Transcripts For SFGTV Health Commission 20240711

I also want to thank the commissioners. We have a fairly full agenda, but everyone submitted questions on many of the presentations, and weve gotten very thorough and thoughtful answers from staff, so hopefully that means we can go through our agenda in a very efficient way and we can go to our different activities of the evening. First item is the minutes. Are there any additions or corrections on the part of the commissioners . Okay. Any comments from the public . Clerk if youre on the Public Comment line, please press star, three if youd like to make a comment on the minutes. No comments, commissioners. Okay. So is there a motion to approve the october 20, 2020, minutes of the commission . So moved. Second. Can we have a roll call vote . Clerk yes. [roll call] clerk just for everyone to know, if the if youre not speaking, then please mute yourselves, and commissioners, if youre making rustling noises, and youre not muted, i am going to mute you. So i apologize, but we want to keep the sound quality good. So well move onto item 3, the directors report. Hi, commissioners. Grant colfax, director of health. You have the report in front of you. Since i am going to give an extensive covid update, and in keeping with commissioner green, so we can move through this meeting, i stand to answer any questions. Any questions on the directors report . Yes. [inaudible] has a very robust lab Testing Program for kids, and i didnt know where we were today or how well that program was doing, which i thought might be nice to let our commission know in terms of being that we just closed out lead poisoning presentation week. Yes, commissioner, we with provide you with an update on that. Ill reach out to the team and ensure we have some things for the commission. Sure. And if i may, commissioner chow, i just sent you a few things. I can summarize to the commission that the d. P. H. Children healths initiative currently serves over 2,000 children a year. Theres 21 million in the sellman funds. They did get that to us. Being ookay. Anything you wanted to, dr. Colfax, to highlight in the report or did you want to move onto the update . Commissioners, all of my update would be covid, so i thought we should launch into that unless commissioners have questions on the directors report. All right. Hearing none, lets do our covid19 update, then. Okay. I believe we have slides coming up. Right now, we have 12,554 cases of covid that have been diagnosed in the city and county of San Francisco. Weve unfortunately had 149 deaths. Weve continued to strengthen work, meeting with Community Groups and making investments going forward. As weve seen across the rest of the country, theres a predominance of male versus female cases. We continue to have relatively few cases among the Homeless Population. Only 3 of our current cases are homeless, and at this time, you can see that the majority of our cases are community contact, and then, you see the distribution of cases by sexual orientation. Next slide. We continue to do well compared to other jurisdictions or similar size or density in San Francisco. You see that our death rate is often half of the next lowest death rate, which is king county, seattle. Our death rate is, again, less than half, with the only exception of miami at 1. 98 , and then, our testing numbers are higher than any other jurisdiction for which these data are available. Things have changed since ive last presented to the commission. We are seeing increase, again, in cases. Our rate of increase in total covid hospitalizations is high in the red alert at 20 increase. Now though this number is i increasing, the speed is important. The good news is our Health System Capacity Remains robust. You can see that at the 21 and 45 . Our case level is creeping back up again. It was 3. 5 last week, and its back up to 4. 2 . Contact tracing, partner notification numbers, while not at quite that 90 and above that wed like to be, we are holding in the mid80s. I would mention to the commissioners that there was a very nice paper published in the journal of the american medical association, thabout d. P. H. Leaders. Its been well received about our work with the ucsf partners. Next slide. And then, our Health Care Workers remain at 100 . This is a hard graph for me to look at every morning, but we need to look at it and better understand how fast the disease is accelerating. Were at 9. 3 million cases. A 44 increase over the last two weeks, and deaths over 225,000 and increasing significantly. Next slide. So i mentioned these are data looking at the various case trends, and you can see here that our cases these [inaudible] so the virus is really spreading very rapidly in the midwest. I bring these up because, you know, even though were doing very well in San Francisco and the bay area, we see what happens or can happen and what is happening in other parts of the country. Hopefully, we will not get to this point, but certainly it remains a possibility. Next slide. So these are our numbers in terms of hospitalizations. In San Francisco, remember, the blue lines are people that are in the medical surge, noni. C. U. Beds, and the other line is people in i. C. U. We had two surges we beat back. In august, we got up to 21 people in the hospital, and were back up to 34, which is why were in the red zones in terms of hospitalizations, so well continue to watch this carefully. Next slide. And our reproductive rates has crept up a bit. It got up to. 79 last week. Were now at. 83, so were obviously watching that very, very carefully. This reproductive rate and the hospitalization is really calculated based on the hospitalization rate. And remember, the hospitalization rate is about two weeks behind the case rate, so that case rate increasing, that overall Positivity Rate increasing, we expect to see the hospitalizations increasing commenceately in the next two weeks. So we made a decision on friday to pause further reopening plans. We had planned for further reopening on november 3, greater capacity with regard to indoor capacities, including indoor dining, worship, and church services. Were concerned about travel for the holiday and the national picture, weve made a decision to put a pause in order to, you know, hopefully ensure that San Francisco can continue to reopen safely. This is also an effort to ensure that we didnt overshoot and have to reverse openings, which we feel is more disruptive and difficult for businesses in the community, and well continue to follow our Health Indicators going for the record. Finally, i just want to say, in terms of our success, just cant emphasize enough the gratitude for all san franciscans taking this very seriously and walking in the streets or driving, its really remarkable to see the masking prevalence, which we show sakns lives, and i just want to thank San Francisco for their support as we continue to work to slow the spread of the virus and look with grave concern at the national situation, but hopefully, we can, again, provide a good example and also avoid some of the situations that this that this pandemic has created in other communities. Thank you. Thank you, director colfax. And i think the whole commission would offer our gratitude to the government, to the mayors office, to your department because the progress that weve shown has been remarkable compared to some areas of the country, and the team has led in such a diligent way, that were all grateful for the collaboration of everyone in this endeavor and how much, sadly, contact is going on in other parts of the country. We have another presentation on the flu vaccine, but we have an opportuni opportunity, before Public Comment, for commissioners to ask questions about dr. Colfaxs report. Anyone . Yeah. May i ask, dr. Colfax, the numbers are certainly remarkable, but is there any indication that the opening of some of the activity might have caused an increase the numbers are so small, i would hope that youre going to actually say no, that weve opened up indoor dining, and weve opened up indoor shopping. So is there anything measurable that would worry you . And i fully agree withholding the line here, that makes a lot of sense. But im just wondering, in your tracing and contact type of work, whether weve seen any of that, or even as certain schools have opened. Thank you, commissioner. So we dont have any indication with the level of specificity that i think we all wish we had, that this increase is due to one or two or three of these activities. I think the bottom line is, since september 1, when weve been taken off the state watch list, that weve been opening up Outdoor Activities to, you know, lower indoor activities, to what would be considered high risk activities indoor dining, in which people cannot even eat inside with a mask on. We expect, and we continue to expect as we continue to open up more virus spreading because its basic biology, and theres not a way to completely prevent the spread. Our goal is to try to continue to get the balance right so that we open, we ensure that people are doing everything they can to stay safe. We anticipate what might be increased risks on halloween, but were getting reports that it wasnt an increased risk. Were trying not to, in a sense, overshoot with our reopening because as you know, by the time the virus takes off, and you know you have a lot, its too late, and it takes a long time to push down, but were looking at the data both locally and then looking at the science to see if there are ways that, as we work to slow the spread of the virus, we may be more surgical with the work in terms of better getting a better understanding of, you know, on the surface, these all might look like equal, what we understand the virus better, these things will rank it up at a higher level. Right now, normally, based on outdoor versus indoor, masking versus nonmasking, good ventilation versus poor ventilation, and obviously, the number of people congregating in these activities. Commissioner guillermo, you had your hand up . Yes. Its a related question, but i know theres some new data nationally that shows that infections among children are at upwards of 60,000, but its probably a way undercount, and so im just wondering, does our Contact Tracing indicate anything demographically with regard to an increase in children either being in contact or being increasing the caseload . Yeah. The virus did shift to a younger population to some degree in the early to late summer. We havent had another big shift in that regard. Obviously, with schools reopening, we expect to probably see more children diagnosed, but were following that very carefully at this poi point. But we havent had a major shift in that direction at this time as far as i m aware. Any other comment dos or questions from the commissioners . So i guess we can have the presentation about the flu vaccine. And i just opened up the presenter wall, so julie should be able to do that in about one second. There we go. Thank you for the opportunity to present about and provide information about this years influenza season. My name is julie, and im the director of Communicable Diseases control and prevention here in the department of Public Health. Our section includes the Communicable Disease prevention unit along with the immunization and travel clinic in addition to responsibilities for surveillance [inaudible]. So this slide shows last years disease estimates for the flu season in the united states, and you can see that there were an estimated 40 to 65 million flu illnesses, 18 to 26 million medical visits, hundreds of thousands of flu hospitalizations, and tens of thousands of [inaudible]. So looking ahead to this season [inaudible] but also to minimize surge in outpatient clinics, e. M. S. , hospitals, and due to flu illness, and also to mitigate increased testing demands due to undiagnosed influenzalike illness. So what is the flu season going to be like this year . Are there any takes we can derive from the Southern Hemisphere, which as you know, their flu season peaks during our summer, so theyve already been through a flu season during covid19. So while [inaudible] in australia [inaudible] on the right side of this graph, australia was doing plenty of influenza testing, which is indicated by the blue line, and finding very few positives of influenza disease, and those are indicated in this graph by the colored the colored bar lines, and you can see it was nearly flat in their flu season during our summer. Australia saw only 350 flu cases, which is down 99. 8 of their flu season [inaudible] and this is thought to be related to the measures that were taken in response to the covid19 pandemic, including social distancing, masking, border closures, and also an increase in flu vaccination. Theres lots of unknowns about the upcoming flu season every year for us. This year, and every year. Flu seasons are predictably unpredictable. We dont know the exact season timing, such as when it will arrive, how long it will last, and this year, on top of that, theres the impact of social distancing and the possibility of a twindemic [inaudible] while covid was circulating. However, even though the Southern Hemisphere did experience a mild flu season, we cannot count on that happening here, and we need to do everything we can to prevent a severe flu season which starts with ensuring widespread flu vaccinations. So where does d. P. H. And the San Francisco command center fit in . So this year, much of the d. P. H. Is [inaudible] in the command center so [inaudible]. Every year and this year, the majority of san franciscans will get their flu shot through their primary care provider or pharmacies, but the flu Vaccination Team is focused on filling in gaps and focusing on the homelessness. So this slide shows our flu vaccine strategies. Our strategies are to clbt with existing City Partners and pharmacies. Number two, modify our supply to encourage document, develop information and guidance for clinicians, standup Community Flu vaccination clinics, to ensure sustainable staffing, and across, all of this, efforts to help inform our plans for covid vaccine. During sept, we connected an age assessment of partner flu Vaccination Efforts in San Francisco to understand the plans for the upcoming flu season. We heard back from 93 flu vaccination sites, and 96 of them anticipated vaccinating either the same percentage of their Patient Population of last year or a greater percent of their population of last year. One of our focuses has been understanding vaccine inventory across covid demand. Its continuing to be distributed incrementally. Manufacturers have indicated no significant delays, but the measure of distribution has gone on longer than usually because of this Record Number of doses that have been produced. Were seeing doses come in now from this federal supply. One of the things that the team has done to monitor the flu vaccine supply is to create an inventory across d. P. H. That gives us a weekly snapshot of the flew vaccines that we have available and have administered. Through the public and community engagement, our goals had to provide the public with are to provide the public with reliable information, including providing information to san franciscans on where to get their vaccine, covered by insurance or not covered by insurance. Thereve been Public Outreach and social media campaigns. For information and guidance, we we sent out our San Francisco Health Officer order that dr. Aragon signed. [please stand by] that we learned about through our Health Care Partner survey. The green bars indicate the sites that are stirred up by the San Francisco Health Network. [inaudible]. And the yellow stars are Community Flu vaccination sites that were working to [inaudible] up. To ensure that there is a low barrier to access to flu vaccine in San Francisco, our strategies have included leveraging existing Health Facilities [inaudible], supplementing gaps by creating these communitybased flu vaccination sites in collaboration with our community partners. These are staffed by b. P. H. Staff and by lab core which is contracted through the California Department of Public Health. [inaudible] will start later this week. Amazon had its first [inaudible] yesterday and there were 59 flu shots given and we anticipate increases. And additionally, the San Francisco Health Network has worked to stand up flu vaccination critics but are colocated with the covid19 testing sites. These a snapshot of our website where we list the flu shot locations publicly available and include locations where people without insurance can [inaudible] or walking in. And last, we plan to learn from our experience with influenza vaccination this year to [inaudible] vaccination buffer. We are building our command centre team, which is working with flu vaccine and will transfer over the covid19 Vaccination Efforts once flu vaccination scales down. We are learning [inaudible] associate distancing and vaccination clinics while covid19 is cocirculating and we plan to adopt flu vaccinations where appropriate for covid19. That is my presentation. Thank you very much. [inaudible] extensive work. I believe this is a time for Public Comment. Yes. On the directors report of this presentation. Thank you, commissioner. Also on the Public Comment line, if youd like to make a Public Comment about item 4 that includes the flu vaccination, a vaccine prex, please press star 3 so i can see your hand and then recognize you. Again, if you aides like to [inaudible] press star 3. I will put your tail on the timer and when the timer goes off, please know your time is up. Ive unmuted you, caller. Caller hello. My name is yung schen. Thank you for the opportunity to speak. Thank you for kaeping us all safe here in San Francisco compared to the rest of the country and the rest of the world. I just wanted to quickly ask a question and make a point about youth sports in San Francisco, specifically out of school time programmes. I am a parent and also volunteer for a Youth Soccer Club called San Francisco seals and we work with about 350 kids in our programme and were currently following the health and safety guidelines that sfphs put out, i believe on august 3, following all the rules like making sure all the kids wear masks and limiting ourselves to 14 kids and making sure that stays stable for a number of weeks. And staying true to social distancing guidelines where we try to maintain distance and not interact with each other, etc. ,etc. One of things that has come up that is very clear from outside world and if we look at sports in general around the world is that there is no indication that covid19 is being transmitted during competitions. I think all signs and evidence points to covid19 being transmitted in indoor settings like meals and shared rooms and cars and transportation and hotel rooms and etc. , etc. It seems like the guidelines we currently have for our kids, which restrict us from doing simple thing like scrimmaging with each other would then [inaudible] of 14 kids doesnt seem to make any sense, especially when were outdoors in open air where there is very minimal, if any, risk of transmission. I wanted to ask, even though theres been a lot of guidelines like, you know, making things for indoor facility making improvements for indoor facilities coming up, there doesnt seem to be any changes to the guidelines for these recreational programmes for youth, especially working outdoors and i wanted to see if we could do something about that to allow us to do thing like scrimmaging within our [inaudible]. I bring this stuff up because there is excuse me. Your time is up. Im sorry. Caller ok. Thank you. And im sorry to cut you off. Its what we have to do to be fair. And just to note to everyone from the public, the commissioners dont respond to Public Comment. I know it is a little strange, but it is procedure so there is not a back and forth. But what happens is the commissioners and the departments will note the issue that you bring up and will take it to the department and see if and in time those questions can get answers through policy or at meetings. Again, thank you for your comments. There is one more Public Comment, commissioners. And i unmuted you. Caller hi. I have two things. One is just a quick comments on the flu vaccine. I dont think you mentioned that the San Francisco Community Clinic consortium clinic as well as our homeless s. O. S. Band have been giving out flu vaccines so we wanted to make sure that everybody knew that, that the flu vaccine theres been some shortages but i know we will be getting some more and people are working our Homeless Programme are going out on the streets and giving flu vaccines. But the main comments is about dr. Cofaxs report on covid. I was at the local Resource Board meeting yesterday and they presented a plan to basically get people out of the shelter in place, hotels. And this is a highly vulnerable population. And there was not one mex of this third surge or any concerns about Public Health. It was all about housing and funding, which i understand thats their perview. But i just wanted to make sure that there is some correspondents going on between department of housing and the departments of Public Health about the possible ramifications of sending Vulnerable People out where they have been sheltering in place in the hotels pretty successfully out into the streets. And i know theyre saying their mraeen is to rehouse people. But it is not clear that the numbers add up and it is not clear that that is going to work. Thank you for your comment. Commissioner girardo has her hand up. Thank you. And thank you for an excellent presentation on the flu vaccination. My question is very simple. Have you reached out to San Francisco Unified School District with your messaging so they can do a email blast to a ul of their families since they are all online anyhow . Because my understanding from the pediatricians i work with, that the vaccination rate for the pediatric population is down. Yes. Back in september, the Communicable Disease prevention unit met with San Francisco unified leadership and provided them a temperate letter that they can send out to all of their families. This letter was also provided to the archdiocese schools and the independent schools in San Francisco and the prek schools as well with information encouraging catching up with routine vaccination because of that stuff. What happens back in the spring during the initial shelter in place and also encouraging vaccinations. They also were provided a list of backtoschool immunization clinics. Thank you. Thank you. I appreciate it. But you might just do it again. Just because what the pediatricians are saying is the kids arent coming in. Just another blast wouldnt hurt. Commissioner christian, you have a question. I do, thank you. Are vaccines given to people who come into custody in the jail . Jailhouse services does provide vaccine and we get [inaudible] given to jailhouse services to provide by vaccination. Thank you. Commissioner . Yes. Thank you for the presentation and im still somewhat curious about the experience in the Southern Hemisphere and perhaps i didnt quite hear correctly, although it sounded like you said the australian experience showed that there was a significant decrease in influenza. What about the other parts of the Southern Hemisphere or is it that they also are showing the same decrease in influenza because of the social distancing and masks and so forth . Thank you for bringing that up. So australia, we were a i believe to access a lot of their data, but there was a c. D. C. Report that also reported on chile and south africa and they additionally had very, very minimal flu activity as well. I dont know about the entirety of the Southern Hemisphere, but the data that we do have suggests that it was there was pretty minimal flu activity. However, its hard to know, you know, what we can expect here. If i could follow up. Did they also then speak about the concurring covid or that there had been a change also in the covid numbers or or if, in fact, they were following the masking and so forth, that these stayed down and did not have sort of another surge. That is a good question. I dont remember the exact details from the south africa and chile experience in terms of what we were seeing with covid incidents at the same time as the flu activity. We do know that with the australian data, they were seeing a surge in flu activities while covid remained flat. [inaudible] im sorry. Commissioner green, i muted you partially. I dont think commissioner christian heard. Your hand is up and were not sure if it is from the first question. Looks like no more questions. Ok. Thank you so much. I guess one question i would have is actually two. How many languages do you have your website information would be the first. And the second is i think it echoes what were hearing about children not getting vaccinated. Patients are not seeing doctors at the rate they did thanks to covid and many are fearful of going into a doctors office, coupled with the fact that many physicians offices which arent large systems have really not received their vaccines. I know my office just got 300 today. But we were out for five weeks. This is disturning some patients and i just wonder how were getting the word out to people if they either dont want to go to the doctor, delaying going to their primary care or traditional spot for getting their vaccine, how were making sure that people can go to the website or find a place where they can get a vaccine absent an encount weather a drugstore theyre afraid of or a actual medical office building. Those are great points. What we tried to reinforce in our guide is how providers can create a safe environment for guidance and how to encourage them to come back for flu advocate nation and all the other flu vaccinations. Particularly for children and adults to stay up to date. In the press release, we did direct people to access our website so well get locations that they can go and call their primary care doctor and their pharmacy first. The issue with the flu vaccine, i think ultimately is probably related to people that are seeing a decent demand for flu vaccination this year give than covid19 has been circulating which is great and we want to encourage that as much as possible. The flu vaccine has been coming in in increments over this early season and it would have been nice if it came early, give than there were record amounts produced. But that is just not the way it work out and now were starting to see it come in. Weve gotten some [inaudible] and what can we do to promote through social media or other ways that people should call their doctor and get their vaccines coming in. And regarding the languages, i have to look into it, i dont know. There a thank you for that. Is there also any band headline on the city test s. F. Website mentions you can get your flu shot when you get your covid Screening Test or anything even at the popup sites that we have that kind of make sure people understand that is an option for them . I mean, we are giving out information. We have flyers made for people who are getting tested for covid. Oin that is available. I can look into this. Thank you so much. The work is incredible and i think were reaching a huge percentage of our population. Were really very grateful to you. I guess well go to the next consent item we have item 5, general public. So if you a like to make general Public Comment, please press star 3. Amy lane would like to make a comment. She texted me. Raise your hand and then i would know you want to make a comment. Anyone . Elaine . All right. So elaine, ive unmuted you. Can you hear me . Im sorry. The connection is not working. Elaine . Ok. Sorry, everyone. Caller can you hear me . Is this elaine . Caller yes. Im putting two minutes on and when the buzzer goes, know that your time is up. Reporter ok. My name is elaine. I have two girls who are aged 12 and 14. Theyre competitive soccer players. They have been able to go to soccer practice. But they have only been able to do conditioning, no scrimmaging so it is not really soccer. So, now that i know that 85 schools have been approved for opening i was just wondering when can my girls start scrimmaging again . Can you address returntoplay with youth sports . Is that the end of your comment, elaine . Yes. As i indicated earlier, it may be frustrating, the commissioners do not respond to questions. But they take note of the comments that you made and well round up the proper folks and hopefully answers come through with policy and all their discussions. Already, commissioners. That is the last general Public Comment. Were on to item number 6, commission kerr. It is finance and Planning Committee update. Good afternoon, commissioners. The finance and Planning Committee met this afternoon before the commission meetings. And we had a lot of contracts to consider. So please bear with me and you will find them on the consent calendar as well. But i think that it is really worth, like, giving a little bit more context to them. The first is the contract report. We have added this to the consent calendars of like five contract amendments and it is the salvation army, the ra Rafiki Coalition health and wellness, the ucsf substance oh. I forgot the name of it. U. C. F. Department of Substance Abuse and medicine and last but not least there is the regions of the university of california. And a ul these different contracts are requested to have like the terms exthe ended and there are some modifications to this as well. I wont go into details because we have a whole bunch of other contracts to discuss. And the next on the consent calendar is the request for approval of new contract for [inaudible] Pharma Incorporated and they provide outsource [inaudible] compound services and productses thats not available commercially and its to be used by San Francisco general. The proposed contract amount is 5. 2 million which includes a 12 contingency for the term of november 1, 2020 through june 2023. And the next request is aprove al amendment number three to the contract of college genomics. College genomics is the contractors we used for covid Testing Programmes. And so it is quite important. And we had the discussions because i dont think that we have seen [inaudible] before. But it is, you know, to increase the agreement amount by 74. 4 million. For an amount not to exceed 84. 3 million and to establish a specific term, date of and please mark the changes here. Term date of april 6, 2020 through april 5, 2021. So, there is a error in the items on the agenda which says april 6, 2020 to march 31, 2021, which is incex. So that is the adjustment. And then we had [counting] and 11 contracts all related to the implementations of the electronic Health System. I was really detailed and there are three parts to the budget. So it is the epic, the venter and professional service. For the contract that we are, 10 contracts of nine different vendors that provide professional services and they prem 15 of the professional services budget. And rather than go into too much detail, ill just like skip the most of the detail and say that the contract amount for each of these vendors 3. 5 million each. Then we have two additional contracts related to sugary drinks, Distribution Contracts and, of course, you know, like as you know, this is a new initiative and, you know, also a new programme that are being implemented from the sugary drink [inaudible] that we received and so there are some learning curves so to speak. For these contracts. So, the first contract is for the Marin City Health and Wellness Centre doing businesses bayview clinic. And what you see on this budget is like the surfaces they estimated for the first year, although we are proving a threeyear contract. And we had decided to t like, go ahead and, you know, aed that to the consent calendar with the understanding that they will come back to usen we know the progress for the next year and what is some of the projected changes theyre going to make for the following two years. And it is similar for the request of approval for the second contract to the contractor 18 reasons and, you know, and we have National Convention same requests, you know, because they are only able to give us the first years budget of how theyre going to implement the programmes. But the actuality of like how what the Health Impact of Health Outcome is not something that they are able to project at this point. So we have asked them to come back also in one year and to give us an update. Hopefully by then we will have like some, like, more updated information to share with the commission. And that is the entire consent calendar that we are asking for your approval. Any Public Comment on this report . If youd like to make Public Comments on the report, please press star 3 now. No Public Comments, commissioners. But i would like to commend you as you did a fantastic job of summarizing that very detailed information. Absolutely. Well, thank you. So i believe there was0s in Public Comment, right . If we move to the consent calendar, then, the goal is to be able to approve the entire calendar. Are there any items that require [inaudible] that commissioners have questions about . I know that this is the area where the staff did such an excellent job of giving us truly detailed responses to many of the presubmitted questions. So, is there anything else that the commissioners want to add or question before we consider a vote . I just thought in addition to the clarification about the epic part of the budget that these 10 contracts are not actually individual contracts in which each person is or each contractor will receive 3. 5 million. This is similar to what we had in the past in which weve had maintenance contracts in which a series of contractors are actually allowed to bid for certain types of services. And so all of these contracts are expert in most of these same services and this will allow them the chance to actually find which contractor, which professional contractor can assist right away with an issue that comes up within this. [please stand by] [please stand by] with some luck we have have savings from the end with this allotted budget. I think the other part is that with the 78 million contract, which is probably one of the largest contracted ive seen in the past, its almost like a bond issue. It actually is the covid testing and they gave an excellent explanation of how all this is going and these are the the tests that are needed. In fact, we did ask about performance and were told at the moment, in less than a day, theyre responding to us and i think david mentioned, at the moment its about half but normally its 24 to 48 hours. Thats a better performance that our older contracts were. Thank you, dr. Chow. I want to thank the finance committee and michelle rugels and her team because this was detailed work with a lot of other responsibilities and also, to those of you on this committee, i know that this was a lot of analytic brown power required of you as well so we really appreciate the clarifications and and this all being presented. There are any other comments or questions from the commission . Well, i guess we can entertain a motion to approve the consent calender. Is there a notion approve. Motion to approve. Second. Do you want to take the roll call. Ill make sure we dont have Public Comment. If youd like to make comment, press star 3. No comment. I will do roll call vote. [roll call vote] i think thats everybody. Did i miss anyone . I dont think so. The item passes. Thank you all for that great work. That was a lot of work today. Yes, thank you so much. Well now im actually looking at the agenda so i know the next item is number 8 the San Francisco Health Network update and mr. Pickens will present to us. Good afternoon. Good evening, commissioners, can you hear me . Yes. Great, great. All right. So thank you very much. Its my pleasure to present this fall 2020 update to you on the status of the San Francisco Health Network. And im joined by my colleagues on the Leadership Team from the network. Our chief medical officer dr. Claire horton, our director of ambulatory care, haligoniansd susan. Hopefully between the four of us, well have enough brain power to answer any questions that may arise during the presentation. In the presentation today, ill discuss our Network Strategic initiatives in the form of our ex matrix and true north metrics and the impact of covid19 response on those initiatives. Ill review our performance in this the last year of our fiveyear 1115 medicaid rar wair and the work we have to do as we begin to restore and reopen our Delivery Systems programs to their precovid19 levels. And finally, our share of brief timeline showing San Francisco health net operations and resources that were required to shift over the last year to respond to the covid19 emergency. Next slide. So as we do with all of our presentations, we start with the d. P. H. Organizational chart to provide a visual reference of the areas well discuss. Today well focus on the lower lefthand section which depicts the San Francisco Health Network. So this is our most current and updated organizational chart for the leadership of the network. And for those of you on the commission, you will know the last few years weve had significant turnover. Claire is our new medical adviser after alex chin left to go to the state. This time last year, maggie was the acting c. E. O. At laguna honda and shes back in her regular job and we now have Michael Phillips as the c. E. O. At laguna and filled his vacant chief nursing officer position at laguna so we continue to refresh our leadership staff and to do the work that we have ahead of us. Next slide. So within d. P. H. And the network we develop our Strategic Initiatives using lane. As weve discussed here before, lean is both a Management System for running an organization and its also a methodology for process improvement that emphasizes value from the perspective of the customer. And in our case, the customer can be either a client in Behavioral Health, a patient in our physical Health Delivery system, a resident at laguna honda or an inmate in jail health. Lean also values the expertise and knowledge of the people doing the work. The people who we reference to in the japanese term for the place where the work is done. In terms of lean, healthcare was a late adaptive lean and theyve been deploying lean since 2005 and weve been d. P. H. And the Health Network weve been on our lean since 2012 and while there are several tools and documents in the lean library, the two primary drivers of an organizations implementation of lean are, the true north and the xmatrix. True north can be described as a precise, concise and universal set of ideals which when taken together provide a compass that describes the ideal or state of perfection that your organization should be continually striving towards. True north involves both our head and our heart and considering both the strategic, the hard goals and the defined business targets as well as a tightlyheld belief to our organizational purpose and its values. The true north pillars facing service experience, workforce, financial stewardship, and equity, are meant to be consistent over a multiyear per idea and should not change very often. Next we have the xmatrix. The xmatrix is essentially our onepage allencompassing Strategic Plan which incorporates our true north pillars and relates those pillars to our very few razorfocused strategic initiative. The xmatrix itself is developed during our annual Strategic Planning process. Next slide. So, just briefly, i want to refamiliarize you with our xmatrix. In the west quadrant to the farleft, we have our true north pillars that we are just discussing. At the top in the north quadrant, we show our few, the three razorfocused toplevel organizational priorities that we set over a year ago, remember, pre covid, ok, moving to the right to the east quadrant, this is where we show some of the key metrics we need to improve in order to achieve our organizational priorities. And then finally, in the bottom box, the south quadrant, this shows our performance target and our annual outcome for those targets. And as you can see, our initiative during the xmatrix have been significantly impacted by our Covid Response and have been deferred. It doesnt mean we stop work on these. For example, those three strategic examples you see at the top. Number one ehr readiness. That was going to focus this year on stabilizing our epic implementation and moving into phase 2 implementation of epic which is set to consider within the next week or two. Work has continued its just that we havent been able to really do it with the vigor and probably amount of attention we would normally do it and similar to our valuebased care initiative, much of that work continues predominantly and the 1115 waiver that has programs that require us to report on our performance on various clinical measures. Over the last of the Strategic Initiatives is develop our people through lean, which is very much had its heart that we would deploy what is called the daily Management Systems in other areas of the network and thats one place where the work just stops due to covid19 because the staff supporting those efforts have been pretty much redeployed exclusively to our covid activities. I wanted to point that out to give you an idea of how we have had to pivot and expand our focus to incorporate covid19 activities. Next slide. The previous slide just shows the progressions of our true north. Actually, can you go back one slide. Lets go to the next one. And one more. There we go. Mikaela, if you can hit it again. We should have some numbers at the bottom for 1920. Yes. So, thank you. So this slide you get to see the progression of our true north over the last several fiscal years and in terms of the fiscal year we just completed, which was june 30th, you will recognize that was half of a year spent pre covid and half of a year in covid so we have 49 true north metrics and you see the results there at the bottom of those 49 metrics, 11 were on target and the vast majority of which were actually had to be deferred because of the deployment of staff to covid activities and the inability to really focus on those initiatives and then we have 16 of those 49 where either the data was not available or the target was not met. Next slide. It so in this slide, you get to see those true north initiatives all on one page. Hopefully the colors are coming out exactly on your screen. We wanted to show you and one snapshot just what our performance on these metrics has been over the years. Green represents those 11 targets that were met the reds those that werent and you will see the proliferation of purple reflecting those metrics that were not able to be persuade due to our redeployment of resources personnel and efforts towards covid. One of the things id like to highlight is, you see zuckerberg, San Francisco general at the hop top, laguna d pc, Behavioral Health and child and adolescent health. Those last four are all within the ambulatory Care Division within the network and you will see thats where most of the purple occurred and that truly reflects just the tremendous amount of impact that our Covid Response has had within the network particularly in all of those ambulatory Care Divisions. Next slide. So as i mentioned in my opening remarks, we in the network are completing the last year of our fiveyear 1115 medicaid state waiver. That waiver has several Different Program components. One is the prime program and prime stands for Public Hospital incentives and ro redefined in medical. As i reported previously, weve done well under this program and we will earn 50 million in available medical funds through this program this past year and kudos and we net 95 of all of our medicine trick tricks and ts and received 100 of numbering g because of the cares act covid relief that was provided that allowed us not have to meet all of the Performance Measures but to report and we were able to receive 100 of the dollars available to us. 6,000 flu vaccines and improvements in Blood Pressure control for avenue americans. Next slide. So, as the 1115 medicaid waiver ends in december, and we will be starting a new medicaid waiver in january but because of covid, that process has been put on hold and theres currently a request at cmf to allow california and other states in the last year of our waiver to get a oneyear extension so we hope to hear about that. Even with that waiver and hopefully being extended for a years, the prime program is set by the Quality Incentive Program and it has 45 to 50 million available to it and you will see under this quality incendiary testify program which is a par for perform apps which means we have to report our outcomes on different clinical measures in receive reimbursement and decided primary care heavenly focused and also we require amount of work with our local medical managed care plans in San Francisco health plan and anthem blue cross. Its important to really note that forward to be successful on the qip, were going to have to really reinvigorate our investments in primary care and the other medicaid 1115 Waiver Program is called the global payment program. This really involves funds to begin to transition providers from traditional inpatient focused services to more ambulatory out patient nontraditional services which met 79 of the threshold earning in 99. 5 in revenue. It was down from our Previous Year which we were closer to 95 and again, reflects our experience with covid19 because we saw a large reduction in acute inpatient days and inperson out patient visits attributable to covid19. Next slide. And this is the final slide in the deck and just wanted to give you a snapshot of what this past calender year looked like for us in the network starting in january up until where we are now, the month we just closed out in october. You will see in the first quarter, thats when the country and the state and the city really went no action with our covid activation. We have the medical surge at San Francisco general having additional icu capacity and put into place and we have a huge efforts to increase our p. P. E. Supply chain throughout the network and we had an initial small outbreak of covid at laguna honda for resources there and i think we reeked the rewards of that effort by having a pretty minimal impact since then at laguna. We also began to move resources from the network to support a covid activity like the testing in the Community Grants of the Covid Command Center. We also deployed a lot of our staff from the network to supportive tease like the shelter in place hotels and the isolation and Quarantine Hotels where formally Homeless Individuals were moved to get them off the streets. So, from the beginning of our deployment back in february, weve had about 1,200 staff who have been moved out of their regular jobs within the network and d. P. H. And own over to do covid specific related activities and as of last month, were still having almost 700 people who are doing jobs other than their regular ones that are covid related. So that concludes my former presentation. Im happy to answer questions and i know there was some questions that were posed previous to the presentation and i dont know if you received the written response and i can provide that now. Commissioners, this is grant. Can i just say that i really want to thank the network leadership. Dr. Horton, dr. Hammer for their incredible work, especially the covid19. This is just been an incredible balance of trying to keep the network while were also balancing all the work needs to be done to keep the health of our community as strong as possible. So its just been a really challenging dynamic and mr. Pickens went through this in detail but just wanted to emphasize the amount of work that what he just showed has taken and well come back to the commission in december to talk about our term planning with regards to priorities in covid. Thank you. Thank you so much. This is remarkable work by staff thats been incredibly trained and its really its a defendantment to your dedication and commitment you can accomplish what you have and i really appreciate it. I guess we should ask if theres Public Comment on this item. Theres no one on the line. In addition to this presentation we have a Vaccine Task Force presentation so the commissioners can comment and then we have that presentation as part of this item as well. O. Lets see are there any comments, questions, i dont see any raised hands at this point. Letlets go onto the next presentation. My question s. Im not sure who is presenting. Dr. Chen are you going to be doing the slides . I am presenting. My slides have been added on to rolland. Great. Give me one second. Thank you, i gave that back to mikaela. Thank you, sorry about that. Thank you, everyone, for the opportunity to present. I will be brief, as its a special day for all of us. As we are looking at national events. I do want to talk about the Health Networks vaccination work during covid. Were really trying to play our part in terms of fighting the flu. You heard earlier from the city wide team thats been working within the c3 from the publichealth division, the fabulous work theyre doing across the city and really we have benefited from collaboration and support from them as well. Well touch everyone coming into the limited services visits, during a time of reduced staffing that you just heard about it and the southeast corridor and the mission. Those of our main goals this year. This year, this is the year to coordinate our response and lead our support in Covid Vaccinations. So the task force is forced participation has been fabulous. There are folks across these entities across the network coming from different experience points in vaccination. Next slide. Its inventory tracking and distribution. Using epic in care to document and report including those who were just now in wave 2 epic there are efforts and for the first time this year they used an online flu vaccine consent form with a qr tracking system and this is been very successful and as of midoctober, they vaccinated 77 of their staff and theyve made sure their colleagues are getting vaccinated. Laguna honda paired it with weekly testing for covid. Theyve vaccinated 76 of their staff as of midoctober. We have partnered with hhs, they work with kaiser in setting up flu clinics for our City Employees and have worked with them to expand some of these into 25 van ness to our centralized staff and also some within general health. Behavioral health started a staff vaccine support effort as well at 1380 howard. Next slide. And so the services and the places that have usually vaccinated primary care, the sfg laguna honda they worked on expanding vaccinations this year to their patients and clients and they are referred to flu clinics and staff worn use who t used to talking about flu vaccinations to talk about it. We streamlined epic work flow across the network and expanded access at weekend flu clinics and radiology theyre vaccinated and the biggest efforts are the ats alternative testing sites for covid testing. Theyve set up popup flu clinics and theyre all life now and 34 do not have primary care as a medical home so we feel like were reaching the community at large with these ats sites as well. The totally new Service Areas include the shelter in place sites that the Covid Command Center has been setting up and so, our whole person integrated care team have been working very hard in terms of reaching the Homeless Population and 1380 howard is vaccinationing for the first time and the tb clinic at the general is vaccinating this year. A number of the ats sites are primary care sites. All of our Service Lines are vaccinating many people earlier. Next slide. We do want to specifically look at disparities in terms of vaccinations and equity is one of our true north pillars. And we have noted from the data so far and well continue to track this and ask our operational leaders to look in this and in terms of differences for a black African American population in particular who are not having the same rate of vaccination. Some of this we believe is due to documentation, lost opportunities for documentation but some of it is also due to a higher rate of decline and vaccination, when asked, i believe one of the commissioners had a question specifically around this. I think this is a great area to look no. There are standardized messages that staff are being trained in and in terms of common myths around the flu shot and i think what probably our operational leaders will end up doing is trying to specifically engage patient advisers to look and see how that messaging is being received and if there are specific types of messaging that need to be next slide. So key successes and learning that we hope to Carry Forward in terms of Covid Vaccination planning with the command center, the collaboration with those teams has been really crucial in terms of quickly setting up these efforts during covid. We need continued coordination of the vaccine inventory and storage. Theres been borrowing that is useful when people have been run slow. I think the q. R. Tracking and the Occupational Health has put forward for zfsg. We really do benefit from using Something Like that across all of the parts of the Health Network in terms of making sure our staff are vaccinated and the need to fix on Health Disparities has continued. Thats it. Theres been tireless work with our operational leaders across the work to achieve what theyve done. Thank you. Thank you so much. Is there any Public Comment on this presentation . No, commissioner. No more callers are on the line. And any comments or questions from the commission . I dont see anyone with a hand up. On bow half of all of us thank you for this work in this resource constrained environment and we are living in today. Very much appreciated by us and everyone in San Francisco. The next item number 9 is the annual compliance inaudible . Yes, thank you and i just gave you permission to share your screen. It might take her 10 seconds to set it up. Fantastic. All right. Ok, good evening commissioners and Maggie Rykowski for the director for compliance and Privacy Affairs and im going to be going over the annual Compliance Training. Annual Compliance Training this evening. This is an over vow of what im going over. This meets our requirement for the governing body to receive annual training on the organizations Compliance Program. So im just going to give you an overview of our Program Components and i will not be addressing other areas of ocpa or providing any data. This is just on our compliance components. Its to ensure integrity and we want to insure our workforce conduct themselves ethically and that we do ensure integrity and dph business and Clinical Operations and we worked very diligently with our providers and workforce and dph staff and to ensure they integrate compliance into their daily operations with d. P. H. Our program is operated in accordance with state and federal standards and regulations. And we do follow the oigs recommended seven elements of a Compliance Program so these are the seven elements and im going to be going over these very briefly. So, element number one is the program must have a com ployance officer and a committee. I, as the chief integrity officer, oversee the com ployance program for dph and we also have compliance officers and Compliance Programs at laguna honda, vsfg and population health. We do have a dph com ployance committee and its the executive and director level and each areas of laguna, honda, vsg and population health, they have their own com ployance committees. Element number two, required to have policy and procedures which we definitely do have. We have several written policies and procedures and we have our code of conduct and we have compliance work plans and we review everything annually and update add needed. The open lines of communication we do maintain a confidential hotline so they expect concerns. We also have an email address. People can give their concerns or contact us if they have any questions. We also often times staff or others will actually contact me directly or our Deputy Director and were always available to listen to peoples concerns and provide guidance as needed. We are required to provide education and training, dph pro voids an annual com ployance training through an Online Training module. Our Compliance Training is coinciding with our privacy training and its a compliance privacy and Data Security training module and we also provide Refresher Training and on side training if any issues arise and we just distribute news letters and we have eye news letter for com compliance and we distribute that quarterly and we have one coming out shortly and thats one is going to be on guests. Since this is a holiday season, we are going to be focusing our news letter on gifts. So we are required to have an internal auditing program. We have auditing both internal specifics ternal and our external audits will be if cms comes in and audits performance audit and we also have internal audits. Every fiscal year we conduct Risk Assessment and we want to give feedback to providers and make corrections and if also if issue comes to our attention, we will conduct an audit and review as needed. So, we do need to have a system in place to respond to detect offenses, ocpa will investigation and brought to if an allegation is substantiated we will do an pro pre a lot resolution and develop action plans and well make sure that we followup to ensure the corrective action plan is in place. If we are doing an audit and we determine that there was an overpayment, we will quickly do a pay back to make sure that the payment is done quickly and we dont have any overpayment. And enforcement and discipline, we are required to have a standard enforcement and dis plan and we work with the department of Human Resources to ensure that there is discipline and stands address are imposed and one thing is the oig states in his guidelines that he wants to ensure i want to talk about our code of conducts. This covers many of our Business Practices and standards and its a good guide for staff. I did provide a copy of the code of conduct. Its 20 pages and its comprehensive and these are the elementelements in the code of. When we do our staff training, part of that training incorporates reading the code of conduct and signing that they have read the code of conduct. The rules, regulations and laws. We want to make sure that you have an awareness of regulations governing provision of care in our reimbursement of services. Monitor fiduciary duty and oversight for dph and the health commission, you have a lot of meetings and you have your having the oversight for the health commission. I just wanted to very briefly touch on a couple of healthcare laws and regulations. That we follow. One is the false claims act and this is a federal statute that sets out criminal civil penalty for falsely building and the this is for medicate and we have to ensure that we have policies and employs our in form of a whistleblower protection and we have it in policies and different education materials that we do provide through employees. And finally the fraud enforcement and recovery act. This just is an act that actually was instituted that increased funding for federal agencies so they can do more robust auditing and inspections for to combat financial fraud under the false claims act. I just want to move on to our statement of i am compatible activities. This is a city wide, its not just dph. Dph we do have our own policy but its a legal requirement for all city departments to have a statement of incompatible and commissioners, i do provide the gph policies. These are covered and uses prestige of office or city work products or professional ganes,. Those are a couple examples. Recognizing and reporting compliance concerns and its the duty of everyone and especially our employees that they need to comply laws and regulations and the code of conduct and other city and and they may we really work hard to maintain a culture of we want to respond quickly to any compliance problems and prevent retaliation to do report and we work very hard and we let all of our staff know that they have a duty and responsibility to report misconduct including potential violations and so we really try to really emphasize with our staff and our partners that if you see something, say something. Air on the side of caution. If something doesnt look like let us know and well look into it. There are consequences of violations. As i said, were going to investigate. When its completed if its substantiated we will take appropriate action to resolve it and this could end up corrective discipline and even up to suspension or termination. And theres also consequences for the organization. We could have the loss of eligibility to participate in medicare and medicaid, lots of our medicaid contracts and reduction and reimbursement rates and also could be loss of organizational reputations. So finally, this is our poster and we do again, whoa we emphasize the duty for violation. These are posters we have throughout dph with our toll fro number and what should be reported . Who to report to . And i think we do get a lot of inquires and we do have a lot of staff and they take our Compliance Program very seriously. And with that commissioners, that ends my presentation. Thank you. Is there any Public Comment on this item . There is not. No Public Comment. Then, any questions or comments from our commissioners . Well, seeing none, first of all thank you so much for this presentation. Yes, i thank you and this is an excellent over vow of the com ployance. How does this fit and its an additional Compliance Plan that we actually are responsible for . Yes, commissioner. Its additional. We are required office of the infect or general and the oig has set out guidelines for Compliance Programs and one of their strongly recommended we look at it as a requirement that the governing body needs to be made aware and really have an awareness of what the Compliance Program is for the organization so this is for dphs com ployance program. And i think some of the questions that were asked and which i would also the then articulate. Do we get a review of what our Compliance Program has created in terms of either number of reports and the results of those . How is it then that we understand that the department is actually doing this and the outreach has worked at laguna we were right with the number of complaints to the state but what do we follow here and when would woozy theswe see these parametet would be nice to be part of this and what would be the years activities that weve had . Ing, i do present an annual report and i did present the annual report in august or septr and all of the office of compliance and Privacy Affairs and the compliance component is part of that. We also, at the jcc, and we also, if there are other reports or other information that you would like, you can please let me know and we can develop a mechanism so that you can get maybe more frequent information. Im actually not sure were interested in frequent but im interested in consideration that as were looking at the Compliance Program, theyre tied to it and also what happened that year so maybe the two things should be put sort of together in terms of a process so that we get our annual compliance information and then we could do also what the Compliance Report for was that year. I think that there may be issues that can happen but it would have been fairly logical and were listening to this we see what were supposed to be doing and how much has been done but we dont know about the how much that has been done off of the codes. I see. I understand. So it just ties all the things. I dont know if you had a specific time that you have to give this or it could have been given at the time thaw gave your annual report. Im not asking for extra work. I think every call that you were giving information before. This comes sort of separately and were trying to tie these all together. Understood. Ok. Again, thank you for the very comprehensive information. Any other comments or questions from the commissioners . Hearing none, well, we also want to thank you so much. Its clear that you did not miss a beat going from your row marketable contribution and leadership role at laguna honda to fitting right back into your responsibilities and compliance. You are a Great Team Player and were so proud to be working with and were so grateful to you for all your contributions in the last year youve given your heart and soul to this department and the citizens of San Francisco and the residents of laguna honda so were grateful to you and thank you so much. Thank you. Thank you. So, i guess item 10 then. Yes. Other business. Is there any other business that the commissioners want to raise . We have a happene a hand up. Commissioner chow. Yes, as you know, dr. Lee passed away this past week. He was the first president of our commission. Appointed by mayor diane feinstine in 1985 and he was actually an out standing citizen of not just our own city but of the country. He was previously in the Johnson Administration and inaudible and actually was one of the people who actually pushed it wasnt the primary person, in terms of the medicare implementation and subsequently of course he was ucsf chancellor. I would like to see if the commissioner would consider adjourning in his honor. Well in recognition of his work with us and having passed away and also suggest that we have a memorial resolution for his family. Thank you so much dr. Chow. I think that is a wonderful gesture and so many of us knew dr. Lee at so many levels. He was a mentor to so many. My generation included but his contributions and policy government, equity, i mean there wasnt a single thing in the development of healthcare in this country that you didnt look to dr. Lee. He was a prolific publisher. Why think he wrote a single thing that wasnt published immediately. To have him homegrown and the first president of the this commission is an honor to us and so i think that would be a wonderful suggestion. I dont know if we need to have a motion on this or whether we can compose a resolution and bring it to the next meeting. The resolution would be something that we can bring to this december 1st meeting or another meeting. The next meeting is the meeting and adjourning, you can do the commissioner suggests you just do that so theres no vote. Theres not an action item on the agenda so when you adjourn, ill remind you that were doing that. Thank you so much for bringing that up dr. Chow. That would be a great addition to our agenda. And its almost a really would be a personal privilege to have brought this up because i actually took dr. Lees position after his four years as president of the commission. And he was a great mentor. Its clear that the direction and the work that the commission here is doing was set by dr. Lee. You mentored many of us so you are carrying on his tradition. I know ive personally been fitted from that so thank you. Thank you. Commissioners, i apologize, due to all the that is happening today, i did not send commissioner chow notes for the sum row for item 11 so would you consider delaying that item until the next meeting and having two jcp reports because dr. Chow doesnt have the information he needs to report and i apologize. Actually, its fairly easy because the work of a jcc was really to screen and to approve information that you will be seeing at the next general meeting. Along with also doing the usual quality work and in closed session having pass the credentials report and the partnership report. And dr. Grown wh grown green mid more but it might avoid giving a report at the meeting and we have only simply duplicated what we were going to do at the next meeting. Thank you. I appreciate your compassion on that. Thank you. So, i guess item 12 is the consideration of closed session. Is there a motion to go into closed session. So moved. Did someone second it. Second. [roll call vote] as we move into closed session, i want to thank everyone who will not join us. Closed sessions include sfgovtv im going to move you out the room and well see you afterwards. Anyone who us didnt need to be in closed session, say goodbye and give me 30 seconds to move us over second. Commissioner chow. [roll call vote] unmute yourself, commissioner. I believe we are at adjournment and commissioner chow asked for you all to adjourn in honor and memory of dr. Philip lee. I would like to move we adjourn in the memory of dr. Lee. I would like to take the privilege of seconding that. I will do a roll call vote. [roll call vote] thank you all. On this crazy night. Thank you, commissioners. We are, we are at the balboa movie theater, but youre not going to be watching a movie today. Maybe tonight, but not during the daytime outside. Thank you all for being here. Im San Francisco mayor london breed, and im joined by a number of folks