Saying aye . Thank you, commissioners and item 3 is the directors report. Good afternoon, commissioners. Im the director of health and just highlighting a few of the items in your directors report. On november 20th, i was really pleased to accompany marilyn and breed in the leadership to announce 72 new residential stepdown beds on Treasure Island for people who are continuing outpatient Substance Abuse patient and who are at risk for hom homelessness. They will be operated by health right 360. They are onetype of Behavioral Health bed to help people on their journey of recovery and people can stay here in these units for up to 24 months so its really a key intervention and the hybrid, crossing over from the intensive behavioral treatment to permanent Supportive Housing and this is a key part of the puzzle that we continue to work on solving in our system and just to reiterate that we contract for Service Providers like health right 360 to operate facilities at various levels of care in our Behavioral Health system and the expansion of these beds added significantly to the 2,000 bed inventory and with investments in her budget, weve expanded the Behavioral Health system by over 200 beds, actually, since i started in early of last year. So making some progress there. And also a reminder that december 1st was the annual observance of World Aids Day and we announced this welcomed news in november, for the first time in history San Francisco recorded a loaf o low of 200hiv residents, and communities of colour and hiv infection rates continue to be high and we continue to work on that and we can look back to the commission with some promising data about how were making progress. I believe that will be mentioned today in the Health Equity presentation. And just touchdown upo touched. And next year as we think about World Aids Day expect contribution San Francisco has made, next summer, San Francisco and oakland will be cohosting the international aids conference. So a major spotlight on the bay area with regard to our efforts and hiv and what weve learned can expand to other communities and equally important is what can other communities and other parts of the world teach us about how we do better. And also highlighting the Chinatown Public Health Center is celebrating 50 years since breaking ground on the construction at the Current Location and a remarkable 90 years of service in the community of San Francisco. The clinical will celebrate on december 5th with healthcare and city leader luminaries, patients, staff and community partners, and commission chow will be speaking with the ambulatory leadership and its an important marker with regard to that anniversary. To highlight another piece and i take particular pleasure in reading the title of this one is medical clowns grand rounds. [ laughter ] so medical clowns held their Fourth Annual grand rounds fundraiser at laguna hospital and for a number of years, the medical clowns provides supplemental therapeutic patients with memorycare needs and this is an example of where theyre providing innovative programs for people and something that is really making a difference in peoples lives and wanting to highlight that and read that title. So i stand available for any additional questions or comments on the rest of the report or any detail that you require i didnt go into. No Public Comment requests for this item. Any questions or comments, commissioners . I have a question under the students who received the rapid hiv test at balboa in the health fair and there were 19 Behavioral Health referrals and nine medical referrals. Do we know if the referrals, especially the Behavioral Health referrals, if they, in fact, received services or do we know any followup from those referrals . Im concerned referrals were made versus were they able to Access Services. An important question and i dont know if dr. Hammer is here. inaudible could you just come to the podium so we can get it on tape . Thank you. Hi, im the director of the ambulatory care and i dont have the exact answer but i will get that to you. I think, for the most part, they were referred to Behavioral Health services in balboa so in all likelihood, they didnt have to wait or go to another place, but i can find out and get gag tbackto you. I dont mean to be a pain, but in their Wellness Center, i know that a lot of times, they are somewhat overwhelmed for Behavioral Health services and so, i am concerned if, in fact, the kids did reach out and say i wanted a Behavioral Health followup, that they were able to receive it either at the Wellness Center or that the social workers did connect the kids to specific Access Services versus, ill see you in three months. Thats all. Sure, and help them navigate to where they were referred. Completely with you and well get back to you. Thank you very much. Any questions or comments . Dr. Chow. I had a question and a comment. I think its commendable were able to get 72 health beds but im wondering how we would connect patients to the real world to speak because Treasure Island is fairly isolated in order to assist them in the transition that would be needed as were trying to move them into a more normal life. When i was out there, i asked that specific question, Health Rights 360 does a good job of making sure people are availing themselves linked to services, lifeskill training and also making sure theres appropriate transportation into the city, frequent transportation so that people are able to get that work. Its very different from being sort of in an isolated place and the thing thats striking about it, the houses have shared rooms and a shared common room and theres a shared sense of community and thats a big sense of the therapeutic program. But theres multiple Transportation Options from Treasure Island to San Francisco and so forth, back to the rest of San Francisco, i should say. Excuse me. I just wanted to make the comment regarding the Chinatown Public Health Center and wanted to thank the department and the commission for maintaining that center. It wasnt that many years ago, several decades ago, when in the face of adverse Financial Issues here at the department, we were looking at closing centers and i think that the department saw the wisdom of maintaining the Chinatown Center as an important point of service that, as you pointed out, has been there for 90 years and that it is really, i think, a forerunner of what we actually now have in the Health Network, which is really a fullfledged primary care neighborhood units that are available for the immediate neighborhoods rather than all having to go either to general or wherever we were concentrating our services. So i think its noteworthy, not so much that the 50 years have sat on top of the broadway tunnel. [ laughter ] not exactly sure, but i guess it did pass earthquake Safety Inspection in the preliminary, but the fact that this actually was a type of service that could have been lost during the financial crisis of the department, but the department and commission felt that it was important to keep it. Thank you, commissioner chou. With no further comments, ill return to the secretary. Item 4 is general Public Comment and we have two requests. I have krista duran and julie. And Public Commenters, as you know, ill have the timer when it buzzes. Hello, how are you . Im here again and im going to keep coming because i just want to advocate for our staff and patients. Yesterday was a really, really hard shift for a psychiatric nurse in psych emergency services. Shes a single mom with three kids and she was mandated for the second time this week, 30 minutes before her shift ended, mandated to work a 16hour shift. And yesterday they worked with five nurses. One of those is the charge nurse and then the other one is the triage nurse, which you know per title 22, they are not allowed to take an assignment. They dont count in the ratios. So thats three registered nurses taking care of 20 to 30 psych patients in Mental Health crisis. And this is a problem. And we need to address it. And the er is constantly understaffed and overcrowded and weve been getting paged out for experienced triage and trauma nurses, wher. Were a levelone trauma center. They dont have enough because were budgeting for nurses that have been there for less than two years. A crisithis is a crisis andwe. We have a surplus of 96. 5 million i dont understand all this math but i can see theres a surplus. So i dont understand where the staffing is coming from. Whats going on . I mean, this is bad our patients are not getting the care that they need. Also, were supposed to be on the agenda for the joint commission, starting december 10th. Im excited that the er will be on the agenda, but i was also not excited to hear that it was just going to be our managers giving powerpoint presentations and not us having a seat at the table. So i would love for you to reconsider that. Thank you. Hi, im julie from the emergency room and ive worked there for 20 years. I started working in the department of Public Health to do Public Health and i dont know what were doing any more. Im having a moral crisis almost everyday i work. Im not alone. Ill actually submit preliminary data. We did a survey of staff and stress levels, 80 are having pstd symptoms. Near 50 of the respondents say they have retired early, decreased their hours or have taken a leave of absence and 86 to 92 have anxiety because of violence and they feel unable to provide the best care they can provide. 65 of our staff feel hopeless because of the situation and i dont understand why we keep coming here and i have not seen anybody from here come to our department and walk around. But anyhow, im submitting for the record the written statements from the past department of Public Health hr director, the statement from the pr nurse yesterday that krista was talking about and preliminary data from our survey, as well as not all inclusive list of things we need to deal with and things to help make this better. Weve gone to regulatory agencies and i think maybe we need to Start Talking to some legal authorities and justice departments because theres money thats unaccounted for and were scrimping and were i scra thirdworld countries. I have people from thirdworld countries look at us like were crazy, were asking for help. Were failing. The department of Public Health is sick. If it was a patient in the emergency room, wed be coding it. Those are the requests ive received, commissioners, and as noted, the december 10th jcc meeting will have an agenda item and youre welcome to attend. Im 5 is a report back from the finance and planning committees and commissioner chou chairs today. In the contracts report, there was an item for crosscountry staffing which is a contract for the registry personnel and its one of three contracts in order to provide red street personnel and we heard the rationale for this and they are the prime contract for approximately an annual amount of 7 million. We heard several new contracts. The first one was the second contract for nursing, for registry and thats for a total amount of about 2 million and this would be the second registry used if the first was unable to provide the services needed. A third registry is also being contemplated as needed. We also then heard a new contract called health space u. S. A. This actually is a new database for the environMental Health section and you probably, im sure, saw the items that it actually will be covering, which includes doing permit issuance, complaint and investigation management and field and tablets, scheduling for employees in order to be efficient in their various environmental investigations that they have to make and that includes, for example, the reference. And they are a company that actually specializes in these. The contract is coming before us as being the second next important item according to the department for it after epic. In order to bring the Environmental Services recording into the 21st century, i think would be the best way to describe it. Apparently its being done by paper at the moment and created from, basically, microsoft, and they set up 17 different programs, which, obviously, i see everybody is homegrown and really, it is at this point outdated and must be why the program uses this as the next biggest item for operations in the environmental department. As you know, the Environmental Services need to pay for themselves, so the hope here is that this will be much more efficient and will be customer and consumerfriendly and brings us towards the 21st century. And that item will be before you aand cost 5 million over a fiveyear period. It will take three years to create it and implement it and they have a twoyear period for the maintenance. So those are the five items we heard and there was also an informational item from our emerging issues in which we actually, as a department, use a conglomerate for doing a number of purchasing, called a Group Purchasing organization. The administrative code are several years behind in terms of being more accurate as to the methodology and the department is proposing administrative code changes over at city hall to the citys code in order to bring that up to date. Essentially, this was the Old University coop that became visiant. With Group Purchasing, were able to get better pricing than those who come to the department and the commission doesnt change the process or the authority that any of us have including the board, but it helps clarify what is the current situation. So we will hear a further report at the finance committee as to the success of the previous contract which was called for in the old ordinance and theyre calling for that type of review every five years to the commission to inform us o of the purchasing contracts. That ends my report and i would happy to answer any questions. Commissioners . Item 6 is a consent calendar containing all items that commissioner chou just noted and recommended for approval. The consent calendar is before the commission and ill call for a vote. So moved, seconded. All those favour . Aye. Thank you, commissioners. And we have an item order change for today, and with your permission and item 7 and then well move to the Population Division health, two north. Dr. Bennett. Do you need assistance with me pulling this up . Im dr. Bennett, here seeing you in a slightly changed role and the director of the office of Health Equity which has existed for five whole weeks. This presentation will give you some background on what that is, why we did it and what you can expect from that office Going Forward. So what ill going to tell you will be both familiar because were consolidating work were already doing and new, as were changing our vision and direction and you already know that equity is a true north and there are many people in the department who will tell you that equity is their work and equity is the thing that brought them to the department but if you look at our data at the black Health Report and many other data reports, we know the current work is not doing the job, right . We still have inequities despite generations of work on these issues and so we are going to talk about some successes, but this talk is really been our efforts to look for a different kind of success, to move from transactional to transformational and look at sustained change and not just moving the needle on a number but leaving the system intact and so, ill be talking about a little bit of answering that what by what kind of structures and activities were going to do. But also, the why, what function that structure is meant to achieve. So that is our new chart. I sit exactly in the same position i was before but weve changed the title. And that is similar to our office. Policy and planning or compliance, an office that sits with the director expect structure that were building initially and i expect this may change over time as we go forward, fits the function were looking for. There are infrastructure bodies, a couple of convenings of staff focused on decisionmaking and sharing best practises. Theres some direct programming. The hope fs program and individual contracts, and theres Health Equity work across the Department Supporting individual departments an in soe specific programs and Health Equity workforce related stuff and staff under thie each of th. That consolidates staff here and one fulltime person and two halftime people