Transcripts For SFGTV Health Commission 81616 20160820 : vim

Breslin karshmer, present. Before we go on to the meeting itself id like to welcome our new commissioner commissioner jimmy royce. He is no stranger to the this department having worked here a full 20 years before retiring as Deputy Director back in 2007. We are happy to welcome him back and to assist us in developing the policy for the department that he worked for. So, welcome on board commissioner. Think you commissioner kalb next item please yes. Item 2 is the approval of the minutes of Mission Meeting of august 2, 2016 the minutes are before you for approval. Is there a motion for acceptance . Moved and seconded. Other corrections or additions to the minutes . If not we are prepared for the boat. All those in favor say, aye [chorus of ayes] opposed . The minutes have been approved item 3, directors report good afternoon commissioners and welcome to make commissioner royce. I wanted to just get a couple eight could i do about items on the agenda on the report in your welcome to ask any questions. One in particular with the health apartment investigating eight bible incident that second 19 people. Was candy that was at a Mission District on august 6 and was suspected and we believe to to be edible marijuana that [inaudible] found thc. The main psychoactive ingredient in marijuana in addition the lab work for 12 hospitalized patients was tested positive for thc. The most recent part of this was all of the 19 patients that were impacted by taking to the hospital on saturday, august 6 and were discharged by the following monday. But many of them were male, nine were female 13 of the patients were 18 or younger. The San Francisco office of California Poison Control Center has been working closely with hospital reading these patients were treated patients collected information on Patient Laboratory results. I do want to say the San Francisco Police Department is also conducting an investigation. Our Health Officer is here if theres questions but luckily, all of the patients were discharged and this ongoing investigation. A quick update on 12 San Francisco residence of those impossible for zika residence as august 12 contacted the patient will traveling in countries with zika viruses circulating. Theres no risk to the public and zika is not circulating in this area with al lawyer incompetent the department of Public Health informed the San Francisco of the bombing of positive test results in the council california continues to update public weekly tally of the numbers of cases by county and provide pregnancy information can as you might have seen in the paper recently, the entire area when rico is right now impacted by the zika virus. So, we keep our eyes on this. We know that mosquitoes are not as prevalent in San Francisco but we have this year added another Vector Control personnel to make sure that people know how to manage mosquitoes in the San Francisco entered so people get concerned about mosquitoes and wicked i know we have a long agenda tonight and if theres any questions on here im just wondering if dr. Aragon wants to give us an update on thisthe edible marijuana . Good afternoon. So, around 930 on saturday evening this was i believe august 6, at a teasing you in the Mission District several children became ill. 19 people were hospitalized. 13 of them were actually minors. Fortunately, for us, the people the patients were covered relatively quickly and what we do know is that they consumed a gummy ring that contained cannabis. So, we were able to identify both through the urine toxicology screen in the hospital. Were positive for thc. We were also able to identify in the gummy rings was also positive for thc. We were able to trace back and identify how that made it to thebecause of the Police Investigation were not saying anything else because there are are still questioning people to figure out exactly what happened. I got involved on the next day which was sunday, and we made sure that what occurred there and what occurred that night would not happen again. Of course, arrest witnesses are concerned we have around cannabis edibles becoming available to children and we know that around the world theres actually products actually treated in a way that are theres cookies and brownies and candy, so theyre attracted to children get in San Francisco, any edibles they have to be packaged in that hope a package that is not look at all like candy. The other thing thats happening in San Francisco do we do have a task force thats been working on preparing if the proposition passes to legalize recreational use, that we arethese are the kinds of issues that are going to be addressed to make sure that, if cannabis is legalized, that we ensure product safety. In the experience of other states that have legalized marijuana, has there been such incidences . There has. So colorado come i think has captured most of the experience around children eating edibles. Fortunately, adverse outcomes like death is very very rare. So, these when these patients become sick they require Supportive Care in a healthcare facility. But, it isyes, this has been an issue. I believe, probably this maybe actually the biggest outbreak that we know of involving that number of people could 19 people want on is pretty big. Actually can i want to give a big shout out to the ucsf Poison Control Center. They were phenomenal. Theyve been really helpful in these types of events in the collaboration with ucsf and us and our being there at the zuckerberg San Francisco General Hospital and then join following up on the test results they were really good. They have fellows following up to make on the clinical outcomes of the patient as well as the toxicology results and then their lab was involved in actually the testing of the gummy rings. I just want to say they were very good. If i may, our team internally in the Department Works really i think really well together and also informed the family, informed the family members, so i think another test to our Emergency Response could i think we did the job of making sure the public understood but more poorly the people that attended theas you know kids will take that kind of candy and take it home so we really did work closely with the families that commissioner singer i had a question relates not to the issue of cannabis into candy, but more our response as a city and what observations that we had and learnings we had in this incident and in particular, the question it seems to me that like with infections in these outbreaks, the issue of when like a seminal event is like a normal course event in an er and when someone in an er or Doctors Office across, there could be more of this and this is so nonstandard that i need to notify someone in Public Health so that someone here can say, oh god i got for calls from four different institutions. How fast, how did that work in this situation and how satisfied are you with that we have god, those notes out there sniffing if you will . So, for my perspective this is interesting for my perspective oftentimes we learn about outbreaks they often are associated with for example a restaurant were usually clinical site thats being in the case we hear. In this one it was really the ems system been alerted from the ems perspective they called a mass casual incident because they had several people that one time need to be transported to multiple hospitals. At the moment that we hear about Something Like this, is that we can consider it an outbreak because its more of aits more pieces of the sewing somewhat unusual than for a place and time. An at that moment, we think about how to find out the source. Is this a type of the iceberg . Are there more cases . If there circulated product out there that me getting more people becoming ill . If we go downwe dont know what happen we go down that route which is really an outraged investigation should its about mobilizing a team of investigators to help through that investigation. We are reallywe were very fortunate that we were able to figure this out relatively quickly, especially when the urine toxicology screen cannot positive we are able to identify the candidate able to trace back how it got in there. So, i was, by sunday afternoon, we felt very confident that we figured out what happened and it was did not spread further. But those are sort of the two different paths that things can happen. We just had a deep reef yesterday just reviewing everything because it involved us, the hospital, environmental hazmat was initially called out, so it involved a lot of different agencies and the Police Became involved as well. Fax. Any further questions at this point either to dr. Airey on what to the director on her report . If not, thank you. And i think that you are commendation to the Poison Control Center shows a number of years ago we talked about whether or not we were able to continue to be able to fund or have a Poison Control Center did i think this is just another very fine example of why its really important for a major city to have one. Thank you. Thank you. Next item commissioners yes next item please item for general public, good about received any request. I think we have one. Okay. Commissioners my name is double i usually tend up for one Second Opportunity minutes on the clock for you. Mr. Duffy, correct . Okay, 3 min. Hon. Dr. Chow. An honorable 10 sanchez and commissioners i normally can attend because i go to the board but on vacation for the month oh here it is august. I am on the tom odell advisory board. Press sometime we can do a more formal presentation because theres a lot of work and on Patient Advisory councils as part of the medical and Affordable Care act. Theres been a quite a bit of energy put into it and am pleased because were getting all of our support that weve got in recent years. A few years ago we got eight kind of an administrative hub because the Center Directors were eliminated in 2003. The minister backfilled at and we are getting a brand within a meet the new one. This is our second one, now. But enemy dumb on thursday. The kind of things that we can provide input on, the patient dr. Interface and the Human Factors being, is smooth. Those are the kinds of things that position can help with. A lot. I am very interested in the prime campaign and see what score to come out with that and how medical is can be optimized. Mr. Kaczynski here, also down because of interested in seeing how for example the hakim is going to fit in. I know they have a clinic and theres been some talk that the hot clinic by combined with that, without urban healthcare urgent care clinic downstairs. I dont know what happened with that. So im kind of interested in that as well. About two years ago there was a retreat and it turns out that your commission at a retreat. It turns out because of the open meeting laws of the public had to be invited. So, i happenedi happen to be there. Thats how i got. I noticed the meeting here i thought ill go to the meeting and, im not the fastest person to catch up on things and think about things. A delayed reaction sometimes and it was a lot of talk. Someone came and presented on the it situation. The servers and the whether it should be an email servers and all the upgrades were going on. He mentioned how things were in a bit of this array any mention theres even a server sitting on a desk in an office somewhere. As if that was a negative thing and i just thought about it a long time and kind of the thing i do is look at things that other people miss. It seems to me that we cant rebuild or renew our it infrastructure every single 23, four yet it is got to be a work in progress. In fact the fact there is a server sitting somewhere unused is actually a sign that were not heard back of transition which the technology were always going to be a proactive transition. Thats the ideal state it is the ideal state we can be in. Something i noticed retreat to years ago i thought i might mention two years late. They do. Thank you. Item 5 is the report that from the community and Public Health Committee Meeting from this afternoon. Who is presenting that . I have that. Commissioner pating were honored at the community and Population Health subcommittee. To have our new commissioner dr. Jimmy royce join us and commissioner chung. We are to reports. One from ms. Mary ann zell was the director of the maternal child and adolescent health division. The maternal and Child Adolescent Health division has 25,000 individual clients under care of which 82 are under medical. We reviewed the metrics for this division. Two of the tumor metrics id like to share with you were the desire to increase prenatal home visits and the desire to increase Fluoride Varnish so the department has set as its true north quality metric increasing home visits for families and mothers that are at risk for preterm or had preterm labors. This would be include africanamerican women, the first term pregnancies and particularly, those that made would be living in Public Housing and at risk for preterm labor. The department outlines three approaches that theyre using good one is visiting nurse family partnerships with user nursing thats pacific we work with highrisk moms to both before and during and after the pregnancy. Theres also a field Public Health Nursing Program and finally, a specific spell out program and were pleased to see the breath of these services as well as the focus that these National Best practice models of care brought to their disparate populations in africanamerican and latino communities. Also, we heard at this commission around Fluoride Varnish. This was elected again as another true north metric. Currently, 30 of 35yearolds of color have cavities which cavities ung youth set you up for poor dentures as adult. The department has achieved 80 of kids receiving Fluoride Varnish and so theyre making Good Progress on Fluoride Varnish. So we are going to be hearing from the Maternal Child Adolescent Health division quite broadly. We think tumor metrics which would been reviewing with that the subcommittee level and at this Commission Level, were enlightened with the departments goals and so we supported them in their efforts for these two initiatives. The second thing we heard was the rivera talked about the move from the San Francisco Health Improvement assessment which we heard two sessions ago to the development of the San Francisco Health Improvement plan. We talked about the three things that made the planned war that will tentativelywe discussed and presented to us in the plan in the following month in the fall. Im not going to go into two great detail but access to care which includes oral health, and decreasing hospitalizations for chronic diseases, Healthy Eating and physical activity which will be measured by making sure that there is food adequacy during pregnancy. Food adequacy for seniors that are on Home Deliveries and exercise and fitness programs for six and seventh graders and Behavioral Health treatment be adequate. These will be things that we emphasized in the upcoming Health Improvement plan but again this is the first draft. We were just raising questions to be able to help them focus the report. What we liked about this and what we will hope the commission will focus on is particular emphasis on disparities and inequities in the plan. This is a new approach to the Community Health planning that we did not have before. Before we look at citywide metrics for example for dental care, for return labor. And at this point what we are looking at is more of the inequities and moving in those subpopulations with regards to access, eating and physical activity and Behavioral Health. So, that ends my report and if you make questions of the glad to answer them. Questions commissioners . My only one was you mentioned that they were now at an 80 fluoride rate . I mean, thats fairly high from where it was before could probably talk about just the people that Maternal Health is taking care of or were talking about the whole city . Is mishandled here . Note . I can follow up on that commissioners and get that answer yesterday when you clarify with the 80 . The matrix we were trying to reach was to move from 73 of identified children to 78 of identified children needing fluoride treatment and the