We will actually put out a request for proposal for an expert to actually come in, do an assessment of laguna and help inform in terms of its current state, and perhaps where it needs to go in terms of being a worldclass, longterm care and rehab facility. In focusing on both short and intermediate and longterm, and we actually internally have documents that break out what those things are. They are just not in what you received today. Thank you. Yes, thank you for your report and thank you for the draft. It was a very good summary of the findings, and the work that you have thus far done. That credit goes to the quality team for putting that summary together. You could see it is in a format that you are familiar with. I think it shows that you have summed up the issues that we are all facing. I do think that the draft needs more of a timeline, and i think that the issue that we have before us is just as important as when we were building the building, where we followed carefully what the corrective action, in that case, the buildings, and how well we followed it. I would suggest then that one of the reporting criteria should be not just in quarterly to the board of supervisors, but that it comes to the health commission. Certainly the j. C. C. , on a monthly basis, appropriate he follows your everyday progress, and that in order to do that, it really requires that there be a more explicit timeline for each of the items that you are talking about, because clearly then we wouldnt be able to follow if we didnt have a timeline to see if we are going to be on target and that the timeline needs to consider not only the regulatory part, but the part in which we are able to take the opportunity to work with our staff and the in the thousand plus employees that we have almost all of who have done a good job, and this is an issue of which a few have blemish the work that so many of us have done in such a fine institution for all of these years. I think in addition to trauma informed, this is a Good Opportunity to look at our application of cultural humility at the hospital, you know, there have been a lot of discussions about how we are actually looking at culture. I think it is not near merely a culture of reporting, but one of truly cultural humility and that may be one of the course of the problems that we saw in the small opportunities of our ability to understand what is happening there. I would ask that as we move forward, that this is a good start, but that we need some timelines, we need some regular reporting done so that we are sure that we are on target, that if there are needs that we all become aware of it and we worked together with this city to ensure that we are able to respond. We may find some things that we really need some greater opportunity to actually take advantage of. Although you spoke of the proposal for partnering with consultants, that that be actually something potentially a lot sooner than the longrange plan because just merely catching back together where we were is probably not the answer, and perhaps one of the ways we want to do it, and it is up to the administration, is to also get expertise from other experiences that allow us to then put in place the right measures that we need in order to understand that our facility is performing and is giving our san franciscan his the best, best, as you say. Thank you for those suggestions and recommendations. We will definitely take those to heart. We will go back and look at the rebuild timeline. I know we worked to really refine that for a way the commission could see progress and look to see how we can adapt that to this reform plan. I think there was a chart that really shows what we do and where we are in terms of being on track. Is that what you had in mind . Something like that. Where we actually are able to understand at what levels you are. You have obviously got one already in which there are regulatory things that have to be done within a certain period of time. With some of the others including doing your hiring where you are with their Community Programs and so forth. If we know where you are going, we will know what to hold you accountable for. In terms of the r. F. P. , i probably misspoke when i said it was more longterm. It is actually in the shortterm the in the developed of the r. F. P. , is knowing how long it takes a put it on the street from this proposal, reviewing the proposal, and awarding the contract. It will be a little while before that happens, but we are beginning on working developing the r. F. P. Right now. Sure. I really do think that that could be really helpful to the department if there is a way to even expedite that and get that so that you all have that expertise and advice that you can all Work Together. I think that will make more corrective action for us. Agreed. [indiscernible] have there been any activities to promote [indiscernible] especially with the patients . Yes. If i miss anything, i will ask the acting c. E. O. To help fill in, but there have been all of that care teams and all of the neighborhoods at laguna have actually had dedicated time working with patients on those units and some of the surrogate decisionmaking to really talk about what happened. We have also had resources from City Health Services to come in and work with staff both in Group Settings and individual sessions who are having difficulties as a result of this entire experience, and we have an openended commitment to supply that type of support for as long as we need it. Thank you. I want to add my voice to my colleagues on the commission to indicate that what has been described in the report regarding that behavior is not reflective of the institution with its history and staff who have been dedicated to san franciscans and our most vulnerable populations. We need to recognize that is very true, as well as the support for line staff and patients, i have said it before, the administrative staff, the executive team, they need that support because they were traumatized just like everybody else who was acknowledged that this has occurred. I want to make sure that there are people in the honda family who get access to that very important support, and i encourage and are encouraged to take it. It is not an order, but you should be encouraged to take some leave to address the issues that have emerged as a result of this. And some of it will be later on. It will be ptsd, kind of, so we need to be on board and aware that that is possible. Thank you for your very thorough report. Next item. Thank you. Item h. As other business. You have the calendar in front of you. I dont have it in front of me so i cant remind you of things. There are two meetings that are coming up with the planning commission, one is october, and again i dont have the date in front of me. It is a thursday. You will all be discussing yes, thank you, in december 12 th is another day that you will be looking at the healthcare Healthcare Service master plan. Those are the two unusual dates coming up. There are two items. One would be the request that we do what we can to respond to the family of brandon lee so that i dont, i dont know what the department is doing, but doing what you can to see if there is any support that can be provided to bring him and if it is possible to authorize a statement of support on behalf of the San Francisco resident and his family, who has dedicated themselves to San Francisco. The second would be with regard to the cease and desist order to the massage therapists, im just wondering if there is administrative relief that we can do, even though there is an ordinance that is in the hands of the board of supervisors. The department here has a role in providing some directionality , particularly given the testimony here, and i guess they report back to us in terms of what can be provided. Thank you. Thank you, commissioners. Item nine is reported back from the august 27th, 2019 meeting. Im bringing you my last announcement that you can read off of. Thank you. [indiscernible] could you craft up the document about the [indiscernible] yes, thank you. I will remind you what happened in this. This is just august 27th, i should remember. We didnt did discuss the regulatory c. E. O. Report and the Human Resources report and we also heard an update on the expensive and very successful go live implementation. The enthusiasm that people had around it, i may note it is one of the first times i have seen an d. H. R. Rollout in a hospital where people werent enthused. During the medical staff report, the Committee Approved the following, a new Psychiatric Department chief, and standard procedures for genetic counsellors. R. N. Medicine refill, ob gyn in pediatric village list, and it was in closed session where we then discussed the reports. Thank you. Any questions from commissioners the next item, please. I believe there was something brief to say. Dr. Colfax . I just wanted to also acknowledge the commission because of the leadership role that dr. Alice chen, who knows the chief medical officer of the department. We werent able to share this in writing for various reasons, but she is moving on from the department to be Deputy Director of Health Policy and chief medical officer at state and it is an amazing opportunity for her, at a huge honor for us to have her go work at the state level. I just want to acknowledge dr. Chens leadership and her many contributions to the Health Department. She has mentored many people in the department, and we will miss her very much, would just to really congratulate her. If i may be so bold, absolutely if the commission would be willing to determine her on her. Thank you. We would do that and say yes to this secretary that we create a document that honours her as she leaves the department. I would foot i will forward you the email where the full title of her new position is explained. The next item is consideration for closed session i would like to move for a closed session. Second. All those in favor signified by saying aye. Aye. Thank you, everyone who is not involved in the closed session. Have a lov move to go back into open session. Second. All in favor . I aye. Motion to disclose or not disclose . Second. All those in favor . Aye. Motion to adjourn in honor of alice chen. Motion to adjourn in honor of alice chens service to the department of Public Health and the city of San Francisco. Second. All those in favor say aye. Aye. Thank you. We are adjourned. Okay. We are here to get the job done. Good morning. Is it morning still . Ive been up since 5 00 i think. Im trying to keep ive been to so many places throughout the day. This is probably the fifth or sixth, but whos counting . Thank you all so much for joining us here today. With me i have dr. Grant colfax, who is the director of the department of Public Health, as well as dr. Anton nagusablan who is the director of Mental Health reform. Daniel leary, the c. E. O. And founder of Tipping Point community, and matthew state, the chair of u. C. F. Department of psychiatry here in San Francisco. Im excited because these are incredible leaders in our community who are going to help us with some really challenging problems that we know we face as a city. Last week we launched the Mental HealthReform Initiative to help those at the intersection of homeless, Mental Illness, and Substance Abuse disorder in San Francisco. And through our detailed analyst, dr. Nagusablan and the department of Public Health have identified the people in our city who are most vulnerable and in need of help. Now, to be clear, we see it. But now we have clear and accurate data. Of those 4,000 individuals, 41 frequently use urgent and emergency psychiatric services. 95 of those folks suffer from alcohol use disorder. 35 are africanamericans, despite the fact that we have a less than 6 population of africanamericans in San Francisco overall. So we have a lot of work to do ahead of us to provide the Behavioural Healthcare that people need. We need partners to do it. We need to work with our state officials, with our philanthropic organizations and our nonprofit communities. Thats why today im excited to announce that the city has partnered with Tipping Point community and ucsf who share our goals of addressing the Mental Health crisis in our city and providing people with the care that they need. We know that addressing the needs of the most vulnerable requires experts in the field, it requires collaboration and the development of publicprivate partners. Tipping point and ucsf department of psychiatry came together to really understand how to improve the outcomes for San Francisco residents experiencing longterm homeless, but who also have challenges with Behavioural Health. They worked with the city departments and various communitybased organizations who helped to put together information to inform this comprehensive report, including the department of Public Health, the department of homeless and supportive services, the hospital council, p. R. C. Thank you, Brent Andrews for being here and your amazing work. Health right 360. Thank you for your rigorous work on what we deal with in terms of treatment for folks who also sadly deal with Substance Use disorder as well. Thanks to the Rigorous Research conducted by Tipping Point and ucsf. We have a report that we can use to implement datadriven policy decisions that will effectively work and change our city for the better. This report highlights how philanthropic and public funding can work hand in hand to help san franciscans suffering. They have provided several recommendations to improve our system coordination, because we know that it definitely has a few holes in it and it needs to be better coordinated. Enhancing peoples access to treatment. Meeting people where we are. We cant think theyre going to show up at the door of a location for help or for support. We are going to need to go out there in the streets and meet people where they are. Engaging more people in care and services. We are excited to partner with them to implement these recommendations. But also in order to address the Mental Health crisis in our city. We need to build on what is already working. Were going to do that in part by expanding the number of hummingbird beds in a city, in our city. Today im really pleased to announce that thanks to the funding from Tipping Point, well be able to add 15 new hummingbird beds which offer psychiatric respite. That is absolutely amazing and its really expensive. [ applause ]. Mayor breed so with these new beds, well be able to connect people experiencing homelessness with Behavioural Health needs, the care that they need. Im not sure if any of you have visited the hummingbird facility at s. F. General, but it is absolutely amazing. I had an opportunity to not only touch bases with clients, but we also did an announcement last year expanding the number of beds at that location as well. To hear someone say to me that im trying, its hard, but im glad to have help, it makes all the difference in the world. This is an incredible facility and im so proud of the work that they do. As dr. Nagusablan will get into more details, we know that the vast majority of the 4,000 people we have identified unfortunately have alcohol use disorder. The Tipping Point report includes some innovative suggestions for treating those suffering from alcohol use disorder and we are looking forward to making some changes and implementing some of these in the coming months. There will be more could you tell mes to come and dr. Nagusablan will continue to implement our approach to healthcare because thats his job. We will recommend more ways to improve care for our citys most vulnerable residents. We all, as i said, need to Work Together to address this challenge that we face. With policy, financial investments, and working in a collaborative approach. So we truly appreciate the partnership of ucsf and Tipping Point. Now, i want to turn this over to the c. E. O. Of Tipping Point community. Theyve done a lot of work to address homelessness and taking it a step further by digging into the root causes of some of the challenges we face to make the right kinds of investments. This is going to make a world of difference. Ladies and gentlemen, daniel leary. [ applause ]]. Thank you, mayor breed for your leadership. We know that the primary cause of homelessness is a lack of affordable housing, but we also know that Behavioural Health conditions, like Mental Illness and Substance Use disorders contribute to homelessness. Without a stable home, these conditions are far harder to treat. In partnership with ucsfs department of psychiatry, Tipping Point engaged a Public Health consultancy called john snow inc. To improve opportunities for San Franciscos existing behavioural system. We convened leaders from city departments, from ucsf, from s. F. General hospital, and a variety of communitybased service providers. We conducted dozens of stakeholder interviews, including a focus group at the respite center. We e