Transcripts For SFGTV BOS Rescheduled Budget And Appropriations Committee 20240712

First its always the hardest and when they look back they really wont see you, but its the path that youre paving forward for the next one behind you that counts. Hi, my name is jajaida durden and im the acting superintendent for the bureau of forestry and i work for public works operations. And im over the landscaping, the shop and also the arborist crew. And some tree inspectors as well. I have been with the city and county of San Francisco for 17 years. And i was a cement mason, that was my first job. When i got here i thought that it was too easy. So i said one day ill be a supervisor. And when i run this place it will be ran different. And i i didnt think that it wod happen as fast as it did, but it did. And i came in 2002 and became a supervisor in 2006. And six months later i became the permanent supervisor over the shop. With all of those responsibilities and the staff youre also dealing with different attitudes and you have to take off one hat and put on another hat and put on another hat. And shes able shes displayed that she can carry the weight with all of these different hats and still maintain the respect of the director, the Deputy Director and all of the other people that she has to come in contact with. Shes a natural leader. I mean with her staff, her staff thinks highly of her. And the most important thing is when we have things that happen, a lot of emergencies, shes right by me and helps me out every time that i have asked. My inspiration is when i was a young adult was to become a fire woman. Well, i made some wrong decisions and i ended up being incarcerated, starting young and all the way up to an adult. When i was in jail they had a Little Program called Suppers Program and i supers program, and i met strong women in there and they introduced me to construction. I thought that the Fire Department would turn me down because i had a criminal history. So i looked into options of what kind of construction i could do. While i was in jail. And the program that i was in, they retrained us on living and how to make the right decisions and i chose construction. And cement mason didnt require a High School Diploma at that time so i figured i could do that. When i got out of jail they had a program in the philmore area and i went there. My first day out i signed up and four days later i started to work and i never looked back. I was an apprentice pouring concrete. And my first job was mount zion Emergency Hospital which is now ucsf. And every day that i drive by ucsf and i look at the old mount zion emergency, i have a sense of pride knowing that i had a part of building that place. Yeah, i did. I graduated as an apprentice and worked on a retrofit for city hall. I loved looking at that building and i take big pride in knowing that i was a part of that retrofit. My first for formen job was a 40 Story Building from the ground up. And its a predominantly male industry and most of the times people underestimate women. Im used to it though, its a challenge for me. As a female youre working with a lot of guys. So when they see a woman, first they dont think that the woman is in charge and to know that shes a person that is in charge with operations, i think that its great, because its different. Its not something i mean, not only a female but the only female of color. I was the first female finisher in the cement shop and i was the first crew supervisor, in the shop as a woman. When i became a two, the supervisors would not help me. In the middle, theyd call me a rookie, an apprentice and a female trying to get somewhere that she dont belong. Oh, it was terrible. It was terrible. I didnt have any support from the shop. The ones who said they supported me, they didnt, they talked about me behind my back. Sometimes i had some crying, a lot of crying behind doors, not in public. But i had a lot of mentors. My mentor i will call and would pick up the phone and just talk, talk, talk, please help me. What am a i going to do . Hang in there. It was frustrating and disheartening, it really was. But what they didnt understand is that because they didnt help me i had to learn it. And then probably about a year later, thats when i started to lay down the rules because i had studied them and i learned them and it made me a good supervisor and i started to run the ship the way that i wanted to. It was scary. But the more i saw women coming through the shop, i saw change coming. I knew that it was going to come, but i didnt know how long it would take. It was coming. In the beginning when i first came here and i was the first woman here as a finisher, to see the change as it progressed and for me to become a permanent assistant superintendent over the cement shop right now, thats my highlight. I can look down at my staff and see the diversity from the women to the different coaches in here and know that no one has to ever go through what i went through coming up. And i foster and help everyone instead of pushing them away. Ill talk to women and tell them they can make it and if they need any help, come talk to me. And they com knock on my door ad ask how i move up and how i get training. Im always encouraging to go to school and encourage them to take up some of the training with d. P. W. And i would tell them to hold strong and understand that things that we go through today that are tough makes you stronger for tomorrow. Although we dont like hearing it at the time that were going through all of this stuff, it helps you in the long run to become a better woman and a person we came to seven straight about 10 years ago. 7th street about 10 years ago. The environment is huge. It is stronger than willpower. Surrounding yourself with artists, being in a culture where artists are driving, and where a huge amount of them is a healthy environment. You are making it safer. Push, push. That is better. When i start thinking, i see it actually sometimes, i do not see it, but when i do, it is usually from the inside out. It is like watching something being spawned. You go in, and you begin to work, excavate, play with the dancers, and then things began to emerge. You may have a plan that this is what i want to create. Here are the ideas i want to play with, but then, you go into the room, and there maybe some fertile ideas that are becoming manifest that are more interesting than the idea you had initially set out to plan. So there has to be this openness for spontaneity. Also, a sense that regardless of the deadline, that you have tons of time so the you can keep your creativity alive and not cut it off and just go into old habits. It is a lot like listening. Really listening to watch what is going to emerge. I like this thing where you put your foot on his back. Lets keep it. Were your mind is is how you build your life. If you put it in steel or in failure, it works. That works. It is a commitment. For most artists, it is a vacation and a life that they have committed themselves to. There is this notion that artists continue to do their work because of some kind of the external financial support. If that was taken away, artists would still do their art. It is not like there is a prerequisite for these things to happen or i will not do it. How could that be . It is the relationship that you have committed to. It is the vocation. No matter how difficult it gets, you are going to need to produce your art. Whether it is a large scale or very small scale. The need to create is going to happen, and you are going to have to fulfill it because that is your life. It is so key here. We have a window to do better. Next slide. And again, another very concerning situation. This related to the reproductive rate of 1. 25, so this means that we will have more people die, and if you follow that blue line, this means we would average, excuse me, 890 deaths from covid19 in 2020. Were at 50 right now, and by the end of the year, we could be at 890 with a reproductive rate of 1. 25, and again, unfortunately, those white shaded blue lines show we could get much higher scenarios, approaching 2,000, and even 3,000. So this is this is serious. This is a we are in a very concerning time right now with this reproductive rate of 1. 25, and we need to drive down below 1 as soon as possible. Next slide. But there is hope, and this is looking as of july 4, because we were looking at the july 4 weekend and asking everyone to do their part. If we could reduce that rate by half, we could dramatically reduce our hospitalizations and our death. We could go from the hundreds that we talked about to as few as 50 and 70. And even the scenarios that i showed you with those light blue shaded areas, we could see more deaths through 2020. So if we do our part, we could save lives and keep people out of the hospital. Again, even in the next two weeks, if we could all do our part, we could really make a difference. You see in the next two weeks, we wait for the reproductive number to reduce by 50 , we still have peak hospitalization at 340 and an estimated 220 deaths in 2020, so time really makes a difference. Next slide. So key introduction to reducing r. P. E. This the reproductive rate. This has real socioeconomic and other consequences, as well. Discouraging gatherings, especially inside, and i just want to emphasize right now that, really, please do not gather with people outside of your immediate household, and especially do not gather indoors, it is very dangerous to do that. Please, it is literally saving lives. And then, continuing to offer testing, expanding our testing, and contact tracing. Such key tools to our efforts Going Forward. Next slide. So i alluded to this, but really, riskiness of the activity, we know that outdoors is safer than indoors. Its at this point that, based on the latest data, its 10 to 20 times safer than being indoors. Its risking out to be involved in gatherings with people outside of your immediate household. Half of the people who transmit covid19 are asymptomatic. And you can get covid19 right after you test. So dont think that just because you test negative, you can get it from people that you hangout with or you can transmit it back to older people in your household. We continue to emphasize wearing face coverings, 6 feet of social distancing, and washing your hands. The frequency, the more people go out, the more they are putting themselves and their loved ones at risk. The duration, the longer people spend time together, the more risk it is for transmission, and then, the distance. This is why we are focused on the social distancing and the importance of that Going Forward. Next slide. And then, i did want to talk a little bit about hope Going Forward, and talk about vaccines are being looked at and developed, and unfortunately, theres not likely to be any vaccines soon. Key experts estimate it could be 12 to 18 months before a vaccine is widely available. Thats very different from saying a vaccine is going to be available in six months to a year. But im hopeful, according to mayor breed, that we will be testing extensively across the city and also at zuckerberg San Francisco General Hospital, and we will be focusing on engaging communities most at risk for covid19 to support them in participating in vaccine trials as soon as august. Thank you, mayor, and thats my completed presentation. The hon. London breed well, thank you, dr. Colfax. I know were at the end of our time here, but i do want to take this opportunity to just speak to the people in San Francisco who are struggling. There are some people who are struggling, who have no paychecks coming in, and its really hard. And what happens, in addition to the loss of your financial ability to take care of yourself and even your family, Mental Health becomes a whole other issue. And it seems as without our churches, our religious services, our ability to congregate and come together with one another, our spirituality as well as our coming together in the world, and our ability to socialize as we do on a regular basis, its almost as if were trading one Public Health crisis for another. We know, for example, Domestic Violence has gone up, suicides have gone up, people are more stressed in trying to figure out what to do with their lives. We see some of the Violent Crimes going up in the city. How do we justify that . The fact is you and i know were going to be living with covid for the 12 to 18 months or even longer, and so this is hitting in various ways as we try and keep people safe and try to prevent the surge in the hospitals and even deaths. But theres only so much we can emotionally handle as human beings, so ktell us how were supposed to deal with all of that . Thank you, mayor. I appreciate this, and again, this is such a challenging time, i would say the risks the downsides to the shelter in place and the slow reopening are very real and very concerning from a health standpoint and an economic standpoint. I think the Counter Point is no one has said, were going to go ahead and open quickly. As you see across the country, the Mental Health consequences of opening and having a surge, many people are struggling in San Francisco, but if we have a surge like we saw in new york or unfortunately like we saw in houston and parts of florida, we would have all of those concerns that youre talking about on top of the overwhelming the Hospital Systems due to covid19 plus the covid19 pandemic and everything that were dealing with and managing today. Unfortunately, theres downsides to where we are today, but theyre even worse. And we just want people to understand that these times are hard, but we have a pandemic in our city, and it could be much worse. Mayor, i have some numbers, and id like to give them. May i give them . The hon. London breed yes. So our warm number is 8558457415. And then, we also have mobile crisis, so for acute situations. Our number is 4159704000, and the last thing is if you see businesses that are violating the Health Orders around social distancing and good hygiene, please let us know. Please call 311. We will send inspectors out, and if people are violating those orders, we will take steps to aggressively make sure that they do. The hon. London breed and also, i want to push back a little bit. Outdoor activities are permissible in certain circumstances with guidelines, and i do think with regards to religious services, if people have the ability to have Outdoor Services or if there are ways that we can get creative with allowing other things to happen because i know your religion plays a role in things like this. I think its going to be important as we see changes in the number, we want to provide people with opportunities to deal with the challenges of what were facing over the next 12 to 18 months at least. Just think about whats going to happen with our kids and the schools and a number of other things. The fact that we have all of these playgrounds, and kids cant even play in playgrounds. It is heartbreaking for me that we cant even provide these opportunities, so i do want to think of these creative ways that we can support people. If youre one of these people that need help, mental help, testing, please call 311. We have a lot of city resources. Weve developed a lot of publicprivate partnerships to provide support you want. We know its not going to be everything that you want, but we do our best to support folks that are struggling in San Francisco. And the sad reality is its not just San Francisco, but its all over the country where we see this impacting our country, we see it impacting our economy, and the goal is to keep everybody safe, so this is our new normal. So thank you, dr. Colfax, and hopefully, well be able to have more conversations in the future. If you have any questions, please reach out to us at 311. Thank you, everyone. Thank you, mayor. Look at that beautiful jellyfish. The way to speak to students and motivate them to take action, to save the planet, they do, they care and my job is to speak to them in a way that they can understand that touches their heart and makes them feel powerful with simple actions to take every day. I was born and raised in the desert of palm springs, california. My dad was the rabbi in the community there. What i got from watching my father on stage talking to the community was learning how to be in the public. And learning how to do public speaking and i remember the first time i got up to give my first school assembly, i felt my dad over my shoulder saying pause for drama, deliver your words. When i was a kid, i wanted to be a teacher. And then when i got into high school, i decided i wanted to get into advertising and do graphic art and taglines and stuff like that. By the time i was in college, i decided i wanted to be a decorator. But as i did more work, i realized working my way up meant a lot of physical labor. I only had so much energy to work with for the rest of my life and i could use that energy towards making a lot of money, helping someone else make a lot of money or doing something meaningful. I found the nonprofit working to save the rainforest was looking for volunteers. I went, volunteered and my life changed. Suddenly everything i was doing had meaning. Stuffing envelopes had meaning, faxing out requests had meaning. I eventually moved up to San Francisco to work out of the office here, given a lot of assembly through Los Angeles County and then came up here and doing assemblies to kids about rainforest. One of my jobs was to teach about recycle, teaching students to reduce, reuse, recycle and compost, im teaching them they have the power, and that motivates them. It was satisfying for me to work with for the department of environment to create a message that gets to the heart of the issue. The San Francisco department of environment is the only agency that has a full time educational team, we go into the schools to help teach children how to protect nature and the environment. We realized we needed animal mascot to spark excitement with the students. The city during the gold rush days, the phoenix became part of the city feel and i love the symbolism of the phoenix, about transformation and the message that the theme of the phoenix provides, we all have the power to transform our world for the better. We have to provide teachers with curriculum online, our curriculum is in two different languages and whether its lesson plans or student fact sheets, teachers can use them and weve had great feedback. We have helped public and private schools in San Francisco increase their waste use and students are working hard to sort waste at the end of the lunch and understand the power of reusing, reducing, recycling and composting. Great job. Ive been with the department for 15 years and an environmental educator for more than 23 years and im grateful for the work that i get to do, especially on behalf of the city and county of San Francisco. I try to use my voice as intentionally as possible to suppo support, i think of my grandmother who had a positive attitude and looked at things positively. Try to do that as well in my work and with my words to be an uplifting force for myself and others. Think of entering the job force as a treasure hunt. You can only go to your next clue and more will be revealed. Follow your instincts, listen to your gut, follow your heart, do what makes you happy and pragmatic and see where it takes you and get to the next place. Trust if you want to do good in this world, thattttttttttttttttt hello everyone, good afternoon. The meeting will come to order. This is the rescheduled budget appropriations meeting. Im sandra lee fewer, joined by supervisor shamann walton, mandelman, yee. Linda wong who is assisted by mr. Brett. I would like to thank mendoza from sfgov for broadcasting this meeting. Madam clerk, do we have any announcements. Yes madam chair, should employees and the public, the board of supervisors and the Committee Rooms will be closed and members will be participating remotely. Precautions have been taken with regards to the local, state, and federal orders and directives. Community members will participate in the meeting through Video Conference to the same extent as if they are physically present. Public comment will be available on each item on this agenda, sfgov. Org is streaming the number across the board. The opportunity to speak during Public Comment period is available via phone call by calling 4156550001. Meeting id 146 4585942 and press pound twice. When connected you will hear the meeting discussions, but you will be muted. Dial star 3 to be added to the speaker line. The best practice is to call from a quiet location, speak clearly and slowly and turn down your television or radio. Alternatively, you can email myself the budget appropriations clerk at linda. Wong sfgov. Org. To submit Public Comment via email it will be forwarded to the board of supervisors and be included as part of the official file. Items are expected to appear on july 21st, and spanish and chinese interpretation are available for those who need Translation Services during Public Comment period. I will now pass on to our interpreters to provide summary of this announcement. [speaking spanish] [speaking chinese] thank you. Madame chair, this concludes our announcement. Before we start the meeting, i have madam clerk call our next item, i just wanted to refer back to our last meeting where i accidentally wanted advice from our City Attorney and i just wanted everyone to note that the City Attorney isnt typically sitting in our meeting during hearings unless theyre specially invited to present, but i will say that our City Attorney is more than happy to respond. If we need any clarifying questions answered that she can be there at a moments notice. I just wanted to note that. Thank you to our City Attorney. Madam clerk, i would like to call item number two first. Yes. Item number two, reviewing the budget process and related updates for fiscal year 20202021 and 20212022. For those who want to comment on this should call. Press pound twice. If you have not done so, dial star 3 to queue up to speak. Please wait until the system indicates you have been unmuted and you can begin your comments. Thank you very much. Today we have the mayors budget director ashley. Hi ashley. Hi chair fewer, good afternoon supervisors. Thank you for having me here today. Today i am going to provide you an overview of the mayors Budget Priorities following up on the letter that was submitted to the board on july 2nd. As part of the budget process legislation that was passed in december of last year, and as amended by the seven supplemental to the mayors emergency declaration, im happy to walk you through the mayors Budget Priorities for the upcoming two year budget. Before i start, i should say that we are still actively balancing the budget and these priorities have served as our Guiding Principles in doing so. So specifics and final details, i wont have those today but they will be coming out in the coming weeks as we work to introduce the budget by august 1st. So to begin, you know, its no secret, covid19 has impacted really every facet of our local economy and city operations. While its highlighted and exacerbated, many of the challenges we already face as a city, we think it demonstrates that were capable of taking bold and Decisive Action to address complicated challenges. So working together with the board, the mayor will focus her efforts on the following priorities. First, the mayor is committed to balancing the budget responsibly during these times of great economic uncertainty. The impacts of covid19 were stark and immediate and required us to close a budget gap just a few short weeks ago and we were able to do that largely with no Major Service reductions or layoffs. That was just the first hurdle that we need to overcome and we face this 1. 5 billion shortfall for the upcoming budget. The mayor has stated clearly that her goal in delivering this balance budget is to protect jobs and services and in doing so will require us to look at everything on the table, new revenues, use of reserves, other departmental and citywide reductions just to name a few. We also need to be mindful that there is tremendous risk on the horizon and uncertainty as we move through this budget process and into the coming years. You know, just to name a few, a surge in covid that we could be seeing now, slower economic recovery, fema reimbursement, these are some of the reasons why we need to make responsible choices today to help us hedge against the risk and uncertainty tomorrow. Despite sorry my dog is barking. Despite these uncertainties however, the mayor will continue to prioritize making progress on our shared priorities of homelessness and Behavioral Health. Covid19 did not make our Behavioral Health challenges go away. In fact, it highlighted the importance of continuing to prioritize in these areas. As you know, the mayor introduced the business tax measure that would unlock the contested revenue from prop c and the mayor will prioritize utilizing those funds to make progress in these areas should the funds become available. Furthermore, the heighten focus on Racial Equity will be reflect in the mayors proposed budget. They announced a plan to work with supervisor walton to redirect funding to the Police Department into services that benefit the African American community. The mayor will prioritize Decision Making in all aspects of her budget through a Racial Equity lens. And robust data drich response to the Ongoing Health pantoja. Covid19 is not over and the city must maintain an Emergency Response system that keeps residents safe and allows us to reopen in a responsible way. We will prioritize maximizing all state and federal resources to offset local costs, but know that the safety of our residents and the security of our economy depend on us listening to our Health Experts and the data that is right for our city. Thats a brief summary of the budget for the upcoming year. Im happy to take any questions you may have. Colleagues, any comments or questions . I have a few questions while my colleagues are formulating questions. So i understand that the departments have been giving you budget instructions. They are told to cut 10 and now its 12. 5 , is that correct . I want to get a deeper understanding about this. Can you share more about these new budget instructions . Sure thing. So, the mayor has sent a letter to our labor partners as part of this budget balancing exercise. Like i said, we need to look at all options on the table. She has made and ask to the labor partners to defer the upcoming wage increases and the two year budget. We have no concessions in hand and without those concessions, we wont be able to we need concessions from labor to help us balance this budget. Without that, we will need to cut deeper into departments. We will issue a second round of instruction to departments to serve as a contingency plan should conversations with labor not result in any savings to support closing the budget shortfall. So, am i seeing then that the first set of budget instructions that the mayor gave assumed that labor would be deferring their wage increases . The first set of budget instructions that the mayor issued back in june, may or june. May i think it was. Sorry, i cant remember what time is anymore. It was reflective. Those instructions were reflective of the deficit there the may 13th update, which assumes that we would defer the wage by six months in accordance with the economic triggers and our m. O. U. S. We always knew that you know, departmental reductions would not be 100 of the solution. Departments submitted proposals back to us. Its a menu of options for the mayor to choose from as shes balancing her budget. There are other levers she can pull that are not related to departmental proposals. So the proposals that departments submitted, youre right, the deficit was based on a six month wage deferral in accordance with our m. O. U. S. So it was my understanding that the m. O. U. S when we go into contract with them, they sign the contract before, was that there was a provision that if the general fund would be reduced by so much, they would get back. I thought that we already absorbed, they already agreed to 47 million in sort of give backs according to that. So was the Mayors Office assuming an addition to that in addition to the 47 million that they would also then be deferring wages . Because i just want to mention that i dont think that it is something that actually even labor leaders can agree to. I think that it would be with the membership. I find it a little unusual that the mayor would actually balance and give instructions to the department, knowing that there is a process that labor has to go through in order to actually defer those. So why would we give instructions to the departments when we didnt even allow labor to go through that process with their own membership and then assume that they would defer . It seems premature quite frankly. Yeah, so the mayor did make and ask to labor to defer the wage over two years. We have not had any conversations with labor. They have not responded to the letter. We do have some scheduled this week, but really this is all Contingency Planning and i think it goes back to the point i was making about just all of the uncertainty that we will be facing as a city in the upcoming year. You know, additional departmental reductions, labor comes to the table, if labor can give back beyond the 6 month wage deferral thats already assumed, there are things that could require us to rebalance through additional departmental reductions. So were really, you know, planning and having those opt n options in our back pocket should we make changes mid year for any number of reasons. Okay, i just think i want to say that i think to give the original budget instruction to cut 10 because they assume labor was going to give back on these wages, but that never transpired. Quite frankly, nothing was set into motion to make that happen and to assume that giving budget instructions with that assumption and now going back and saying oh, you know, now can you cut an additional, whatever percentage because labor did not give the concessions. I actually think its the messaging is not correct because in fact what should have happen is that the mayor should have probably given instruction to cut the department by 12. 5 and that after labor would agree then you would be looking at not significant cuts in the department. It just seems a little i just want to say it seems premature to budget on something that is very unknown. Yeah. Yeah, so given the timing then of it. We are asking them to resubmit those budgets with additional cuts. Will these new reductions be included many Mayors Office 1st submission . It looks like were running out of time. We are definitely running down to the wire in terms of timing, the extent of which these new proposals will be incorporated in the august 1st budget. Were sort of running out of time. I think it would likely should we need to take any additional reductions would be in the form of perhaps should any of the assumptions in the budget on august 1st not come to pass. I miss that. Yeah. You cut out ashley. Oh, im sorry. My internet is not great. You were saying what would happen it was the punch line. Would you mind if i turned my camera off. That might help. Thats fine. I have to turn minoff mine off a lot. To chair fewers question about timing, youre right. We are running down to the wire on what would happen. Were receiving new proposals from departments that would be due july 27th. Thats only a few days before the august 1st submission deadline. So those would be, i think those would be options for us to consider for a rebalancing plan should any of the assumptions in our budget should not come to pass as submitted by the mayor. So that means you would not the mayors budget would not reflect the additional 2. 5 in cuts in departments. Is that what youre saying . Its unlikely we will have time to incorporate them. Okay. So would we at the board see the 2. 5 reductions that the departments have proposed in additional cuts . I mean they will be submitted to our budget our office, and we will be happy to share them as we receive them. All right, and then i wanted to ask about the Police Department. We heard a lot about the reductions into the Police Department and we had press conferences. Could you give us any idea on what the mayor is looking at in the Police Department to reduce . Sure, i can give you some initial ideas. So obviously the department itself proposed about 23 million worth of reductions through cutting vacant positions. So that is a proposal that we have taken into consideration. As you all know, the Police Departments budget is heavily personnel driven over 80 of their budget as personnel, salaries, and benefits. There are really limited choices there beyond people and trying to maximize any further reductions in the form of nonpersonnel reductions is an area were looking at. So in the personnel reduction, do you know whether or not that is a civilian personnel. Depending on what the office offered, were looking at the pros and cons of taking one versus the other and combination of the two. Okay, so do you so did you say an amount ashley that theyre looking at to target . I dont have a specific amount, but i can say that the department itself had offered about 23 million worth of reductions in what they had proposed to their commission. Sure, so when we actually look at the 23 million in reduction, that also is part of the reduction that the mayor is requiring of every city department. Is that correct . Thats right. That was their reduction target. So in order to generate yeah, go ahead. So it wasnt in addition to. So for example, the mayor would give instruction to say every Department Must cut by 10 , but she was looking especially at the Police Department. So i just wanted to know if there were additional cuts above the required 10 that the mayor had instructed for every single department. The question is was she looking at cuts beyond the 23 million . Yeah. The 23 million seems like its the baseline. Every department is asking to cut by 10 , right . Yeah. So thats their 10 . They would im asking if the mayor is looking to cut deeper than the 10 than what she is requiring of every other department in San Francisco. Uhhuh, yeah. So like i said, there are other nonpersonnel areas that weve been reviewing and analyzing as part of this budget balancing process. The same goes for every department. You know, every department offered some amount of reduction, not every department offered up to the 10 . So its really my team has been working really fast and furious on the last month since we got Department Proposals to understand whats possible, whats feasible, in a way that maximizes jobs and minimizes service reduction. And it is our job actually to find beyond the 10 . Thats right. So supervisor ronen. Yes, thank you chair fewer for the excellent questions. That was really helpful and sparking my brain. So, what are the nonpersonnel reductions youre looking at the Police Department. Very few options because the department is personnel focused. There are vehicles that our option to review other equipment and any kind of personal Service Contracts within the department. Youre not looking at all about management staff, maybe pairing down management staff . Im sorry, i thought the question was nonpersonnel. This is a separate question. Oh, okay. I was moving on from the nonpersonnel one. Okay, thanks. Sure, i mean you know, like i said, everything is on the table. These are hard and complicated decisions. As i walk through the mayors priorities to minimize Service Reductions and preserve jobs. So were taking you know, were making decisions through that lens. So im curious, as youre doing this, the police offered up 23 million, which happens to be where their vacancies are at this time or the monetary amount of the vacancy. Is that how youre looking at the reductions or are you looking at it like Police Reform or maybe its not necessary for police to do traffic stops or not having Police Involved in homeless and Mental Health is e issues, like looking at it in terms of the type of work that Police Officers do now that perhaps they shouldnt be doing in this new way of looking at policing in our communities or are you looking to set them, what happens to the monetary amount of vacancy. That makes total sense and its a great question. I think its both. They are both shortterm decisions we can make and those tend to be the quick, you know, what are some monetary reductions we can take. Then the longer term discussions are around how do we change policing, how do we change response, how do we go through the road map that the mayor outlined as it relates to police. Those things take a lot longer. It will require resources in other areas as well. So its kind of both. I think there is some shortterm things we can accomplish in this budget and there are some things that will take more time and more resources and more thought to implement in this budget. Were trying to be targeted on what we can take care of now and what we know and what we need to think about more as we move forward in the next year or two years and onward. You said when the mayor held her press conference on homelessness and Mental Illness and no longer using the police for those purposes, is she eliminating if i remember correctly, it was about 11 million for the Police Involvement in the h. O. T. Team. I cant say specifically if were eliminating that particular item. Were looking at ways we can bolster up other Response Services and programs in the budget. So that has been the focus on how we can enhance any of our other programs and services that serve that need. Okay. Okay, thats all. Thanks. Thank you so much chair fewer. The one question i do have, did you say overtime is a possibility of redestruction of redirection of resources. I guess i was grouping that into salary and benefit bucket, that would be a personnel reduction. Yes, certainly its an area were looking at as well. And i think right now overtime is averaging over the last three years, definitely over 20 million a year, right . Yes, huhuh. Thats my understanding as well. Thank you. Not balancing the budget off the backs of the lowest wage workers. Has there been actually any conversation about cutting the salaries of people who make over 130,000 a year, 150,000 a year, 200,000 a year . Sort of a tiered reduction of, you know, i think a reduction of salary for the highestpaid workers in the city trying to protect our lowestwage workers. Has there been any strategy around that or discussion . Sure. I can try and answer. So obviously, all of those decisions would need to be made with our labor partners. I think were open to all any ways we can save money as a city and sort of focusing on the mayors priority of equity, certainly an area we would be interested in exploring with labor should it be an option put on the table. Supervisor fewer sure, because i also just think what im concerned about is when we had analysis done with Human Resources about who was in these lower paid positions, they were mainly people of color, mainly africanamericans in these positions, average white person makes 150,000, average asian 112,000. Filipino 120,000. But when look at the africanamerican, they are about 60,000. I also have another question about. I can see how departments would first try to eliminate jobs, seek to eliminate positions that are not protected, meaning that they are temporary or, you know, theyre not Permanent Civil Service. I would say that while we had a hearing we heard there were people in the temporary positions for 25 years, some of them, and never having a pathway into a Permanent Civil Service job. Im concerned that would be those people will be the lowhanging fruit and the first to actually go. And then i also just want to say that when i if we were to cut from the highestwage earners, then it would be a strategy amongst, i think, the unions that represent some of the highestpaid workers in the city. And before we actually talk about acrosstheboard postponement of wage increases, start with the lowest paid workers. I felt like i had to express sort of a that i think this board would be open to seeing considering how our lowestpaid workers are being hit the hardest especially during this Health Crisis. Lets open this up for Public Comment. Oh, president yee. Hes raising his hand. President . President yee thank you. Ashley, if you were to take the end of the year, i guess, staff funding that we get at the end of the year, the surplus we get from not hiring people every year . If we took that from every department and looked at it and totalled it up and totalled those have the same total for three years in a row, and with the just making a wild guess that every year we probably dont hire positions at 100 million or Something Like that. And weve seen this every year for three years. Have you considered doing that and saying, take 50 of that savings . Thats a really good question, thank you. So i think there are two answers. As part of the when we gosh, in may when we were doing the rebalancing exercise, we were really aggressive with departments to make sure that they were accurately reflecting the salary savings they were going to experience for yearend in order to minimize the number we had to solve for. We had to solve for 250 million and you know we were really aggressive with departments to tell us what their yearend savings were going to be so that number didnt get any bigger. Obviously, hiring were in a hiring freeze. Some things were delayed more than people expected. They were giving us their best guess where they were going to land at yearend. So i think there will likely be some additional salary savings that happen in departments at the end of the year, but i also think there is going to be a lot of shortfalls in other areas that we didnt know about in may, so any of those additional salary savings will be used to fill gaps elsewhere so we can close the year. And then in terms of for the upcoming budget, many departments as part of meeting their target proposal or target requirement for the budget, in order to avoid, you know, Major Service reductions or in order to avoid layoffs, you know, were pretty aggressive in their assumptions of how many vacancies they would have n year, so year taking a lot of those savings for the upcoming budget. But youre right, everyone does their best to estimate how theyre going to look at the end of the year, sometimes there is more, so its a good point. We tried to be really aggressive last years budget balancing exercise and this one on that point. President yee i think for seven years now i hear we always do bad. And then at the end of the year, we find we didnt spend the money. So its not i guess im looking not as a punishment. Were talking 1 million total, not a big deal, but were talking much bigger numbers, that could help with the balancing of the budget. Some departments will have bigger surpluses of funding at the end of the year than others due to hiring staff, but i think we should really look at again, if youre looking at it and average for the three years, its only 1 million, then you might not want to spend a whole lot of time. But if its more than that, i would say its worth spending some time. Yeah, thank you, thats helpful feedback. Supervisor fewer i also just want to say that, you know, i have seen a lot of departments where we budget we budget in fat years where weve been for the last couple of years and they hold onto these positions and they just even looking at d. P. H. What the b. L. A. Shows, this is Unfilled Positions. There is not just a couple of them. There is a lot of them. I think every department has those positions that they kind of hoard and its budgeted for. I dont know how to get to that. Because if we want to be lean and mean, i say we have to dig deep to look at what those positions are and how they have been funded but not filled. And then before we actually look at cutting staff and also laying off some of our workers. So anyway, having said that, lets open this up for Public Comment. Madame clerk, Public Comment on item number 2. Clerk madame chair, operation is checking to see if there are callers in the queue. Operations, please let us know if there are callers ready. If you have not done so, press star 3 to add yourself to the queue. Wait until the system indicates youve been unmuted. Are there any callers who wish to comment on item number 2 . Yes, there are currently three callers in the queue. Ill queue up the call. Hello . Hello, caller. Hi, i dont know if you can hear me, but im trying to comment on item number 3. Supervisor fewer were on item number 2 now. Yeah, should i just join the queue again . Supervisor fewer yes. Because im interested yeah. Id rather join the queue and wait for item number 3. Supervisor fewer thank you very much, speaker. Next speaker, please. Im actually on the call for number 3 as well. I apologize. Supervisor fewer okay. Next speaker, please. Hi, im waiting for item number 3 as well. Supervisor fewer okay. Youre on the wrong line, so if you dont mind waiting, well going to item number 1 and then address item number 3. Any more speakers in the queue for item number 2 only . Hi, im a resident of district 3. And were really troubled to hear that the Mayors Office hasnt been looking into any personnel costs at the sfpd which is directly in conflict with things that the mayor said about diverting nonviolent calls from the Police Department and nonLaw Enforcement agencies and that the office is looking into other resources to build up. But it just seems like were wasting so many resources on the hot team and other things. I would encourage the Mayors Office to try to use a little more imagination in their approach to the budget. Thank you. Thank you for your comment. Next speaker, please. Hi. This is mimi. Why am i not surprised that london breed is not suggesting any substantial cuts to the Police Department beyond the original 10 that she requested . You know, the fact that like the previous caller said, that, you know, hot team and the hsoc are not going to be addressed is, you know, really, really, sad. You know, she portrays herself as, you know, a champion of black communities and im just not seeing it. I mean, what is there for the black community other than, you know, not filling slots that are vacant anyway . And, you know, the acrosstheboard cuts, you know, are absurd, yes. It should be the people at the higher end that bear the brunt of this. There are just so many ways that the budget as youre presenting it is wrong and not in tune with what the people of San Francisco are thinking. So i encourage the supervisors to, as you have done in this hearing, to press on these issues and make sure that the budget that is passed is reflective of what the people want, particularly in terms of policing. Thank you. Thank you for the comment. Next speaker, please. Supervisor fewer are there any more speakers in the queue . Madame chair, that completes the queue. Supervisor fewer thank you very much. Public comment on item number 2 is now closed. Comments any comments, questions for the budget director . She has to go to a meeting. I would like to thank her for the presence here. I would like to continue this to the call of the chair. Could i have a second . Supervisor ronen second. Supervisor fewer thank you, supervisor ronen. Roll call vote. On the motion, supervisor walton aye. Mandelman aye. Yee aye. Ronen aye. Fewer aye. Five ayes. Supervisor fewer thank you very much. Can you call item number 1. Item 1, ordinance approving Health Service system plans and contribution rates for the calendar year 2021. Members of the public who wish to provide Public Comment should call the number on the screen, meeting i. D. Number on the screen, and then press pound twice. If you have not already done so, please dial star 3 to line up to speak. System prompts will indicate you have raised your hand. Wait until youre unmuted and you can begin your comment. Supervisor fewer supervisor preston, i believe, is on the line with us. Is that correct, supervisor . Okay. Hes not on the line. Im sorry. Hes a sponsor. I just wanted to i think hes one of the speakers. Supervisor preston, are you online here . Okay. Then we have the director of the Health Service system. Hi. Good to see you as well. Yes, im abbey ant, the executive director of the Health Service system and here today to Committee Members to present the rates and benefits for year 2021. Today there is supervisor preston. Good afternoon. Today you have before you an ordinance approving the Health Service system plans and contribution rates for calendar year 21 2021. The Health System agrees with the b. L. A. Report. I would like to comment on the key components. I can either take questions throughout or at the end of my presentation at your preference. I am most grateful for the significant contributions to this work and the presence of our actuary mike clark from aon, as well as pamela our c. F. O. And larry who is online as well. I did want to comment at the suggestion of supervisor preston of the time line that Health System works within each year to bring this package of rates and benefits to you. The cycle is continuous and we have to abide by the clock. And for those of us who appreciate deadlines, it works. It gets everything done in a timely way each year. So at this point its a culmination of bringing the rates to you. Following the approval process, the rates for the board of supervisors, were in the back shop, if you will, taking all these approved rates and programming them into our stem, which is a very heavy lift that must be accomplished in a short period of time. Were also preparing all of the materials and information for all of our members to make their open enrollment decisions in october. So they have to be, you know, put and delivered into the hands of each of us by october 1st with all of those new rates embedded in there. And any other changes that may be part of the package. So that happens in october. Were all familiar with that. On november 1st, we start crunching the numbers. And this is another herculean effort on the behalf of the i. T. Folks. To get the numbers to the plan so on january 1st you have an insurance card that affords you access to these benefits. During that time period, were restarting the whole process again toward working out our ask in the renewal process. We send out official letters. We are those responses to those letters come in starting february through june, were negotiating the rates and bringing them through the Health Service board and back to you in july each year. So as you can see, its a very rapid process that is super time sensitive virtually every step. So i just wanted to kind of give you the big picture of where we are today. This ordinance before you establishes the amount contributed by the employer towards the employee and Retiree Health premium. The charter requirement referred to see the 10 county average where we survey the 10 most populist counties in california, not including San Francisco. The survey notes the amounts contributed by the employer for employeeonly coverage under each of the countys medical plans. The average amount is then the basis for the employer contribution to retiree rates and a few of the. If we could with the slides, if we want to do the slides, linda, on im speaking to slide one now. So this thank you. This 10county survey as we said in the little right hand corner, you can see the result was 729. 19 which represents 3. 3 increase from last year. The 10county average has been set. So slide 2, please. Thank you. The aggregate projected cost increase for the Health Service system which includes all four employers, the city, the Community College district, the Unified School District and the superior court and includes contributions of the employees and the four employers for all medical, vision, dental, life and longterm disability insurance. The total package is increase of 3. 66 . The projected increase for just the city is and that includes the retirees, is 3. 7 . So the projected average medical cost increase for Health Services system is 3. 87 , while the city is only 3. 94 . These increases do compare favorably to variable benchmarks. The 2020 Health Care Trend survey published by the actuary firm says that the combined cost increase on a National Average is 5. 7 to 6 . Slide 3, please. So as you know, we have relationships with three vendor partners, kaiser, blue shield and United Health care. Kaiser has both hmo plan for active retirees as well as a senior product taking advantage for the medicare retirees. The Health Service board increase of 4. 33 for active and premedicare retirees and medicare retirees. Thats the total of all three products both products, im sorry, with kaiser. The kaiser lets move to slide 4, please. The kaiser hmo plan is offered for active and or retirees and that rate increase is 5. 78 . The kaiser also provides the medicare and premedicare retiree to hmo plans in outofstate, in hawaii, oregon and washington. And that is their rates are combined there in the previously mentioned aggregate of 5. 78 . The planned changes, were no changes approved for the active or early retirees by the Health Service board. The kp retiree medicare and senior medicare product showed a decrease this year of 5. 03 . As you may recall, retiree rates were increased last year by up to 12. 2 . This is a significant swing and has to do with the reconciliation process that kaiser does when they receive the actual rates from medicare. Those medicare rates dont get set by the federal government until october. And so its a little bit of a guessing game on kaisers part in the way that they project their costs. So they do see the swings year to year. The Health Service board approved two plan enhancements for the transportation benefit for folks that are wheelchair, they can get oneway rides to support the hospital discharge needs for health care appointments. So thats scheduled to go in place. They have partial plan in place this year and theyre expanding it next year. The second change for retirees is the home meal program where folks, again, on discharge from the hospital can get up to 84 meals delivered to them in their home. Next slide, please. Blue shield of california in 2021, there is two hmo plans that will be continued to be offered by blue shield. The health board approved a rate increase for the trio plan and rate increase for the access plus plan. Those are both hmos. The aggregate for them combined is 4. 3 . And there were no plan design changes and blue shield were in the not in contract with them for any [inaudible] slide 6, the United Health care partner. They administer the city the ppo product that fondly known as the city plan for actives and early retirees. They also administer a ppo plan for medicare retirees. The aggregate cost increase is 1. 63 . Im talk about them separately. The Health Service board approved a rate increase. This increase is due to the plan experience and change in the way the rates in the available Rate Stabilization reserve which is down over the last number of years. Its approved by the Health Service board in 2021. The uac ppo Medicare Advantage product is also showing a rate decrease of 2. 9 . The majority of the increase is due decrease is due to the permanent termination of the Affordable Care act Health Insurance tax. That was the 10 tax in place pretty much every other year since the aca was passed in 2010 and it is now no longer in effect at all. The vision plan slide 7, please. There is no the Health Service board did not approve any rate changes for the basic vision plan. There is premium increase for the premium plan of 4. 1 . Folks do like to use that. The more you choose, the more costly it becomes. The premier plan is 5. 6 to 6. 3 . Slide 8, we have the dental plans of which there are several delta dental has a ppo for active and retirees. The active plan costs went up by. 6 . The retiree ppo went down by 1. 7 . And they both had some design changes to offset some of the costs for nitrous i. V. Sedation for folks that require that. There are also plans, hmo plans where there was a 1. 7 rate increase for delta care u. S. A. For the active and retirees. And the delta care hmo had a 3 decrease. And slide 9. The last set of benefits to speak to is Life Insurance and longterm disability. Carried by a Company Called the hartford. The Health Service board approved aggregate 1. 5 decrease across the Life Insurance and longterm disability plan. 7. 9 rate decrease in the Life Insurance is what carried that along. So before i conclude my presentation, id really like to thank the id like this also speak to to also speak to the budget and finance Committee Clerk to request minor revisions on the ordinance on page 2 of the ordinance, section d, line 3, in this section of the document. I request that the Health Service Board Meeting date of april 11th be omitted as this meeting was cancelled. On the same line, i request that the march meeting date be listed to march 12 rather than march 14. And i would request your approval of the ordinance approving Health Service plans and contribution rates for calendar year 21. Myself and our actuary mike are available if you have any questions. Supervisor fewer thank you. First, before we have the b. L. A. Report, before i call on president yee, i see supervisor preston in the queue. Supervisor . President yee i believe he was in the queue before i raised my hand. Supervisor fewer yes. Supervisor preston thank you, chair fewer. Yes, just some general i apologize for missing that window right before director spoke and i just want to thank first of all recognize supervisor mandelman who previously represented board of supervisors on the Health Services board, so thank you for your service. And its really been an honor to serve on the Health Services board in the last handful of months. And to join fellow commissioners and the director and the staff of h. S. S. To work to secure best possible health care for city workers and retirees, especially during this time of a pandemic and deep economic uncertainty. I also want to recognize the work of mike clark of aon, who the director recognized, who has been extremely valuable and indispensable in updating Board Members and explaining, frankly, some very complex concepts to us at the board. Also want to recognize my fellow commissioners on the h. S. P. To be honest, as a democratic socialist who believes in medicare for all, working on contracts under Health Care System that does not treat health care as a human right can be frustrating. As we look forward to the time when we win that battle and win medicare for all, im confident in the decisions that were made on this comprehensive package that is before you. Very proud of our citys work on this and the ability to bargain with the Health Care Companies to make sure were getting the best possible rates and benefits. I also want to thank some labor union, including the california nurses association, National Union of Health Care Workers, sciu1021 and local 21 who represent those who are covered under these plans and also those who work in these Health Care Facilities. They weighed in loud and clear at the Health Services board and i think we heard loud and clear that Health Care Workers need their p. P. E. As a top priority. They need and deserve the right without fear of retaliation in their workplaces. And that city workers and retirees should not face increased payments during this time. Im proud that our board unanimously voted down increased copayment in solidarity with the locals who worked closely with us to make sure, that, frankly were not discouraging workers from using their Health Care Plans which increased copayments would have done. I just want to thank you all. All the Committee Members for entrusting me and our board with the these Important Health care contracts for thousands of city workers and appreciate the update that the director has provided and look forward to any questions you may have. Supervisor fewer thank you. President yee, before i call on you, would it be okay for the b. L. A. Report . President yee yeah, i can wait. Supervisor fewer thank you, president. Could we have the b. L. A. Report, please. Yes, chair. Budget analyst office. This ordinance approves the Health Service system rates for calendar year 2021. We summarized the percentage increase in the rates by type of service, type of plan. As youll see, the increase to the city, the estimated cost to the city is 25. 9 million. Thats the city cost as an employer. And we recommend approval. Im available for questions. Supervisor fewer thank you very much. President yee . President yee thank you, supervisor preston for serving on the board and supervisor mandelman before you. Its sometimes a nuts and bolts type of committee, but you just see it impacts everybody. So the decisions are very important decisions. And thank you, director, for putting to the a good package for us. And i want to get into the weeds a little bit of something that i had brought up last year. Some concerns about inequitable access to benefits to a subset of members. Its my understanding upon investigation there were i guess many people that were denied the benefits and then went on to appeal that or try to get the benefits back and then so when 30 of those people were denied over the past two years were then recently overturned, thats a big number of people that fought for it and eventually got it. So were concerned, why do we continue to practice denying a subset of people when and put them through the process to get reimbursed and then after that, then they get reimbursed. So i think thats something we should really look into more carefully. If it were 1 out of 100 people, that was a special case, but 30 is a lot of people. I dont know if that is something you knew about, director, and if not, then maybe thats something where the Health Service board could look at it more carefully to see if you want to start researching the policy and maybe changing the policy itself. And in the copay and specialty of pharmaceuticals are covered at 50 of the negotiated rate. Were finding out that some of these these drugs fall into a category that are paid outofpocket and were finding out that outofpocket is actually for the same drug, costing more than what the reimbursement for the drug would have been if it were covered. So i dont quite understand how a drug costs more when its out of pocket, when its covered under the insurance. And there is no way of changing that, is there a way to at least tell our members, get some notification to them, that they shouldnt be paying out of pocket. And maybe they should use the insurance instead . So its a little confusing for me, but if one choose not to have insurance because of copay which may be cheaper, but nobody knows that. They say ill just pay out of pocket. Out of pocket is way higher. If that makes any sense. And then also, president yee, i think that in the last couple of budget cycles when we worked together to address this issue at committee, i think what we found is that for some of these fertility drugs that they were actually more expensive if you went use our medical plan and out of pocket president yee the other way around. Supervisor fewer its the other way around. First, there was this issue and, president yee, thank you for bringing this up. I want to piggyback on this. Some of these a lot of lgbt folks and single women were denied access to coverage around fertility. And seems a little antiquated and a little sexist of an issue. And then also that they were paying for drugs outofpocket less expensive than if they were to use the medical plan. And so i think that is sort of a discrepancy we had discussed before and were bringing up again. So correct me, president yee, if im wrong, but i remember our past conversations about this that employees have come to us and said were paying more if i were to buy through my plan, it would be considerably more. Were not just talking about 5, 10, were talking about a considerable amount of money more than if you were to buy these pharmaceuticals just out of pocket. President yee yeah. Thank you, chair fewer, for correcting my i knew it was as i was talking i was thinking, this doesnt make any sense. Supervisor fewer i know weve had this conversation before. So i know that when we discussed it, you gave me an update, but maybe for the full committee you might not mind addressing that issue, because i think our employees are impacted by this. Thanks. Yes. Thank you. Yes, this is a complicated issue that was brought to our attention a little over a year ago. Our board has had many, many discussions on this. Weve been working very closely with blue shield of california to identify the cause of some of the denials and problems that have existed for our members. I would like to clearly state that we are bound by state law that prohibits discrimination based on sexual preference. And so its been a journey of understanding all of the touch points in a fragmented Health Care System of how that can be administered in a way that does not create the problems that some of our members have experienced. And so we did some clarifications on the infertility benefit last year. Blue shield has a dedicated staff person for our membership to work with each woman that is considering that she may have difficulty conceiving. Then they work directly with the case manager to overcome any of the barriers that may exist in the system and theyre correcting them as they work through each of these issues. And so we i think the last piece that you have spoken to, the pharmacy piece, has been very difficult. It is a way that blue shield has contracts with their pharmacy benefits management companies. They have indicated to me and ive spoken with several of you that they would have this corrected by this november. In the meantime, the case manager does work with each individual woman should they need to access the pharmacy benefit to determine what the best option is in her case at that time. And so theyre getting special attention on this on an individual basis. We do i did do a forum this week that blue shield is also hired a new project manager to oversee all of this because they have, with our insistence, recognized the complexity of this and that one case manager is not enough to solve all the one case manager cant do the pharmacy contracting for instance. So we are on track to have that pharmacy issue resolved by the end of this calendar year and on the docket for our Health Service board in november to report out on that solution. President yee thank you. Does that have any you know, the solution that might be coming at the end of the year, does that impact the rates or anything . It should not, no. President yee okay. No and i think the other thing that you both alluded to that i also agree is very important is that our membership understands and appreciates that this benefit is available to all of them. And so were working with our Communications Team and the Communications Team at blue shield to deliver that message. President yee thank you. Appreciate it. Supervisor fewer if this is going to be followed up in november, then perhaps supervisor preston, you will report back to the board and keep an eye on this since you are the representative on the committee and weve now alerted you of the issue that we have discussed for over two years now. And hope that by the end of this year, it is resolved. I would say that if it is not resolved about the access to fertility drugs, and if theyre in violation of california state law on discrimination, then i think that this could be a case for the City Attorney to look into. Thank you. I see supervisor ronen. Supervisor ronen yes. This is obviously an issue near and dear to all of our hearts. I had a followup question on this. Having been through infertility and used to the service through the city, i can tell you that having to fight with the Insurance Company when going through this really difficult experience being on hormones is a nightmare. Then to be discriminated against because of your Sexual Orientation or because youre a single woman, it adds insult to injury. So really, we need to fix this and get this right. And, director, i appreciate so much all the work youve done and all the progress we have made, but im wondering when the language in the contracts that require the diagnosis of infertility will be removed. Because you know, if personnel changes and right now we have this wonderful person who is working with each City Employee to advocate together, to make sure that problems are resolved, but if the written guidance is contrary to that and requires a diagnosis of infertility, then that is problematic. And so im wondering if we can, you know, sooner rather than later, especially in the middle of negotiating these new rates and increases, we can get that requirement of diagnosis of infertility removed from our benefits package . We continue to work on the clarification of the language on that. There are constraints on being able to remove it entirely, in that if we cast it as a clear Reproductive Technology benefit, it becomes a taxable benefit. And so were working within the confines of the law to offer those services. And so its a nuanced piece of language that is why we need to do a better job of communicating, because it should not be any womans concern on how an Insurance Company codes their services. It just shouldnt be your concern. Thats a backshop issue. And so what weve worked on with great persistence and have been met fully with partnership with blue shield, is a way to understand the services that are required of any woman to conceive and that and that those services, should they be such as an Artificial Insemination, are available and covered under this benefit. So weve worked really hard to do that. What i think has been unfortunate in the conversations that weve had about this is its been cast as a problem with an infertility benefit. And that leads people to think that they have to have a diagnosis, but actually, you know, in state law, a heterosexual couple that has had normal intercourse for six months is considered eligible for infertility services. So by offering the Artificial Insemination to women who havent had heterosexual sex, in covering that service, we have equalized the benefit. But the language were kind of stuck with, but its a backshop language and it shouldnt be part of the conversation with women that are considering conceiving. So its truly a communications matter. Its a challenge, but weve got a terrific new director on our team and blue shield has put their marketing people on this. And i think that if we do this well, then women will understand that this benefit is for everyone that is considering having any difficulty conceiving. Supervisor ronen i do see what youre saying. Its just very frustrating because to make that culture changes takes time. And many doctors are still believing that these benefits dont kick in until, you know, until a woman has tried six times to get pregnant. Yeah, and you hit the nail on the head. It is a culture change. And its a true one. It is a shift. And were being very demanding that we continue on this path so that all women have access to these services. Youre right. Supervisor ronen i just want to echo president yee and supervisor fewer and just say both to supervisor preston and the director, if you can not just wait for the problem to come to us, but proactively, you know, find out, you know, ask these questions, what have they done every meeting to ensure that the culture change happens. Also, you know, review if this is possible review denials of service to make sure that were not seeing a pattern of this happening again. I do think we have to be proactive to make sure the benefit is protected and we know how expensive these services are. And how awful the process is. So that would be fantastic. Thank you. Any other questions or comments. If not, lets see. Lets open this up for Public Comment. Is there anyone who would like to comment on item number 1 . Clerk operation is checking to see if there are callers in the queue. Operation, please let us know if there are callers ready. If you have not done so, press star 3 to be added to the queue. Those already on hold, wait until the system indicates you have been unmuted. Let us know if there are callers who wish to comment on item number 1 . Yes, there are currently three callers in the queue. I will unmute the first caller. Supervisor fewer thank you. Im waiting for item number 3. Supervisor fewer thank you. Are there any callers that would like to comment on item number 1 . Im sorry. Item number 1. Yes. Hello. Hi. Im in district 6 and this is more commentary on the questions afterwards. I see what the hospital what is being done to allow people to get infertility treatment, but it seems a grander point can be made that if were pushing for more universal health care, regardless of whether or not there has been a benefit or a way to cover that care for everybody, regardless of whether they were considered infertile, then that would be a more equitable version of care. And i think this is yet another round we need to reimagine not just reengineering the system, but throwing it out and rebuilding it all together. Everyone should have that care. Thank you for your comment. Next speaker, please. Im sorry, im here for item number 3. Supervisor fewer okay. Next speaker, please. Madame chair, that completes the queue. Supervisor fewer okay. Public comment on item number 1 is now closed. And i believe you had some minor amendments to the ordinance, right . So i dont believe theyre substantive, so i think well make a motion to approve the City Attorney, i dont think there is a substantive youre correct, they are not substantive. But i wanted to ask a clarifying question, director yant asked us to make changes. The same dates appear on line 12. I wanted to clarify if you wanted to make the confirming amendments there . Yes, please, thank you. Supervisor fewer thank you. Okay. So lets have a motion to approve the amendments of change of dates and amendments that our department of Health Services has brought fort. I make a motion to approve the amendment and i need a second. Then id like to make a motion to move this to the full board as amended. Could i have a second please . Second, mandelman. Thank you. Madame chair, can we take a roll call on the amendments, first . Supervisor fewer yes, im so sorry. The motion to amend, supervisor walton aye. Mandelman aye. Yee aye. Ronen aye. Fewer aye. Five ayes. Supervisor fewer thank you very much. Id like to make a motion to move this to the full board with a positive recommendation as amended. Could i have a second, please. Supervisor ronen second. Supervisor fewer roll call. On the motion, supervisor walton aye. Mandelman aye. Yee aye. Ronen aye. Fewer aye. Five ayes. Supervisor fewer thank you very much. Madame clerk, can you call item number 3. Item 3, hearing on the budget for the Public Health department including analysis of changes over the last decade, structure for the department, and covid19related impacts on services, revenues and expenditures and requesting the Public Health department and the budget and legislative analyst to report. Members of the public who wish to provide Public Comment on this item should call 41 5655001, meeting i. D. , then press pound twice. If you have not done so, press star 3. The system will indicate you have raised your hand. Wait until the system indicates youve been unmuted and then begin your comments. Supervisor fewer thank you very much. I think that what we would is s can make it 100 . I dont know. Good afternoon, chair fewer, members of the committee. Im with the budget and legislative analyst office. Im going to provide a brief summary on the report on the department of Public Health. This is the fourth of five reports. This is part of the prebudget review activities. As you may remember from the three prior presentations, for each of these reports were asked to provide a breakdown of divisions within the department. And changes to these organizational structure over the last 10 years. A 10year lookback at changes to the budget as well as information about the total amount contracted health within the department. In addition, we were asked to include the fiscal impact of responding to covid19 and to report on specific policy questions. The department of Public Health is organized into nine divisions within the citys budget and financial division. These nine divisions include Public Health administration, Behavioral Health, zuckerberg General Hospital, health at home, jail health, laguna honda hospital, Health Network services, primary care, and Population Health. Wild funding for the while funding for the department of health flows through those nine divisions, the department provides services through two primary branches. Those are the San Francisco Health Network and Population Health as shown in the organizational chart on this side and in exhibit 1 on page 5 of our report. The San Francisco Health Network serves as the citys complete care network and covers primary care for all ages, dentistry, emergency and trauma treatment, medical and surgical specialties, diagnostic testing, Skilled Nursing and rehabilitation and Behavioral Health. San francisco Health Network Services Include San Francisco General Hospital, laguna honda hospital, ambulatory care and transitions that throw throughout the system. Flow throughout the system. This is focused on protecting and improving health. With compliance of 11 ingrated areas integrated areas. Disease prevention and control, emergency medical services, Public Health preparedness and response, Public Health quality improvement, applied Research Community health, epidemiology and surveillance, innovation and learning. The center for Public Health research, h. I. V. Research and the operation finance and Grant Management branch. Over the last 10 years, growth in the departments budget has been driven by increases in cost associated with citywide salary and fringe benefits. The opening of the new laguna hospital in december of 2010. [please stand by] [please stand by] about 752 million, or 32 of that 2. 47 billion of the departments budget comes from general fund support. The budget for San Francisco General Hospital is about 626 million in fiscal year 201011 to 991 million in fiscal year 1920. The budget for laguna honda grew by 66 over the same period. Funding for Mental Health and Substance Abuse services increased by 54. 8 over the last ten years, from about 288 million in 201011 to approximately 466 million in 201920. The departments fulltime staff has grown by 55 in the last ten years. Behavioral health positions have grown by 26 over the same time period. The departments contracted Services Account for about 657 million in fiscal year 20192020, which is up 39 from 201011. However, as a percent of the total budget it is down to 27 . Detailed contracted Services Expenditures by fiscal year are provided in appendix d of our report. As of july 9, 2010, the department of Public Health had spent approximately 96. 5 million on covid19 related activities and encumbered an additional 96. 7 million. Department acknowledges that approximately 40 of these costs are for personal protective equipment, but all of them show up as d. P. H. Costs due to the nature of the equipment. Costs include costs for equipment, cleaning equipment, and other supplies, expanded protection and overtime for d. P. H. Staff, and other items related to the health emergency. The city expects the u. S. Federal Emergency Management agency, or fema, to help with a portion of reimbursement, and the state has reimbursed an additional 18 of costs. This would bring the total cost down to 16 , however, caloes has not yet activated this system. Because the Health System serves a capacity of people with Substance Abuse and Mental Health disorders, children, youth, and families, in may 2019, d. P. H. Presented the graphic shown in exhibit 5 on page 12 of the report and on this slide to the board of supervisors. This graphic illustrates the points of entry into Behavioral Health services and the increasing levels of area from prevention, early intervention, and outreach, providing a level of care inform facilities that provides the best care available. The system is monitored through external audits of Mental Health and Substance Abuse services, per medical requirements, and contract management of Behavioral Health services contracted program. D. P. H. Staff divided the Access Points into three areas. [inaudible] decrease frequency of Substance Abuse, and introduce readmission for patients into psychiatric and Substance Abuse services, and service, which includes overall satisfaction, quality and appropriateness of care, range of treatment, and cultural sensitivity. In fiscal year 1920, Behavioral Health services had approximately 1. 32 billion in contract funding, contained in an existing multiple Year Contract spanning multiple years spanning multiple organizations, of which 296 million was budgeted specifically in fiscal year 1920. Behavioral Health Services contracts may include funding that only covers one service area, such as Mental Health treatment, or contracts may be combined to provide services such as substance suspect services and Mental Health services. Total contracts are shown on page 6 and the full list of contracts is shown in appendix c of our report. D. P. H. Staff report that workforce vacancies are due to insufficient Human Resource staffing, as well as increased competition for psychiatrists and other clinical staff. D. P. H. Staff have reported that 20 of clinical positions were available as of may 2019. Department Staff Reports that to address this, they have worked with the department of Human Resources to create a new psychiatrists job classification series, with an adjusted pay scale which resulted in a decrease in psychiatrist vacancies citywide from 23 in january of this year to 35 in as of this month. Behavioral Health Services staff have also cited challenges providing language appropriate services, particularly for spanish, russian, and cantonese speakers. D. P. H. Staff reports that in order to address this issue, they are working with d. P. H. To explore alternative testing methods which will be to certify interpreters when testing resumes [inaudible] and our first policy recommendation in our report was related to this, and that was that the board of supervisors could request the department of Public Health to provide a periodic update, such as quarterly, on Behavioral Health workplace vacancies and efforts to increase language capacity through hiring to the board of supervisors. D. P. H. Provides various types of Behavioral Health beds for Mental Health and Substance Use disorder treatment, seeking to provide services in the least restrictive setting in San Francisco. A review of Behavioral Health beds provided by d. P. H. These are Group Contracts agencies as listed on pages 14 through 16 of our report. D. P. H. S inventory of service beds includes Substance Use and Mental Health treatment beds. This graph summarizes the number of treatment beds in the fiscal year 1920. Exhibit 8, also on page 17 of our report, and shown on this slide, summarizes the number of treatment beds in the citys Substance Use Services System for fiscal year 201819. The city maintained a total of 503 Substance Use treatment beds, including 251 for open residential treatment, and 193 in transitional and supportive housing. Fiscal year 1920 Service Budget included funding to add more than 100 Behavioral Health and Treatment Recovery beds, including Mental Health and Substance Use disorder beds. In addition [inaudible] in total, d. P. H. Received funding for 212 additional beds, including 188 beds in community placement. 47 have been opened, 37 have been opened, and 16 are no longer available or are pending. The 16 that are pending are reflected on page 7 of our report. In 2020, the d. P. H. Mental Health Reform team performed a bed optimization simulation. This analysis, published in june, utilized 1829 available data to free up beds, and then utilized a scenario to see how they could improve patient flow. The analysis recommends an increase of 117 beds with t tthe [inaudible] these recommendations are exclusive of the beds funded in fiscal year 1920 as the team used fiscal year 1819 data for its analysis. And this leads into our second policy recommendation in our report, and that is that the board of supervisors with with the budget and appropriations funding [inaudible] to address the gaps in specific types of Behavioral Health beds identified in the departments june 2020 patient bed analysis and additional ongoing funding needs. And b, consider enhancing additional funding. The departments analysis, again, recommended a 117 bed increase we would estimate an ongoing cost of 10,649,788. Chair ronen through the chair, could i just ask a question. Do you know what the cost the figure is for the 16 that were eliminated . The number of beds or the cost . Chair ronen the cost. So you can said that the policy option is to use that money that one time that was re sorry. Sorry. This policy action, is that what youre talking about of the 16 of additional beds that was were funded and eliminated . This was irregardless of the 16 that were eliminated. Supervisor mandelman but what is the onetime funding . Sorry. There was some onetime funding that was not used from some of the beds that were delayed, that its possible, and i think they may have more information. Chair ronen and whats the amount of that money for the beds that were delayed . Unfortunately, i do not have that in front of me, but i can find that for you. Chair ronen okay. Sorry. Thats okay. D. P. H. Reports that as of june 2020, there were 58 nurse fulltime equivalent positions f. T. E. S or 4. 2 of all 1,388 f. T. E. S listed in the annual salary ordinance. These include 13 f. T. E. S which candidates have been selected and 48 f. T. E. S for which candidates have yet to be selected and processed. In response to covid19, the mayor issued a declaration to expedite city hiring of nurses, along with other frontline Health Care Workers. In response to this need, d. P. H. Staff reports the facility has hired an additional 90 nurses. On page 21 of the report shows vacancy rates for the registered nurses for the past three years. This is not total budget authority, which is adjusted to reflect for approximately 10 savings that the department cannot hire without exceeding its authority. According to compliance data, as of 2018, 41 of d. P. H. Public contact staff identified as multilanguage, that 2,708 staff. The languages spoken by multilingual contact staff, include staff, wipanish, canto russian, and other languages. The Language Access ordinance Compliance Report finds that d. P. H. Is in compliance with all measures, including funding adequate number of Public Contact employees who are multilingual, having a Language Access policy, submitting their annual Compliance Reports on time, providing Language Services training to Public Contact staff, and completing mandatory training. And with that, i am available for any questions if there are any. Cha clerk vice chair walton, would you mind facilitating the next portion and any q a or comments from colleagues . Supervisor walton thank you very much, chelsea, and i, of course, would love to do so. Do we have any questions or comments from my colleagues on this item . Supervisor mandelman mandelman. Supervisor walton i do see you in the queue. Supervisor mandelman can you just tell me the percentage of beds and what were the outcomes . The beds eliminated included ten beds for transitional age youth to rebalance the current year budget as high supervisor mandelman got it. And there were also 23 assisted living beds that were no longer in process due to changes in 2019 and union objectives d objectives according to d. P. H. Staff. Chair ronen say that again. So there were 11 transitional age beds eliminated in 1920, and then its our understanding that 23 behavioral Living Community assisted placements were no longer in place due to legislative changes in 2018 and union objectives. I think these beds were to help with the shift of the adult residential facility beds to open additional hummingbird beds. And unfortunately, d. P. H. Staff might be able to provide more detail. Supervisor mandelman okay. Great. Hope im not butting in out of order in the queue. So that, as mr. Gonchar said, those go back to the decisions at the Behavioral Health center. About a year or so ago, when there was a plan to relocate some of the clients in that facility to ditch Community Locations in order to make room for new hummingbird space at the b. H. C. , and those plans were retained where we maintain the space at the b. H. C. So that was when we planned for that transition but ultimately did not end up making it in conversations and agreement with members of the board. Supervisor mandelman okay. Because i dont think that that that the beds that we saw expanded last year, i dont know that we imagined those to be replacement beds for the a. R. C. Yeah, so this is supervisor mandelman okay. Going back to, you know, it may be two budgets ago, but we had ultimately contemplated those beds, and since we changed the plans, weve reallocated that funding, and that includes the new funding of the beds at [inaudible] instead of the b. H. C. , so this is a conversation and a shift thats occurred over probably the last 18 months. Supervisor mandelman and so for either mr. Wagner or mr. Gonchar, one of the things that i think the mayor was excited about and we were excited about last year was the opening of the most significant increase in dual diagnosis in a generation, i believe, is the phrase that we were using. Did any of the dualdiagnosis beds get opened . cause it looks like thats the thing that didnt happen. On that question, i believe hellie or marlo has the data on those beds. Hi, this is kelly. Or kelly. Yeah, this is kelly hiramoto. I do special projects i do special projects for the director, but my normal job is im at the covid command center. Unfortunately, they had some challenges getting finances through the bank, even though the department had provided a letter verifying that the dollars existed. By the time they got through the hurdles of the bank, covid crisis was arriving, and so the site search is although it is still going on, it has a very different look to it. Set that [inaudible] was asked to step in to do the beds, they had just finished getting approval to do the acquisition of grove street house, and so they proposed the renovations on that site before covid hit. So both things are in service, and both things are in play, albeit at a much slower pace. Supervisor mandelman thats sad. All right. Thank you, kelly. Thanks, everyone. Chair ronen is d. P. H. Going to make a presentation . Supervisor fewer yes. So right now, i lost my whole Internet Connection in my house. So i am back, and id like to bring dr. Brent colfax to give a presentation. Thank you. Hi. Good morning, supervisors, and thank you, b. L. A. , for that presentation. Im joined by our budget director, our director of the Health Network, our acting director of Behavioral Health, and as you just heard kelly, our director of special projects. Im going to go through a few slides describing our budget and then obviously be available for additional questions, follow up, or direction from the board. Next slide, please. So just to provide an overview, our mission is to protect the health and wellbeing for all in San Francisco. Our vision is a robust one, making San Francisco the healthiest place on earth. What we do, Research Health in the community, educate the public and providing Health Care Providers, and ensure equal access for all. Next slide. So we are an integrated Health Department with two primary roles and two Major Projects to fill the mission. We have a Population Health mission, which is focused on protecting the health of the population, and then, we have the San Francisco Health Network, which you can think of as the primary delivery engine of the Health Department, providing high quality care and prevention directly to People Living in San Francisco. And i think that this combination of both a Population Health and a Network Service based approach has really strengthened our response to many situations in the city and has really come to the fore in our covid19 pandemic response, where we are able to respond to the Population Health needs but also ensure that direct care for those most vulnerable to covid19 is available. Next slide. So as youve heard in the b. L. A. S report, we have a significant budget, 2. 4 billion. Nearly 1 billion of that is from zuckerberg San Francisco General Hospital. It is, as you know, one of the premier id like to say premier Public Health hospitals in the country, and a trauma center. Our second budget is in Behavioral Health, followed by laguna honda hospital, our other Health Network services, administration, Population Health, and then, you can see primary care, jail health, and health at home. Next slide. This graph shows the revenue drawn down by each division in the blue section of the bars, and then, the general fund that is needed to fill gaps. So overall, we generate approximately two thirds of our costs with we fill about two thirds of our cost with revenue, and by far, our biggest source of revenue are medical and medicare, which totals approximately 1 billion a year. Can you go back to that slide, just no, back yeah. I just also want to point out one of the challenges in our Health Care System and a major investment that we continue to make with general fund dollars is jail health. You see that, and just to remind the board, those dollars are not medicaid or medical reimbursement due to Public Health guidelines. Next slide. So with regard to our operations, we are a highly regulated department with many agencies having oversight for much of our work, both at the state and federal level. As the board well knows, we have mandated staffing ratios, both at San Francisco general and laguna honda hospital, and there are very specific state requirements for safety net Health Systems. We have numerous funding streams with rigorous reporting requirements, frequent reporting requirements. As you saw from the b. L. A. , Health Care Costs are expensive, and Health Care Inflation has historically been much higher than inflation overall. Unfortunately, we are not immune from those effect lating costs with two 24hour hospitals and many hospital services, and theres also a changing landscape that i think is a good landscape to change to, but one that is difficult to manage and challenging to manage with regards to shifting to valuebased payments as the state was moving aggressively to medicaid payments. I shouldnt say obviously, but this has been delayed substantially due to covid19. Next slide. Next slide, please. Yeah, thank you. So just to go back a decade, there have been significant accomplishments by d. P. H. And the city as a whole. 2010, the opening of laguna honda hospital, and then, the safety of the San Francisco birth net, which is the care net for those born in San Francisco. Opening of the new San Francisco San Francisco General Hospital in 2016, successful implementation of wave one of the Electronic Health record, the wave system, which has allowed us to more effectively review data from across our Many Disparate systems, obviously, of value during covid19, but something we wouldnt have had until last year. And then, speaking of covid19, so much of our focus since february has been addressing this unprecedented challenge locally. So for fiscal years 20 to 22, we are continuing to work with in the department, i would say reenvisioning and looking to transform or Behavioral Health system with the leadership of mayor breed and the board, advancing equity in our community and investing in the workforce. Youve seen that weve made some progress there but continue to need to improve. Improving quality outcomes and becoming more of a datadriven organization. We are data driven, certainly, in our covid19 response and many of responses of our systems, but we still have room for improvement there. Completion implementation of the electronic work record. There are ongoing there other places that we need to integrate and implement our unified e. H. R. And then, we continue to work with the state in preparing for the new cal medicare waiver program, also known as healthier california for all. Next slide, please. So i know the board is familiar with, or very familiar with the our covid19 response. Again, weve been monitoring and managing this since january 2020. We have recently unified our operations under a single unified command center, which includes d. P. H. As a major driver of that work. It also includes the department of Emergency Management and the Human Services Agency Working also in partnership with the department of homelessness and supportive housing. Key strategies to our datadriven approach include these pivotal tools the contract tracing, the testing, outbreak management, ensuring that theres adequate p. P. E. , lots of information and guidance that our teams are working on for the many stakeholders across the city, working to, with our partners of the other departments i mentioned, working on sheltering in place, beds for the most vulnerable, and then, most especially, right now, as we are experiencing a surge in our covid19 infections, our reproductive rate in the city is above 1. Weve seen a surge in both case diagnoses and hospitalizations. We are next slide. So i mentioned Mental Health San Francisco, Mental Health s. F. , an ambitious plan, transforming our system. Some of the key areas that weve talked about, having a Mental Health service center, having an office of coordinated care, expanding our Crisis Response, including our Crisis Response on the street, and expanding services and bed capacity to reduce wait times and ensure appropriate flow of people through the system, so people at the most appropriate level of care to meet their needs, and that the system really adjusts to what people need rather than expecting people to adjust to what the system requires. Obviously, given the many rules and regulations that we are required to follow through the state and feds, this is a challenge to fully implement to the best of all possible options, but we are really committed to making sure we give our very best efforts and investments and priority to transforming the system. We need to continue to develop, and i would say, support a Behavioral Health workforce to sustain this work. Taking a Harm Reduction approach, we know that, again, following a Harm Reduction approach according to or data and science, a Harm Reduction approach is essential in meeting people where they are, supporting people in the choices that they make, but also ensuring that they have options for their own health and their familys health. Continuing to collect data and conduct analysis to be as up to date as possible on things that families and individuals t continue to be affected by. Next slide. So another priority in the department is advancement in equity and investing in our workforce. Equity has been a key value of the department, and equity goals are in many of our initiatives across the department. We have, for instance, the black African American Health Initiative with outcomes in diseases that are disproportionately affecting black African Americans. Another example is getting to zero hiv aids infections, but we need to continue to take an equity approach frame to that work. In fiscal year 1920, we established our office of equity that is doing a lot of work with regard to normalizing conversations about race, racism, and equity. Were organizing across our systems of care and across the entire department with regard to staffing and and data analysis, really focusing on developing Equity Leadership teams and equity champions, and then operationalizing, making sure that our policies, our work flows, and our culture reflects equity, and then, our outcomes are very much focused on improving equity throughout the city. Next slide. Finally, our Quality Management and Electronic Health record implementation is i think one of the key pieces in the discussion that doesnt get highlights enough is Quality Management, so i see that as a key component of our equity approach and using that analysis to track datadriven outcomes. Some things we have been tracking are reducing hypertension, reducing readmissions to the hospital, and monitoring the number of new covid19 infections and where the infections are so we can better focus our responses. And then, as i said, we are continuing our implementation of the Electronic Health record. Perhaps an interesting topic, but a dry one, to get our responses across the city a better one, and then, to optimize our systems to meet the clinical, operational, and reporting needs. Next slide. And then, preparing for the new medical waiver. This is an important component to our work. It currently provides 150 million in annual net revenue, and we are working with the state to support the new medical healthier california for all, and you can see that we are working in a number of areas to ensure that the department can continue to provide services for those at need with the greatest needs under this new waiver. So that completes my presentation, and i am here along with the d. P. H. Team to answer questions and concerns. Thank you for your attention and your support. Chair fewer thank you so much. Supervisor ronen, i see you in the queue. Supervisor ronen yes, thank you so much. I wanted to talk to you about the implementation of health s. F. In the coming fiscal year. Thanks so you and greg wagner for all the work that you have done to quantify the cost of implementing the different components of Mental Health s. F. , and supervisor mandelman and i are currently in the process of working together to get on the same page about what we think is the most urgent, you know, to begin implementing immediately, and the cost of that for this budget year. And assuming were on the same page, and this committee is able to find the funding in the budget, together with the mayor, to fund Mental Health s. F. And the different components. And let me be clear, it would be the 24hour Mental Health s. F. Service center, the office of coordinated care, with the increase in case managers that you all laid out for us. And again, we can go over this later with the Budget Committee in detail, but the Crisis Response team, and what that would take at least to pilot in the most impacted neighborhoods in the city, and then, the increase in beds the report that dr. Bland lays out. Do you think if you had the money that weve been working with you to quantify and we were able to find that, that thered be the capacity within the department to implement those components of Mental Health s. F. . Well, thank you, supervisor. We would need to continue to build capacity to do that, and the challenges that were there before in terms of moving things forward are only compounded by the pandemic. Both the with regard to the capacity of the department to take on this additional work, which is very much needed, so i want everyone to hear, of course, were extremely supportive of this work. Its needed, and we want to do it. And theres also an added component of the uncertainty where we are with covid19. So the ebbs and flows, weve just had to pause reopening. So theres that uncertainty, in addition to the additional work. And then, i think theres also, in addition to sort of the need for more workforce and hiring more quickly, which you saw in the b. L. A. S presentation, weve made progress on in some cases some areas, and i really want to thank the team that worked so hard on that. There are safe issues, as well, right, that are different now, right, with regard to covid19 and thinking about those dynamics and what that looks like. Having said that, i think with the right investments and building out the workforce to do this, the department is committed to moving it forward. It will not be as fast as it otherwise would have been, and even before covid19, it wouldnt have gone as quickly as we all know it needed and would like to have go, but i dont think we have a choice here. And, in fact, as many of us know and seen and, in some cases, have experienced, the our ability to the interventions weve had to take to address covid19 also had serious Behavioral Health consequences, and so this has been a priority. And obviously, in the covid19 pandemic, the fact that its a once in a century occurrence is unprecedented. But i think as a department and as a city, we need to also be aware that the Behavioral Health needs that have always been with us are also even further augmented and more challenging to address. So that was a really long answer, but i wanted you to hear the commitment, understanding, and the need, and that its a challenge Going Forward, but we are committed to doing everything we can to realize the vision of Mental Health s. F. Supervisor ronen and i recently saw the Job Announcement for the Behavioral Health director. Where are you in that search. Do you have a timeline to complete that search and have a timeline for hiring and getting that person up and on board . Yeah. So we are that position was posted. Its a very exciting position, and we think that we can bring in, hopefully, some really talented applicants for that. Again, it was delayed by covid19 pandemic, but were actually recruiting for the position, and i hope that we can get get get people depending on the candidates that we get, that we would be able to hire somebody by late summer, early fall. I want to make sure that we get the right people in, and the process is going to take some serious vetting and go through some some really candid interviews, but i want to make sure that we get the right person, and that we really look not only locally for candidates but also nationally. Supervisor ronen mmhmm. And as the chair of the rules committee, ive been holding back on scheduling applicants to the Implementation Working Group Mental Health s. F. Because i wanted to have a little more clarity on what is possible during this time because we were all gung ho, and then boom, and you and i talked about we need to pause, as all sources in the department were rightfully addressing the covid crisis. And so now that we know that were going to be living with this for quite some time, do you think that we should just your opinion wait until we hire the Mental Health s. F. Director to empaneling the Implementation Working Group or do you think thats something we can do even prior, because its going to take some Department Staffing to get that group up and running . Just kind of like to hear your thoughts on that. I would id like to say wed do it all now, but that that would be given the priorities that i just described, and the needs, i do think it would be, longer term, more productive, for us to bring the Mental Health s. F. Behavioral Health Director in, get a better understanding of the investments being made Going Forward so the work groups have an understanding of what was plausible and possible, at least over the short and medium term, and then, wed have a they could set tangible goals for that under the support and leadership of what i hope will be a Mental Health s. F. Team, including our you know, the new leader of this work. Supervisor ronen okay. And then, i just have one other question for you separate from Mental Health s. F. Theres been some questions and information on behalf of employees of General Hospital to replace the sheriffs that are providing security at general, and im just curious to hear your thoughts and opinions about that that effort. Well, i think there have been a number of discussions in the past before my tenure here around the dynamics. Certainly, alternatives to Law Enforcement to provide support and security to systems of care, its increasingly apparent that using Law Enforcement solely for the work is no longer the standard and, you know, really thinking through what other Health Care Security approaches can be taken that are not Law Enforcement driven but focused more on not that the sheriffs dont do this, but have a different background and training in supporting both patients and staff to deescalate the situation, so that is the standard of care. We are actively exploring both at the hospital and actually across our system of care what could that look like. Obviously, we want to ensure that staff and our patients feel safe to go to go to our services, but i think also what were hearing from staff and from community, that having a uniformed law presence a uniformed presence in situations is having the opposite effect in terms of that. So we are looking at this pretty intensely right now, and are happy to come back to the board when we have more information, but as department head, i am supportive of transferring this work to a new model. Supervisor ronen thank you so much. Supervisor fewer yes, supervisor walton . Supervisor walton thank you, chair fewer. Thank you for the presentation, dr. Colfax. I just have really a couple of juvenile justice related questions. I know that your organizational chart for Behavioral Health services, i see six people dedicated to serving youth, and i dont know well, i guess my question is how many youth to you serve connected to the juvenile Justice System you maybe dont have that information right now and are all of the individuals dedicated to serving the juvenile youth in the Behavioral Health services . Thank you. Im going to ask some other staff to provide a little more detail to answer your question. Thank you, dr. Colfax. Chair fewer and members of the board, hopefully, you can hear me okay. Chair fewer yes. Okay. So im Roland Pickens, director of the San Francisco Health Network, and Behavioral Health services, as you saw in the presentation, is the second largest of our divisions. Supervisor walton, i will defer to marlo to give you specifics, because particularly, t. A. Y. , transitional age youth, is part of her specialty as being director. D. P. H. Provides the funds for juvenile justice, and while most of the positions for juvenile justice are not at d. P. H. We provide the management staff, but marlo, i think can give you more specifics, and shes on the line. Good afternoon, supervisors. Thank you, roland. So we serve about 4,000 young people and their families under the age of 18, supervisor walton. I dont know what percent of that are involved in the juvenile Justice System, and we have as roland alluded to, we have a primary care and Behavioral Health clinic onsite at juvenile haul, so that is definitely staffed by frontline providers. We also have a juvenile justice serves that are embedded across contracts, and i would have to get you a more detailed list on that and how many f. T. E. S those contracts support. We have a small Oversight Team that oversees foster care, school relationships, and juvenile justice, but i can get you more details. Chair fewer supervisor walton, more questions . Supervisor walton yes, i have sorry about that. I dont know what happened with my mute button. Thank you, director. I would like more details, particularly on the amount of youth served in the juvenile Justice System. And im glad youre here because i have a question in terms of what is the number what is the number and plan for the Mental Health beds for our t. A. Y. Population . So it remains a priority, certainly amongst our community partners, to develop a Residential Treatment Program that is dedicated for transitional age youth. We again had to pause because we had problems finding a site, and then, we had covid hit, and then, the funding was redirected. So we arent able to open a site this year, but we have funding and its still a priority. We also are addressing the system to help transitional age youth and have partnered with others to make sure that t. A. Y. Are being adequately services across our system. Supervisor walton so what would be the beds for t. A. Y. In our system . Currently, there are none. We have a lot of adult beds, and t. A. Y. Are served in the adult system. Supervisor walton but none of them are served out specifically for t. A. Y. . Correct. So we want to have a dedicated t. A. Y. Program, where it would be serving only t. A. Y. Or younger adults. Doesnt necessarily need to be capped as 25 at 25, but younger adults, and thats still on the wish list for the future. Supervisor walton thats kind of problematic. Let me ask you another question because i know you stated that covid had something to do with why we had to delay the opportunity for Mental Health beds for t. A. Y. Youth. Can you explain that in more detail why thats the case . Yeah. So we got the funding, and we started the planning process and started Progress Foundation on the hunt for property, so that was the primary delay, and they had not found a property. And about the time covid is the, we delayed the planning group, that it was very close to a final Service Model appropriate for transitional age youth. And then covid, we learned about the funding being redirected. Supervisor walton thank you. And so i just want to be clear, so im speaking with the same information. The current proposed budget for d. P. H. Has almost 8 well, over 700 million from the general fund, correct . I believe so. Supervisor walton and there is no way that we can find 2 million in d. P. H. S budget to make sure that we have Mental Health beds set aside for our transitional age youth here in San Francisco . I would defer to dr. Colfax for that response. There are obviously a lot of competing priorities, and because t. A. Y. Are currently being served in adult systems and having recently outcomes, we certainly want to always do better. But whether or not that would be prioritized over other priorities would need to be the call of the mayor and dr. Colfax. [please stand by] have conversations about the possibility of making this happen within the current budget . We are in current conversation with the Mayors Office around the budget and priorities and certainly can bring this forward and just to reiterate, i think the b. L. A. Mentioned, the funds that were allocated for that work were repurposed due to the Covid Response. As the conversation continues, well come back to board with regard to whether that funding can be realized for the near future. Supervisor walton i definitely understand the reallocation, what the pandemic has caused, but i also know you have an extremely large budget and this is a very important population that needs to be my hope is that within that extremely large budget there are possibilities to provide this Additional Service for our transitional youth. I appreciate you and dr. Colfax. Thank you. Supervisor fewer thank you very much. Supervisor mandelman . Supervisor mandelman thank you, chair fewer. Echoing, i think, some of what supervisor ronen said, i do in recognizing that these are extraordinary times and that dealing with the pandemic has to be d. P. H. s first priority, but i feel strongly as she does, we cant wait another year to be making progress on the Mental Health s. F. Investment that she described. And i think, as we think about making those investments and as i hope the mayor built into her budget and this board looks to augment if she has not been able to do as much as we think she should or the city should, i do think last Years Experience is instructive, because, you know, we did put in a lot of money for that expansion. And that expansion happened about halfway. And left out were the beds that i think in some ways may have been the most critical, the dual diagnosis beds, that you know, these things take time. Which is another reason not why we cant put this off for another year. Because, you know, putting the fix to our Health System on hold and particularly its services to folks who are on the streets, i think is politically untenable, but also just in terms of getting the work done, we cant lose a year. So i guess, i think there are budgetary figures floating around, around what it would take to do the bed expansion and the crisis intervention teams and the Mental Health access to the Bayview Health center and the various components, but i guess maybe the first question is going to be, like, what additional administrative or Staffing Resources are needed to kind of do this work . Because i do think if we we can put we can try to find money for things but if the department is not set up or prepared or able to move on that, thats going to be a problem. So. Supervisor fewer is that a question . Supervisor mandelman statement invitation to say anything. Supervisor fewer sure. I just want to piggyback on that before i call on president yee also and dr. Colfax. I think were in a hiring freeze. So we are, instructions have been there is no hiring across the board, city and county employees. So i dont know how i think you might stack up. I dont even know why we would be hiring the s. F. Mental Health Director during a hiring freeze. So i think our question has been also with the Mayors Office, is this a hiring freeze or it is not a hiring freeze. The staff in your department during a hiring freeze, what is the game plan . I feel like this is a middle of a 1. 7 billion deficit and the mayor has given instructions were not hiring any new people at all. So what is your plan . So with regard to the Mental Health s. F. Behavioral, that position had been funded and approved before the hiring freeze. And for the reasons that we went through earlier, that position is and remains a priority. I think, chair fewer, your point is very well taken and i was remiss in adding that if were going to implement Mental Health s. F. And build that, the only way that can be done is to bring in the clinicians, the administrative support, the policy support and the financial fiscal oversight support and billing support in order to recognize that vision. It would not be possible to do that under the circumstances were currently in. It will be challenging to do that even if we were able to realize those positions. And i would just emphasize to the board that one of the key challenges we have in terms of the the uncertainty of covid19, is that we have been in a position where many staff have to be pulled to respond to covid19. We dont have the capacity to have people waiting for a surge and then pull them. Theyre doing other work. For instance, and they can talk about this if the board wishes, a lot of our Behavioral Health team and primary health team and hospital teams have been pulled for the covid19 response. So even if were able to build out these positions and hire depending on the surges, depending on the pattern of covid19 Going Forward, the challenges that are we have are only heightened and the uncertainty that covid19 brings in makes it even harder to be certain about how quickly we can achieve our goals. But bottom line is, yes, we have to hire for these positions to recognize a transformative program, so there would have to be exceptions made in order to do that. Supervisor fewer yeah. I just want to say that every department we have spoken to wants exceptions made also to their hiring process. Like they say that these their positions are crucial also, so i just want to put that in the proper perspective. Were in the middle of a big budget deficit and the mayor has said there is a hiring freeze and other departments also have said we have crucial positions we have to fill but the reality is, that we are not hiring new people in San Francisco. We can barely hang on to the people that we have employed now. Supervisor mandelman, did you have more of a question . No. Okay, president yee. President yee the it is a question that you raised, chair fewer, in terms of the concept of the hiring freeze. If you need nurses, you have to hire the nurses or do you just say, look, we cant hire those so lets close down part of the hospital. Speaking of nurses. Its good were actually hiring in terms of the nurses and i guess there are issues raised around the training that they received and other nurses, existing nurses also. And there is concerns about patient conditions. I dont know how youre addressing these issues at this point, whether they are overly addressed, but these were concerns that were raised before the pandemic, during the pandemic and right now. So you want to take a crack at that . Yes. I just want to say that safety is paramount and we continue to ensure that the staff that are hired we are required to ensure that they meet the proper standards of care. I will turn to Roland Pickens to talk about the hiring process and we can also ask dr. Er to join. President yee before you answer that, its been retaining our medical staff. And not losing nurses all the time. So if you could maybe shed the light on what the plans are. Good afternoon, president yee. Thank you for your question. In the absence of dr. Or lik, ill try to answer. There have been several inquiries from staff, they are really concerned about training, in particular safety in the workplace. And i know a lot of work has been done at zuckerberg San Francisco general by the Emergency Department and several other departments. Dr. Or lik herself and the chief nursing officer have meet with frontline nurses and Nurse Leaders to address their concerns, also bringing in our director of security basil price, so there has been a lot of efforts to address those. Youll also know there were complaints to external agencies like cal osha about safety and also regulatory bodies. All of those agencies have come out and done inspections and reviewed the situation and found that we were providing safe care both for our staff and our patients and there were no deficiencies. So, obviously, we can always do better and continue to strive to do so. Making our staff feel safe and are safe. We will continue to take every measure we can to make sure that happens. President yee you mentioned there is that has been done. What are some examples of that . The doctor has joined us and can provide more details, president yee. Hi, good afternoon. Members of the board, supervisor yee, im happy to respond to your questions about worker safety. I would say in the past nine months weve had a really dedicated focus to this issue. Weve had actually two very detailed and indepth surveys, one by the California Department of Public Health and another by cal osha. They came out, they investigated the circumstances of multiple things, especially workplace safety. We worked very hard with these agencies over a period of months. And we have satisfied all of the issues and complaints that both dilatory agencies brought and have in the process of doing that, have developed really robust plans to address workplace safety. We were working with cal osha actually, during the whole covid pandemic. And that the pandemic has actually heightened our awareness of safety and we work every single day with our Infectious Disease team, our Infection Control team, to ensure that we have very robust standards for p. P. E. Use for patients. We also have done lots of things just even with the physical plan to ensure that workers are safe when theyre in breakrooms, when theyre conversing with patients. Weve installed literally hundreds of plastic barriers between our staff and patients to ensure their safety. We screen our patient, safe and visitors every single day coming into campus. Staff, we take their temperature every day as well as respond to questions. There has just been a huge amount of work done in this area and i would say that our staff, our patients, everyone is safer as a result of this. If there is more specific questions youd like to hear about on any aspect of this, im more than happy to respond further. President yee these were general concerns. And thats why i ask. Maybe a lot of things have been proved. Things that have improved. By the way, when you say that not take temperatures every day of patients. I thought that was always done. I meant staff. If i said patients i meant staff. Take staff temperatures every day as long as a long period of screening questions. President yee i was thinking, what, you dont test patients . [laughter]. Thank you very much. So can i jump into another line of questioning. The b. L. A. Report sort of answered it, but i wasnt maybe it wasnt fleshed out enough for me. Can you explain those 200something beds in which we were, i guess, allotted for our share and i saw in the report it says 37 of them were unopen beds, meaning that theyre not staffed and nobody could use them. What does it really mean . And why i guess what is the reason for it not being open . 37 of the 200something beds, which totalled to be 78 beds that were unavailable for services. So what is the cause of that . Yes. So im going to turn to our c. F. O. Greg wagner and then director of Behavioral Health, Marlo Simmons to answer those specifics. It gets a little more detailed. I dont know which wants to go first. Sure. First may i clarify, i think that president yee is referring to on the b. L. A. Report, page 15, which states that funding for additional beds, 212 additional beds, funded in fiscal year 20182019 and a fiscal year 20192020, 47 are open. 37 not yet open. 16 eliminated. I think that is what hes referring to, is that correct, president . President yee thats correct. My question, too. Supervisors, greg wagner, chief financial officer. Ill defer to director simmons and kelly for details on the program. Two of the items were what had kind of previously tangentially come up which were the 2 million for the t. A. Y. Beds redirected and then the other 23 beds which we touched on earlier in the hearing. Those were initially slated to move certain patients out of the adult residential facility at the zuckerberg campus. And to use that space to expand hummingbird. We reversed that plan and allowed the arf to stay as it is with additional patients. Thats 23 beds. The funding for those is not eliminated, but was redirected into other avenues. So on the b. L. A. s calculation, that is correct, although the ultimate result is that money was repurposed to do a communitybased hummingbird expansion. Then lastly, before i turn it over, ill just note that it had come up earlier, but the dollars associated with those beds that were we were not able to locate a site and open it. Those dollars are part of the calculation for what could we do for the upcoming budget . And how can we use those dollars or continue the use of those dollars . I have nothing to add to that. Thats a complete summary, thank you. President yee so the zuckerberg, the youth beds mentioned. Are they being used at all right now . Yes, theyre being used for the adult residential facility which is the preexisting use. So boarding care at the Behavioral Health center. President yee [inaudible] a year ago i guess . Ill defer to others on that, but, yes, were trying to fully use that facility. President yee and the t. A. Y piece, that was available until a few months ago . What was the reason why we didnt use it was because we couldnt find anywhere to correct. President yee okay. Thank you. Supervisor fewer okay. Any other supervisor mandelman . Supervisor mandelman sorry, chair fewer. Supervisor fewer no problem. Supervisor mandelman it would be great to know what the census is for the three levels of the Mental Health building at general for the rcfe and the third floor, how many are currently filled and how many are vacant . So i have it on this call, we can provide that, too, quickly. Supervisor mandelman i think the d. P. H. Budget does not anticipate all of those beds being filled. Like, for example, the third floor has some empty beds, but i dont know that your budget includes those being filled. There are some Unfilled Positions associated with that facility, but we are working to staff and fill those positions. So that is our current trajectory. You budget for staff, you dont budget for beds . Correct. Supervisor mandelman at any rate, i would love to know how many beds are empty . President yee [inaudible] hiring freeze. This is Roland Pickens. Well get those numbers to you right away. One of the things you should know is because of covid19 weve had to space out patients, particularly on the third floor, Mental Health facility. So not all the beds are filled because we have to do the social distancing. So well put a footnote to that in the data that we send to you. Supervisor fewer done, supervisor mandelman . Okay, great. You know, i have a series of questions and i feel like everyone is going to be really tired, but i have to ask just a few of them. One of the things that i think weve had conversations about is our infant mortality rate. We have talked about that. And i wanted to know and i have spoken to people in d. P. H. , i said what are we doing about that . And i know there was a Doula Program that was grant funded, but what else are we doing around that . I just find it just appalling, but also inexcusable of a city of such great wealth. Can you give me update what kind of resources in your budget is being put toward that effort . Yeah, so we also have this as one of our key priorities, our Health Equity priorities under the black africanamerican Health Initiative and have been working in our Maternal Child Health program to continue to address this. One of the things that we are hoping to have greater investment in in our new budget is working with Key Community partners and stakeholders to implement something called the Abundant Birth Program that would support black africanamerican women who are pregnant and after they give birth with Wraparound Services and actual stipends to support them and their new family, their child and their family. So this is a program that is based on the best evidence in terms of providing basically a stipend to support the needs that data and Research Show that young that mothers [inaudible] need. So this is one of the key projects that we can provide more details on that if the board so requests. And this is being done again in the Health Network under the maternal and child health program. So that is one of our key new initiatives that we would be working with our other partners including the h. R. C. On this, and depending on the results of that pilot, potentiallily scaling up. Supervisor fewer so you have havent implemented the pilot yet . No. Again, this was another covid19 situation where things were have been delayed because of that, the Doula Program is continuing and our budget reflects that ongoing work. But, unfortunately, the project the implementation of that with that. Supervisor fewer i just want to say this is an issue that is not new to San Francisco. This is an issue that has been ongoing. I think that this is an issue that years ago, i mean of course i think a wealth gap and our situation here in San Francisco has exacerbated the problem, but clearly this is an issue from a while ago. And also messages of racism is in our own Public Health system. Disappointed this is happening, because i think this is an issue of great urgency. I just wanted to bring that to your attention. In april of 2018, the b. L. A. Did a performance audit on the Health Services division that included several findings and recommendations for improvement. Can you give an update about how those recommendations are being implemented . For example, Service Clinic falls short on these measures. They need for intensive Case Management services by two to one. Clients are not consistently on discharge. The department of Public Health is implementing the whole person care programs of integrated services for the population. But Behavioral Services should become more involved in the program because Behavioral Health does not [inaudible] with information. There is a limit of information on the capacity of the Mental Health and Substance Use services. So just an overall sort of update if youve addressed these issues in the 2018 b. L. A. Performance audit and their recommendation i mean these issues that [inaudible] that are partners were actually doing a better job than Public Health, so you can just give me a little bit, a synopsis of an update on how those things have changed since the 2018 b. L. A. Performance audit. Thank you. Certainly were continuing to address the issues that were raised. I think weve made something improvements there in terms of expanding our oversight of services, our quality of services, our staffing as you saw. Weve made real changes successfully in hiring more people to provide those services. And ill let Roland Pickens and acting director simmons answer in more detail and certainly we can provide you with our responses to that report when it was issued. And provide updates on some of those details that you went through today. Supervisor fewer thank you very much. Hi. Good afternoon. Hello. This is Roland Pickens again. So, i would say weve done a pretty good job of addressing all of those issues. One example i can think of off the top of my head is the connection to services after leaving p. E. S. We set up a very robust process where we actually have navigators stationed in p. E. S. That do a warm handoff. Will take clients from p. E. S. To the programs theyre referred to. It was a deficit that p. E. S. Would tell people, go next door and theyd be lucky to get there. We have them that will walk them to the various programs. Director simmons may have other examples. Ill also say that as we begin to implement Mental Health San Francisco, it will, i think, continue to build upon correcting a lot of those areas for improvement. But weve made Good Progress and we have been keeping track of that b. L. A. Report and actually monitor how were doing with addressing each one of those. And were happy to give you that detail information in more detail. Supervisor fewer thank you very much. I didnt want to lose site there was an audit done and there were recommendations that were hopefully implemented. Thank you very much. Any more chair . Supervisor fewer any other comments . Any more comments or questions from my colleagues at all. I know this has been long. Youre such a Huge Department now. And also encompasses so much information that i actually think i knew this was going to be kind of long. I think we should open this to Public Comment. Madame clerk, how many people in the queue . Chair fewer, let me check on that for you. For the time being, should i go ahead and open Public Comment . Supervisor fewer yes. How many people in the queue . We have 44 listening and 25 in the queue. Supervisor fewer okay. I think yeah. I think we should do a oneminute limit on the just because the queue seems to grow pretty quickly. And so we will also and the reason i say this is because we will also so, listeners, we will also have Public Health back before the Budget Committee. This is just a hearing to get sort of an overview where we actually talk about the Public Health budget, they will come back again so we have another chance to comment on it. This is just an overview to get us familiar about has is happening in the what is happening in the budget. Lets open up to Public Comment right now. Speakers, were limiting to one minute today. Again, we welcome your Public Comment at future meetings also. Thank you very much. Please open up Public Comment. Okay. Madame chair, operations is checking to see if there are any callers in the queue. Operations, please let us know if there are callers that are ready. If you have not already done so, press star 3 to be added to the queue. For those already on hold, please continue to wait until the system indicates you have been unmuted and you may begin your comments. Let us know if there are any callers that wish to comment. I am sending the first person through. Hi, can you hear me . Yes, we can. Please begin. Hi. Im Vanessa Taylor and im [inaudible] School District and i just started over 30 years and 20 of those years ive been in the district 10. Im just calling about the funding for im just asking for you not to use the funding for appropriately not as far as the sheriff and the police whether its in the health, General Hospital, or if its in the because we need all the funding that there is so much that we can use the funding and not taking away just by, you know, with them. So this week that happened and i was a little bit concerned about ways that we should not have police in our place of school or in our Health System. So just make it so we need funding for there, just you know, for our schools or for our mental and Health Issues that we need. Supervisor fewer thank you. Next speaker, please. Hi, good afternoon. My name is naomi, im a Nurse Practitioner i worked for the department of Public Health for 19 years. I worked for 10 years on the campus of San Francisco general and worked in many of the primary care outpatient clinics. I just want to voice my support to the call to remove the funding for the Sheriffs Department from the d. P. H. Budget. Invest instead in programs that support the health and safety of all people in San Francisco, particularly the patients, staff, families who get to work care and work at the general and for the d. P. H. My years of experience at s. F. General as well as a number of clinics, ive seen the harm of having Law Enforcement present in our spaces of care and witnessed disproportionate impact on communities of color and other marginalized group. Ive seen Harm Reduction training deescalate the majority of issues that might otherwise trigger security responses. So i want to encourage the board of supervisors to take this bold step of removing funding for the Supervisors Department. Thank you. Thank you. Next speaker, please. Hello, my name is abdul. Im in district 1. I am nonbinary and there is about 90 second delay between the government tv and phone calls, so you can adjust this. I want to [inaudible] community about defunding the Supervisors Department and s. F. General. I recently had diagnosed with a Mental Illness that was onset and i went there to triage for treatment and was accosted by no less than five or more armed and uniformed sheriffs who came into my room for no reason at all. No reason at all. They came in and started intimidating and that was highly [inaudible] and decreased my healing time exponenti exponentially. I dont feel i as a patient [inaudible] Community Time is up. Thank you for your comments. Next speaker, please. A couple of videos online for women of color, minors pulled over in their car, the girls were handcuffed and let go. This has happened to me. They did not know a gunshot victim to s. F. General. They put out that further criminalizing the young women causing more harm. That spoke to the gunshot victim and not the humanity of the girl. There are hospital staff and workers who are uncomfortable with the sheriffs present at s. F. General. Some of our most vulnerable i am asking you to please defund the sheriffs deputy in the Public Health facilities. These can go to hiring more black midwives, doulas, doctors and paying them more as well. This could be part of the harmreduction approach mentioned earlier by dr. Colfax. Thank you, im done. Thank you for your comments. Next speaker, please. Hello, supervisors. Im a primary care physician and i care for transitional aged youth in the department of Public Health. I live in district 9 and i work in the tenderloin and the health center. Id like to speak on issues primarily im standing with my community and my colleagues from across the city to demand that we defund the sheriffs within the department of Public Health and San Francisco general. Theyve caused more harm and make our places of care unsafe. Dr. Colfax mentioned wanting alternatives and were happy to discuss with him many. Our system has abandoned our t. A. Y. Patients in their time of need and sacrificing them further in addition to disproportionate violence they suffer at the hands of police and sheriffs is unconscionable. I stand strongly with my colleague who has taken [bell ringing] thank you for your comments. Next speaker, please. Hi, my name is tim muldoon. Im a physician at San Francisco general and i live in the outer sunset. Just calling to voice my support for the proposal to end the contract of the Sheriffs Department and the alternative ways of keeping patients and staff safe. I work primarily at nights in the hospital. I spend a lot of time in the Emergency Department and i know that there are a lot of situations that require support to keep staff safe, but i also think that the heavy presence of Law Enforcement there is extremely threatening and goes against the creation of a safe and welcoming environment which the majority of our patients. We should pursue alternatives that other hospitals have done to keep people safe without Law Enforcement. Thank you. Thank you for your comments. Next speaker, please. Hi, im the resident of district 6. Im calling to stand in solidarity demanding the cancellation of the Sheriffs Department from d. P. H. And defunding models of Community Safety. Putting into health care is unsafe and dangerous for everyone who has to receive health care, which is everyone. I have had personal experience when people have been having a Health Crisis on the street and theyre asking me to call 911, i know if i do police might arrive and very bad things might happen to them and putting sheriffs in hospitals is another way of doing that same thing. I want to say that the mayors budget, we dont need posterity when the city class positions continue to we need a divest. We need to redistribute the wealth from the [bell ringing] the rich and the capitalists of the city. Thank you for your comments. Next speaker, please. Hi, this is [inaudible] foundation of district 10. I want to thank the board for your focus on Behavioral Health and the championing that many of you have done. I think its essential theyre not the for the department of Public Health budget and that these innovative programs that are necessary that have been delayed by covid be reinstated. The necessary Covid Response is [inaudible] including an increase in Overdose Deaths. Were seeing more Overdose Deaths than covid deaths since the beginning of shelterinplace. Defund the Bayview Health, including our stonewall and programs at h. I. V. Funding primary. Than this this Behavioral Health care services. Thank you. Thank you for your comments. Next speaker, please. In future i think you all should state right at the beginning how much time youre going to give for Public Comment. Its not fair that you all talk all you want to and then the public is given very little time for input. Having said that, the disparity of San Francisco is compared to a third world nation called rwanda. I see the supervisors, some of you all come to the Health Department, youre not paying attention to the monitoring that two doctors are doing in the bayview. Youre not paying attention to that. Youre not paying attention to the homeless who are dying. There are thousands of people that are slowly dying. So when it comes to quality of life issues and this great talk that you all want to make to have services comparable to [bell ringing] the best nation in the world, its [bell ringing] thank you for your comments. Next speaker, please. Hi. My name is katy. I am a social work student. Last year i interned at a clinic. This year i will intern at an inpatient department. Im calling in to speak as a current pandemic is making it clear, the Health System is overwhelmed by health disparities. They are present and unavoida e unavoidable, especially now. And having the Sheriffs Department and Law Enforcement in Health Care Settings only exacerbates that and makes it harder for marginalized communities and people of color to seek needed care and that is only going to further widen this gap. And its not going to help us build a more Equitable Society and Health Care System. So im here to advocate and speak against having the Sheriffs Department in the Health Care Settings because i dont believe it increases safety. Thank you for your comments. Next speaker, please. My comment is to defund the Supervisors Department. The department of Public Health vision is to make s. F. The healthiest place on earth. This cannot be achieved with the presence of the sheriffs presence on site due to the constant mistreatment, disrespect and tyranny carried out by Law Enforcement on and off site. This vision cannot be achieved if the Sheriffs Office is present because Law Enforcement has caused trauma after trauma to the people theyre supposed to protect. Many of their racial bias, logic, humanity. Laws have been put in place to protect the people from Law Enforcement. The change has to start within the institutions, Law Enforcement and government because the system is broken and has failed the people. I am related to the four young women who were mistreated by the police and violated over there at General Hospital. The Police Officers failed to abide protocol and did not read them their miranda rights and pointed a gun at them. These people work in the community. These young women have been traumatized by this experience and feared for their lives. This is unacceptable. We need a mandated reform of how Law Enforcement interacts with the people theyre to protect. Thank you for your comments. Next speaker, please. Hi. Good afternoon. Im a physician at s. F. G. H. And womens clinic. Im calling to stand in solidarity with my community and d. P. H. Must divest coalition in demanding that the sheriffs be removed from d. P. H. Facilities and s. F. General and investment in alternative communities, models of safety, as well as establishment of an Oversight Committee to hold accountable. We all know that the Sheriffs Department at d. P. H. Does not create a safe environment. It perpetuates systemic racism. We know it targets black and brown individuals and there are countless examples of sheriffs, d. P. H. And general, exacerbating situations and traumatizing our community. This does not create a healing environment. Thanks for your time. Next speaker, please. Hi, my name is juliana. Im a familiar physician based out of s. F. General hospital. I would like to see a complete defunding of the supervisors sheriffs in the budget. Ive seen so many situations where people are criminalized or situations are currently on strike until the sheriffs are removed. This has to happen immediately. We cant wait. We must invest in alternative Response Teams. These models already exist, need to be expanded and better funded. We need to invest in housing. We have proven with covid19 we can be nimble and make changes. This is more than necessary. Defund the supervisors. Take them out of the d. P. H. Budget. Take them out of the d. P. H. And invest in True Community safety. Thank you. Thank you. Next speaker, please. Hi, supervisors and dr. Colfax. I live in district 6. First saying thank you to the department of Public Health for the excellent care you provide. And thank you to director colfax for your answer to supervisor ronen when you say you agree we should remove most of the supervisors from San Francisco general. That is fantastic. Im calling to ask that the board and the mayor remove all the sheriffs in this years budget. San francisco spend almost 20 million on the sheriffs and [inaudible] between the department of Public Health and the Sheriffs Department. This is unacceptable. San francisco spend only 100 million on all of for the whole city. If we take 20 million, we can expand primary care by 20 . And actually make San Francisco healthier and safer and better for all of us. Please, supervisors, defund the sheriffs from the d. P. H. Budget so we can make San Francisco healthier and safer. Thank you. Thank you for your comments. Next speaker, please. My name is ohave a. Im a Behavioral Health clinician. I urge this committee to completely remove funding from the s. F. Sheriff and reinvest money that will support the health and safety of san franciscan. This committee has discussed Mental Health. As a Mental Health care provider i have witnessed the impact of police during crisis. Patients in particular black and brown, live in constant fear of violence. Their fears are not unfounded. A 2015 report from the treatment and Advocacy Center found that a minimum of 1 in 4 fatal Police Encounters ends the life of an individual with severe Mental Illness. I want to repeat the sobering statistics. 1 in 4 fatal Police Encounters ends the life of an individual with severe Mental Illness. Seeking treatment in the Public Health care system. I ask that you build a healthy and equitable future for all san franciscans. Thank you for your comments. Next speaker, please. Hi, good afternoon, supervisors. A first generation american born and raised in bayview Hunters Point public housing. We want d. P. H. To remove the sheriffs from General Hospital as this site serves the most vulnerable population. Exactly a week ago wednesday, july 8, my four nieces, 23, 17, 16 and 15 years old, were involved in an incident with the sfpd and sheriffs in our hospital. Upon leaving the family home, four brown girls who are active servants of community were stopped by a man bleeding. Upon dropping him off at the hospital, our girls were violently am bushed by sheriffs, to instructed them to get out of the vehicle, had them on the bellies and no other instructions and information. This is targeting and criminalizing of our bodies is unjust. Again, we want sfpd out of our Public Health facilities. Thank you. Thank you for your comments. Next speaker, please. Hello. My name is kylie. Resident of district 6. Im calling in solidarity with the d. P. H. Divest coalition to demand the removal of funding of sheriffs from the budget. As you heard from the previous caller, sheriffs are known to escalate crisis in clinics with Excessive Force resulting in injuries and trauma for patients and providers alike and this disproportionately affects providers. Deescalation that address these situations and do it better, and there are already teams of psychiatric nurses at s. F. General that respond in this way. Lastly i want to voice my support for the black nurse and midwife at s. F. General who stated shell remain on strike until the Sheriffs Department is removed from the d. P. H. So defund the sheriffs d. P. H. Thanks. Thank you for the comments. Next speaker, please. Hi, im pauline. I want to show my support with my community to defund the Sheriffs Office from the San Francisco General Hospital as the Public Health budget and to invest in trauma care of deescalation and Community Investments that are not Law Enforcement. And also i saw in the news today that the Trump Administration is going to report to the isnt going to report to the p. B. C. Anymore and i thought this was concerning and thought that would be addressed in your meeting today. I wondered how that is going to affect us in San Francisco and how the d. P. H. Bill will be accountable to us as well. Thank you for your comments. Next speaker, please. Good afternoon, supervisors. Im shirley wong from district 4. Im in support and solidarity of defunding the sheriffs from the department of health and s. F. General. Im standing in solidarity with the four girls who had a very traumatic experience with Police Officers that harassed, terrorized and essentially demonized them. Next caller . Hi. Im resident voter district 6. And, yeah, i too would like to call with regards to budget discussions to point out you could remove the Sheriffs Department and come up with 20 million that would cover that 10. 6 million you were looking for the 177 beds and other stuff besides. Id also like to say that, yes, further in terms of the nickels and dimes that you all are looking at, if you advocated for the defunding of the Police Department as a whole [inaudible] entire additional laguna honda hospital to the s. F. Budget, i would encourage you all to divest from the Sheriffs Department being with the department of Public Health and impacted by this from San Francisco general and maybe the money would turn up for all of the other services. And hiring freeze would be immaterial because wed have a lot less costs. Thank you for your comments. Next speaker, please. Hi. Ive lived in San Francisco for 35 years. I first want to commend you for what i think is cityfirst in response to public demand showing yourselves during Public Comment. I hope this will be a standard that is taken by all the other city committees. I, too, urge you to remove the funding for sheriffs in the d. P. H. Budget and invest in programs that provide true health and safety for San Francisco residents. I think we can all agree its important to keep conditions to a minimum. That is our Health Facilities should not cause injury or disease to a patient. Then, two, we must strive to eliminate all police conditions, that is harm caused by having Law Enforcement at our hospitals and clinics. The american Public Health association said, i quote, physical and psychological violence that is structurely mediated by the system of Law Enforcement results in deaths, injuries, trauma, et cetera. I join my community, the d. P. H. Must divest coalition and the courageous black midwife in demanding that d. P. H. Cut all ties to the Sheriffs Department. [please stand by] [please stand by]. Caller hi, supervisors. Thank you for letting me speak. I am curtis bradford, the general chair of the peoples congress. And i want to say today that we need a budget in San Francisco that reflects the actual values of the San Francisco beliefs and values. And what does that look like . That looks like keeping the sheriffs out of the d. P. H. And fully funding the Public Health department and increasing their budget. And we dont need equal cut from all departments and we need equitable cut and increasing funding for health and police and funding and that reflects the areas to get behind as san franciscans and need to fully fund this year. And we need it now more than ever. It needs to be done. We cant wait and let it drop through the cracks. We need a budget that reflects the value of San Francisco. We care about the community and their well being and the health. The budget should reflect that. Thank you for your comment. Next speaker please. Caller hi. I am danielle a primary care doctor and work with San Francisco General Hospital as well as the department of Public Health community clinic. I think that the city has been doing a great job in the Covid Response and i think we can use this moment in history to do even more for the health of our city and i urge you to support the coalition and defund the will haves department and get them out of our places of healing. I was around when fernandos video video was released in which he was beat by a member of the Sheriffs Department in our own emergency room. I knows that have a violation and led to a lawsuit for the city. When things like that happen, it is not creating the values in the city that we want to promote. And i want to know that issues of hiring fees are brought up and a huge amount of money that goes into funding the Sheriffs Department and if that was taken away, it could be put into Community Care and deescalation expert who would likely make us safer and make everyone feel better about being in a place of healing. Thank you. Next speaker please. My name is alena and i am a Health Worker as well as the center and sf again and i eurge you to cut the funding for the Sheriffs Office and i heard one of you ask what is the city doing to help with the mortality rates for black women and thank you i think defunding the Sheriffs Department in the budget will be a great step. I join the community in demanding that you that this board vote to defend to defund the Sheriffs Department and focus on True Community safety. Thank you. A chair fewer, if i may, this is graham colfax. Im sorry to interrupt the public. We are in a covid surge and i have my covid surge response meeting. We will have d. P. H. Staff say on to listen to the important comments. I apologize to the board but unfortunately i have to go address the current pandemic in our city. Thank you, dr. Colfax, for joining us and answering all your questions. A thank you. An operations, next speaker please. My name is jessica kaplan, a resident of district four and the thank you to announce to the supervisors on this call and much appreciated that you are working with this last week. I am calling in solidarity with the coalition and the traumatized patients and those who have experienced violence in their community. To keep people away from care and is not the idea and the m. O. U. Of the Sheriffs Department and having that space to develop alternative models and such as the Community Ambassadors and inspiring kind of model and trained Crisis Response and deescalation trained workers. It sounds like even the sheriffs themselves have expressed this comfort and know this is not the right role for them. They dont want to be there and the Health Care Workers dont want them this. The patients dont want them there and with cops are not a solution to every problem and in San Francisco we can be more creative than that and i encourage us to do so and the board of supervisors to disapprove funding for the sheriffs and find something more appropriate in the budget. Next peeker please. Caller hello, supervisors and d. P. H. I am nick jiels in district six and i am calling in to urge the removal of the Sheriffs Office in hospitals which is traumatizing to people who have been terrorized by police in the communities and experienced abuse. The militarizing of police and the manifestation believes lead you to believe we should not have armed forces in the hospitals. We want the sheriffs budget and d. P. H. To be eliminated and not transferred elsewhere. We want the sheriffs budget overall to be defunded. We ask the board to vote to defund the Sheriffs Department and invest in True Community safety. Thank you. Clerk thank you for your comments. Before i call the next speaker, just letting everybody know that we currently have 50 listeners on the line, 21 of which are lined up to speak. So we do appreciate your patience. If you want to be added to the queue, please press star 3. And for those already on hold, please continue to wait until the system indicates you have been unmuted and you may begin your comments then. Next speaker please. Caller hello. I am a resident of district six and i urge you to eare move funding from the sheriff from the d. P. H. Budget and programs that provide true health and safety for residents. They are a threat of well being of safety and provideers and patients and i am in support of the strike after witnessing the incident of Police Violence on september 27, 2020 and will eare main on strike until the sheriffs dew points is removed from d. P. H. And i ask you to support her and other Health Care Workers who are unsafe in the Health Care System as long as sheriffs are present. Invest in True Community safety and thank you for your comments. Next speaker please. Caller hello. My name is avi and i am with the treatment on demand coalition. I want to thank the board of supervisors for prioritizing Behavioral Health needs and with a time now to the local organization and incarceration is a Public Health issue. And getting the sheriff out of and we strongly recommend that. And also to invest the savings from defunding the police in order to develop Effective Community Public Health alternative. And we also want no cuts to other departmental budgets such as h. S. H. Which will understood mine the effectiveness. And in conclusion, i think we are at an exciting time to reimagine what our society looks like and what the Health Care System looks like. A thank you for your comments. Caller i am russa and i am calling on behalf of a group of defunding the Sheriffs Department and it is inherently oppositional to the mission of d. P. H. Which is to provide care and access in the hospitals that makes people not want to go and receive care and creating a dangerous situation. The sheriffs themselves know that is not the place. Cut the police to fund black mid wives and the education and the abundant birth project and expecting justice to take care of the citizens from birth and not be placing them in dangerous situations. Thank you. Thank you for your comments. Next speaker please. Caller i want to thank the south koreas and with that and the audio for individuals and the live treatment. With the Public Comment and so advise that with the Sheriffs Department and all together. Thank you so much. Thank you for your comments. Next speaker please. Caller we have the idea outside and going to i am a family practitioner and the department of Public Health and d. P. H. Coalition to remove funding for sure. And the patients and Health Care Providers and here to support the provider and advocate who will remain on strike from the d. P. H. D. P. H. Cant claim to be a Data Driven Organization and shown instead of spending 20 million and s. F. D. And the estimates and actually provide health and safety and we need to invest in the Response Teams and deescalation and negativity and address things that sheriffs do in hospital. And the appropriate skills and actually foes kued and everything. Thank you for your comments. Next speaker please. District 11 and i am calling in complete support to defund and get rid of the sheriffs and the pub i willing Health Department. Proper care cannot be provided when people who do harm, a. K. A. Cops and sheriffs, are armed in the spaces. Also, so many of the city and sheriffs and cops and on the streets and how are they providing care. And urging to defund the sheriffs from the budget and to completely disband from and so great to see your lovely faces on camera and some of you were quite distracted. And i want to say remove the Sheriffs Departments from Health Department and defund housing and health care and apolish police and no body is disposable and black lives matter, black trans matter. And take care of the public. Thank you for your comments. Next speaker please. Caller hi. I am lily and i am a family physician at San Francisco general and i live in district five. I am also here to join the d. P. H. Coalition to demand that the board vote to remove the funding and the d. P. H. Budget and with excessive use of force and escalated in numerous moments of crisis. As you heard the sheriffs also harm Health Care Workers and i am in support of black nurse mid wives and the general who is on strike after witnessing the incident of Police Violence and provide Safe Environments and reinvest that money and education. Thank you for your comments. Next speaker please. And family resident physician and work at San Francisco General Hospital and live in district nine. And removing the San Francisco General Hospital and from the d. P. H. Budget and as doctor at the general and multiple ins stances of presence and traumatizing for myself as a black Health Care Provider and traumatizing for the patients and this kind of deployment of Law Enforcement and disproportionately affects black patients and pokes holes in the trust that we as medical providers work and with the sheriff and to do it now. And the time is now for this. And there hasnt been evidence in the past that has kept people safe and we have an abundance of sorries and evidence that shows that the presence has violence for our patients and. Thank you, speaker. Time has elapsed. Next speaker please. I am a physician who works in delivery and with the d. P. H. Coalition and support the strike with our own black midwife providing prenatal care. And the labor and delivery and the unanonesed presence and just the sheer presence make people leave, shake, cry, and black business and providers feel incredibly unsafe. And the presence and the defense and what will be a healing environment. We have made the statement that black lives matter more than clinical comfort and divest from the sheriffs. Thank you for your comments. Next speaker please. My name is jason and i am a resident of district 10 and enrolled in healthy San Francisco and sentencing disruption and concerned by the budget cuts being asked of the department of Public Health. We are in the midst of a Public Health crisis strange all the Health Care Facilities and San Francisco and now is not the time for cuts and to prioritize the health and well being and San Francisco sheriffs and along with sfpd are a Public Health crisis and any positive contribution is offset and the San Francisco board of supervisors, the mayor, and d. P. H. Have an opportunity to center the priorities and health to make it the healthiest city for San Francisco by reappropriating any and all sheriff and line item budgets and putting them towards housing, health and Mental Health care reparations and even providing free healthy groceries to san franciscans to provide this pandemic. What are our prioritys . Your time has elapsed. Thank you for your comments. Next speaker please. Hi. My name is anthony and i live in district eight. Thank you for keeping the cameras on during Public Comment. I am calling to voice my support and solidarity on strike until the sheriffs are removed from d. P. H. And urge you to funding and d. P. H. To say he is supportive of transitions to the new model and has the opposite effect and has to leave the meeting in the city and taxpayer money and not gun toting incity gators and we need to follow the lead and answer the clinicians and saf from the d. P. H. Department and seems misguided and in the middle of the time and redirected away from it. And putting in sfpd. D. P. H. Must divest. Thank you for your comments. Next speaker please. Hi. My name is dan meltzer, a Public Health works in San Francisco and resident of district five. I want to echo the demands and others on this call and demand you remove the funding and the sheriffs from the d. P. H. Budget and health and safety for San Francisco residents and i stand in solidarity that the d. P. H. Must demand and with the investment in alternate models of Community Safety and the accomplishment and administrators. Thank you so much. Thank you so much for your comments. Next speaker please. Hello, caller. Perhaps we should go to the next caller. Caller hello and member of the American Culture center board and i live in district nine and defending to provide true health and safety for San Francisco residents. Everyone else mentioned adding the element of trauma is detrimental to the effects and events of care for these patients. And the d. P. H. To fund the Sheriffs Department and invest in the community and safety review. Thank you very much. Next caller please. I already spoke, i think. Thank you. Hello, supervisors and d. P. H. My name is erin, a resident of district nine. I am calling to remove the funding of sheriffs from d. P. H. Budget and invest in programs to provide health and safety for San Francisco residents. With Critical Health disparities and we cant afford to keep squandering armed officers to traumatize patients as others have noted. We want the sheriffs budget in d. P. H. To be cut and for those sheriffs positions to be eliminated. And not just transferred elsewhere. And we also want the sheriffs budget overall to be defunded. In solidarity with the community and other callers tonight and demanding that the board vote to defund and Defund Police and sheriffs and black lives matter. Thank you. Im done. Thank you for your comments. Next speaker please. Caller hi. Im deborah. Calling from district 11 and i am a registered nurse. And i stand in solidarity with ismara and i courage you to defund the sheriff from the d. P. H. Budget and invest in programs that truly provide for the health and safety of the community. We need to invest more in Response Teams who are skilled in trauma informed care, deescalation skills and cultural competency and cultural sensitivity and psychiatric nurses at sfgh are already practicing these skills. And so we should follow their lead in that and invest in developing and expanding the type of alternatives to mention and invest in housing for all and most especially during the pandemic and invest in Mental Health care, more primary care services. Speakers time has elapsed. And operations, next caller please. Yes, my name is regina and i live in district three and calling to say i support the strike and i also believe the sheriff and the police are not Health Care Providers. They have absolutely no place in a Health Care Setting and remove them and remove funding and this might be done know. Thank you. Next speaker please. Caller hello and defund the Sheriffs Department and you can hear it we do not want that here. Thank you for your comments. Before i call the next speaker, we have six people in line waiting to speak and if you have not already done so, please press star 3 to be added to the queue for Public Comment. For those already on hold, please continue to wait until the system indicating you have been unmuted and you may begin your comments then. Thank you very much. Next speaker please. My name is christine a resident in district three and demands for d. P. H. And i appreciate the personal story from the personal Health Care Stories and creates more violence and criminalization in hospitals and disproportionally targeting people seeking care and providers alike. And we dont need armed sheriffs and the ritual screen only. And even then verbal deescalation and that will come from the health care and not the sheriffs. And d. P. H. Budget and provide true health and safety for san franciscans. Thank you. Thank you for your comments. Next speaker please. Hello, supervisors. My name is mike and i work in district five as one of San Francisco Health Networks fewer than five and only gender nonconforming black primary care provideers. I am calling as one of the organizers and most divest coalition and defunding and sheriffs d. P. H. And the position web honor and of San Francisco and privilege of serving in the filmore i have seen the best and the worst that we have to offer. It is clear Structural Racism and the policies and practices are unacceptable the limitations and the Community Hospital and the sheriffs opt and black and brown population. And stands true today and bayview and with regard to their humanity. And we should be focussing on ways to reinvest engaging in communities and Community Accountability and comes from and on one occasion and we have the models and the funding and to defund sfd. And black lives matter. All lives matter. Thank you for your time. Next speaker please