Thank you supervisor mar for bringing this resolution to us and to all the folks that came out. There is clearly a need, particularly in a growing city, where we are adding density in areas that have not had density before or as much density before , to make sure that we can can can contend with all the challenges that will be coming with that. One of the speakers said that we figured out how to handle the seawall and the potential infrastructure challenges on the eastern side of the city and i think thats pretty much not true, but, you know, looking forward over the next decades, we will have extraordinary infrastructure challenges everywhere in the city, but i want to thank you, supervisor mar. I will make a motion to forward this to the full board with a positive recommendation. We can take that without objection. Great. Mr. Clerk, please call the next item. Number six is an ordinance amending the health code by amending the sugar sweetened beverage morning ordinance and revise the definition of advertiser, reduce the required warning size, modified their warning text and revise the enforcement provisions. Supervisor walton . Thank you. I just want to Say Something about item six before we move forward. This ordinance will require advertisements for sugar sweetened beverages to contain a warning level label and telling information and Health Effects of these beverages. The ordinance was originally introduced by supervisor scott weiner in you know and unanimously passed by the board of supervisors in 2015. Since that time, a lawsuit was brought against the city and county of San Francisco on this ordinance in the ninth circuit and to the ninth circuit ruled against the city holding the ordinance from taking effect we have reintroduced an amended version of the 2015 ordinance. Legal battle or not, we will not stop fighting for the health and safety of our community. There have been countless studies connecting these beverages to weight gain, obesity, type two but diabetes, and tooth decay. These are large Beverage Companies that are often specifically targeting and advertising to communities of color, creating Health Disparities across our city. We know that warning labels are an effective way of providing ever community with information like this. They deserve to be informed before deciding to consume one of these beverages and we owe it to our communities to provide them that transparency. This ordinance is Community Driven and Community Focused and because of that, our office is committed to gathering input from everyone. A number of Community Members have been in touch with our office. Recently on ways this ordinance can be as effective as impulsive as possible and improved. For that reason, i will be moving to continue this item to the call of the chair so we can hear from everyone in our community before moving forward on this incredibly important piece of legislation. Thank you for the time, chair madelyn. Thank you. Lets open this up for Public Comment. I have a few members of the public who have indicated they are interested in speaking. If there any other members of the public want to speak, line up on your right, our left. Hello. Good afternoon, supervisors. I am here representing the American Heart Association as their Community Advocacy directive. We want to say thank you to supervisor walton and other supervisors for supporting this very important piece of policy. We do know the effectiveness of Consumer Education and believe the public have a right to know the risk of these beverages. It is proven by science at this point. The aj is available as a Technical Assistance provider. We do have a lot of expertise in this area and my colleague worked on the state level bill back when that was going on a few years ago, and was first on this issue and able to provide support. Thank you for continuing to be open with conversation and we want the most effective policy pause possible. Thank you. Thank you. Next speaker, please. Good afternoon, supervisors. My name is john and im the past president of the San Francisco medical society in here on behalf of our organization to speak in support of the concept of a warning label. In 2014, a ucsf medical student first proposed the idea of a sugary drink warning label as part of the California Medical Association contest. He won first place for this novel innovation to address the twin epidemics of obesity and type two diabetes. It served as the inspiration to supervisor then supervisor weiner and senator bill morning s efforts to champion this forward. The medical society endorsed senator weiners legislation when he was a supervisor and i have a letter from our president in support of the current conceptualization. This really highlights the importance of raising awareness. I would draw to your attention a recent paper in internal medicine which highlighted which after the Medical Center had restricted sugary drinks sales, they followed 214 employees were about 10 months and they showed a decrease consumption, decrease waistlines, and a decreased insulin resistance that resulted we would like to thank supervisor walton and supervisor brown for their leadership in championing this effort. We would like to be available as this is discussed further. Thank you. Thank you. Next speaker, please. Quite a number of years ago, the economic agreement with brazil was made with the intention that the latter would increase Sugarcane Production for the ethanol market. If you visit brazil today, you will notice a huge volume of soda dominating Grocery Store floorspace and a middleaged population that is experiencing record rates of obesity and diabetes. While here in the united states, with a population of 330 million , there is an estimated 37 million individuals with kidney disease, greater than a tenth of the population. And hundreds of billions of dollars are expended annually on directly related healthcare costs for this very reason. President trump signed an executive order last july to say more individuals might receive hemodialysis at home. And so that the government can better regulate actors in the organ transplant industry in the hope of doubling the annual reno translate renal translate renal transplant rate to prospective transplant patients. Sugarcane is actually a species of gigantic grass, so i dont know how much of this grass someone would have to consume in order to become obese. Probably more than is humanly possible if it werent refined and reduced into a pure chemical state. I believe that soda is in a category of its own when it comes to the production of fatty tissue in the body and i encourage you to tax it accordingly or to increase existing tax on sweetened beverages, particularly if you cannot compile a printed warning thank you. Are there any other members of the public would like to speak before i close Public Comment . Seeing then, Public Comment is now closed. Supervisor walton, your desire is to leave this to the call of the chair. Correct. So moved. We can take that without objection. Great. Thank you. Mr. Clerk, please call the next item. Agenda item number seven is the hearing on the 2019 budget and legislative Analyst Report on short conservatorship his and requesting the department of Public Health and the office of the public and servitor to report. Great. Thank you. We are having this hearing on our conservatorship analysis prepared by the budget and legislative analyst back in july time flies when you are having fun. We have spent a great deal of time over the last year or two talking about conservatorship in the city, but it has been mostly or much of that conversation has been in the context of s. B. 1045 and s. B. 40. And although i believe that those that that legislation was important at the state level under decision to opt into it locally was important, that is, of course, even at its maximum capacity, a program that is going to affect a handful of people at a small proportion of the folks who are participating in Conservatorship Programs overall. Of course, lettermanpetrus sure it has been the law of land for many decades. So as we have been going through this conversation about s. B. 1045 and s. B. 40, i wanted to have our b. L. A. Take a look at what we were doing and have been doing over the past number of years with the more traditional conservatorship his. There is, it seems to me, apparent to the broader public, a pressing need for the city and county of San Francisco to be doing more to care for people who cannot care for themselves. And it has been my understanding that conservatorship his are the principal mechanism for either family members or the county to take care of people who cannot take care of themselves, and yet plainly there is a mismatch somewhere where we are not actually doing that. I do think the conversation about conservatorship over the past couple of years has created an expectation in the public that is not merited by recent history that conservatorship his are somehow going to be the solution to all of the problems that we have. I was at a castro merchants meeting yesterday and the district the interim District Attorney was asked whether she could request that conservators, the folks that are being brought in on misdemeanours, the condition of their not being jailed be put into conservatorship. And of course, that is not the way this works. The report, for which im very, very grateful, identified some interesting trends. Partly, you know, i am hoping that we will spend some time today clarifying some of the information that was in that report. One of the statistics that caught a lot of folks attention about the statistic or about the report was a chart that showed that San Franciscos rate of conservatorship was significantly lower than surrounding counties and significantly lower than the states. There is, my understanding is disagreement about whether this is in fact, the case. But there were other elements of the report that i dont think are contested and do raise interesting or perhaps troubling issues such as the decline in conservatorship his between 2012 , 13, in 2017 and 2018. A pretty significant decline in referrals for conservatorship over that time. And so i am hoping, in part at least, that we will be able to use this hearing to discuss issues that need to be clarified and to better understand some of the decline that everybody agrees own. I do think the conversation about conservatorship over the last couple of years may have led to a renewed focus on this potential tool and i do notice that conservatorship his and referrals are up over the last couple of years and i take that to be a positive thing, but even with that increased number of conservatorship his, i do think there remains a real mismatch between what laypeople, neighbors, my constituents would expect for how conservatorship his would be used, and how we are a cabbie using them in the city. I see in my office in here in my office and i know other supervisors do the care of the neighborhood characters who have been on the streets for years, were frequently coming through psychiatric Emergency Services, may or may not be struggling with Substance Use disorders, but certainly have a Mental Illness or chronic inebriation often and i really want us to dig in on why we are having so much trouble using conservatorship as a tool for some of those folks. We need to understand why. No one in City Government should be shrugging their shoulders or trying to make the best of a bad situation. We are in a crisis and we should be doing everything we can at the local level and advocating for changes in state law, if necessary, to address that crisis. Thank you, colleagues for being here and for participating in this conversation. I really want to thank the b. L. A. For their hard work on the report and i want to really think the public and servitors office for working closely with the b. L. A. On the report and some of the aftermath of that report. First up, well be hearing from the b. L. A. And then we will hear from the director Deputy Director of programs for over at the department of aging and Adult Services, and then we will hear from the director of forensic and justice and Behavioral Health services. We also have the department of Public Health here for more on the s. F. General side if we want to take it to some of the issues around what is happening around referrals or what may have happened around referrals of the last several years. I think that is it. Lets start with mr. Campbell miss campbell. Good morning, members of the committee. Im with the b. L. A. Let me get the slideshow for you here. Can you help me . Okay. Yes, supervisor mandelman did ask our office to look at the conservatorship in San Francisco as they currently exist. This is looking at the current state. We presented a report in july. Just a brief overview, the act was passed in 1967. The concept of the act was created for uniform civil process for involuntary detention. So that they would be some standards across the state for when people were involuntarily detained. This requires a superior Court Determination of grave disability, grave disability means a person cannot care for themselves because of illness or alcoholism. Significantly, it does not cover Substance Use disorders. If the court does determine that somebody meets the definition of grave disability, in the county can appoint a public conservator who then becomes responsible for decisionmaking on that individuals behalf. His two components to the conservatorship. Theres the first which is a temporary 30 day conservatorship this is the period a period in which the public and servitor can i would like to go back a step. All these referrals come from a Mental Health provider from a psychiatrist. Once referred to the public conservator to the courts, the public conservator then has 30 days to investigate the case. Someone can then refer to a permanent conservatorship after they have been through the 30 day conservatorship at some point. However, when we say permanent, it is one year. It has to be reestablished by the courts every year. So to go back to what supervisor mandelman was talking about, our report looked at state department of Health Care Services data shows the number of o. P. S. Conservatorship his by each county each year. The most recent year that was reported by the state at the time of the report was for 2016 and 2017. What we took from that data was that San Francisco was below the state average. After the report came out, and in our discussions with the public conservator, we understood that there was a misreporting by the county. So what this state said is the county he his report all the new conservatorship his. So those who are newly referred and all those who are reestablished. Because the court has to reestablish everybody every year , then the entire conservatorships caseload should be counted. In fact, San Franciscos only counting the new referrals. So it is significantly understated. So the state data still under reflects and understates the San Francisco numbers. We ask ourselves we asked for data from the 50 largest counties in the state. We got responses from 13 counties. What it showed is and then we went to San Francisco and said what is your conservatorship data . How many are new . Hominy are reestablished each year . Said taking the data we got in this from the superior court, we got to finding witches San Francisco has, among those counties, a high rate. They are equivalent to the county of san mateo. They were higher than the other counties and just to clarify, we are reasonably short and this is now apples to apples. We are not. So the other counties might be might have been under reporting their conservatorship his . Potentially. I think four counties reported to us on what was new and what was reestablished. We felt, at this point, we didnt validate the data individually. We know the state is not validating the data. We think there could be some incident uncertainty in it. What we are certain of throughout the report as we are confident in San Franciscos data. But they reported to the state it is a Nonprofit Agency contract with the state that reports it. That data wasnt correct. And throughout our reporting period, we believe that the other San Francisco data is accurate. The one other piece i would like to say is the state auditor is now looking at the Conservatorship Program statewide. They have begun this audit. That audit work plan for los angeles goes through two other counties and San Francisco. It does give different results. We are confident of San Franciscos numbers unless confident of everybody else at this point. At this point, comparing us to other counties is a really hard thing to do. It doesnt tell us a lot. We did have conversations with other bay area counties, and anecdotally, some of their experiences were very similar to San Francisco in terms of the program itself, but