to speed along the agenda. Our fixed team has been actively engaged in the effort to ensure that the health and safety of our residents and to minimize the spread of covid19 among our staff and residents and to support the staff and to provide the necessary equipment and resources. And also in supporting the staffs Mental Health and wellbeing. And weve really been focused and engaged in those efforts. We meet twice a day as a leadership group. There are some 20 or 30 of us and all are actually focused on achieving those goals in addition to the daily meetings, we also have two calls on saturday and sunday. And to continue that effort. In terms of the new admissions, so we as you probably know, have not been accepting new admissions since march. That was after the facility went on quarantine. The we received guidance from the c. D. C. That indicated that we should refrain from taking new admissions until the quarantine is lifted. But despite the fact that weve not been taking new admissions, weve maintained an occupancy rate of 98 . In addition, regarding our census, earlier in the year laguna honda hospital implemented a goal of increasing our average census in both acute rehab and acute medical. And that effort was going really well until we went into quarantine. So we will continue that effort after quarantine is lifted. Laguna honda hospital also implemented or requested a program flex to flex our acute beds to smith beds. This is an effort to assist San Francisco General Hospital in Surge Capacity and limiting the Surge Capacity. In terms of our Human Resources and staffing, staffing and efficient on boarding continue to be a priority while the quarantine remains in effect. Our vacancy rate was 6. 5 . And we expedited the filling of nurse positions and thats one of our main focuses. Dr. Colfax talked a little bit about our covid19 cases earlier. As of today, we have had a total of 28 im sorry 29 positive covid tests. Of those 29 positives, 18 are staff related. And 11 are among residents. 13 of the 18 cases on the staff side have recovered while five of the 11 resident cases have recovered. We began universal testing during the week of may fourth. Thus far we have tested 1,369 staff. And with 1,207 tests, testing negative, and so we are pending 160 tests to see what the results will be with those particular tests. Only two staff have tested positive as a result of the universal testing. And we continue we completed testing on 13 residents and on all 13 of our resident units. And thus far only five new residents have tested positive. We anticipate the completion of universal testing towards the end of this week. And we will wait for further guidance on the frequency of universal testing going forward. We believe that it will be probably be a month, testing frequency on a monthly basis but that hasnt been determined as of yet so we wait for guidance on that. So ill pause here and see if there are any questions. Clerk commissioners, before we actually ask you for questions, may i go to Public Comment . Okay. Public comment line, can you let us know . No calls from the public. Commissioners, any questions, please raise your hands. Or dr. Chow you could speak up if youre on. Yes, i wanted to also commend our team for coming together and getting back our medicare status. And also to report that the reporting on the months for the aowl over the past year. And thats been something that we normally have asked for and thank you very much for providing that in this report. And i know that youre going to have other segments that ill comment on later. Clerk thank you, commissioner. Mr. Phillips, you can continue. So thats the end of my report. Unless there are more specific questions regarding it. Clerk great, thank you. Any other comments or questions, commissioners . Okay. Thank you very much, mr. Phillips. And, again, thank you for your help and assistance during the past month. We can move back and hopefully go back to item 8, is mr. Fraser able to unmute himself . Testing, do you hear me . Clerk yes, yes. Hello, nice to hear you. Okay, thank you very much. Clerk actually i was going to say to call the item again to make sure that the public understands what were doing. So moving to item 8, a resolution authorizing the department of Public Health to recommend to the board of supervisors to accept and expend a gift of 125,652 to the laguna honda gift fund from the friends of laguna honda. Thank you. All right. Good afternoon, commissioners. Thank you for having me at your meeting, especially in such a busy time. My name is William Fraser. I am the gift Fund Program Manager at laguna honda hospital. Laguna honda report requests that the Health Commission passes a resolution recommending to the board of supervisors that they authorize the acceptance and the expenditure of a donation from the friends of laguna honda totaling 125,652 to the laguna honda gift fund. The friends of laguna honda is a private Nonprofit Organization Whose Mission is to benefit the general wellbeing and the quality of life of laguna honda residents. And theyve been supporters of our communities for over 60 years. Give me a breakdown of their donation, again, 125,652. 50,000 of which goes to the wish list. Let me tell you a little bit about the wish list. Its a longstanding tradition of funding by the friends of laguna honda that allows the departments and the nursing units to request materials, equipment and supply that would be used directly to benefit the residents and to be used directly by our residents. Some examples of that are ipads and computers, large flatscreen tvs and electric pianos and homelike furnishings and those types of things. And then our next category is 5,000 for farm program, our farm is what we affectionately call our animal assisted therapy program. And the 5,000 would be used mostly to pay for veterinarian service. However, our farm program is much bigger than that. But the 5,000, again, would go to just veterinary services. And next category is 20,000, thats been enthusiastically embraced by the friends of laguna honda. We asked for much less than that and they said that were giving you more. So they wish to donate 20,000 for that for discharge packs. And discharge packs would allow us to buy supplies for residents as theyre discharging with the success of that discharge and to maintain that discharge. Some of the items that we would purchase with them would be toiletries and clothing and were hoping that we also can add to that Grocery Store Gift Certificates and to help them to tide over from the hospital to the Community Setting as the services are getting ramped up, it would help to tide that over. Wellness programs, 15,340. We have our Wellness Center at the hospital, its quite nice. And in the Wellness Center we have classes for our residents, including tai chi and yoga. And 17,000 of the donation would be for music programs. And that allows us to bring in professional or semiprofessional musicians to perform live music for our residents. And then the last one is for our voices choir, 18,312. And the choir is a collaboration with the Community Music center. We have a contract with them. This would pay for the next contract year. And i know that a question was submitted by the commissioners about that program continuing. Generally the latin voices choir runs from september to about may of the following year. So we will have to see what the outcome of the Current Situation will be to see if that would continue on. I know that the Controllers Office instructed us to continue to pay our nonprofit providers, but i think that thats a limited time period. So i have contacted the Controllers Office and our contract staff at d. P. H. To get clarification on that. However, again, the normal contract year runs from september to approximately may, 36 weeks, which includes weekly rehearsals and at least two performances by our residents. And as you may understand that its primarily focused on our spanishspeaking residents. And id like to take any questions that you may have at this time. Clerk before we do that i want to check to see if we have any Public Comment. Public comment line, could you let me know if theres anyone on the line for this item. Okay, no Public Comment. Commissioners, do you have any questions or comments . Commissioner bernal . President bernal yes, first of all, thank you soap for this presentation so much for this presentation and thank you to the friends of laguna honda, mr. Fraser, for these generous contributions. The programs that are being funded through this contribution i think are really critical to you know, maintaining and enhancing morale and also creating community and connectedness among the residents there. Given the Current Situation in particular, are these programs able to function currently with this lockdown and with the response to the pandemic . Well, im going to try to give you my best answer on that. The wish list again is the procurement of equipment, supplies, and so those things can easily be brought to the resident units. Many of the residents are having to remain on their units so that is a big challenge for us. But, again, this funding would be focused on the next fiscal year. So we can hope for the best for that. And i cant tell you whether or not the farm programs are continuing. I know that it is normal for them the Therapy Department to bring in animals into the hospital. But i dont know if thats continuing at this time. Discharge packs would certainly continue because it is always to be our goal to get residents in the least lowest level of care and that continues where possible and its just a beautiful program, the discharge packs. And the wellness programs, yes, are not currently happening because theyre communal and they have been in our Wellness Center. And the music programs are not continuing to happen as were restricting nonessential personnel, but, again, i say that the hope is that we be able to use that money with less restrictions on our population next year. President bernal great. Thank you. We all look forward to the day when these programs can continue to the benefit of everyone at laguna honda and the community. So thank you for that and thank you again for the generosity of the friends of laguna honda. Clerk commissioners, it turned out that there was someone on Public Comment so with your permission lets take that now. Caller, are you on . Caller, are you there . My understanding is that theres one person on the line. Caller, you can hear us or hear me . Ill announce one more time, anyone there for Public Comment . Okay. So commissioners, its time to move on to a vote. I will note that commissioner guillermo had to leave the meeting temporarily so theres four of you. Commissioner bernal. Commissioner bernal . Undo your microphone to vote so that we can hear you. President bernal yes. Clerk commissioner green, yes. Commissioner giraudo, yes. And commissioner chow. Yes. Great, thank you very much. We can move on to let me see we move on to item 10 which is the laguna honda Regulatory Affairs report. Mr. Smith. Hi there. Its Troy Williams first before we have adrian come on. And i just wanted to report that and to acknowledge the work that adrian has been doing here as the acting chief quality officer for laguna honda. Hell be transitioned back to zuckerberg San Francisco general on june 1. And since this will be his last laguna honda regulatory report, i just wanted to take the opportunity to thank him for all of his work over the last year and really helping to stabilize the Quality Program here at laguna honda. We were working on transitioning him back in february, and then our Covid Response began and as usual adrian stepped up to the plate when we were asked to stay and to be the Incident Commander and the deputy Incident Commander for our structure. So i just really want to personally thank adrian for all of his work. I know that here at laguna honda that there is soa so much gratie for everything that hes brought to this team and, you know, hell still be available to, you know, to consult on regulatory issues as they come up, but i really just wanted to take this opportunity before he reported out to you to acknowledge all of his work here at laguna honda. So with that i turn it over to adrian. Thank you, commissioners. Clerk thank you, troy. Im embarrassed so ill try to not trip over my words. Thank you, commissioners, for giving me time on the agenda to bring you up to speed with the regulatory report. And i will give you a summary and have time for questions. If we look at the first page i wanted to point out that we had a slight reduction in the amount of cases that are reported. And a significant reduction in the residenttoresident allegations and that really speaks to me about the family that we have here at laguna honda. Our residents have been as much a part of the wave that we have responded to shelterinplace as the staff and providers have been. And theyve really coped with this containment in their neighborhoods incredibly well and thats reflected in the reduction of the residenttoresident cases. And we also had some great news. As part of the waivers submitted to the California Department of Public Health and to the center for medicaid and medicare services, we asked if our first survey could be reviewed as a desk review instead of requiring a reset and revisit survey. And that waiver was accepted. And the District Office of the California Department of Public Health really asked for a lot of information and a lot of data that have been collected regarding the plan of correction. So it was a fairly stringent desk review and they found us to be in substantial compliance with all of the conditions of participation on april 24th. And the denial of payment from new admissions and the daily Civil Penalties seized a ceasede 23rd of march. Which was a huge achievement for the operational side of laguna honda because these changes really showed a significant amount of work and improvement and focus on the patient and resident safety. So i wanted to celebrate that. And i also wanted to acknowledge that we as we move forward in this process that the continual survey and readiness and educational update, that we would normally do on an ongoing basis have been entirely focused on covid and our response to covid. But the state an have asked thae adjust our plan or Quality Assurance and Performance Improvement plans to focus on covid. These two things really have put us in a good place to move forward with our plan because we have a phenomenal amount of data and we have a phenomenal amount of evidence to demonstrate how we have been nimble in the way that we have delivered care to our residents and how we have maintained our Infection Prevention practices here at laguna honda. Thats the high level summary. But i want to give time for any questions that there might be about the material. Clerk commissioners, lets check to see if theres any Public Comments before we are taking questions that you might have or comments. Any Public Comments on the line . Im still waiting. Anything there . Lets go ahead and take your commissioners. I havent heard back and i think were having trouble with the line. Any comments or questions, raise your hand. Dr. Chow. Commissioner chow i want to congratulate dr. Smith and his work and look forward to seeing you again at general. But i particularly wanted to comment on the manner in which the Regulatory Affairs report has been given in terms of the status bars and it helps to summarize whats been going on. When he said that the numbers have gone down, this is really very helpful to allow us to see how each of these are being answered all participants are now commissioner chow to compliment this is something that we have been looking for for quite a while and i appreciate it. Clerk thank you, dr. Chow. Looks like commissioner green, yes. Vicepresident green yes. I just wanted to echo commissioner chow and mr. Williams comments, adrian, about the work that both you and maggie have done. You came in with insurmountable challenges and a huge agenda and an environment where you really hadnt worked before, just like maggie. I think that the way that you not only led the two of you working together but the way that you engendered the confidence of the team on the ground. And it was remar remarkable to u come together to address these challenges and to do so in such a positive manner. And i think that you have created a culture that there that since i joined the j. C. C. I have seen evolve in a positive way and the data that were getting are much easier to understand. But i think that the idea that you and maggie came in and you were able to accomplish so much both culturally and statistically and the effect that you had on the whole profile of the l. H. H. Community with the cdph, is really quite remarkable. And so i just cant quantify how grateful i think we all are to the way that you have all worked together and to your contributions in particular. Thank you, commissioner. Clerk any other comments or questions . So commissioners, we had an issue with the comment line so i want to make go ahead and activate it and let everyone know who might be listening to call in again if somehow they were dropped. Your conference is now in questionandanswer mode. To summon each question press 1, and then 0. Clerk great. Do we have any callers . Michael, this is grant, can i make clerk sure. Can i make a comment . Clerk sure. I just wanted to thank the laguna honda team and, again, to add my appreciation for adrian. And also to troys remarkable work and maggies work with the support of roland. And to the endeavor, i think that its really we have made great progress at laguna honda. And the strength of laguna honda have been reinforced where there were challenges and quite frankly some problems. I think that work has made significant progress and i think that while the pandemic is challenging the Institution Even further that we were fortunate to be able to have the team do the work that theyve done and the staff at laguna honda to do the work that theyve done across the neighborhoods to improve. And as a result were in a much better place for the pandemic and i just wanted to express gratitude to the teams for the incredible improvements they have made and the hard work that that has taken them to do. Clerk thank you, dr. Colfax. Commissioners, we may move on to item 11 which is the action item and another item action, laguna honda hospitalwide policies and procedures. All so, distancing appropriate. Good evening, commissioners. Laguna honda hospital is the hospitalwide policies and procedures for approval. And included in the list are one new hospitalwide policy. One revised hospitalwide. Two revised e. V. S. Or environmental services. And one revised medical staff policy. And two revised nursing. One revised pharmacy. Approval is requested unless there are any questions. Clerk so, lena, i forwarded some questions from commissioner green. Im wondering if they got to you . I think that one was specifically around the environMental Health the e. V. S. Policy, a concern about bleach. Im not sure that, commissioners, if you want to articulate anything else. And if i checked in and out of hospitals with temp checks and so forth, depending what youre cleaning the surfaces with, theres a duration that the material has to be in contact, especially with viruses and bleaches is about a fiveminute window. So i didnt know if in light of covid19 whether there should be detail there depending on the product about how long it must be in contact with the surfaces to be effective . We have notes from the reviser of this policy in response to your question. And it says that there are many different clorox products. Clorox pro is a fiveminute contact time. But we have Clorox Health care and for the cleaners they are both oneminute contact time or kill time. For covid and three minutes for cdiff. Vicepresident green thats great. Clerk im sorry, any other questions . Were talking about cleaning and chemical products. It seems to me that are these the only ones being used . And or are we then having to add each time another product . And i think that you mentioned several other products that dont seem to be listed here. Actually, the reviser of the policy did reach out to me just yesterday and they mentioned that they forgot to make a little note. And if its fine, we will be adding a little note in the policy to state that, you know, when we run out of a product that it will be replaced. And so this was caught but not in time to make it into the version that youre looking at. So if thats okay, we will add that little note so that we dont have to keep revising the policy. Yes, because it seems that with it would be better in general to be well, to be more general by saying that, you know, you need to follow the product time and in this certificate of limiting you, right. So are you suggesting that as we pass this that note to be added to the approval of the changes here . Yes, we would like to do that. Okay, so youre recommending that a note that will indicate that these are sort of examples and not limited to only these, right . Yes, thats correct. Clerk and if you would send the final policy with that note to me i can forward it to the commissioners. Sure, no problem. Okay, that would be helpful. So does this help i dont know if there any other comments but i can make a motion to accept these otherwise. Clerk please do, commissioner. So moved. Second. Second. Clerk great. I will do a roll call. Commissioner bernal. Yes. Commissioner green. Yes. Commissioner giraudo yes. And commissioner chow. Yes. And thank you all very much and thank you for presenting and well say goodbye to the laguna honda folks. Thank you very much. And the next item can we also again commend maggie for the amount of work that shes done and keeping her eye on the ball along with responding to covid in such a very positive manner really. So id like to see if the commission can commend her for that. Clerk absolutely. Thank you very much, miss racowski. Item 12 is the zsfg c. E. O. Report. And i wonder if dr. Ehrlich can pop on. I am here. Clerk great. Now youre on. Great. So commissioners, thank you so much for having me here to do this report. I thought a lot about this report because there is so much to say and ill try to be as succinct as possible and to invite your questions. I wanted to start by talking about our staff because i just cant say enough about how incredible our team here has been. And the thing that came to mind for me was in this definition of heroes. A person who in the face of danger combats adversity through ingenuity and courage and strength. I think that says it all about our team here because they have really done it all. And as i go through this description of what we have been doing with covid, its really hard to overstate how much things have changed here. The buildings look the same, but everything inside them and all around them has really changed so much with covid. And thats been just a huge lift for our team. And theyve done remarkably well. To start were part of the Overall Department Operations Center and we have our hospital incident command systems that meets here now once a day, every day at 10 00. And its basically an expanded executive team meeting that we have that explores every aspect of our operations in detail. And we went from meeting twice a day now to once a day because of the situation that we have. And thats led by our chief of Clinical Operations jeff schmidt who has been an amazing leader through all of this. And our work is led by a surge plan that we created as well as a desurge plan which were in the process of being operational under now and that work has been led by our chief medical officer, and not only has that plan been really been instructive for us and guided us through our operations here, but its also been a model for other hospitals in the city. Weve shared it with them and theyve adopted similar plans and we have, in fact, have a citywide plan that guides our work and has been very helpful in the paradigm that dr. Colfax described. And three people that i want to call out for their contribution and that is our Infection Control nurse Elaine Decker and our feinfectious disease specia. They have been our guides and leaders on all things clinical and every question that you can possibly imagine having to do with pretty much everything that were dealing with right now. So theyve been front and center in everything that we do. And they have daily clinical rounds and consulting with teams on the patients who are in the hospital and then to the rest of us on various topics and issues. And the other thing that has changed quite dramatically with the entry of patients into our facility. I would say that is a combined effort of the Emergency Department, of course, and psych Emergency Service and our urgent care clinic and the richard fine Peoples Clinic. And im going to show you walk you through data but the data really tell a picture about who how that has changed by necessity as the types of patients have changed quite a bit and as well as the way that we see them and we need to cohort them both in terms of patients presenting with respiratory symptoms and nonrespiratory symptoms and then for what theyre presenti presenting. And the other issue has to do with staff and patient and visitor screening. So as dr. Green mentioned, anybody who comes into the building is screened. We screen staff every day and using temperatures. And we have an online tool and also asked questions when they present. And we are screening patients and visitors and its a very complex way that we have screened them. We have the urgent care clinic set up in the lobby of building five to address patients who have respiratory complaints. And then we have tents set up where people get tested. Those patients as well as staff who present with symptoms. And we have various types and brent and andrew, our chief Communications Officer is the leader on that but we had couldnt biewgzs from other members of our team, including iona johnson who led the screening work. And to address the spiritual issues and the wellness issues that we will try to work with the staff on. And then last but not least we had a huge outpouring of gratitude from the community through the San Francisco General Hospital foundation and the philanthropy they have bought in, totaling 4. 5 million and thats gone for all things directed at patients and staff. And so i will pause there. And theres an update and i wont go through in detail and it was prepared by our amazing chief medical Information Officer dr. Nita. And you can review that and im happy to answer questions on that. And ill pause for a minute before i go through the data which i wanted to go through in a little bit of detail as well. Clerk any questions, commissioners . This is dr. Chow again. And on the update could you see us running down and how they are used in this setting and whether it extends into your exterior efforts. You can see in the report that is written both in terms of optimizing surge, so the epic team has been front and center with planning for the alternative care sites and we they have been very involved with testing or preparing reports so this is not just a cfgsc, but throughout the Health Network and the department. And also with the command center. So there isnt as this report goes through, there really isnt anything that the team and i. T. Hasnt been involved with from terms of helping us to understand the Patient Population and to delivering the data reports which are really been phenomenal and what is going on internally and helping to explain what is happening with the public. So its what we would have hoped, the e. H. R. System could do for us then, is that right . And its really fulfilling the promises that we are hoping for from this type of electronic records . Yes, absolutely. And the other thing that i just want to comment on because you might not notice it but recall that almost exactly four years ago we moved into our new acute care tower. And almost every day i think about how critically important that building has been to us being able to meet the demand of this pandemic. And that starts with the Emergency Department that was quite a bit larger than previously and had individual patient rooms. Our whole inpatient area that has single occupancy rooms. We have an additional i. C. U. Unit that has enabled us to meet the surge in that demand. And so i just am grateful every day that this community and our foundation built that building, because i dont know where we would be without it. Thanks. Clerk any other questions, commissioners, before we move to data. Go ahead, dr. Ehrlich. Okay, great. So, you know, we have reviewed these charts every month at the j. C. C. And they are really different now than theyve ever been and so i think that theyre a great representation of how much things have changed here. So i wanted to just walk you through some of the changes and to give you a chance to reflect on that and to ask questions. And so first of all, you can see right away with the Emergency Department that our average daily volume has dropped by about 30 . And we dont know exactly why. And its probably due to a few things, one, that theres fewer city in the people now. And as dr. Colfax showed you, people are moving around a lot less and theyre clearly moving less into the Emergency Department. Also dr. Green, i wanted to respond to your questions about how what are the people presenting for. And as we look at in epic and we see both the chief complaints and the diagnoses that people are presenting with they have shifted and so the top diagnoses precovid were falls and headaches and chest pains. And now the three most common diagnoses are shortness of breath, cough and suicidal iraq ideation, interesting enough. And we have still coughs and headaches and chest pains but lower on the list. And so and along with your Emergency Department being down, the volume being down, so have our average daily admissions gone down which is not surprising because most of our admission comes from the Emergency Department. You will notice though that they are down by as much and thats because the percentage of admissions from the Emergency Department have gone way up. For as long as anybody can remember that percentage has been about 15 . And now its somewhere between 20 and 25 . Reflecting that the people who do show up in the e. V. Are sicker than they were before. On the next graph we can see some really dramatic and positive changes that have come as a result of covid. And one is that our leave without being triaged numbers are almost nonexistent. And ambulance diversion which was commonly thought to be an intractable problem is suddenly solved by covid, which is fascinating. This is not just because the volumes are lower. We also simultaneously have an experiment, if you will, going on in the city called cave. Which is run out of our Emergency Medical Services agency. And its basically a project that was envisioned for long before it happened this month. And very fortunately coincided with this pandemic. And the idea is to ambulance load traffic throughout this. And its with the ambulances calling in to the physician to get destination advice. And what has this has resulted in is that its a level loading. So were not experiencing the same ambulances that we did prior to the experiment. And, fortunately, everyone sees how valuable this has been and so now the experiment is going to continue i believe through july at least, which is great. Urgent care has also gone down and now part of this is because the urgent care volume is split between urgent care which is seeing all of the respiratory urgent patients and the Peoples Clinic that is now seeing the nonurgent patients. And were reducing the care in r. C. C. That is combined back with the urgent care clinic and thats a workload that were working on. And the other thing that i will say is that you will notice that the psychiatry volume has not changed much at all. And there are some slight changes that belie some of the big changes that we have made in that volume. So a while back now we decided that every Single Person going into p. E. S. Needed a test for covid. I can explain more about why we made that decision a while back. But if you see the p. E. S. Encounters going down, part of that is because all of these patients are going first to the Emergency Department where they get tested. And theyre also being evaluated there in some cases by a psychiatrist and so more people i believe are being discharged from the Emergency Department before they even make it to the p. E. S. And the admissions to 7b and 7c dont include the fact that we now have covid positive patients who are admitted just for psychiatric admissions on h52. Which you will recall is the forensic unit that we never used but now thanks to the Sheriffs Department being flexible with us that we can use that unit for these patients who would otherwise really not have a safe place to be at. And i think that i will stop there and because i have been talking a long time and see what other questions that you have about the data or any other aspect of our operations which as i think that you can see have changed pretty dramatically in the last few months. Clerk and dr. Hammer is here after to answer questions that dr. Green had. I dont want to leave her out. Commissioners, any questions . Yes, commissioner green. Vicepresident green well, first of all, you and your team are to be commended for your work. Its remarkable. And i know that you had a lot to do with bringing the Hospital Council together. When you stepped up to lead i saw big changes in the leadership of my own institution every day. Im so grateful to you because i can see your invisible hand guiding them. Thank you. Thank you. Vicepresident green and know that you will see us through regardless of the future in this epidemic hold. One of the things that was brought up at the last meeting and maybe dr. Hammer can talk about this, and the primary care clinics that we have recruited some staff from those clinics and im wondering where you stand on the analysis this sort of postsurge aftermath where we have untreated conditions. please stand by oh, dr. Ehrlich . I think she may have had some connectivity issues. Can you hear me . Yes. Could you speak up . You sound very faint. Thank you. Is that better . Yes, thank you. Good afternoon, commissioners, and i just want to this is hallie hameran, director of ambulatory care for the San Francisco health care network, d. P. H. , and also the outpatient well, the outgoing outpatient lead in the medical branch of the d. F. D. , and id be happy to answer commissioner greens question about ambulatory care and particular the primary care in our plans for reopening. I just want to add my recommendation to the leadership that you all have commendation to the leadership that you all have recognized at the start of this meeting. Its been great to be a part of this department, citywide activation, and starting with mayor breed and certainly our leaders, dr. Colfax and dr. Aragon, and then, just really want to call out Susan Ehrlich and her team and s. F. G. And the service that i get to witness each day when i call in to the meeting. Its been an incredible operation, and i think we have a lot to be proud of in San Francisco, and a lot to be grateful know, and our staff know or at least i hope they know that theyve been part of saving lives every day. As far as ambulatory care, and just to remind you, ambulatory care includes jail care, maternal care, integrated health, and the whole person care, which brings together a number of nontraditional services which serve people experiencing homelessness across the city. So across ambulatory care, we basically deployed a huge number of staff from three of those five sections. Those three sections being primary care, Behavioral Health, and m. C. H. Which in response to the health order to limit our ambulatory care services, those three sections really stripped down their staff and their services to just the most Urgent Services being provided in staff, and in so doing, we were able to deploy 200 ambulatory care staff to the d. O. C. , and then even more to our Clinical Services that grew in response to the covid pandemic. And so so so three services really stayed the same because we had to prevent outbreaks in the jail, so jail health, we really maintained our staff there. And then, particularly integrated care, as attention shifted to the impact of the covid19 on the people experiencing homelessness and living in supportive housing, we shifted a lot of ambulatory care staff to whole person integrated care. As as weve been realize that were in this fortunate place to start looking to phase 2 and phase 2 planning, weve been planning on resumption of some ambulatory care in those areas where we really had to reduce our services. Many of them will have to stay in the d. O. C. Where theyre continuing to provide care. The areas of the d. O. C. That we will really continue to support with ambulatory care staff and ambulatory care leaders are the hotels where over 1,000, now about 1400 people experiencing homelessness who could not who could not do so safely on the street have been housed. Weve also been supporting the isolation and quarantine hotels, both in terms of leadership, administrative support, and frontline clinical sites. So we have some testing attached to care clinics in areas of the city where we really wanted to focus on low barrier testing for our San Francisco Health Network and other safety net patients. So those are the areas of the d. O. C. That well continue to support as we move to resumption of ambulatory care services. Commissioner green, weve been working with with ambulatory care providers throughout the city, especially in the safety net, to help give guidance to provide resumption of ambulatory care services, particularly in ambulatory care. A lot of this is dependent on facilities, so theres a lot of variability in our facilities, which which will dictate how we treat this and the number of patients well be able to call back for inperson visits. Our expectation is across ambulatory care, along, with a lot of variability, and including, i should also mention, specialty care, that we will shoot for going back to about 30 of our visits being in person and continue to provide the majority of our care with telehealth visits, so telephone visits and some video visits. Our Behavioral Health services has done a phenomenal job in converting a lot of their routine Outpatient Services to telehealth. Id like to call outline dr. Hamilton holtz who is the medical director for primary care Behavioral Health and has been the lead for Mental Health Behavioral Services in implementing telehealth, and telehealth has been able to engage approximately 85 of their patients through limited very limited in person visits and then a lot of telehealth. So as we as we move to phase 2, to some limiting of restrictions and sheltering in place, we will be moving to some things that we cant do with telehealth. Childhood immunization, the kind of things that we need to be facetoface, clinical exams, and also visits for those people who are hard to engage over the phone, so people with serious Behavioral Health issues, those with limited english proficiency, and those with Severe Health concerns. Were working with Occupational Safety and health to assess the physical spaces and work with teams on their workloads to make sure that they can do that safely. I think ill stop there. Ive been talking a lot, and then, im happy to answer questions if there are more questions about ambulatory care. Im not sure if theres any follow up questions. Commissioner green . Yeah. I was wondering if you had an assessment of the Financial Health of some of the clinics because we know that telehealth appointments arent compensated very well, and i wonder if youve talked to clinics about their ability to stay open and their ability to maintain staff . Yeah, and thats a big concern and has been a concern right from the beginning. Weve been fortunate among the safety net clinics, that most of our telemedicine, its been reimbursable. Behavioral health, were also fortunate that we can bill for much of the telehealth. Our biggest concern is the safety net clinics that rely a lot procedural procedure procedural care, so, for instance, those San Francisco Community Clinic consortiums, clinics which have a large dental have large dental services and rely, in large part, on their dental revenues. I think those clinics have taken a large hit. Yeah, i mean, this has been really, really devastating for, i think especially some of the small providers of throughout the city, small primary care providers throughout the city. I think fortunately, for a lot of the Behavior Health providers, theyve been able to pivot very well to telehealth, which is great, but i think the what were going to see as we move into phase 2 is not just as as mr. Wagner mentioned earlier, that well be having a lot of people who have lost their employerbased Health Insurance and will be enrolling in medical, but i think well see some real impacts in terms of access because of some some of the some of the providers of care not being able to stay afloat. Thank you. It would be great to follow up on that. I think theres National Concern about it. Commissioners, i believe that theres a longterm plan maybe in september to have a primary care update, and i will talk to dr. Hammer and talk to shan and dr. Pickens. Are there any questions for dr. Ehrlich. Well, i just wanted to ask dr. Hammer one question, which is as youre trying to move towards having additional inperson visits, what is your time frame for that, and how does that affect our phase 2, you know, program . Our San Francisco Health Network clinics primary care clinics have been planning they were instructed at the beginning or at the end of april to look at may as their planning month, so theyre really planning now for early june to be resuming some inperson and inhome care. Well be looking to make sure we can do that safely, so screening everybody that enters the clinic, making sure that everybodys masked, making sure that we really limit the number of people in waiting rooms and nursing stations, etc. , so theres a lot of work that needs to be done to be able to do that safely. But i think what well begin to see in most of our clinics some some return to inperson care at the beginning of june. And before we shift the questions to dr. Ehrlich, i wanted to make sure that the question that i was asked was primary care, and im the director of ambulatory care. Primary care is part of ambulatory care, but the director of ambulatory care will come back to report to you, and thats ana behr. Shes been working 80hour weeks since the beginning of the activation in the d. O. C. While also running ambulatory care, so just want to commend her for her incredible leadership. So dr. Hamer, thank you also for your services these years. And since, as you reminded us at uhir about ambulatory care, jail is actually part of that. Can you tell us if jail is actually able to cope with the issues of social distancing and so forth thats necessary within the jail . And actually, dr. Hamer, before we answer, commissioner chow, just so you know, therell be a jail update at your june 2 meeting, so the next hearing, youll get an update on jail health. Well, ill wait to hear the report, and thats perfectly fine with me. Ill just say briefly, like the rest of us, that we have the gift of time that a lot of municipalities did not have at the beginning of the covid outbreak across across the nation. We were i think it was midmarch before we had our first positive case of covid of a person in custody, and and before that time, dr. Pratt was observing, really learning from the experience of other county jails across california and the country and in touch with jail Health Directors all over the place and used that experience to develop a really, really comprehensive prevention and mitigation plan. It was right after we started testing all people in custody at the time of intake . Right after that, i think it was within a few days that we had our first person test positive, and and they already had in place a protocol for keeping people as distant as possible from the rest of the population until their test came back . Unfortunately, thats its not really possible to completely isolate everybody coming into the jail, nor would we want to, so it s been very very challenging. Dr. Pratt did work with the investigation team. When that person tested positive within about a day of admission into the jail, and unfortunately, weve had no within the jail transmissions, as far as i know, and im really, really pleased to say that, and its a testament to the planning that dr. Pratt and her team did. Weve had, i think, about five positive cases of people in custody in the jail, not staff. There have been some positive cases among the Sheriffs Department staff, and those cases of people testing positive in the jail have been up up you know, managed appropriately. Dr. Pratt can share with you more details. Some have come as transfers from other county jails. Like, last week, we had one from santa rita. Its been really challenging to make sure we stay on top of everybody coming in, but i think so far were doing an excellent job in the jails. All right. Thank you very much. All right. Commissioners, any final questions for dr. Ehrlich before we move on . You know, the treatment in the jails, is that something that can be continued on an emergent situation . Would we be able to continue to find ways in which we would continue these lower levels of lower levels . Hi, dr. Chow. So one of the things that really helped us a lot was the contract that we had with Chinese Hospital. Right after laguna honda closed to admissions, we had a big spike in cases waiting for Skilled Nursing care. And now, Chinese Hospital has 23 of our patients, and theres been a little bit of turnover with that group, but but mostly, its the same patients kbho who were there from the beginning. We have patients who require Skilled Nursing care, especially custodial care, and so that is an asset that concerns us, the lack of that asset, especially because laguna honda, for very good reasons, is going to be closed to admissions to us probably at least until june. So even though the numbers look really good right now, we we are concerned about them staying as low as they are, and we have an amazing skilled and resourceful team who manages placement of people and patients in all kinds of settings, so its something were keeping a very close eye on right now. Thank you. Thank you, dr. Ehrlich. Were going to move onto the next item. Mark, before we move onto the next item, i want to reinforce my gratitude for dr. Ehrlich and dr. Hamer for their incredible leadership. Their teams have been engaged in not only doing the work that theyve been responsible for for several years now, but especially at the Department Operations center, their teams, their leadership, their detailing of the membership of the d. O. C. Has been fantastic, so i just want to collectively thank them. They themselves have been working sevenhour and many hours every day, and i just want to express my gratitude to them, and to their families for supporting them during this time. Thank you, dr. Colfax. So everyone, the next item will be item 13, zuckerberg generals family hospital. [inaudible] good evening, everyone. Thank you for giving us time to present the regulatory status report from San Francisco general. The status of this report, we had three high stakes surveys still scheduled for this year. The joint commission surveys remains suspended, but my understanding from speaking to the administrator of the joint commission, for the rest of 2020, the focus will be on the Infection Prevention and control. I think that will put us in a great place to address when that happens later in the year. The commission on cancer, granted, all of their accredited facilities are oneyear extensions, so we now have that survey scheduled for 2021. Also, the biggest piece of new in there is the calosha Workplace Violence Emergency Department complaint, and we submitted an appeal today around some of those citations because we really have requested some more information so that we can address the complaints more fully. In the background, the workplace Compliance Committee led by frontline staff have been doing a lot of work to to abade many of the things that were discovered, and were definitely moving in the right direction with that piece. Of the open site visits, the three or 8, 9, and 10, we have ongoing investigations into those three events, and weve seen a different methodology from the California Department of Public Health, with a lot of the investigation being done remotely by via document requests and interviews done over the phone. So that has enabled us to continue with those investigations. And we only have one new facility reported incidents to bring to the committee today. And we have submitted the preliminary investigation into the last one. The last allegation, we were unable to substantiate that. Those cases, when investigated, we have a lot of data to present to the investigators when they come from California Department of Public Health. Im looking forward to being fulltime again at s. F. G. So i can work in collaboration with the executive team there and the rest of Quality Management so we can really shape the way that we focus on the infection contro control kra controls more regulatory response to covid. Is there any questions or comments . Commissioners, there are no Public Comment items. Commissioners, questions from you . I dont know if you are itching, but i dont think any of you have your hands up. Thank you very much, mr. Smith. Thank you, commissioners. Thank you. Okay. Dr. Borden horton, the video is not on, so shes just on by phone. Dr. Horton . Lets see. Lets give them one second. Im going to text her. Dr. Horton . All right. So shes having trouble being heard. Give me one second. Im going to ask her to hang up and call back. Dr. Horton is going to have to hang up and call back, so give us another 30 seconds. Hello . Can you hear me now . Yes. Can you hear me now . Yes. Okay. Great. Wonderful. So i will go ahead and launch into my achievement staff report. Thank you very much for the welcome for my new role earlier. The one thing thats not listed on the chief of staff report that i wanted to comment on is we are doing a virtual med staff dinner, which is not surprising that wed have to go virtual on. It is on june 8. Most of the business we covered at m. E. C. Were similar to all the reports youve heard. Tonight, weve been discussing p. P. E. , weve been trying to keep leadership up to date on all of those issues as well as working on staffing the surge areas and the potential surge areas. There was no p. I. P. S. Meeting, but there will be in june. We did send out documents to commissioners that presented the results of the committee that was led by dr. Jack chase, chair of our Ethics Committee that really took a deep dive and laid out some key priorities and worked towards how we will proceed if we hit a time of critical resource scarcity during the time of covid. So i believe those were in the documents that we sent around, but i did want to commend the codirectors of the unit that worked on this, as well as dr. Chase and his whole committee for bringing such thoughtfulness and getting such work into these documents because we have so successfully flattened the curve and have not overwhelmed our medical system. Im very grateful to have them in place so that if anything should happen quickly, we have we can have a really thoughtful approach to it. So im going to pause for a second and find out if anyone has any questions for dr. Chase from those documents that we sent around . Commissioners, any questions . These are about the resource allocation during crises . This is dr. Chow. On the color coding, is that the color coding thats traditionally used in triage . Thanks, dr. Chow, for the question. This is jack chase. That color coding that we use is consistent with the main published guidelines on the topic most specifically from the university of pittsburgh allocation criteria, which was set up by doug white and bernie lowe, who are two experts in the field. No, thank you, because i know in the military, of course, we had different colors, and i couldnt remember what the colors were. So just when i think okay. So red is the highest priority, and this comes from the standards that were using. Thats great. Thank you. I also see that commissioner green has a question. Oh, i just wanted to thank you and commend you for these documents. Theyre so thoughtful, so well written, so compassionate. The letter is so well written, and i just want to thank the team for coming together and coming up with such an excellent template and guidelines. Thank you, commissioner. Well definitely convey that to the committee, as well. [inaudible] procedures were actually called out as special privileges that required individual doctoring, and so we have simplified that. The division of cardiology has simplified that and lumped those that are more considered to be core cardiology privileges into the core section and only are falling out four special privileges which require individual proctoring as opposed to proctoring for a general type of procedure. Are there any questions about the cardiology privileges . Dr. Horton, i think my only question, and its actually my ignorance is the prerequisites, is that these are the specialty boards from abim and not not the primary board, then, is that right, that were asking for . Its the specialty boards for interventional cardiology. Is that your question . Yes. As the thing for specialty board for cardiovascular disease, which is different from just getting a regular abim, right . Right. Thats my understanding is specifically, its the interventional cardiology board. Right, right. No, thats what i was trying to clarify. Right. Because if i remember now, they have a number of different specialties which are added boards, right, on top of the regular boards. Yes. Yes, thank you. I have no problem. Move for acceptance. Theres no one on the Public Comment line for this item. Any other questions on this, commissioners . Okay. So theres a motion. Is there a second . Second. Second. Thank you. Any other discussion . All right. So i will do a roll call vote. [roll call] all right. Thank you very much, dr. Horton. Youre welcome. Commissioners, item 15 is other business. Yeah. Any other okay. Theres no Public Comment on this item, so we can move onto item 16. Sorry that agenda item is incorrectly done on that slide. 16 is a consideration for a closed session. Is there a motion to move into closed session . So moved. Second. Mark, we need Public Comment . Yeah. Theres no Public Comment on this item. Ill do a roll call vote. [roll call] okay. So just a reminder to everybody, laguna honda folks, youre going to be first, so dr. Hu, please sign out of this. Everyone has to go to the closed session. S. F. G. Folks, please stay out im going to notify kim and dr. Ehrlich that were done, and they can join the valencia has been a constantly evolving roadway. The first bike lanes were striped in 1999, and today is the major north and south bike route from the Mission Neighborhood extending from market to mission street. It is difficult to navigate lindsay on a daily basis, and more specifically, during the morning and evening commute hours. From 2012 to 2016, there were 260 collisions on valencia and 46 of those were between vehicles and bikes. The mayor shows great leadership and she knew of the long history of collisions and the real necessity for safety improvements on the streets, so she actually directed m. T. A. To put a pilot of protected bike lanes from market to 15th on valencia street within four months time. [ ] valencia is one of the most used north south bike routes in San Francisco. It has over 2100 cyclists on an average weekday. We promote bicycles for everyday transportation of the coalition. Valencia is our mission fits our mission perfectly. Our members fall 20 years ago to get the first bike lane stripes. Whether you are going there for restaurants, nightlife, you know , people are commuting up and down every single day. I have been biking down the valencia street corridor for about a decade. During that time, i have seen the emergence of ridesharing companies. We have people on bikes, we have people on bike share, scooters, we have people delivering food and we have uber taking folks to concerts at night. One of the main goals of the project was to improve the overall safety of the corridor, will also looking for opportunities to upgrade the bikeway. The most common collision that happens on valencia is actually due to double parking in the bike lane, specifically during, which is where a driver opens the door unexpectedly. We kept all the passengers the passenger levels out, which is the white crib that we see, we double the amount of commercial curbs that you see out here. Most people arent actually perking on valencia, they just need to get dropped off or pick something up. Half of the commercial loading zones are actually after 6 00 p. M. , so could be used for fiveminute loading later into the evening to provide more opportunities or passenger and commercial loading. The five minute loading zone may help in this situation, but they are not along the corridor where we need them to be. One of the most unique aspects of the valencia pilot is on the block between 14th street. We worked with a pretty big mix of people on valencia. On this lot, there are a few schools. All these different groups had concerns about the safety of students crossing the protected bikeway whether they are being dropped off or picked up in the morning or afternoon. To address those concerns, we installed concrete loading islands with railings railings that channel channeled a designated crossing plane. We had a lot of conversations around how do you load and unload kids in the mornings and the afternoons . I do like the visibility of some of the design, the safety aspects of the boarding pilot for the school. We have painted continental crosswalks, as well as a yield piece which indicates a cyclist to give the rightofway so they can cross the roadway. This is probably one of the most unique features. During the planning phase, the m. T. A. Came out with three alternatives for the long term project. One is parking protected, which we see with the pilot, they also imagined a valencia street where we have two bike lanes next to one another against one side of the street. A twoway bikeway. The third option is a Center Running twoway bikeway, c. Would have the two bike lanes running down the center with protection on either side. Earlier, there werent any enter lane designs in San Francisco, but i think it will be a great opportunity for San Francisco to take the lead on that do so the innovative and different, something that doesnt exist already. With all three concepts for valencias longterm improvement , theres a number of tradeoffs ranging from parking, or what needs to be done at the intersection for signal infrastructure. When he think about extending this pilot or this still this design, theres a lot of different design challenges, as well as challenges when it comes to doing outreach and making sure that you are reaching out to everyone in the community. The pilot is great. It is a nobrainer. It is also a teaser for us. Once a pilot ends, we have thrown back into the chaos of valencia street. What were trying to do is incremental improvement along the corridor door. The Pilot Project is one of our first major improvements. We will do an initial valuation in the spring just to get a glimpse of what is happening out here on the roadway, and to make any adjustments to the pilot as needed. This fall, we will do a more robust evaluation. By spring of 2020, we will have recommendations about longterm improvements. I appreciate the pilot and how quickly it went in and was built, especially with the Community Workshops associated with it, i really appreciated that opportunity to give input. We want to see valencia become a really welcoming and comfortable neighborhood street for everyone, all ages and abilities. Theres a lot of benefits to protected bike lanes on valencia , it is not just for cyclists. We will see way more people biking, more people walking, we are just going to create a really friendly neighborhood street. [ ] announcer youre watching coping with covid19. Todays special guest is dr. Steven getnick. Hi, im chris man us and youre watching coping with covid19. Today my guest is the director of the Behavior Therapy Center of San Francisco and Professor Emeritus in counseling psychology at the university of San Francisco. Doctor, welcome to the show. Thank you. Lets talk about managing anxieties during this pandemic. What types of issues are people facing at the moment . There are a number of issues and i really want to point out that this is affecting everyone and has come on very quickly. So it is normal. If you are not experiencing some anxiety, something is a touch off because this affects us all. I think some of the main ones are our health and worried about getting the virus and our developing serious complications. I think for a lot of people who are single, living alone, in isolation, has been very difficult. I think being in close quarters with people who we normally have some space from now are together 24 7. Thats produced a lot of stress and anxiety. That loss of connection with others. We already addressed. And having kids home. For a lot of people. Yes, absolutely. What are the other problems that they might have . I think without that dynamic, the good things are not a problem. It is the difficulties we have. And when were together 24 7, again its like hooking everything up to an amplifier. So, what kind of problems could be created from working home from home, perhaps for the first time in your career . A lot of people are not used to working at home and a working at home just isnt the same. For one thing, there is a lack of social interaction. Some people find that that affects them greatly. Some people are actually finding theyre getting more work done at home without distractions from work. The lack of structure is probably the most common. We see it here with work at the office. People are kind of watching. We know that our schedule is, suddenly youre at home and you are on your own. Absolutely. If those are some of the issues people are facing, what are some of the techniques people can use to overcome their anxiety . Caller i think there are many. One of the first is how managing and keeping track of your thinking, we think and talk to ourselves a lot. Thats normal. We have a dialogue with ourselves often and we need to monitor that a bit. People tend to ruminate versus problemsolve. That is they tend to worry about all the things that might go wrong. And what i suggest is, look, there are things that can go wrong, but ruminating about the worstcase scenario is not going to be very productive. Sit down, figure out what the things are that you have to deal with and try to problemsolve. I think any of the selfcontrol techniques for anxiety can be helpful. And there are dozens of them. The common ones are meditation, relaxation techniques, yoga, for example and another is diaphragmattic breathing. If you google that, you can learn diaphragmattic breathing in about 10 minutes online. Its incredibly simple and it is a really nice way to reduce anxiety in the moment. Selfcontrol procedures, exercise. Whether if youre fortunate enough to have equipment at home, thats great. If youre not, get outside and go for a walk, keep your safe distance, of course. But you need to be active. Thats helpful. I think people marry be dealing with information overload at the moment. How do you suggest people manage that . I was just going to say that. I think it is really important to kind of limit the information you get. Not in terms of accuracy. I think in terms of accuracy, you want to identify a few sites where people are coming with evidencebased information and scientific information so you can form yourself well. Once youve informed yourself, you need to not be watching all day long. Ive talked to people who are mesmerized from the tv and a it keeps that anxiety going so you need to limit your viewing for sure. This can be stress for people who have economic concerns and worried about their family and friends and loved ones who are essential workers. What would you suggest they do to help manage anxiety and stress . There is a number of things. One of major ones for depression is behavioral activation. Simply, it really means that people will tend to not be depressed as a number of reinforcing activities to engage in. Whether it is hobbies, you read, you listen to music, you crochet, you whatever. These kinds of things are very important so you want to make sure that youre engaging in activities that literally make you feel better as opposed to sitting around ruminating, worrying about the worstcase scenarios that might happen. What about trying to do some selfdevelopment . Yeah. Its a very interesting time. Ive talked to a couple of my own clients who are finding, in a very positive way, that this isolation, while at first can generate a lot of anxiety, particularly if youre just not good at living alone. For a number of people, its giving them a chance to sit back and really think about what is important in their lives, what are the priorities. I think that maybe if there is any Silver Lining in this epidemic, its really forcing all of us to kind of rethink whats really important. Indeed. You know, though, at the same time, there are people who are feeling very lonely at home. How would you encourage them to overcome that . You get online. Facetime, skype, zoom, like what were doing right now. You can stay connected. Its very possible. Most connections are important. We are social critters and we need that connection. I think for people who dont have those options, pull up photos, take a look at pictures of family. You need to stay connected. And its very important. And finally, do you have any suggestions that are specifically for families . Yeah. Well, again, i think one of the interesting things thats come about from all of this, is i talked to families on video is theyre obviously spending more time together. While its a bit awkward, particularly for parents who are in the house working a lot. Its a chance to really deepen relationships and spend more good, quality time together. I think parents really need to step back and kind of plan their day a little bit. Not micro manage it, but have some ideas. Can the family play games together . A lot of people i talked to, theyre even together as a family for the first time. So i think there are a number of things that people can do. I think it is qulaouzful for the families to take five, 10 minutes and say how did the day go . I talked to someone in the phone book before we started who said they noticed what time of day all their anxiety kind of comes together and they start sniping at each other. Now theyre taking a few minutes at tend of the day to say, ok, how are we doing . I think they need modeling good behavior, something you can do within the family, too, to try to thats right. I think thats relevant. Very relevant to how children are going to do. Most of the research from crises, particularly things we cant control showed that children do as well as their parents do. So i think it is important for parents to think about how theyre react aing and they stay calm because whatever they do is modeling, coping for their children. So, that can be very useful. It can also be problematic. When we talked earlier, you mentioned that acknowledging that your kids are afraid is important. Yes. I think that ties to your last question. I think modeling you know, its not incompatible with saying, yeah, you know, mom or dad is a little nervous, too. It means a lot of stuff is going on, but were going to be ok. Were going to stay together. We have our time together. Were going to be safe. Well fill in the blank. So you can do both. You can reassure but in a realistic way that once the kids know its normal to be anxious in these times. Thank you for coming ton show, doctor. I really appreciate the time youve given us. Youre welcome. Thank you for having me. And that is it for this episode. Well be back with more covid19 related information shortly. You have been coping with covid19. Thank you for watching. [ ] i just dont know that you can find a neighborhood in the city where you can hear music stands and take a ride on the low rider down the street. It is an experience that you cant have anywhere else in San Francisco. [ ] [ ] district nine is a in the southeast portion of the city. We have four neighborhoods that i represent. St. Marys park has a completely unique architecture. Very distinct feel, and it is a very close to holly park which is another beautiful park in San Francisco. The Bernal Heights district is unique in that we have the hell which has one of the best views in all of San Francisco. There is a swinging hanging from a tree at the top. It is as if you are swinging over the entire city. There are two unique aspects. It is considered the fourth chinatown in San Francisco. Sixty of the residents are of chinese ancestry. The second unique, and fun aspect about this area is it is the garden district. There is a lot of urban agriculture and it was where the city grew the majority of the flowers. Not only for San Francisco but for the region. And of course, it is the location in mclaren park which is the citys second biggest park after golden gate. Many people dont know the neighborhood in the first place if they havent been there. We call it the best neighborhood nobody has ever heard our. Every neighborhood in district nine has a very special aspect. Where we are right now is the Mission District. The Mission District is a very special part of our city. You smell the tacos at the [speaking spanish] and they have the best latin pastries. They have these shortbread cookies with caramel in the middle. And then you walk further down and you have sunrise cafe. It is a place that you come for the incredible food, but also to learn about what is happening in the neighborhood and how you can help and support your community. Twentyfourth street is the birthplace of the movement. We have over 620 murals. It is the largest outdoor Public Gallery in the country and possibly the world. You can find so much Political Engagement park next to so much incredible art. Its another reason why we think this is a cultural district that we must preserve. [ ] it was formed in 2014. We had been an organization that had been around for over 20 years. We worked a lot in the neighborhood around life issues. Most recently, in 2012, there were issues around gentrification in the neighborhood. So the idea of forming the cultural district was to help preserve the history and the culture that is in this neighborhood for the future of families and generations. In the past decade, 8,000 latino residents in the Mission District have been displaced from their community. We all know that the rising cost of living in San Francisco has led to many people being displaced. Lower and middle income all over the city. Because it there is richness in this neighborhood that i also mentioned the fact it is flat and so accessible by trip public transportation, has, has made it very popular. Its a struggle for us right now, you know, when you get a lot of development coming to an area, a lot of new people coming to the area with different sets of values and different culture. There is a lot of struggle between the existing community and the newness coming in. There are some things that we do to try to slow it down so it doesnt completely erase the communities. We try to have developments that is more in tune with the community and more Equitable Development in the area. You need to meet with and gain the support and find out the needs of the neighborhoods. The people on the businesses that came before you. You need to dialogue and show respect. And then figure out how to bring in the new, without displacing the old. [ ] i hope we can reset a lot of the mission that we have lost in the last 20 years. So we will be bringing in a lot of folks into the neighborhoods pick when we do that, there is a demand or, you know, certain types of services that pertain more to the local community and workingclass. Back in the day, we looked at mission street, and now it does not look and feel anything like mission street. This is the last stand of the latino concentrated arts, culture and cuisine and people. We created a cultural district to do our best to conserve that feeling. That is what makes our city so cosmopolitan and diverse and makes us the envy of the world. We have these unique neighborhoods with so much cultural presence and learnings, that we want to preserve. [ ] the 2020 meeting of the police commission. Sergeant youngblood, please call role. A commissioner dedejesus. Here. A commissioner hamasaki. Present. Hamasaki is present. Commissioner elias. Here. Commissioner elias is present. A commissioner brook. Present. U a Vice President taylor, you have a quorum. For the members of the public who wish to make a comment the number is 4084189388 and the access code for tonights meeting is 146 6282245 and as always, please make sure you are in a quiet location and try to mute your sound, the sound around you to eliminate background noise. For the commissioners and presenters here, i will ask you to mute yourselves and minimize background noise unless you are speaking. And as always, either type your name or the emoji of your choice into the chat box if you would like to be heard. Tonight i will allow two minutes for Public Comment and lets get started. All right. Thank you, commissioner. For the members of the public this, meeting is being televised by sfgov tv. If you are interested in making a Public Comment, please dial 4084189388 and enter access code 146 628 2245. And then press pound. Press pound again to join the meeting as a participant. You will hear a beep when you have entered the meeting. When Public Comment is announced for the line item or general Public Comment, dial star 3 to advise the mad moderator you wish to speak and you will hear, you have raised your hand to ask a question. Please wait to speak until the host calls on you. When you hear the moderator say, your line is unmuted, this is your opportunity to provide Public Comment. You will have two minutes to comment and will be moved back into the queue as a participant unless u you disconnect. You may stay on the line to comment on another item. The number is 4084189388 and an access code 1466282245. And thank you, again, for your patience. Commissioner taylor . Can you please call the first line item . Line item one, reports to the commission. Discussion, chiefs report. Weekly crime trends, provide overview of offenses occurring in San Francisco. Significant incidents events, provide a summary of planned activities and events occurring since the previous meeting, including summary of response to events related to the scheduled demonstrations and a brief overview of any unplanned events or activities occurring in San Francisco having an impact on Public Safety and determining whether to calendar at a future meeting. Commissioner inquiries, provide a brief followup to inquiries made by commissioners during previous meetings to include the sb1421 and the wearing of face masks. And presentation of the Crisis Intervention Team end of year report and the status update on booking Photo Department notice. Thank you. Good evening, Vice President tae lore and commissioners Vice President taylor, commissioners, and executive director anderson and the public. I will start off with the chiefs report on weekly crime trends. Overall our Violent Crime is down. It is down 13 overall compared to 2019. This week versus last week is down 3 . The not so good news is that our homicides are up 18 . We have one homicide during the week ending june 7, 2020, and a total of 20 homicides year to date. There have been two homicides in june and as i reported last week, there were four homicides in may. 12 of the 20 cases have been cleared, 11 cleared by arrest, and one cleared by appearance. And from last week and to you to and the victim was located with the gunshot wound and transported to the hospital. And the incident apierce to have been from a vandalism call earlier in the day and escalated into this shooting. And a person has been identified and arrested connection of the homicide and our investigators are working with the District Attorneys Office. At this point charges have not been filed but the investigators are working with the District Attorneys Office in that case. In terms of total gun violence, year to date, we are down 16 . We had two shooting incidents that caused injury to victim this is past week and there is a total of 46 injury shooting related injury year to date resulting in 47 victims. 46 incidents resulting in 47 victims. In term of property crime overall t property triem is down 15 year to date. This week versus last week were down 29 , so were happy with that. For auto burglaries are down 31 year to date. And when we compare to 2017 where we really had a significant spike in auto burglaries, we are down 50 . So were happy with that. As we reopen, we will continue to put emphasis on prevention, asking the public not to leave items in their cars and also some of the measures that we had taken prior to the shelter in place orders and will resume and including patrols in areas that have been known and plagued by auto burglaries. Units working specifically to identify prolific auto burglars and working with the public on Crime Prevention strategies. In terms of other property crime, not happy to report that we are still up in burglaries, significantly up in burglaries. Year to date were up 33 which represents over 600 crimes. Motor vehicle thefts is still up 18 year to date, which represents over 300 crimes. In arson were up 47 which represents a total of 42 crimes over this time last year. Property crime has been driven down overall by a significant reduction in larceny and theft, which includes auto burglaries, which are down 26 year to date which represents a decrease of approximately of 4,300 crimes. As far as critical incidents, i already talked about the murder from last week, and other than that, there were no significant incidents to report to the commission in terms of crimes. However, we did have an incident that our officers that were called to respond to that got quite a bit of news attention, and this was an incident in Pacific Heights where a person witnessed what was believed to be a vandalism and eventually the homeowner we found out had spray painted black lives matter on their retaining wall. The police were called for that incident. Our officers responded based on the call, and i want to illustrate how important i believe the commissions approval of our fivepoint which explains bias by proxy and gives guidelines to officers in how to handle calls when that is believed to be the case. In this particular case, everything worked like it was supposed to. Community policing was in play. The officers actually because of their knowledge of the community knew the individual who had spray painted on his own wall. They knew he live there had because of prior contact and knowledge of the area. And that is really what Community Policing is the essence of Community Policing. And they did not take any action on this case, and of course, i think that the gentleman who painted the black lives matter on his retaining wall was the one that brought this to the medias attention, but again, i just want to highlight i think we are, if not the only, but one of the few who have written policy on bias by proxy and some guidelines on how to deal with it. I think that given that policy with the spirit of that was met in the way the call was handled. Kudos to the officers and thank you to the commission for getting that passed and getting that conclude. Hopefully we will have that in place shortly when we have the meet and confer. Significant incidents, i do want to call attention to an incident that occurred last week. We sent a contingency of San Francisco Police Officers, our color guard, along with command staff went to Santa Cruz County today, unfortunately, for the Public Memorial Service for Santa Cruz County sheriff Sergeant Damon gutsweiler. The sergeant was tragically killed while on duty june 6, 2020, while investigating a suspicious vehicle. An additional death and was wounded during that incident. A short time later the people believed to have committed the murder of the officer carjacked a vehicle and engaged in another shootout in which the california Highway Patrol ended uptaking this person into custody. Sergeant gusweiler, 38 years old, leaves behind a wife, son, and unborn child due to be born late they are morn. I just want to call out that our color guard and our command staff attended the sergeants memorial service. And just want to pay tribute to an officer that lost their life in the line of duty. The next item is well go to our 1421 update. And we have commander Robert Osullivan who will present that, and that will be followed up by commissions inquiry on the incident with the ppe we had several weeks ago. And then well have a presentation on our c. I. T. Commander osullivan, youre up. Im sorry, its commissioner taylor. Questions about this part of the report . I can answer them now or at the end. I have a question, chief. Specifically about the killing of sergeant gusweiler and the federal security officer. I was reading reports like everyone else about just this being orchestrated by a far right group and the indictment in the u. S. Attorneys office that was filed. So what f anything, can you tell us about them and kind of nationwide there have been certain groups and generally certain news reporting. And fox news is making this about protesttors and what can you tell u us about the murder of the two officers . I think the indictment and i read the press release and the connection between the federal killing of an officer in oakland and the individual that killed sergeant gusweiler and im and the group that you speak of boogaloo has risen to the surface and gotten attention an i cross the country as being very active right now. It is a far alt right group and information out there and Public Information and they are getting sources and some of the violence and the protests. A lot of that is about as much as i know in terms of unclassified information. But again, with these protests we cant take that too lightly because the bottom line on it is the vast majority of people that have participated in these protests across the country are peaceful and want to get out and exercise the First Amendment rights. When we have groups whether it be a group like that or any other group whose sole purpose is to cause chaos, violence, and hurt people, that really rises to the level of Law Enforcement attention. And we want to do everything we can in our city to insure that we dont have that type of violence. So we are continuing to monitor our protests and allow san franciscans to protest peacefully and express their right. When we see that with any sign we have groups like that in the mix, it is a cause for concern. And it is a time for us to step in and take action and make sure that we protect life. Commissioner can you tell us and if there are any of the people the department has arrested for violence and protest thus far, do you know if there is any association with that group or other rightwing groups . Not that i know off. There is speculation based on the social media posts that we have seen, but we have not been able to connect that to individuals that we have arrested or identified in any of our protests. There is a lot of hate out there on social media. We need to take it all seriously. And vet it as best we can do that. But we havent made any solid connections. Commissioner hamasaki . Commissioner thank you. And thank you for bringing this point up, commissioner taylor. Chief, i asked about this maybe a year or two years ago when we had charlottesville, and we were seeing a lot of activity around the rise of white supremacist, hate group, and id asked you if the department was engaged in any investigation around whatever that category or classification we want to use, alt right, but generally white supremacis supremacists. Is the department continuing to monitor for these groups and their activity in the community . Yes, commissioner, we are. And open Source Information and when i say open source, information that is basically something anybody can monitor. That is always the first source. And there is a lot of information out there on social media some pertaining to the city, some pertaining to the bay area, and some nationaltype of information, be u we monitor it all. Anything pertaining to San Francisco we do what we can to take precaution whether that will increased presence or if there is specific individuals that just point to, we will definitely investigate that. We have to work with the regional or Law Enforcement agencies across the region and frankly, the National Agencies as well to make sure we are all coordinated in terms of making sure that we dont have those type of events in our city or in the region. We dont want them anywhere in the country. But we definitely have a responsibility to do that. So yes, we are working with everybody that we can under the policy that we have to make sure that we do what we can to be vigilant on this. Commissioner is there a special Division Within the department or who handles it on an ongoing basis . Not just when things get hot around protests and forth. Our special Investigation Division when it rises to that level, it is handled from the Investigations Bureau and the special Investigations Division will handle that type of investigation. Commissioner okay. Interesting fact. The boogaloo is from a 1980s or something movie about break dancing. Breaking to electric bugaloo and the internet repackaged to use, like a lot of things that have existed on the internet, they packaged it for hate crimes or to support hate groups. Just thought i would share that notsofun fact. Some of us know that movie well. Maybe just me. Maybe i am dating myself. Okay. Commander osullivan is ready for the 1421 update. Okay. Good morning. Or good evening, rather. Could be morning. Commissioner taylor, commissioners, chief scott, director henderson, memberses of the public. I am commander of the Risk Management office and i am here to update the commission and members of the public with regard to the departments recent efforts around senate bill 1421. Ill start this evening as i did last week with a little bit of background regarding senate bill 1421 t. Bill requires the disclosure of records and information concerning four types of incidents. They are as follows. An officers discharge of a firearm at a person. An officers use of force against a person which results in great bodily injury. A sustained finding that an officer engaged in Sexual Assault involving a member of the public and fourth, a sustained finding of dishonesty by an officer. Since january 1, 2019, the department has received 142 public records as requests related to senate bill 1421. For the most recent period t previous week, june 3 through june 9, the department did not receive any new public records request. We did produce 39 releases and we closed three pro records at request. Thank you. Thank you. Next item. Sorry. I was on mute. In last weeks hearing or might have been the prior week, i think commissioners had questions and wanted to ask questions about the wearing of the ppe with the thin blue line. Vice president taylor, how do you want to proceed . I can give a brief overview or open it up for questions. Which way would you i think it might be helpful for a brief overview and if commissioners have questions, we can ask them. I will start off with the timeline of how we got there, if you will. February 25, mayor london breed issued a declaration declaring a Public Health emergency related to covid19. On march 7 of 2020, our City Department of Human Resources notified employees that the first positive test for covid occurred in our city and issued guidance to protect against contracting the disease. A shelter in place order went into effect on march 17, 2020. On march 20 our city administrator declared that the City Administrators Office was managing all ppe supplies including disinfected face masks and gloves due to critical shortages in the city and to have efficiency in terms of the issuance of ppe to the various departments who particularly front line or essential workers who needed ppe. On march 25, the department issued the Department Notice 20050, exposures of covid19, and it was issued stating that ppe is in limited supply. At that time there was no mandatory wearing of facial covering or face mask. I provided this information to all members related to the first known exposure of several members of our department that there was a known exposure who worked in our s. V. U. Unit. On march 31, our City Department of Human Resources released an updated guidance on use of respirators and masks for City Employees to include mandatory wearing of masks during their work shifts. On april 4, 2020, Department Noticed 20055 was issued and updated the guidance for use of respirators and mask to align with what the City Department of Human Resources guidelines. This notice allowed for the wear of simple barrier isolation masks with no writing or designation on them. On april 14, 2020, Department Noticed 20066 was issued and this was an updated guidance for mandatory use of new masks. And as stated the barrier masks have no writings or designations on them and the notice further stated as commercial ppe masks are limited in supplies, members are encouraged and allowed to weartain that own personal simple barrier mask as long as they are work place appropriate and do not reflect discredit upon the department. On may 1, 2020, i sent a message to all members and that was the day i discovered that the thin blue line facial coverings were being used by the department members. Let me just go into a little detail of this. It was brought to my attention actually by a community member, several Community Members who called me. There were member of our community and people of color and some africanamerican, and they had issue with what the mask represented to them. They felt that the mask represented some racial prejudice based on information that was out there on i looked at this, there was a lot of information that the masks were associated with white supremacist groups and others who were deemed to be believed to be ratist. I will say the thin blue line has been around for a long time, and i knew this symbol to be a symbol of fallen officers. I have seen it at memorials for a long time, but as commissioner hamasaki pointed out before, people tend to sometimes rebrand things and this is one of those examples where this has been rebranded. Nonetheless, people who live in our city found it to be offensive. Not just one person, but many people. That same day i issued a Department Wide email banning the use of it and in the Department Wide email, and inthe San Francisco stands for respect and safety for all and in appreciation of concern that some of the officers face masks may be perceived as divisive or disrespectful, we are taking steps to provide alternative neutral personal protective equipment. At the same time, i made clear in the public messaging that the thin blue line was adopted more than three decades ago as a symbolism for national Law Enforcement officers ememorial and was developed and for most of us in Law Enforcement remains a meaningful expression to Honor Fallen Police officers. Parallel symbolism and the thin rail line was adopted by firefighters to honor those who have give their lives while serving in the line of the global pan dem that i can has seen far to many First Responders lose their lives around the nation and the world, it is important that the officers wear are meant to honor all who make the ultimate sacrifices for people we serve. Please know how much i appreciate your continued effort during the covid19 crisis and i have every confidence that the vast majority of san franciscans share our dedication. And that was the information statement that i put out as we recalled those thin blue line masks. Now w that said, i will stay in speaking to many members of the community and this gets back to something you all have heard me say in the commission and publicly, and we have to listen to what the Community Members are telling us. And in my opinion chief of police, when i have many members of the community telling me that that symbolism is offensive to them, that means something. Thats the reason is that was the right thing to do. A question was asked there were brought to the attention of the department and i think the story broke online or one of the local newspapers had a picture with some of the officers wearing it. They were not approved by the department. And upon learning of it, within hours, i issued that statement to recall. So from safety and respect, and it does mean something to me and to this organization, and when we have information or things out there there that are disrespectful to any segment of the public that we serve, we have to listen and we have to take that seriously. And director henderson to have the investigation as open and ongoing and it is my understanding there were public complaints about this. And we are supporting and as a matter of fact, i called director anderson and invited that. So definitely we want to make sure no policies were violated and no rules were violated. But the bottom line is we must be and have respect and appreciate the perspectives of the communities we serve. And thats why that mask is pulled and has been forbidden. Commissioner . You are on mute. Commissioner thank you, commissioner taylor. Chief, you answered most of the questions i had. I am hear that it was not in any way authorized or approve by the department. I think that would have been extremely concerning for a lot of us. I got the same calls and taggeded in social media posts about it from the beginning of whatever day that was. And people were upset and the nuance that you mention with the history, that is a Law Enforcement and that is something that the broader public doesnt understand. We have seen it and i think it arose in response to black lives matter and the Blue Lives Matter and that is when the White Nationalist or White Supremacists started using it, so thats the association a lot of public has and they dont understand the history that you know, and i appreciate you addressing that and taking action quickly. The other issue to me and i have mentioned this to you before is this my understanding and correct me if im wrong is these masks were distributed by the p. O. A. For the officers to wear. And i dont know maybe they didnt know about how the symbol has been used, but it was pretty tied to previous Law Enforcement protest, so thats one issue. And the other issue is putting their p. O. A. Symbol on it which i think is divicive in a number of is divisive in a number of ways. One, not every member of the sfpd is a member of the p. O. A. Its not and to the city and the city has soundly and voters especially have rejected a lot of measures put forth by the p. O. A. , proposition ht one that sought to take power away from this commission. And so me it seemed like almost an attack on the department in saying the p. O. A. Is in charge, not sfpd and not the chief. Have you is this a dialogue that you have had with the p. O. A. And have you expressed concern . Ed you are on mute, chief. Sorry about that. There was a dialogue and there was a dialogue that night and this was a conversation that night. And this is, commissioner, to your point, particularly right now it is really important that the lines are clear and made a statement and the Police Officer association does not speak for or on behalf of the department. They have a role as a unit and i respect that role and they do not speak on behalf of the department. We need to make that line very clear and bright that what the department condones and what we dont. And so hopefully i did that and if that happens again to be pointed out, hopefully that will be communicated and i have seen a lot of statements from them in the press about selling them and being silenced and i dont remember if this was one of the times they called for your removal. They do it every few weeks it seems. So i would hope that they would understand that there is a hierarchy in the department and what the rule is. I am glad that you were able to have a conversation with them about that department. I have nothing further. Commissioner commission dejesus. Are you able to control her microphone, officer youngblood . I can mute her, but not unmute. Commissioner okay. You are still muted. I think this is going to be one thing that webex may not fix. The ability to use the microphone button. Do you want to try wait, i think you just unmuted yourself and muted again. Do you want to try it . Whatever you just did. Do it again. All right. So when the mute button goes away, it diappears and i cant get it to come back up. That is my problem. Where did you all go . We are here. We can hear you. Okay. Let me see where everybody went. So let me chief, i just want to look at the timeline you gave. So my understanding is the city administrators were handling the ppe equipment and on march 31 the department of Human Resources and mandatory masks were required for employees. And the question i have is did we even ask the city administrator for a mask for the department . Did anyone in the command staff make a request . Yes, ms. Dejesus, we made that request. At that time, you recall there was a critical shortage with hospital workers. You made a question and they couldnt provide. I wanted to know if you asked. Yes, maam. And i want to be clear and they worked real hard to get it and the ppe that the city needed and eventually we got what we needed and at that time we werent there yet. I know a lot of calls, too, and i was told the mask had the p. O. A. Logo or name on it. And the pictures i cant tell and i can just see the flag and if