Here i have the privilege of chairing the meeting and secretary morewitz will you take the roll . Hi. Call the roll commissioner green. Here. Commissioner chow. Present. Commissioner chung. Present. Commissioner guillermo. Front. Commissioner giraudo. Present. Dimiss anyone . Im sorry. Me. Right. Commissioner. All right. Thank you. I have a script to read. You need a mask. Do you have a mask . Welcome to the november first, San FranciscoHealth Commission meeting in hybrid in person and broadcast live on sfgovtv via web ex or listen by calling. The access code is on the good afternoon remind you present approximate attending in person today that all safety protocols adhered to. This includes wearing a mask. Covering mouth and nose any time you may speak. Adhere to the rules approval from the removal of the room. We appreciate your cooperation with the rules and requirements in the interest of everyones health and safety. Note that hand sanitize are stations at the upon entrance of the room. We welcome will participation during Public Comment. There will be an opportunity for general Public Comment in the begin and an opportunity to comment on each action item on the agenda. Each comment limited to 3 minutes. Public comment in person and through call in. The commission will take it first from here in person and then people attending remote. Those in person requested to submit a card to the Commission Secretary and remote on page 4 of the meeting agenda. City policies with state and local law present discriminatory against employees and others. Will not be tolerated. Comment on the jurisdiction of the Health Commission. Folks on the line those of you who wish to make Public Comment i urge to you raise your hand by pressing story 3 to make sure you get your hand up in time in case have you a delay on your end. Press star 3 the begin if you go intend to comment. Thank you for joining us be patients we learn and grow with our hybrid systems. I have the privilege of reading the land ocknowledgement. The Health Commission acknowledged we are on the unceded home land of the recommend ram the africanamerican inhabitants. As the indigenous stewards with translations the recommend ram never ceded, lost or forgotten their responsibilities as care takers as well as all people who reside in their traditional territory. As guests we rescue noise we benefit from live and working on their Traditional Home land we pay respects acknowledging then cest tors of the Ramaytush Ohlone community and affirming their rights as first people. November is american inldzian and alaska native heritage month. It is time to celebrate and acknowledge the rich culture, tradition and histories in addition to the important contributions of native people temperature is an opportunity to educate the general public about the challenges native people faced and the ways which the communities worked address these challenges. This year the Health Commission ash rude 2201 addressing health of local American Indian communities written with local American Indian lead and acknowledge the experience by the communities. Resolution directs the department of Public Health and the communities to identify recommendations to address this. And honor and privilege to acknowledge this month on the first day of november. So. The next item is the approval of the minutes of the meeting of october 18, 2022. Are there additions or corrections to the minutes . I like to add a note on the minutes under the closed session there was a member of the public had questioned the electric of Public Comment taken on your actions regarding disclosing or not. I wanted let you know i checked with the City Attorneys Office they confirmd that the practice of not take Public Comment on that portion of closed session is alined with law and practice of other commissions and noting that the closed session has several portions and will take comment at the beginning. It is one item. I want to close this loop for to you know i checked and the process we are currently enacting can appropriate. Thank you very much. Secretary morewitz. Are there corrections to the minutes . Okay. Is there a motion to approve. I move. Second. I will check to see if well is public upon comment. Folks on the line we are on item twot approval of the Minutes Press story 3 if you like to make comment on this item. Okay. No Public Comment i will do a vote. Commissioner guillermo. Yes. Commissioner chung. Yes. Commissioner green. Yes. Commissioner chow. Yes. Commissioner giraudo. Yes. Minutes are passed. Thank you. The next item is the directors report. Good afternoon. Commissioners director of health with the report i will summarize items and happy to answer questions from the commissioners. First item is San Francisco ended Public Health emergency to mpx on october 31st. The case slowed less then and there a case per day and 27,000 people are vaccinated. The Community Support for Critical Resources such as vaccines coupled with early action drove San Francisco to successful response and enabled to reach this mile stone. San francisco proactive about health and protect themselves and others. [inaudible] 3 months of the declaration it is important to that mpx is circumstantial lit nothing communities and is a concern. Work must continue. D ph will focus Public Health resource where is they can be effective and address health despashities in communities. Vigilent in responds to out breaks, monitoring trends and keeping the community inform when new issues arise. Health systems and clinics cites will offer vaccines, tests and other resources. Also encourages people to be proactive about screenings other infections can present similarly and require medical care. New tools to prevent disease should be considered when promote. A trial conducted by d ph at city clinic and ucsf and d ph the Health Program and the university of washington found this a single dose taken within 72 hours after sex reduce infections. It is the first prevention drug effective in to the rited reduce infections. Promise to decrease rates of syfilous in San Francisco the highest in the country. Syfilous is the sti the highest potential for severe disease the eyes and nervous system. New guidance to be used among men and trance women when had an sti in the past year and oral sexual contact with one male or transfemale partner. Anyone with a history of syfilous receive it. They will support and participate in research hapromotes the health of the communities we serve. You will seat links to information. I wantedd this is an example of Research Done within the department with Academic Centers ucsf and university of washington take the findings and with a positive result. W to implement the findings in the field as quickly as possible and scaling up operations to meet the needs of our community. Next is the china town Child Development center. We cell brits the 50th anniversary. A Health Clinic in china town. Center served needs of children throughout china town since 1972. D ph established it to serve children, youth and families providing Mental HealthServices Accessible and culturally appropriate. Ccdc integrates a Behavioral Health model for all eligible focus asianamerican communities. Provides by a team of providers. Dc also works with Community Members throughout the parents to address the stigma and associated with accessing health service. Through educational learner train and robust language services, ccdc credits a supportive environment to over come these challenges. Next is code lavender launches. [inaudible] in the sfgh foundation. Code lavender a crisis tool Health Care Workers can now call when incidents impact staff wellness occur. When staff called a code lavender a Team Responding with a stress diffusing mech niche. Wellness and next steps. It is piloting expanded hours in the emergency department. Next is with regard to uniting for u Grain Program the Community Health and prosecute motion newcomers Health Program. San francisco Tb Prevention Program and the Sf Health Network are collaborate to welcome and support ukrainian in san pran when fled due to the war. Many are joining sponsors to say in the u. S. Temporarily under the program enentitles them to employment and medical conferage after leaving their home. Since the u noticed for Ukraine Program start in the april. The team supported ukrainians from ages 4 months to 86 years of age. They are a collective effort and shout out to the staff for welcome and patient centered care y. There are additional announcements Training Opportunity in the directors report and i will go on to the am covid update with if they could come up on the screen. Commissioners you see here that in terms of our cases per 100,000 in San Francisco this is the larger it graph on the slide. We continue to plateau in terms of cases very much reflecting the u. S. Trendses shown in the insert. Next slide. And in terms of hospitalizations our hospitalizations have been stable over the last few weeks. Were averaging between approximately 40 and 50 people in the hospital with covid. Once again these are people who may be hospitalized do you to covid. Or 19 hospitalized for other conditions and have covid on admission this includes oust countef transfer residents you see that our Health Care System in terms of firefighter acute care remains robust. In terms of vaccines you see on this slide we continue to have high rates of over all vaccineful coverage in the city 0 to 4 year olds are less vaccinated compared to other groups a third of the age received a dose in a fifth an initial series this is higher than the National Rate and the same time it lower than we would like to see in terms of adequately covering that group. And then we have an mpx slide this is look at cases per day and case reenforce the fact we are very low numbers over case per day and you see case over time have levels off. Next slide. And with less than one new mpx case per day, we have ended the Public Health emergency. Sf covid rates are stable and Hospital Capacity is adequate. Booster dose added to sfgov. Org dash board in the next week we will have updates on the. Biveilant roll out. We do believe that increasing this full and winter lead to increased covid cases and encourage people to be prepared. Using the steps in the bullets on the slide. And we are working with the state to coordinate for the end of the california state of emergency which the governor announced in official 23. And i believe this is my left slide. Happy to take questions. Thank you. Thank you for the report and the progress we see in so many areas. Is there any Public Comment . I will check. Item athlete directors report if you like to comment about anything in the report do so by pressing star 3 to raise your hand. I see no hands wrochl commissioner questions or comments . I see a hand . Yes. I got it working. So. Director colfact im please period you [inaudible] the [inaudible] Child Development center it is an excellent [inaudible] the forefront of continuing to bring Mental Health to our children but to all our population. I know that the area and [inaudible] or a significant amount of [inaudible] may not feel enough. I wonder as you are talking about them moving into the china town Public Health center. Glad to see we are work on that. Im wondering if there is enough room that were not shorting them [inaudible]. Thank you, commissioner chow. Just with regard to the question administered by the team at ccdc that the renovated center can, comidate the ccdc alcohol be located on the third floor of the c ph c. Okay. Thank you. And appreciate this report. [inaudible] china town and [inaudible] of the choina town Public Health center. Thank you. Any other commissioner questions or comments . Okay. Thank you. And seeing none the next item is general Public Comment if you like to comment about manage not on the agenda of anything that is not on the agenda. Press story 3 if you are interested in making general Public Comment. We will wit a few seconds. I see no hands. Commissioners. All right. Then upon the next is the fiscal year 202122 Fourth QuarterFinancial Report. D ph chief Financial Officer. I will be sharing my screen. Good evenings. Throughout chair jenny Financial Officer for department of public healing im pleased report the Fourth QuarterFinancial Report for the year this close in the june of 22. This is the spoil spoiler alert the Fourth Quarter financials the final balance after the routine beens we do at the Controllers Office there is significant variances of the close of the fiscal yeesh. The positive balance of projecting in this and all other quarter low reports required off set the fund deficit. I note we had above budget ref now from one time and temporary source. The Controllers Office made a one time adjustment of 18. 7 million to repay a prior with drawl. This is was of something that addresses with drawl from several years agos. And was directed by the Controllers Office and City Attorney top do. Operating funds does not include any of the covid19 expensep spngs project. It is reported separately. Controllers office does make a 9. 8 Million Dollars transfer to address the short fall in q3 this is similar to what the Controllers Office done for part of of all city departments and Covid Response. Genetics big picture bottom line when we see over all is we will ends the year with 129 Million Dollars surplus in ref now and detail out what is driving some of this increase. It it is unusual amount off set in addition we have 13 penalty 4 million of savings and those 2 combined result in 142 million over ending fund billions of commissioners know we have a management reserve. We made 9. 2 million a deposit in previous quarter and it is update to the 2224 budget we increase the cap on the reserve and allows you to make 10. 6 million. Department expects ending balance positive of 122 million. I will note i had questions about 13 penalty 4 million savings. It it is a large amount of money. I will note that percentage wise when you electric at offering budget of 2 billion, 245 million. It reports. 6 . Of our operating budget over all. In terms of upon variance from a percentage wise, it is in the as significant but we recognize there is 13 penalty 4 million unupon spent dollars in our budget. Commissioners sought slide in the Third Quarter the numbers again is our estimate as we look at some of the formula changes that happened overnight last year. Not to support public healing system. Estimate about 94 million of the 1 twine million is related to the policy changes. Should take the numbers grain of salt a lot are formula rate changes. Layered upon volume change this is is an analysis i had the team do to give a sense of what is the main one time drivers of the revenue. Sorry. The new item that we did not see in the prior year was 4. 9 million, funsd by the federal government part of the american recovery act. And used to support Public Hospital systems in the efforts to address the covid19 pandemic. Commissioners remember prior we received 23 million over all from multiple phases of the revenue starting in 2020. And we released received a final dispursement of 4. 9 million in the current year. We expect that this will be the left disbursement of relief funds from the government. In addition to the net increase approximate following the submission of the prf claims reports for the 21 ref now prior fiscal year close the trf revenues were realign in the our budget to match claiming suck mission. Revenues work the city received the dollars in advance of submission of i claim. We made our best guess where to budget them and rescue noise them. But once we got the final