Transcripts For SFGTV Health Commission 20240712

Order. Will you please call the roll. roll call . All right. Moving onto the next item. The approval of the minutes of the Health Commission meeting of july 21, 2020. Before we begin with this item on maf o behalf of my fellow commissioners we approved to help equity resolution declari declaringit was based by the Human Rights Commission during their june 25th meeting. Ours had the addition of some resolved statements that were tailored to health and programs. On behalf of my fellow commissioners i want to acknowledge the critical work of the commission and their staff along with members of the Community Group mega black sf. And develop the resolution of the same name that was approved of the commission and all the hard work and energy they put in to creating that resolution. The commission is very proud of the resolution that contains some measurable outcomes to achieve equity and combatant eye black racism. It was apparent that there were some issues with respect to the development of the resolution and the process by which the commission approached the discussion of this item. Last week the secretary and Staff Department of Public Health and Human Rights Commission meant to resolve were committed to developing a process and protocols for our continued Work Together to address anti black racism and other crisis effecting San Francisco and discussion of these critical issues. I speak on behalf of any fellow commissioners saying well continue to address anti black racism and advance other Health Related issues at our meetings and in consideration of future resolutions. During the covid 19 pandemic and were grateful for all the hard work being done to combat the pandemic. Everyone is doing their best to conduct all of the necessary work. We can do better and will work collaboratively on developing a strong process moving forward. Thank you for your attention and commissioners do we have a motion to approve the minutes of july 21 . So moved. Is there a second . Let me check to see if theres Public Comment. Give me one second. If you wanted to make Public Comment on this item, press star three right now. I doapt se dont see any publict on this item. Okay. We do have a motion, is there a second . Second. Please call the roll. roll call . Just a reminder to all the folks who arent speaking, please mute yourself if youre not speaking so theres no background noise. Its a little hard to focus. Good afternoon, commissioners. Director of health. The details where we stand with regard to our covid 19 response and budget. Those follow on agenda items. Im happy to take questions on any additional questions that you see on the directors report. I recommend we go to the covid 19 update in the budget that will answer many of those questions. Its fine to proceed. Folks if you would like to make Public Comment on the directors report, please press star three. I actually had a question on the Behavioral Health dhr. Yes. Please go ahead, commissioner. It was only a question of clarification. The dhr being developed for Behavioral Health would it be compatible or is this also developing a Mental Health ehr. This has been a long standing controversy about whether or not well have merging ehr. I turned this over to dr. Hammer who oversees Behavioral Health. Could you provide answers to the questions. Could you clarify what youre referring to. I dont know what is in the directors report that you are referring to. Ill try to clarify. Its the new dhr thats being developed. The question is whether or not this is consistent, compatible with ethic or would one still need to use two different ehrs to be able to get a complete record . The plan is that we will bring Behavioral Health services onto epicim not sure if its not. Were currently in early wave two. We had our anniversaryim not sure exactly what you are referring to. We will not have any interim new Electronic Health record for Behavioral Health. Well continue to use avatar. I guess perhaps im miss reading the item. It seems Behavioral Health services Electronic Health record is here. Perhaps we can d do this of line in terms of trying to clarify that. Sure. That sounds great. Ill look to see what you are referring to and get back to you on a more comprehensive answer. And congratulations on one year. Were looking forward to many more things with our present pandemic. And i have to say, it has been, i think a lot of us have been feeling so grateful that we have epic and that we passed the immediate post school live period before the pandemic hit and had to put it to the test. We have really benefited from being able to use epic to coordinate care and access testing results. Its been such an important tool in our covid response. Great. Thank you. Well move onto item four which is the covid 19 update. Thank you commissioners. Here to provide you with a covid 19 update. Have some data to present updated information and i believe some time for discussion. You see the deeper curve on that right side of the graph. Next slide. In terms of our testing. We have far exceeding our testing goals. Our average is thirty one hundred eighteen tests. I will note that demand for testing has out stripped supply not within city and Health Department sites but we are far exceeding our testing goal. Our positivity rate, our rolling seven day average you can see here running from april to early august is currently nearly four percent and consistent with a high number of cases were currently diagnosing. As the commission is aware, we have inequities within the pandemic particularly in the Latin X Community. Weve been working with key stake holders to address the pan emipandemic in that community. We continue to do well on many aspects of our response compared to other jurisdictions. Our case counts per one thousand is relatively low compared to other jurisdictions with respect to king county. A death rate low, a total of sixty one deaths. Rate of one every ten thousand. Our testing is not meeting the full demand but is certainly a success compared with other jurisdictions. Baltimore is the one jurisdiction thats close to our total. D c is somewhat higher at a rate of four point one three per one thousand. Next slide. This is our rate of hospitalizations and the commission recall that we are in a surge scenario. You can see that in april we peaked at a tole of ninet totale hospitalizations. It declined in mid june to twenty six hospitalizations sm that number saidly cloimed in s. You can see the light blue lines represent the medical surgical beds. A slight decline over the last few days. We are watching these numbers very very carefully. Because it takes about two weeks from someones dates of infection to being hospitalizations, the hospitalization was about two weeks ago. A little bit of hopeful data with regard to the declines you see there. Watching it very carefully. Next slide. Our key health indicators, these were updated as of this morning. Our hospitalization rate which exceeded the 20 was level four in red. Just a week or so ago because of that decline and a negative three point six percent rate. We remained at good capacity. Its twenty three percent and twenty seven percent for medical and icu beds. The testing numbers that i described earlier, their one hundred and eighteen. Our Contract Tracing had fallen behind. This is due to a number of fact yores including the increase in keasecases and delay in test re. Locally and nationally the labs have not been able to keep up with the testing numbers. Weve currently experienced delays of seven to ten days as lab corp. And other commercial labs are waiting as long as two weekweeks. City test sf to get results turned around more quickly. Our Public Health lab is catching back up. We expect returned results within 72 hours. With regard to our personal protective equipment were at 8l protective equipment has a thirty day supply in the city. This is our r reproductive rate. These are estimates through about august 1. You remember reproductive rate over the line is more than one person i is infected. We really need that reproductive rate less than one. The veer us had a reproductive rate of eight point five. You see that increase in estimates starting around june 15th. We went above one and went to about as high as one point three. This created a situation where we paused our reopening and took aggressive actions with regard to education around prevention activities that were needed to tract the reproductive rate down. We see some hopeful signs that reproductive rate is tbing down again. Its wu one point five. This is still a high number. Were concerned that were still above one with the reproductive rate. If theres no change in the reproductive rate even at one point one five we would estimate that peak hospitalizations would be three hundred seventy with three hundred ninety deaths in 2020. That is marked by the followup blue line going from the august fall through the end of year. More vair eations in the reproduckive number can cause a difference in estimates in the fought youre. The plausible number that can be in the hospital which is neen tean hundred on ct 30th, 440 deaths. These are models and estimates. This is all about probablity. The shading of leans represents the probability of zero to 95 . Certainly we have a window of opportunity as we hope fle can ten to drive this reproductive rate down dramatically. If were able to reduce by 30 , you can see a dramatic shif in our future. An update on our testing approaches Going Forward. We have set up across the city and this is not just e ph but across the city theres a total of 29 testing sites throughout the city that has performed nearly a quarter of a million tests. We have achieved more testing access than any other surrounding county. We early on tested surrounding city sites and exceeded our testing goals. We expanded our access to anybody who requests to test. We have had to set priorities to challenges we have had locally and state wide and nationwide in regard to steadily supply of testing and unified testing strategy for the nation. We have prioritized san franciscans testing with symptoms of covi covid 19, foret line Disaster Service workers. This is a slide that marks our relative success in addressing concerns about spread of covid 19 in our skill nursing facilities sm these arfacilitie . These are dataits a little hard to read. The numbers of infected Health Care Workers are shown in the blue line. Infected residents with the orange line. Hospitalled patients shown in the gray line. Deaths in Skilled Nursing facilities across the city has been relatively low compared to other Testing Facilities across the state and nation. This is due to the fact that we have a scaled up testing in these facilities. We are testing all patients and all staff every two weeks. This takes about three hundred tests a day. We have issued orders requiring other nursing facilities to do the same. Obviously its not just about testing. Ive said repeatedly were not going to test our way out of this pandemic. Other resolutions have to do with good infection control, mask wearing and good hygiene. Youll see he on the far right an uptick in positivity rates among the Health Care Workers and that is certainly consistent with more Community Spread both in San Francisco in the region. We inspect to see this as theres more Community Spread and that would obviously effect the people working at these facilities sm we also continue to focus on testing with regard to out breaks and Residential Care facilities, shelters, and sros. And being aggressive with our testing in the jail. In collaboration with our dph data teams is with u c sf. We continue to file the data with regard to our testing priorities. These maps of importance. The green and orange map is prevalence of diagnosed covid 19 cases. You can see the darker orange census tracks represent where theres a higher prifl ens of covid 1prevalence ofcovid 19 in. The lighter green or some color between orange awnd green tha ai dont know the name of, those are the wider census tracks. The second map shows where testing is available in the city. Theres a mismatch where testing is available and where covid 19 is being diagnosed. This is not just dph or city test sites this is Health Care Providers across the city providing covid 19 testing. You can see the testing rate per capita is hardly surprising that people are getting tested in the neighborhoods where there is testing availability. Theres a pretty clear match there. Our testing strategy Going Forward will be an adaptive testing strategy that will focus on where cases are being diagnosed and scaling up where those are census tracks. Our new testing goal is five thousand tests a day by Early September of twep 2020. Pushing ourselves beyond that thirty five hundred to five thousand. Really focusing on our neighborhood strategy and concentrating neighborhoods most impacted. I would remind the commission that because of our Health Clinics across the city we impleimplemented multiple test s early on in the pandemic including south east Health Center and also in the parking lot of zuckerberg General Hospital where the Research Building is supposed to go in the future. We did extend testing availability in those neighborhoods. We are also looking to expand capacity and speed of lab process to shorten turn around times. Were looking to ensure that private providers do their part. Ill show you data in response stto that. We have more cases so they can manage up to two hundred cases a day. Were incorporating Emergency Technology into our time line for expanding testing. I dont have the private providers data. Ill provide the commissionwith regard to the private providers and working with them to do their part. Many of our larger Health Care Systems. Actually, if you could pre vied thaprovidethat slide so the comn see the relative number of tests that other health care sif ems s have done. While waiting to bring the data up, ill remind the commission that our Health Officer issued a health order two weeks ago that requires Health Care Providers to test certain people who are at high risk for covid 19 within the 48 hour period of presenting to the system. This is data with regard to other Health Care Providers and their contribution to covid 19 testing. Just to say that our city supported systems and Health Department system has done a total ofrelatively smaller contributions of certain key private providers in the city, seven point six percent, four point six percent, some of our larger Health Care Systems. I would iterate that these systems have been incredible partners during the pandemic. They are very committed to working with us and other key stake holders to ensure more testing is available for their patients and staff. With regard to our neighborhood strategy, the mayor announced also just last week, i believe, that well be expanding our testing options for people. Well be working to scale up two new mobile test sites that will be able to go to various parts of the city. Especially where covid 19 is highly preflen. Highly prevalent. Those are on the dprownd now as wground now aswe speak. There will be a permanent site, were working to select a permanent site in the southeastern part of the city which will have an additional ability to test five hundred people a day and be in addition to the city test sf sites which now have the ability to test approximately two thousand people a day, fifteen hundred at the site. I would also emphasize that in addition to the testing that we are ensure thag right now we all need to behave as though were carrying covid 19. Which is why we advise not to use a test as a way to indicate. You need to use a facial mask and good hygiene. Thats key to flatten the curve and key to getting that reproductive rate closer and hopefully below one. Thats all i have for the commissioners and i will stand by to answer any questions. Im not seeing any Public Comment. If you wish to make Public Comment press star three. Seeing no Public Comment, commissioners. You can continue with your comments. I do have a comment and a question. Going back to the long term hospitalization projection slide with regard to the reproduction number, i want to under score that if youre looking at the four months since the beginning of the pandemic. Weve suffered the loss of 61 lives. Looking forward to november first, that number if we follow the median at the same reproduction number could be six and a half behind that. I know the mayor has spoken out about that and frustration with not wearing masks. This should say more than anything about lowering those numbers. We have six and a half times as many deaths in the next four months as we have had in the last four months. I hope everybody is taking that to heart. In regard to the testing priorities, i know were looking at the prevalence in the Latin X Community a lot of that has to do with members being essential workers working at Grocery Stores or other areas where people need to Access Services or the functions of daily life and also often times the Latin X Community has much higher rates than people who do private work. If people are essential workers, they cant get tests at city test sf. Weve been working very hard with the Latino Task Force on covid 19. Establishing pop up testing availability for people, for instance at the hub in the mission. We takewe dont turn anybody away for testing. That low barrier access to testing is really pivotal to our work. As people do test positive, we ensure there are ku culturally appropriate Case Investigations. Half have been in spanish ensuring social services are made available including food and other wrap around services. If people are not able to isolate in quarantine, we offer free of charge hotel rooms where people can isolate in quarantine. Theres a very robust package offered to people who do test positive. Our goal is to continue and expand testing and no one is turned away in communities that show high prevalence. Well provide testing to anybody who requests it on that day if there is capacity available for testing. Thank you. Next queue, commissioner green. I ask that other commissioners and participants on the phone, please mute your microphone. Thank you for this. Its very rich information and very much appreciated. Along the line of testing Health Care Workers. Man dating the other Health Care Systems and expand testing. I was wondering if you could ewill be rate a little more on not only the mandated across the board. please stand by you and hdiscussed. They provide people to test people with symptoms and close contacts to find if someone who is in contact with someone who is in dying know of for 15 minutes and more and those would be tested within the 48 hour window period. 48 hour period of asking for a test as well as anybody else and we are working with kaiser and starting conversations with other Healthcare Systems to better assist them where they can get expanding testing. They are under limitations as they are across the state and nation with regard to supplies and and Additional Technology that we could potentially use partner to use i dont know together is the right word and in terms of expanding Rapid Testing and using homes and so those home test kits theres not an actual test you can do at home but you can do a simple collection and accepted it in. Those have relatively a short turn on times and we are whether you can pool samples and test its a more owe efficient way if you have prevalences of covid19 in the institution or circumstances in what you are testing. So were looking at working with all of them with regard to those techniques. In terms of testing healthcare workers. And really towards a consistent approach to this but we havent reached that yet. That is certainly something that we would like them to do. We have limited capacity to enforce that. Is my understanding. Thank you. And in extension of what you were paying about home testing, can you elaborate that what the potential is and when, as you look or not and the potential anticipated numbers that the commissioner was talking about and if that and its an option. I appreciate the question commissioner. Rather than my speculated on that it would probably be ok if we have some of the Technology Experts on test coming to the commission and consent what the horizon looks like. We have people working at covid commands including a testing so we can bring them to commissioner to answer more specifics of the question that you are asking. Thank you, development. Very. Yes, thank you. I was curious about who things and i appreciate the data on the swift institutions and it appears that i guess all smiths are following the same guidelines that laguna is. If i recall we were going to suggest and i have not seen the guidelines themselves but if theyre following that it looks like one of the reasons i think that smith beds that we have in San Francisco. So i appreciate that and i also appreciate there are people who are really anxious to really do see their loved ones but i think with the surge going on right now its really difficult to try to bring more people into an institution which seems to have been because of the community spared right now and were really in danger of very vulnerable populations, i understand that. I want to go to test forgeron aa moment. Your data shows that we are trying hard after that one incident that edmonton early in terms of strat guards which is frightening by itself. In testing, i thought it could be helpful to us in terms of looking at how you are doing in the testing of certain areas because while you have tests sites it doesnt mean all the test sites are doing all the cases and also, i do note that apparently in the 29 sites, im not sure if those also include some of your other temporary sites because, i thought we were doing a lot more testing already in the mission and the bayview but it doesnt look like that from your test reports and i would think that its to understand how many tests are being done continue a particular sensuous track or it would may be the better way to do it because there maybe several test sites within those census tracks so we can understand the numbers that are being done in the vulnerable areas. I appreciate that, commissioner. The purple map showed the prevalence of testing percapita by census track and you always said you are right the dots on the map, which showed the testing sites do not reflect the mobile sites so the pop up so if theres an outbreak where owe do a day of testing in a certain local cal that wouldnt be reflected in these testing maps. Its particularly with those resources we need to concentrate on the southeastern part of the city and go where the virus is and test as many people as possible particularly in those high prevalence census tracks and that what we will kobe with these new testing resources that the mayor announced just a couple of weeks ago. And then, im sorry, the other, with regard to the visiting at the nursing homes, we are taking a look at our health order and our policy because five months into the pandemic, the social isolation that unfortunately has developed while we have been working to get people ways to connect we know its not the same so we are looking at that and theres a teamworking on plows able, safer alternatives that could allow for more proximal interactions with Skilled Nursing home residents and their families. Looking at things like outdoor visits and so fourth. I cant speculate beyond that right now but were taking a hard look at that because the Health Consequences of we need to balance it by the risk of what covid can do if and when it gets out of control in one of these facilities. Thank you. I didnt appreciate your righthandpurple map as much. I think we were to look at how well you were doing and increasing the testing we might see a progression of the number of test. This is darker because wore doing a great job and maybe that can match the prevalence. It could be helpful to understand how we are doing in terms of identifying and also i dont know this may be difficult, trying to understand how we have been. I had one more question was really related to contacts. Is there any evidence by delaying our information that is valuable after youve done a test, if it takes seven to 10 days, how many more people we have been impacted which could then drive even more well not more demand because thats the problem. A more urgent need to really get the supplies correct because while weve all talked about these delays, what has it meant which could then help us really push for own a better supply line . The delays are concerning. If you have a seven or even 10 or 14day lag in getting your test results and the relative value for that person of getting a test result is diminishing as well as the close contacts of that person in terms of the isolation there it snow because because of the Contact Trace asking challenging and the return diminish further because of that. So thats why were focusing improving these turn around times at our dph site at city sf and working with providers across the city. These are issues of sings like free agents, right, and primers that are not available and sufficient supplies and this was the case in march, april, may, june, july, now august and its were doing everything we can do this work and ive explored homegrown copses around trying to come up with these supplies. How to process the specimens and its really not efficient or feasible for us to do it because of the way the west works and the cartridges and the materials need today perform those testings. We need a steady supply chain to get at the root cause of these terne around times from the larger labs. Thats unfortunately not something that we have jurisdiction over and we have an ability to be flexible and move is to work with systems that are able to turn the test around and were encouraging private providers to look to those systems. If you get a positive test result, it comes to the Health Department and we are the ones that are needing to reach out to do the Case Investigation and the longer it takes for the test to come back it diminishes our ability to be reflective and the more risk there is to publichealth. Raise your hand if you have a question or comment for the director. If you do not see any currently unless someone would like to speak up. Without any questions or comments, we can move on to the next item, general Public Comment. On the phone, dial star there. Is it. I dont see any hands raised item 6 the dph proposed budget and we have mr. Wagner. Give me 30 second to move you to presenter so you can share your screen, please. And weve got jenn on the phone. You are good to go with your screen. Mikaela, are you still on . Yeah. At the top of your screen where it says display settings, do you see that . In webex. In powerpoint. Do you have two screens sometimes . Let me text you a picture. Everyone is going to be patient and we appreciate you working through this. Id like to take the opportunity to think again for leading us through this new process. At the top of the screen when two monitors are active together it will show the full and different features. So, im going to text it to you. Im going to try this. I just unplugged my monitor so im working off the laptop. Thats a good idea. Nothing shows right now. Of course. You can also send it to me and i can share it for you. And so, um, in the mayors proposed budget, there is significant funding for three of our key priorities and to which no surprise the response to covid19 19 pandemic prior tieing Racial Equity and the allocation or resource and that is riel occasion of dollar from the citys and to initiatives and that are aimed at Racial Equity programs and Mental Health sf and the initiatives that the and it is meetings in june and i believe its a last time we did this and its an increase to our budget. Is there quite a bit of uncertainty arent budget and i will talk a little bit about that but, all of this good news is depending on assumptions and those include the assumption that we have some sense of what is going to occur with covid19 which is questionable. There are a lot of things that can change there. And it is assuming that theres going to be a voterapproval of a Business Tax Reform measures on the november ballet that would free up dollars for Mental Health underlining the Mental Health sf initiatives. And, its also assuming other federal revenues and labor contracts that have not been achieved so theres a lot of good news in this budget for us and i think over all, were in a better place than i certainly expected that we would be but theres a lot of uncertainty and i think that this is going to be a situation where well real evaluating the budget over the course of the year given the fluidity of the situation. So, this slide is a snapshot of the highest level change in the budget you can see in fiscal year 19 and 20, our total budget the year that we just passed was 2. 4 billion. In the mayors proposed budget that goes to 2. 77, and 2. 58 so its an increase of 344 million in the first year of the twoyear budget and 149 in the second year. Down below you can see some of the big items are that make up that change. And ill go through each of these in a little bit more detail. Obviously the covid19 response is the largestmoving piece in our budget and a number of other city departments budgets the Racial Equity initiatives is 36 million and funding in our budget and the Behavior Health is 113 million in the first year and 108 in the second year of new pro appreciations and its not available to us and ill talk a little bit about more about the nuances to that and those are the big moving categories in our budget. First a little bit more detail on the covid19 the entire city wide budget is 446 million for the covid response. 205 of that is within d. P. H. And were the single Largest Department in the covid19 response but theyre big programs that are outside of d. P. H. And the two biggest of those are the Hotel Leasing and operational costs born by the Human Services agency and the leases for the shelter in place hotels and the this gives you in the dpr portion of the this program so you can see on the left row labels are categorizing where the expenses are in the budget. The first numerical column is the total effort so you can see weve got a budget of about 299 million worth of total effort so a very major effort is expected to continue and expand over the coming year. The second new measure i canal e intend to satisfy by repurchasing existing resources so the majority of that is Disaster Service work source its taking an existing department worker and repurchasing their job for a new lead under covid19. Theyre also some contracts in that category and that leafs us with a gap about 205 million that is required to english pendture and it will be a new experience. Back for the department of publichealth and the city wide covid budget were making some assumptions and these are out of the Controllers Office and some assumptions about what we will be able toll draw for reimbursement for this program through fema and through the federal legislation that has been passed so far to help with reimbursement for expenses related to covid. You can see on the cot um of the right, how much is leftover after we assumed the seem a reimbursement and ill show you the cares act on the next page but its a large program. Couple of the biggest categories, as you can see, looking at that first new mer i canainumerous numericalcontract. Our Contact Traceing and Case Investigation programs and testing as you have just been discussioning will be a and we also have hospital surgery, support for the hotels and support for our outbreak programs and all of those and grouping categories. So, that is a very high level description of what is in our budget and were happy to talk in more detail about that or take questions on it. I will say that we have been very intentional both dph and city wide as we developed this budget in acknowledge interesting are unknowns and we have to be adaptable to to what the world brings us over the course of the year. So this will have controls around it and were continue to go put those in place but we will, within those parameters have a lot of flexible to move dollars around to respond to changing circumstances in a way that we dont in our normal city budget with our normal city financial rules and constraints. Next slide, so this is going up to the city wide level. This is the city wide covid19 budget. You can see at the bottom of the page the grand total is 446 million. Again, the reason for that sue can see that so many of the dph costs are in the bigline items in this sheet as well testing ppe and operating supports and we have large dollar and the good thanks and programs and pit stops and they are the hand washing and hygiene stations throughout the city and all of that together adds up to 446 million and when you subtract the fema and cares act funding you can see the net general fund bottom line for the city is about 93 million. Ill just lately say on this, we have flexibility and theres an understanding that were making some assumptions about developing this budget. Weve come at this from a perspective of youve seen a lot of the modeling thats been done and command center where were taking up a more pessimistic than median approach but acknowledging that were not going to be able toll plan in the budget for every scenario so we made some assumptions here and i think theres a collective understanding that we got this wrong and the Coroners Office is hold something reserves against the need for a surge and were already obviously starting to see some of that surge happening even sooner so i think this will be changing and evolving for the course of the year. So next big category, on Racial Equity and resources. City wide, the mayors budget redistricts 120 million over two years and from the Public Safety department. So primarily the Police Department and Sheriffs Department and that funding has been allocated into multiple departments with the idea that that those dollars will be repurposed to programs that are being district today repair the legacy of racially disproportionate policies on health, housing and economic outcomes for African Americans. Leading up to the budget, the human rights direction at the direction of the mayor has been taking a leadership role in this process and has been doing a lot of Community Process gathering input and talking to various folks within the community and to get input on what are the best uses of these funds, what are people seeing as a need that can be met with these funds. One the big categories that came up was health and Behavioral Health in particular. Because of that, the mayors budget of that 120 million, 72 million of it is allocated to dph so 36 million a year. Right now its still at that relatively high level, theres not a granular program for how this 36 million is to be spent and that is intentional. The next steps are the Human Rights Commission and its going to continue to lead a process after that commercial round of input and to make decisions and we will be closely involved in that and its a communitydriven process to make decisions about specific allocations and so theres more to come but this is really aligned with a lot of what the Health Commission and the department had been focused on in terms of Racial Equity and its a big step for the city, really trying to make tangible changes in a short timeline where we can have some effect on our Racial Equity. Next up is Mental Health sf. So, could the commissioners know that this was legislation that we worked on and the mayor breed led on and ultimately came to ar ordinance board by the board of supervisors last year and its a big Visionary Program and total estimated cost is 100 million or more per year to implement and were not going to have 100 million or more but in this budget is funding for us to take big steps into the first phases of implementing that Visionary Program. The budget does make the assumption that they will approve a Business Tax Reform ballot measure and its on the ballot in november and what that measure will do, if approved by voters, is you will recall in june of 2018, voters passed proposition c a business tax measure for homelessness and behavioral Healing Health and ts held up due to a lawsuit in the courts and is being litigated in the courts. It will free up a significant portion of those dollars regardless of the outcome of the legal back and fourth. And make it available to dph and the department of homelessness and support of housing to begin spending those dollars. So there are two categories. The first is, the on going revenue from that business tax measure. That would be 28. 1 million in fiscal year 2021. 38. 4 million on going and that is kind of the core basis where we have used to design the programs that is in the budget. In addition that, there are onetime funds and those total about 115 million and its been collect today date thats been held under litigation that would be released and because that is kind of retroactive onetime funding and because theres still quite a bit of legal processed to play out, those funds are going to be held really strictly and they may be used in some circumstances for onetime uses and there are a lot of restrictions around those so those are appropriated in dphs budget but we will to go through the process with the Controllers Office before we program them for specific use and they may be available to be available for capital spacek what decision and other costs associated with the program. In the Mental Health sf program, there are four core pieces to the program that assumed in the budget. The first is establishing the office of coordinated care and this is a piece of the Mental Health sf budget and the past and this is in some ways its really the core of the vision for the Mental Health sf program and this would be the new function where weve heard, in many cases, we have a lot, we have a strong system but its not use working together in a way that is clientcentered it can be hard to navigate and the pieces 2003 have the infrastructure to make sure the pieces of the system are alike. So the office of coordinated care will create that infrastructure to do coordination data analysis, planning for our Case Management and care coordination functions and really the glue that holds the system together. The behavioral investments. You know from previous hearings we have, under the work of dr. Bland, and his team, been doing analysis of our Behavioral Health med supply and demand and trying to make determinations about the gaps in the system that are really creating a do theel neck odobottleneck. That work has been completed and identified a number of needs and they include lock beds, residential Mental Health beds, site beds and the last category and were going to assume that we will meet those recommendations and it will be a process as we go in through future budgets. This is a new streetbased team that would be in partnership with the Fire Departments ems6 group and dph where we would have clinical staff that would be out on the streets responding to calls for 311, 911, other courses and this would be a way to have more appropriate response where we can send out people with medical and Clinical Experience and knowledge to respond to these calls today which are by police due to availability of resources so this is a big improvement in our ability to be responsive in a appropriate way and get people linked into the system of care. And then lastly, as i Mental Health service center, another piece of the legislative vision would be a physician site and have access for people to come in and engage with services. There would be a pharmacy on site so out of these opportunities to connect people who need services to the system of care could occur at that site. They would be expanded hours and services on site. In addition to the legislation tied to the business reform tax theres quite a bit of general fund included for Behavioral Health and a lot of this is tied to programs that are already on the way but need to be funded to continue and for our emerging increases that were adding up and i woke up to all of these in details but you can see a lot of things weve done over the past couple of years, which were adding treatment beds and doing expansions with grant money. The mayors budget is providing general fund to continue the funding for those services so well be able to maintain and pod fie that capacity as we think of a best concern of the clients. Also, we have 5 million for a creation of a psychiatrist class. This is one of the things the city has done to address the issue of difficulty and recrewment and retention of psychiatrists in our system of care this was done with the department of Human Services and our labor partners to really take a deep look at our competitiveness in terms of our compensation and make us more competitive. This is to emphasize a lot of good news in this budget and a lot of opportunity and a lot of uncertainty and they are what is going to happen with the covid19 pandemic, i dont need to spell that out for the commissioners. A lot of things could change including federal response. We have the budget continuing on border approval of the business tax in november and the other city wide assumptions including wage increases. I will lastly note we talked last week about the fact the Mayors Office and the asking us to be prepared with a potential adjustment should they be needed if the city cannot come to agreement on its labor Union Partners on modifications of the of of the contract. There are wage increases scheduled to be in effect over the next two years of the budget and to have asked the labor partners to host home and delay the wage increases but it has not crept yet. Its a very high level look at if we were asked to meet those additional targets what would that mean in terms of kind of the the scope of solutions we see would look at that and it would change the equation for our budget and we would go back to do some additional thinking at that the is case. So, very last august 14th, next week we start our hearings at the boards Budget Committee and then we expect budget will pass out of the board in august and full board approval in september in the mayors signature in late september and early october. So, its a lot of talking. Im happy to take questions. I see that one person has raised their hand if you would like to make Public Comment. Please, press star 3 and i will recognize you by unmuting you. We have one person so give me one second to get this going many of. My name is francisco decosta and ive been paying attention to this subject not only today but it has come up before the different committees of the board. What i see missing is that we havent filled some positions. Leadership positions. And yet we talk in general tees so if you havent filled the leadership in Behavioral Management we cannot talk in generalities, the other thing is that, somehow we are not really having dialogue with the community at large. The welleducated, stellar, citizens of San Francisco. We have a budget of over 2 billion and fundamentally, whatever programs we have we have to have rep around services. So, when we lack empathy and compassion, and we are not going to have results so right now all over San Francisco, we have thousands of people slowly dying. But the most important thing i want to say today is, we cannot allow our infants, our children, and our youth, our elders, those are compromised health, more mentally and physically challenges to slowly die. Your time is up, sir. Im going to move onto the next call. Thank you. Im trying to make sure everyone as a chance. Star 3 if you would like to make a comment. You can condition your discussion. Do you have any questions or comments for mr. Wagner . If you do so, please raise your hand. Press the hand button. Or just speak up as well. Mine is only a comment to say that i am actually very appreciative of mr. Wagners presentation is as he began it is a farber picture in terms of trying to obtain resources to do the work if the department has to and the recognition on the part of the mayor and hopefully well be the boards recognition and its important to be able to continue the work and were not pitting covid against that and not for getting the initiatives that the city has prioritized including Mental Health programs and programs for Racial Equity so i just wanted to compliment mr. Wagner for actually taking that almostsounding impossible sounding task and really being able to show thousand could be done obviously contingent upon many things including the voters in november and i think we recognize that. I just wonder, i guess it would be at the time there are significant changes during the i do a log you might want to bring that back just to keep us updated on what is happening with the bored. Absolutely. Well stay in close touch with mark and at this time of the year, we often have at least a brief check in on each Health Commission agenda. Until the budget is complete. So well certainly keep in touch as things move and change its course. Thank you. We have a commissioner. Thank you, excellent presentation. I submitted a question earlier through a comment. In my concern to the Public Safety funds that will be coming to us and in focusing on Behavior Health with a Racial Equity lens that we are cognizant of the fact that with the Community Input, et cetera, that we really look at youth and elementary and middle and high school since my concern is this group is often not totally focused on it until the kids are in trouble. So, im hoping we can look at formulating some Prevention Strategies within these dollars and within the areas that i think could be very, very helpful. Thank you, commissioner. I received your questions and i meant to touch on it and i also do know if dr. Hammer or anyone from Behavioral Health wants to chime in on that comment and that element of the work. I think its a great question and its a lot of receptive teeo that idea to go in that direction. We have, as probably know, a number of Early Intervention programs for school based and some communitybased organizations and theres a lot of interest in using some of this redistricted money focused on Health Equity and reducing Health Disparities and to this Early Intervention work and they are acting direct to be of Behavioral Health services wasnt able to be on the call but she has expressed to me lots of interest in this sort of work and in really with Community Input figuring out which of our intervention programs are really having an impact and we have a good program at the bayview and working with dcyf and identifying where we can really focus on this work o so it has the biggest and well definitely be working on this. Next also, well, well make sure that we do some thinking as we understand what this process is to make sure that were communicating what all the commissioners and bringing you in on that process as it happens. Commissioner. Thank you, very much, i appreciate it. Any other questions or comments . I want that thank greg and his team for the work. This is the been an unprecedented year in many ways including on the budget. You saw the multiple opportunities and also challenges the budget presented on any sort of normal year any one of those would have been a challenge and talk about having many balls in the air and a tight deadline and i want to thank craig and their team for doing such a remarkable job and coordinating with the Mayors Office, the controller on all of this, it was a effort but this one was for the record books so thank you the team for the work. Thank you. You beat me to it. In addition to the work that goes into putting together the budget every year to have to scrap the whole process and start over again in the midst of a pandemic, greg, for you and your team, for jenny louie, thank you dr. Hammer, i know that dr. Bland had a lot to do with the Mental Health aspects of this as well. So to your entire team thank you for your hard work and we look forward of track particular to the process. Thank you and i will pass it onto the team that has really worked hard on this. So thank you. Thank you. Item 7 is the monthly contracts report. And we have folks inform present furniture across the city. Next commissioner. Good afternoon. This is michelle rugel. Sorry i dont have all of a camera. And so im going to go through the report and we have other staff, i believe, on to line your questions and do my best ok. The first contract my hospice. This is an ongoing contract and we are here today to ask for approval of an amendment and which will be to extend the contract terms by throw years for a total of 6. 6 million. I mean 6. 6 year term and then we have increased the contract amount with con ten again see so its the full amount of the contract to and theres a 71,200 increase which is the inclusion of onetime funding and this is a program that the San Francisco residents living with hiv aids and the end of life hospice or 24 hours killed nursing care and the program has they have met their declarement. Do you have any questions of this contract . It looks like not. Please continue. Ok. The second contract is asian and Pacific Islander Wellness Center doing business of San Francisco community Health Center and its improvement of amendment that would extend the contract by 14 months picking it up to 10 years and that also has rised under the existing contract terms and this is on going and the target population is trans women and trans men, including transgender persons of color and joseph is on the phone and he worked hiv Health Services as the manager to talk about this contract and also to point out, as we bring these contracts back to you, and this one has been at the opened of a longterm, the terminology has been evolving with the contracts and so you received one v. And we have the newer terminology and is joseph on the line . Not joseph but john is. John, im sorry. Yes. [laughter] hiv prevention. Just contract is really an extension of a contract that has begun in 2010 and we had rfp on these services out last year and they were to begin or they should have already started by now but we had to put a hold on everything due to about what were dealing with in terms of covid19 so the original language at that time we were talking about men and women as female to male and male to female and now that we realize its no longer appropriate that really focuses on a procedure rather than the person and so similar to other types of language with people firsttype language where we talk about people experiencing homelessness and rather than the homeless so its really more oust respect to the individual that weve changed that language. Well continue to do so. Any questions on this contract . Thank you. Hi, thank you, john. The last contract on here is called the shanty project. This is on Going Services but we had to move it into a new contract document to update because it was easier to move it into a new contract because the boiler plate has changed so significantly than to document all the changes so that is why it shows us the new contract. Its really the continuation of on Going Services. This is going to be, were asking for approval for this contract and when this contract is over december 31st, 2021, then we would have this would have gone out to bid in a new contract will replace it. This is bridging the gap for that period. This contract provides services for and the and i lost my place. It provides services and support of the margi Breast Cancer program and then services and and San Francisco and the, i think the still on the phone. And she has patients and then i think and im just going to carry on if there are too many questions i cant answer, then t. We can either foal up or bring it back but its an ongoing contract youve seen before and dr. Chow raised a question or brought up a question and he was interested to know how much this is being used and what the volume of usage is so one question was specific to the mammogram. The manovan volume. Ill use 2018. They did 5,305 screens of barbra just emailed and 5,305 screens. 1,637 diagnostic i dont know what the rest of that word is. That is the whole thing. And then im sorry. I dont know what these if the table, lets see. The table says screens, 5,305, dog months tick 1,637 and the mamovan1190 so those are the numbers for that program and followup and then the director of the program provided with the support services, which is a different grand, they had 384 clients had received care navigation, 78 had received survive oership navigan and support Service Ideas servie provided to clients as of july 1st, 2019. Thats the update on the numbers. I dont know if that answers all your questions or if you have other questions that i can stumble through. Commissioners, any questions or comments . Theres Public Comment on this . My name is francisco decosta and ive been involved with Health Issues for the last 40 years and ive especially been involved with the shanty program and and while i want to advise the commissioners is that over the last 25 years, its been difficult to support our most vulnerable population in San Francisco even though our budget is over 2 billion. So we need those in charge to think outside the box. And now this pandemic is going to challenge us. And San Francisco and this is a where to think outside the box and do something. So that the positivity we had to bring to the fold. We cannot allow people to die in the tents. We cannot allow the most vulnerable to die. If you do you can really read the laws that have been brought fourth by the united nations. Thank you, very much. Thank you for your comment. Theres one more caller, commissioners. Caller, welcome. You have two minutes. Caller hello. The caller disappeared. Thats the last Public Comment for this item. This is an act item. Its a rewinder to my fellow commissioners and the public given our abbreviated meeting schedule during the full commission is acting as opposed to the finance and Planning Committee and the publichealth committee to we will be considering for action for a vote which normally would have gone through the finance for Planning Committee before coming to the full commission, however, both those committees that the mentioned, the publichealth committee will resume meeting starting in september and well have that schedule Available Online for people so they chose to view. So, commissioners, do you have any questions or comments . See before we go to a vote. Thank you, commissioner. In the spirit recently passed resolutions, i also want to mention that you know, from what we know, in general, is that African American women tend to have their diagnosis more advanced stage you know like of Breast Cancer so i am very curious, you know, to know more about how a program like the role is shantys providing helps to fill some of those disparities so hopefully in the future, that we won able to invite them to come into the presentation. Thats it. Thank you, commissioner chung. Any other comments or questions before we move to a vote . Seeing none. Mark, would you read the roll, please. We need a motion to approve. Motion and a second. Ill move. Ill second. [ roll call vote ] thank you. Next is a request for approval of a new two Year Contract with brightbart health. Also, Marcus Judy Martin on the line. Ill just introduce it and turn it right over to Judith Martin who is the director of there she is. Substance abuse services. So, just to introduce it this is brightheart health and its upon your approval would be a new contract for dph under behave yearal Health Services in the amount of 232,960 which includes the contingency and that is a two 46 Year Contract and its a sole source contract. This one is a sole source 21. 5 which skates there isnt another provider similar to this and as dr. Martin explains this you will see why this one is a little bit different than a few dialed up and looked in google tele health, opportunities the same. Im going to turn it over. Thank you, michelle. I think this is an unusual contract because its a vendor. Its a telehealth vendor and we started talking about it last august when director coal fax invited us to meet with dr. Di vito from marin who had experience with this agency, with this vendor, telehealth vendor, brighthart health in helping with Behavioral Health services to extend the reach in marin county. Weve been working on San Francisco is a very compact county. We have seven methadone clinics and we have had since 2003 funded and now drug medical covers it and medical pays for it and its a pharmacy benefit. Many of our primary care programs and many of our regular out patients Substance Use programs and some of our residential programs all offer these services and yet, we have an overdose increase every year and so and so, where they provided medication at Harm Reduction sites in other words, theyre approaching people who do not perceived the need for treatment or do not feel they can access our treatment for whatever reason. If they have same day access at methadone clinics its still theres some people who dont reach and of course, those are the people who are highest risk for overdose and so, if someone comes to the Access Center and picking up needles because theyre planning to use heroine and how about morphine instead of heroine and evaluates them and sends them with a prescription to the pharmacy three blocks away. Its equipped to provide and observe dosing and do tox screens and has done this since 2003. Theyre very experienced clinicians in terms of providing medications as their treatment. We designed this use because they have started providing people morphine in response to the Opioid Epidemic and theyre unusual because they have worked with this state to under the spokesmodel that the state used their state of i remember response funds and when they first got them and they have been a hub and spoke to one of our San Francisco clinics and they also provide the Health Services to ucsf and since august, weve met with several and did surveys and met with several of our providers in the city of Harm Reduction and in particular glide and Harm Reduction Therapy Coalition and syringe access San Francisco aids foundation. Were interested in working with us and a lot of their services are located in the tenderloin which is one of the most highly impacted areas for Overdose Deaths and so, we asked them to ask brightheart health to do demos and talk to the Harm Reduction providers just to be sure it was a cultural match that brightheart Health Clinicians who well play a talk with someone who was anxious to get out of there and couldnt stand in line and couldnt fill out forms and maybe didnt have current medical and really didnt, wasnt there for the highest purpose of treatment was there because they were using drugs. And yet it was something they were willing to talk about. So this kind of very low threshold is what street medicine has been doing now for several years and it has been judged to be successful and so this is our way of expanding it. So, we didnt expect to start this in february and then in april and you know what happened. We brought it up because we thought it would help in the sick centers and the doctor wants to use it at the alternative care sites and expand hospital locations and step down from acute care for covid19. So thats what this is about. The structure of it is that Bright Heart Health would provide tablets that are key to them and in other words, they wouldnt be used for playing games or being on the internet, it would click open to their clinic there would put them in a waiting room until the doctor is ready and in the case, they would be interviewed immediately by a nurse and they would take down a lot of the information that is needed to make a decision about treatment. Even if the physician wasnt ready right away the person wouldnt have to wait and this is a response to testing theyve done in other sites and in california. They designed a whole model and had a whole program for low threshold. That is what were proposeing and were looking forward to having it. I apologize for jumping in. No, you are not. My questions or comments . Again, just stating one more time that its the financial and Planning Committee and will be taking action on this item today. Commissioner chow. Yes, there was only thank you dr. Martin for explaining how this works but then how does the recipient not and the tele health get the medicine . So theres several ways that that can happen. This is partly because this organization has response that can cover the medication. So, if the Behavioral Health pharmacy is open and has hours and near walking distance, which typically would be true for those organizations, then the person would be advised to go to the Behavior Health pharmacy and to get their medications and including motivational interviewing techniques and so on and so we would be able to decide and talk to a person about how long and help the clinician decide if they need it was a Street Medicine Program the pharmacy had found is many people didnt come in for a month after the prescription had been given and so it was stale and needed to be reassumed or refilled or reinitiated and the person sometimes came in in a different state of health and looked like they needed to be evaluated so the pharmacy in this case will have a tablet to talk to the heart great people and they can evaluate people on site at 1380 howard. They could call in a prescription and raise funds for it to be billion dollar to the grand they have at Bright Heart Health. Well see how many people go to wall greens and how many people go to Behavioral Health pharmacy. I asked, you led up with a various program that you had pointed out they would have to go to the pharmacy so i was thinking maybe you actually had a way on site and that avoids them going two or throw blocks or over to wall greens but its not true. You still have to go off site in order to get the medicine. Yeah, theres no way that we can figure out the dea would allow us to have a scheduled narcotic and theres no safe storage for medications. Ok. Because in they were trying to get a clinician to match without giving the drug, right, at the same time. And i guess that just isnt possible from what you are saying. So, the program say methadone clinic. They can dispense at the window so theyre a mini pharmacy for specific medications for methadone clinics. Is that what you were referring to . Thats what i was thinking if you were doing this, one of the barriers after the consultation district said whether its live or way way of the tablet is getting them to the next step and by these are difficult and its just another one of those, right, when you get and you convinced them and its just better or perhaps even more effective to be able to say and here it is. The only time it would happen for this effort is and that is why we have office space and they have been there and we snuck out so these are even lower threshold in the office space induction clinic and at hu looked at the experience and you were placed at an uptick that was worth doing this and in order, half the patients moved on and did get the medication or acceptance or higher and in carrying telemedicine for this type of a visits. These are some of the things were going to follow. The street medicine effort was studied and they found that they had treated about 400 people when it was studied and 140 of them were remaining in care in some forms. Thats pretty high. Yes. Very good. I hope our results will be just add good. It sounds like a good program to try. Thank you. Commissioner green. Yes, well, thank you for your presentation and its row marketable to recognize the potential of tele health in this area and i wonder if you would comment on a few things, theres a amazing article foray dex treatment and i dont know if you saw it but one of the pointed it made was entry into a program does not require an inperson visit as the First Encounter and you can also give pain for a month rather than a week. So there are things i would really love to know your vision. One is, do you that i that we have better entry points, this is one of the points in the Entry Barriers we talk about in what were doing and do you think that would lower a significant number beyond what weve just said about not having to be this person and this first go around and whether the ability to read the pharmacy is a big barrier when someone is in the program and also, they talk about the program where they use their mobile them for purpose and wondering how you rethink that whole program and in relationship to whats really becoming i think a much more accessible type of treatment and how we plan on capitalizing on the changes that legislation promoting telehealth have come along as a result of covid19. Snail of all of a sudden our heavy regulations went rational and so, counseling was banned and it was considered the height act with around inperson visit starting medication assisted treatment has a statement related to emergencies and so covid19 was an emergency and allowed initial contact to be by telephone so a lot of the providers from primary care taking advantage of that and using telephone visits to provide medication and this is what happened at the Containment Center as well and people were using opioids and prescribing it and then the containment nurses would pick it up and so, there have been a lot of Creative Things that happened with addressing that the Opioid Epidemic because the pandemic allowed people to declare it an emergency. Thats one of the things we need to look at and maybe collect actual data about to see how much advocacy we should do to keep that going after the emergency isnt an emergency anymore. Is that what you were asking . There was Great Potential here that you never had before. And you are way ahead to reach people and to treat them. Yes, thank you. Im also very impressed with what otap493 has done in the parking lot. I dont know if you heard about that. They have decided to use fresh air as much as they can because to reduce the traffic through their clinic as a way of keeping people safe and methadone maintenance was a initial visit that was not required and so, they came up with very Creative Things that they already had methadone vance in the bayview and they moved a van into the parking lot outside of clinic and the csfg and moved a lot of their stable patients to go to the van. They didnt even have come in the clinic and there was a tents which now i think theyre using a container and one of those modified containers to be the councilor. They have ordered telephone booths with glass doors where theyre installing tablets for Video Conferencing with their councillors so people who walk in can now have tele health which was not so possible. Thank you dr. Martin and commissioner green. Commissioner chung. Im sorry, you are muted, commissioner. I echo the innovation of this program. There are a few things im curious about also. One is you know, im assuming that these tele Health Consultations done in soundproof rooms . The booths are described are soundproof. But the Harm Reduction though therapy is not soundproof but the clinics have chosen spaces where theres a small room where the person can go. Theyre trying to i mean, were allowed, because of the emergency, were allowed to use telephone and tele health and get verbal consent on the phone to explain that this might not be completely meet the standards of complete privacy because were here on the street or in a van but as much as possible, people will be they have a place for the Nurse Practitioner which is pretty private. Thank you, i think theyre clearly important because a couple of things that i could think about immediately is the privacy and also the stigma around being engage in this kind of Behavioral Health services and though like ownership treatment. So i think that you know, San Francisco has always been very owe have a tive and as a and my followup question, does bright heart also prescribe naloxone to these patients if they are do they need to ask for it . They have to the rules like the rest of us to do when you prescribe a ownership and i think its unlikely they would have to do it because Harm Reduction sites are offering naloxone and in fact, that might be why the person was contacted and you need naloxone by the way would you like some. Naloxone provision also happens at the pharmacies. The pharmacies so theyll be multiple chances for the person to get naloxone. And im really impressed and all this innovative searches that were doing to lower the barriers for access, you know, to this much needed services so, thank you so much. And i look forward to hearing what the outcomes are like. Good, thank you. Thank you, commissioner chung. Commissioners, any other questions . Thank you, dr. Martin. Thank you ms. Ruggles. Commissioner green used the word present. I would have to go with her the timing is fortuitous and this is, as you mentioned in your summary, preserved Staff Resources and limits the opportunity for exposure to covid and im hope be suggest cease for this program and it made be a model for the nation and providing these Critical Services in the future. And i support it. Thank you, commissioner. Thank you. Since we have no other questions or comments from commissioners, do we have a motion to approve . So moved. Second. I will do roll call. [ roll call vote ] all right. Move to the next item, commissioners. Item 9 is the sfz medical staff bylaws and medical staff rules and regulations and just to note the zsfg joins the recommended approval of this document at its meeting last week after a thorough discussion and review. Thank you, mark. Lisa is here to present. You are muted. Thank you. Thank you for the opportunity to present the bylaws and rules and regulations today. I believe a written copy was submitted that includes the major changes and as was mentioned, we did have a indepth and at the jcc on jul july 28th, and people might have questions about any of the changes or updates. Public comment on this item, commissioners. Commissioners, do we have any questions . I would really like to know the chair of the zsfg on i dont know conference that within that discussion we did say that there were still considerations theyre not going to await just another one or two year they hae discussion and recommended that the commission accepted it at this point and met be back and im absolutely correct. Thank you, commissioner chow. Public comment. Thank you. Any other questions from commissioners or comments . Seeing none. We can entertain a motion to approve. Move to approve. Second. All right, roll call vote. [ roll call vote vote ] thank you dr. Winston. Thank you dr. Winston. Item 10 is the 2006 publichealth and safety bond update and weve got mark mark o and harry salas. Can you see us . Yes, we k. Ok. Good afternoon, commissioners, dr. Cofax and my name is mark and advise tore the directors office. Well not go through every slide in the interest of time but i dont want to say as of a couple of hours ago, the city and the Negotiation Team just agreed to all the terms and conditions and closed escrow which means we can sign on wednesday or thursday for 99 years and ensure that the Research Building gets built. I want to thank the city team and the Real Estate Department and City Attorneys Office and the ucsf side and their Legal Council office of the president and then the real estate chain as well. This is. 2012 and the second flor in city hall as a discussion and exploration of whether it can be done and it took a while to get this point. The exciting thing the is the building can serve when im in august and then moving in the first or Second Quarter of 2023. Um, in this program of the 2006, we are gearing up to be the last sale of 174 million sometime this november and that will complete the entire funding that is in the 2016 bond. I will just go to slide six which is a little bit more detailed view of the zuckerberg piece which is 222 million. If you noticed, weve added a second column across to the right from the budgeted and its called other funds sources and although, we have not identified any particular sums right now because were working closely with the general foundation and Capital Campaign is underway and well start it as soon as we start seeing commitments come in and supplement with the bond funding and then the other column is pretty much what you are seeing before except now we track the actual money that is spent and in one column and we look at what is inkum berdych for various reasons. We want to make sure were spending actual spending money at a pace that the Controllers Office and we want to see and in slide seven, its identical slide that you saw previously and the other Funding Sources here we start to see supplemental Funding Sources that will come and sustain and the Mayors Office and at the state level and now we start incorporating that into various categories whether construction or project control and were taking advantage of other Funding Sources and not just the sorry obligation model and then the next slide, well jump to slide 18 because i want to show you what weve identified as optical Funding Services and so its from a to i and these are things that we know now and it doesnt mean that this will be the complete list and these are some of the targets that ill go to slide 15 and ill turn it over the director for zuckerberg office. This is what weve been doing accepting document and get the design and team and ready to go on the roadway and as i said, well close on wednesday or thursday and theyll Start Construction and that roadway south and of the hospital in august and a couple of years later they get them into first and Second Quarter of 2023. At this time, im going to turn it over to jerry and. Our contractor has been awarded with eight projects under the belt and so we passed this this proposal and issued it to builders and right now theyre in a phase when theyre reviewing the packages for awards to the trade and hopefully it will be starting construction in early 2021 on those projects. For projects we have going on, we have our seismic retro fit phase 1 which is completed. That did a lot of work to strengthen the building as far as the stoke which was the south side of the building we the fiber wrap and we had concrete columns to strengthen them and also did some strategic to reach the structure and the next activity that the panel will be doing will be validating the sequencing and instruct ability of the proposed work completes too. Our 6h Office Search space is 90 complete and they should be completed by the end of the year in 2020. First, open Office Work Plan that is kind of a wrong time to come out with an open Office Work Plan because it will open area and so were addressing the social distancing issues in this plan by changing some of the higher transitions and afford more social distancing so its interesting to see how it will come out. We have a project coming along and construction continues and walls are in place and we have multiple issues on the project and covid19 is one of the impacts with resources and actually permanent delays and were looking forward to the construction to continue and with a completion in 2020. A family Health Center has been designed and and were looking forward 100 normal reestimate the project and do some reconciliation and our specialty project out of the relocated building 5 is in a design phase and its completed 100 weve done the programming and weve got issued 100 snag design and its reestimated and well be doing some budget wreck salati n and to the inventory chair bold for Health Centers and the Health Center and and the improvements happening there and the structural permits are actually this month and the mission Health Center receives plan approval back in 2019 and the instructions are supposed to start by the end of the year. We were able to secure a has ar Mitigation Grant to support this project as well. And then the south east Health Center project approval and plan approval and construction contract was awarded and it started and right now theyre doing site work and site gradi grading. That completes the 812 as far as had are impacts with all the projects and those surrounded are they involve the supply chain and contractors interpretation of the Health Orders and clarifications basically communication and we seen the impacts to labor and were contractors will not come to this price. Project approvals are hard to get when some of the offers have shut down. The amount of work happening from the homes so that proper design process is impacted because of the work from home. And then we also have campus restrictions which it hard to get around campus and then, it requires social distancing and theres an impact. Were basically evaluating these items and well be available for that at a later date and total impact on these covid related issues. That completes the accomplishments and the inaudible . Are there any questions that we can address . Mark, do we have any Public Comment . We have Public Comment. Commissioners, any questions . I would if it would be can i interrupt you. For anyone else who is not speaking please put it on mute. Mark, you lets go. My question is really mostly on your timing. Understanding all the issues that were facing whether at the next Quarterly Report is what you are intent is in terms of telling us what your making these and what is a dollar consequence of the delays. Terry has been modest. I have been dispatched over here for to help out with various things of from the testing sites to the food activation and to the general foundation to help the doctors and the nurses who are working so hard with this chair and i have been able to