>> >> welcome to the city and county of san francisco health commission meeting this afternoon at 4:00 pm., tuesday, february 20, 2024. we're dlgd too, so many people here and start by calling roll. >> dmurng present. >> xhishlg present. >> commissioner giraudo present. >> commissioner chow present. >> commissioner chow will read the land the land unceded ancestral homeland of the ramaytush (rah-my-toosh) ohlone (o-lon-ee) who are the original inhabitants of the san francisco peninsula. responsibilities as the caretakers of this place, as well as for all peoples who reside in their traditional territory.

elders, and relatives of the ramaytush ohlone community and by affirming their sovereign rights as first peoples. >> thank you commissioner chow next >> 2. approval of the minutes of the health commission community and public health committee meeting of december 19, 2023, meeting. any corrections or additions to the minutes hearing none, motion to approve. >> i move to approve. >> my public comment on the minutes. >> anyone in the room.

>> i'll check to see if any handles are up great no hands so i will roll call. >> commissioner chow i didn't see. >> commissioner giraudo, yes. >> vice president guillermo, yes. >> commissioner christian and president green. >> and statement before we begin to take general public comment. >> i'm to remind folks starting on january 16th remote public comment can only be permission for given if folks contact we by on a the day before two folks have permission. and here is um, a little script on general public

agenda. with respect to agenda items, your opportunity to address the commission will be afforded when the item is reached in the meeting. reached in the meeting. commission from taking action or discussing any item not appearing on the posted agenda, including those items raised at public comment. where you know maybe sent to the e-mail the word commission dph at.org and on the website if you wish to special your name in the minutes do so in general public comment and the city policies - and . >> thank you and we do receive appreciate where you know written communications it is for items phone number not on today's agenda any public

comment in the room? yes. >> good afternoon health commission i'm christopher and i've spoken and want to provide background and i have over 25 years of investigative experience working with high tech crimes and both with the state and federal level and with the federally-funded programs and task force outside of bayview and with the department of justice to and using a i and policies to benefit the technology and i handed off to the secretary in san francisco and not say part of my public comment and controlled clarified information. this infrastructure

cybersecurity and compliance. this is the number one issue right now in san francisco and too many credentials were giving out i submitted this to the board of supervisors and with the terminal and provided insight to the sheriff issue and the corin woods and among i apologize to dr. colfax for not getting this statement to him a timely manner and we see increased violence in san francisco i urge you to work with dr. colfax and the leadership at h s f. thank you. >> thank you. >> anyone else in the room like to make a public comment? all right. one hand up online and please unmute the caller.

>> thank you. >> what about the agenda number 2 on the meeting minutes from january you stick that agenda item i want to speak on it. >> so no hands were up? general public comment you're welcome to make the public comment right now use your time. >> okay. so i'm not hearing to please mute the caller. >> office of the inspector general so that's the only public comment. >> thank you. >> next item on the agenda is an honoring and the director for laguna honda to present the resolution. >> afternoon commissioners.

>> oh, please continue mr. picking i think so. thank you. mash. >> good afternoon, commissioners it is my pleasure to say a few words about anyone has been a colleague and friend and as i deliver those words i'd like to take a trip back on a time in 1991. at that point i just couple of 10 years work for san francisco general for uscf holly hammer worked at san francisco general hospital and i came on board as an employee and spoke to you for the primary

care and medical specialities and other things and at san francisco general. and holly and i working closely and in 1991 preying for challenges and some of those include the free work and healthy to and was a technical part in design and implementation. and the airline crash in san francisco general response to that holly was a part of that and the court covid pandemic and holly was there right there and recently laguna honda had a presentation and she was called on for our staff and herself to lend assistance not one significant inlt that

happened in the network for san francisco general or dph where we have been apart i've been dreading this day for several years and - experiences and good fellowship for those many years and as i'm leased back to introduce the resolution i like to give a few words that summarize i think hypothetically assistance within the network and dph and in the words from the authors and who were prolific writers of the day and by the group boys to men and hard to say goodbye to yesterday

i'll par frays i say goodbye the good times that made us laughter outweigh the bad i'll take with me the memories like sunshine after the rain it is hard to say george washington to yesterday goodbye and mr. hammer please come up for our day of glory. i'll read first is that okay? >> wars she's served the department of health. and whereas, dr. hammer began as a residents in the hospital and on leadership positions and most as

is ambulatory care. and whereas, dr. hammer was a key informant of 2012 readiness act by the city and county of san francisco department of health and kroirmdz that led to the san francisco health network as a single deliver and best structure to meet the demand and early work evolved of the networks operational improvements and dr. hammer is overseeing renovations of dph clinics and southeast and the castro and have led to the accessibility and a wider scheme of services for speciality and during covid dr. hammer set up the care for ambulatory care for

vaccinations and testing in the community and shifting the clinical approach to meet covid for alcohol entertainment and brown dr. hammer has provided primary care for all san franciscans will be missed by her patients. and whereas, dr. hammer has been a colleague and public health leader and thought fullness and integrated care and childhood and other behavorial health and san francisco health commission honors her for her it's been a long time coming. leadership and wishes her well in their combraerz and holly will give a little -

>> who gets the honor to move this resolution? >> okay. >> so moved. >> laughter. >> (multiple voices.) >> so moved. >> yes. >> let's first quickly check any public comment in the room? >> anything online i see no public comment. >> so i guess we have a motion and second. >> so commissioner comments start with the end and work our way down. >> commissioner chung. >> i don't know where to begin i them like i'm so old and quickly how long i've known you it's been inspiring and i'm glad to have an ally like you to be

there for us and like also help developing some um, hopefully confident services we're seeing today so. thank you very much. and enjoy you're well dlefrsz retirement. >> i've not had a much of a chance to work with you but worked with the team and extraordinary very inspirational with the behavorial health and both from my specialized interest and been amazing. >> continue to grow across the years and it is will continue to grow because of the foundation you built and done along the way i wish you the the best and hope

you're able to enjoy you're free time again and thank you for being here for what you've done for the city. >> when i came on commissioner breslin a couple of memos before we shut down for covid i was a very green commissioner and i asked you multiply questions about that clinics, etc. and you were so helpful in educating me and inviting me down back to balboa to meet with you and shut down. so but your education, your help and your finding of how to really educate a new commissioners has that many, many thanks i appreciated your

help and your expertise. in all you've done for the city and county of san francisco residents in particularly in my area you made a difference. and what you have done and really opened the doors for lots of kids so i thank you. and also wish you well in your next chapter. >> vice president guillermo. >> primary care has a special place in my heart where i started my career in health and primary care didn't nearly get the kind of credit that it sdeersz in san francisco and the bayview i know the departments here the network has created a

clinic working hand in hand with the community-based clinics has made a tremendous contribution to the um, the - i guess the respect three primary care can now have. weathering all the crisis and issues. and that effect our community and heart not just a heart by (laughter) of all of that you deserve more gratitude for all the years and dedication in leadership and provided in san francisco and actually to the rest of country. thank you very much. >> commissioner chow. >> yes. thank you. >> i think i have been able to follow our criteria dr. hammer through the generations and

always you performed so well, you exemplify the best of best during our department in serving the public hard to say in a special way the important roles you've not achieved and brought us to a higher level of care perhaps with the san francisco health network you developed a true network to i can only wish you well. in any of our future endeavors recreation and additional work for it you'd like to undertake for others it is just in been a pleasure to have the opportunity at the work with you at the department.

thank you. >> thank you. commissioner chow. >> i'd like to add the rest of your work is extraordinary and in the primary care is really elementary to the city for the vulnerable san franciscans and you've done an amazing job of expanding that and making it welcoming to individuals and also the place to go after a health crisis and it is really the backbone of the commission of our heat department to make san francisco the healthiest place in the country that was wonderful you got the award for the event and so well-deserved and we're blessed to have i and wish a wonderful future i know that dr. colfax wants a final word. >> i don't know if if there is a final word but thank you,

commissioners and mr. pickens and just the deep appreciation for your focus on inventory care and for the record very broadly and deep in um, responsibility and the department for primary care clinics general health and great care and certainly the work is exemplar and as a city i appreciate your efforts and the establishment of the x martinez clinic shows how to are provides the state of the art care and - sorry (laughter). >> um, so i want to thank you for that and that the fact that

with your depart you're credibly passionate about the future you continue to make san francisco the healthiest place and going to i think one of the asks remarkable we met each other in zuckerberg san francisco general hospital and i was is intern in primary care and as all the fierce commitment and focus on paint care is something that is in the record the back - even in the and had a clinic every week ago and receiving every time that bureaucracy got in the

because you focused on this patients need you appreciate that and the department will make sure we ground ourselves at the dr. hammer. >> we'll have a draw hammer. >> actually no, i recommend you do your action. >> i have a motion and second and roll call i want to note not a resolution but dr. hammer never said no to take over a vacancy and yeah, she was the director before the other dr. and the world was on her shoulder. >> commissioner chow, yes. >> commissioner giraudo, yes. >> president green, yes. >> vice president guillermo, yes. and president green. >> now, it's your turn dr.

hammer. >> thank you very much. and dr. colfax. thank you very much for the incredible position that means so much to me and like i said many times on this transition for the retirement journey serving the people of san francisco through working in the department of health over the past almost thirty years has been such an hour had the privilege of knowing and serving with hundreds of most inspiring the most initiative the most determined and dedicated public service i i can't imagine work with the career that starred at san francisco general and two

weeks ago after going to medical school and through the years worked with incredible leaders way many to mention here i want to call out a few 23678 with grufld gratitude with the leaders of department of public health were meaningful by showing the way. director of the san francisco health network and my long time friend alex chinning and san francisco. >> (calling names.) >> and dr. colfax my successes in the health network you built a huge sense of fulfillment and gratitude and for san francisco an incredible commitment and

investment san francisco makes in public health and all the work left to be done and with my colleagues throughout the network and the department especially um, the leaders and he does ambulatory care honor to work alongside we work hard to achieve the mission. also want to appreciate dr. albert been with generosity and embrace the director acting director of ambulatory care and i will miss the collective work together with the vision to retire much young had an than i imagined. >> public health is the leader and front line procedure is

credible it is grueling and our political environment san francisco so often from the work i love to build san franciscans that serve people. my great hope that as no matter oversees will make the work for the staff so they can focus on the work they're called to do for the health and well-being and thank you, commissioners thank you for that for that recognition and all work throughout the years such an honor and pleasure to work with you all and . >> dr. hammer please come up for

the podium for a picture with the commissioners and dr. colfax. >> and thank you all for your patience i know you're here for your items. >> (taking pictures).

>> thank you very much. the next item on the agenda is resolution honoring greg wagner and dr. colfax will present. okay. >> well it is um, my great pleasure to introduce the resolution honoring greg wagner mr. wagner has played and key roll in the department i know the resolution i'll go through the details but want to first

congratulate greg and the health and wellness and know if mayor london breed nominated him to be the controllerer for the san francisco board of supervisors to confirm his appointment great for the city and great for the department because get to know the local controllerer and because of what greg track record in the department has been and no small feet with a $3 million budget and incredibly vast network of hospitals and clinics and population health. he read many initiatives an

incredible work in terms of infrastructure where our primary care clinics in particular were renovated. and helped organ and drive the transformation of our it system which is greatly improved and modernized our healthcare system anding as the director of health department and appointed by mayor london breed and incredible job there as well. during covid greg was he headquarters and making sure the money kept open flowing and all that said the criminal resources were drawing down were from the federal and state level

helped me to sleep at night the thing about greg no later than big the country at the moment he is so calm and composed and bringing forward the solutions i feel so again honored i'll be controller thank you, from the department and thank you to the city and in your role here as the city financial officer and his work with continue because again, he's got a great team is gathering great mentor and many people in the departments will continue to look to his lying to mash we continue to have the

health for all san franciscans and every now and then people from the departments will give the controller a call greg it's any honor to be your friend. >> thank you and we will hear the resolution secretary. >> whereas, greg wagner has certified the city and county of san francisco and behavorial health and please wagner began in 2006 serving in mayors gave them and ed lee and joined the department of public health and during his tenure the key public health and priority with the city's response to the covid and built the hospital and outpatient sites and

presentation of the mental illness and with the implementation of acting and led the $3 million department while as city financial officer. and whereas, the current operating edifies of capital hill greg organs the largest department with the laguna honda hospital and the citywide primary care and at other projects and the certification effort. and whereas, mr. wagner humanity 19 calm leadership and confidence and accessibility whereas, mr. wagner has the leadership to improve the lives of all san franciscans will be darryl missed by the health commission. and whereas, mr. wagner was

appointed by mayor london breed as controller and we hour him and wish him well. >> we'll entertain a motion to approve in resolution. >> so moved. >> all right. >> is there any public comment on this. >> any public comment in the room on this item? >> i see no hands so commissioners, i building it is up to i. >> all right. i think someone in the room times to say something so order and commissioner chung. >> (clearing throat). thank you. >> um, i know that the resolution covers so many with what mr. wagner and personally when i first knew greg and when he first came as the city financial officer it was at a

time we had to time we return the general funds back to the city and we have to ask back for it because the huge population but with his knowledge of working added city hall and created this very important reserve that allowed us to do so much i secondly, wanted to thank him personally for his work that during the period he was acting director was wonderful, and i worked closely with him as the chair of the search committee.

it was really a wonderful personal experience to realize that everything that dr. dr. colfax did was wonderful and searching for a leader and mr. - should receive and doctorate for that and as acting director. and maybe need a permanent director. i think that one item that is missing that we often need to remember the interpretation effort we assisted us in to be able to afford - and i think a decade journey by the time it is finished and looked like an impossible task to get enough financial backing in order to even begin this project. and yet

i think that from a patient startup we were to look for anything was contribution by the fact we were able to not only just as the hospital but throughout our system he continued to put it through the the rest of system served our patients well. i am sure enumerable things (unintelligible) and understand the health status of our patients. so those are some of the things and so greg find that is wonderful that the city is able to use your talents in the work and now as dr. colfax says we won't forget the needs that

the department asked and went us i remember and need to be a healthy city and look forward to you're continued work with us and thank you and across the street i regret i can't be through today to thank you, personally. >> vice president guillermo. >> in the words of past president i wish to associate myself with that comment and congratulations and acknowledgements that commissioner chow has expressed and the the other thing is know having a career in improvement is far from glamorous and um,

but it is so important to the lives of so many people don't understand the role of the government leader. is and you are someone that does this exemplary as has been evidenced by my husband in the reduces thank you for that and want to thank you for staying and sticking with the city of san francisco and sun shining that that is worst while to be a public servant and maybe not public reward but i won't say anymore by thank you for that and look forward to more and better in the coming years.

>> thank you, commissioner >> dmoorgz commissioner giraudo i want to thank you and congratulate you for the work in the department and what you and our team brings forward to us in the commission to help us even more fully understand the complexity of the finances of the departments that we are responsible for too so your leadership with our team and is wonderful and for those that are clinictions helped us to understand what in a great way understand the finance. and look forward to you're new position that is best of luck to you as you move forward to also keep the city and county of san francisco physically sound so,

thank you. >> um, for now. >> (laughter.) >> as we go forward (laughter) as well thanks. >> thank you, commissioner >> xhishlg. >> definitely associate myself and congratulations i'm so glad you have the capacity to take on another big job in the city and can't say a bigger in different ways will be helpful i think to have the controller be aware of the familiar with the work that needs to be done and is done instantly by this department and needs and really look forward to what you're publishing but helpful too so have someone that is familiar with the department being involved with whatever reports you get published by the controller so thank you for helping and your team helping me

understand the finances and look forward to the work you're going to be doing have a great time. >> thanks >> commissioner chung. >> wow. (laughter). >> let me start with saying that we are really want to thank you for the years you've been working with the department. >> i came to this commission are an assumption that anyone comes from the mayor's office will protect the department but you proved me so wrong and you erased the steps but we carry um, so we get to start fresh about we start implementing i don't think that is a mall deal at all and as chair the finance and planning committee thank

you. for all our patience and helped me from like not knowing when i talk about to pretending i know what i'm talking about and got many of the questions down were upable to offer solutions to the way to get straight to what this is about, you know, for the fiduciary duties and long report, you know, i still remember the first (unintelligible) and thank you for trusting my judgment and hip, you know, create more - for, you know, for your team and also take away some unany bureaucracy from our meeting i

can't thank you, enough and been thinking about this how to say that as as way i'm really happy that you decided to go from the frigging pan to the fire especially with that time with challenges but thank you and looking forward to is in relationship with you and looking forward to working with you. >> greg you're the wizard and not that many financial wizards for an approachable and bifurcate we see is reports coming from all the positions yourself touched with the public health and we see your fingerprint it is remarkable the

quality of work and the complexity and you've led aspects of this department through so in crisis and it seems to me hasn't been a champion urban forester not run into and never, never turned down the opportunity you always, always tried your best to bring our skills to whatever the needs are in the department. i think that is a real incredibly special aspect of who you are as commissioner chung said from the frying pan to the fire but helping everyone give them what was going on and gratitude you have decided to have public service and benefited it is

unique we're really grateful and thank you, such and look forward to seeing bigger things from you, we know the team you left behind will continue to perform at the level you have established so we are aggressive. >> now time for vote. >> commissioner chow. >> sorry i had to - again, yes. >> vice president guillermo, yes. >> president green, yes. >> commissioner giraudo and commissioner chung. >> mr. wagner. >> thank you so much. commissioners for that honor of the resolution your kind words and dr. colfax thank you, for the introduction and i heard a little bit of that and can't find the words and want to

briefly address the commission to say that um, i think this commission has walked really fine line of being supportive of me and the staff and dph and pushing us to do more and better at the same time that's a balancing act that is difficult i've experienced oversight by that don't always need it but you've managed to do it in a way so the work is important but also colleagues for the next how we'll do more or better and thank you for that. i am excited and looking forward to this new goal a chance to serve the city and you said to be an ally and

participate of public health and in a new capacity but with the department of public health has been incredibly rich and awarding and sometimes really hard always rewarding experience working here and i can't say it for eloquently but people are committed and persist and dedicated to what this department is doing and to come and do the hard work even which we're not getting it done fast enough and want to seen call out my division and thanks for the kind words commissioners but all of us few minutes and h.r. combined security teams are

coming to work everyday he not having the light shine on their accomplishments but creative and kind things to support the work it is an honor to be associated with those teams and really a great team will continue to support the department. um, so i'll just um, that's all that i'll say about that. the work in the department is hard because we're trying to do big things and important things it should be hard if not hard enough we're not setting you're sights high enough and not complimenting but special thanks to dr. colfax and a supporter and especially in

the transition i joke but show morale support to go to a divided department which he did thank you for granting for all the support and so thank you for your support. >> you can't get away that easy have to come up.

>> (taking pictures). >> thank you all and the next item is the board discussions the hunters point shipyard and have susan our health officer and the deputy director for the community health welcome. >> good afternoon,

commissioners.. president green and vice president guillermo and dr. colfax happy to be with you this this afternoon and for the ongoing work for the naturally of naval shipyard and joined by the majority of our presentation by the deputy director for the community health but wanted to start out with just thanking you and also saying to you that we appreciate your feedback your encouragement as we just heard director wagner say that fine line between recognizing the work and the public you have will talk about the work around the naval shipyard

next slide, please. thank you very much for this slide. >> so this is really to show you an oil the topics we're to cover quite a bit a deputy king will cover most of that. next slide, please. the reason we are doing this work in the because you to introduce the new approach we're tang to decades-long efforts point department has been involved with and we want to also introduce the exert of dph the disciplinary team leading the work the shipyard and 3450erd the community and heard from you all in the chambers we will be taking a different approach engaging on this work we want to show you the process

as we continue to improve and what we've done own this topic. so to that extent we want to share the efforts to listen to the community engagement and then explain our work and our overwhelming plan for continued work on the shipyard issuance. next slide, please. so our commitment to continue to listen and suggesting a time and resources and investment working with the hunters point community and focus more support to improve health outcomes overview i know the shared goal with the commission and colleagues in the department and in our advocates and residents living in the community around the shipyard. next slide, please. and as a reminder the hunter's point navel shipyard is the

federal property and the lead agencies for clean up at the sighted and federal and state regulators endorse this this the u.s. environmental protection agency the california department and the san francisco bay water cell board and more details in the handout it was part of the meeting materials. next slide, please. so then what is our role at dph we are not directly responsible for clean up that is u.s. navys responsible our the dba and have a critical role to review information throughout the process of clean up to make sure that the health of and well-being of the residents is protected approach is taken and

to uplift the community voiced in those processes and throughout this system. so to do this we now have an expert in the disciplinary team with expert knowledge and community health and engineering and communication. to give the community a comprehensive support that we are leaning for throughout this process. and. next slide, please. and um, to share with you um, the make up of the team and to be able to reference that where the team arise from the department and also the range of discipline we have this structure of a admitted chart that represents that work to the 17 decade theme is represented by me and by the director the director of the public affairs and we're grateful to have that

the director of communications i really make sure that whatever information we put out and also to really urge the navy and the leaders just to be clear, in their communication with the public as well and under the population health decision i lead we have several areas areas of expertise involved with the technical work from the environmental health ranch and injuring diversity within will chin the work of the really following the process of the refusing of technical documents along the way and giving input our lead engineer and once our schools have been

accepted by the city at that points dph and the city assumes the regulatory role under article iii 1 for the development of accepted parcels that article iii is regulatory work on seen by bill chin and that is separation of those transfers we have the benefit of them as engineers in into phases of that work. within mph c we have the blue and happy that the doctor specialize in behavorial health and with that clinical public health lens the doctor brings that mobility to weigh in on the clinical aspects of clean up work and the concerns of the residents in the area. (clearing

throat) and deputy director for the haight has a long history of working directly with the communities and engaging the communities efforts and instrumental in centering the focus around the community voice and concerns in partnership with a community residents and leaders i'm happy to i'm going to turn it over to deputy director. >> good afternoon, commissioners.. and dr. colfax. >> my name is a king the deputy director of the community health and care at the department of health and before we move on with the presentation i would like to take a moment to acknowledge the community members who may be listening here or in the room many of whom i had the pleasure of meeting on

several occasions since the last time we appeared before the commission. um, and they they're commitment to this issue to the safety of their community and willing to oversees on this relentlesslyly and i feel fortunate for the attention they've given me so like to acknowledge and thank you, very much. and the doctor said on this slide in addition to myself and doctor phillips have a team of very well-versed staff here at dph who have spent a lot of time on the issues and that though i'm the only member of team speaking here today, many of my colleagues working on this

issue are in the room and diligently working on this issue for many months. next slide, please. so at the corner of the work we are doing on the shipyard has been in the partnerships with the community as i said myself and members of team have had the opportunity to meet many community members and partnerships and listening to understand what the concerns were. we know has been concerns around our approach to this issue and this is why both myself and many of us who are new totes did not have taken on a new approach really listening and starting with community members we're fortunate to have that opportunity. and the second part of our strategy about

communication. we listened to the community members and heard a lack of clear communication or simply note enough the information what was happening on the shipyard we're going to talk about the different avenues we approach giving additional source of information and some of the opportunities that i have to go to the community lagoon with oat members of the team. and thirdly, will compensated engagement that is not just the department of health so it is the critical that we try to gave me as much as we possibly can with the fair market value and

other regulatory agrees we can get the community information that is critically needing and desired on the issues. so engaging with different agencies for the sake of getting community the information. and lastly, last but not least the commitment to help equity and eligible healthy um, at the focus on the issue. we know that we have to take a comprehensive approach looking at health in the entire community and not just issues that came up around the shipyard. next slide, please. so some of the different ways that we been involved in the community and had the opportunity to meet from a to z and advisory committee that

committee was members of the public that have been appointed by the mayor that is the primary place where the navy gets information and the status update about the shipyard clean up. and in addition to those meetings we are attended bimonthly committee meetings and this is a primary opportunity we have on a regular ongoing basis to be terrance hong community college with community members and additionally with the regular meetings you'll see here in the all excuse me - in the - that outline the opportunity that we have that to go into the community facing since the last time back in august of 2023 and um, here as you can see we have engaged with some community led

efforts are environmental justice submits and september and december and additionally, we been at the forums with the navy is explaining about the clean up and with the demolition of one of the buildings on is hip shipyard and an opportunity ongoing relationship with the regulatory agencies as well as community members to be engaged in the community forum we hope will continue on an ongoing basis so this is the highlights of those efforts those efforts will be ongoing we are in direct communication with the goes up that know we'll partner in the future on their plans and

activities. next slide, please. on this screen a screen shot a method we've been working on to get the community information that is a screen shot from our new website that we created since the last time we appeared. and on this page focus on health enlargement related efforts in the bay hunters point community this is really opportunities for us to say all of the different efforts we're working on in the bayview and. next slide, please. the bottom parts of this page highlights all of the different efforts we are making in the community to invest in the um, and as you can see in the center circled our focus on the shipyard and having a says to a

healthier environment and the. next slide, please. you'll see that um, that page is a specialed page focused on the hunter's point shipyard and on this page we are sharing out all the information that we have with community members directly from the navy and regulatory agencies and providing opportunities for community members to get directly connected with the division markers and those involved in the clean up and this is what has been um, what we heard from the community so this is one avenue to get the information out into the community and additional on the page the

public sees an update and at the future site and people can see where things them relation to where they live and on this sharing out what the recommendations we have the information and both people can report different health concerns and the appropriate agency to report them out do we know that this is one tool and that can help the efforts to be in communication with community members but an for shout out for greater transparency and information sharing. next slide, please. um, as i mentioned before part of our strategies has been around interagency engagement that looks like as that relates to community it is paramount in

an outreach work groups to assure the plans and corporate banking with one another about our efforts and engage with the community members and additionally communication meeting involved in the same as we participate in and share information about any upcoming public correspondence and community meetings. next slide, please. >> um, and conclude i'd like to highly some of our future man's pause plans the issue is ongoing effort by the department

to highlight the future first participant in many listening sessions we've been invited to participate in by community advocates and leaders and so we've heard in the community members want to see our department directly impact the community speaking with the different um, residents that have concerns so we do intend to do that and making plans to participate and additionally as i said before in december we had our first of what i'm hoping will be standing forums that will conclude dph and both myself and many members of our team at dph have been participants and will continue to do so. also navy has an effort to launch community

survey and draft required community involvement plan and so we've been in communication about their efforts and providing input and encouraging them to directly be in existence and make themselves available to the community to rally information and hair from community anybody's the concerns in the community to better have information on this issue next we have plans to convince environmental supports to discuss action for additional assessments and actions we know so much of the concerns about what is happening around the shipyard and the health information we know that in

addition to our team has living and involvement in expertise we have community members have been concerned about the - also have medical expertise we want to invite them and share their concerns and thoughts and figure out ways we can work together on issues. um, additionally i'll talk about a moment and a little bit more debt about the 5 years review but to also say that something i will add own the slide about data and our efforts as the department as a public health we're working at the data as it is available and don't have data today for health related issues but apart part of tour goal to look at the health

in the different neighborhoods to see where there are concerns definitely a goal of ours and plan of ours to look at comprehensively and working to reduce the disparity. and lastly, tube the 5 review associated. next slide, please. and to say a little bit more about what it is the navy is required to do a periodic valuation of collapse program and this is because they see hunters point is designated with a liability site so what that means have to provide information to the public that is evaluates whether or not at

clean up solutions will protect human health and environment that report currently on the navy's website and have listening public review and feedback on this document. both the department and the regulatory agencies have been involved have been advocating on behalf of the community to get sees for the navy to listen to that input and additionally as a department unless our technical team and environmental health working closely watching the processed of clean up will provide technical comments on that document and will release them to the public as well we are hoping with those combined efforts to make known to the navy what our opinions and thoughts have are an, an technical startup and community startup and about the eclipse

solutions have been proposed and the progress that the navy is making. i'm with that, my last slide and i'll be happy to answer any questions you may have. >> thank you for that great presentation and clarification i know many that commissioners with supportive of your work that is data driven and so our engaging in the community and definitely want to hear what the members of the community want to say and start with public comment and secretary. >> commissioner singer has listed the names of people that want to comment and you're have limited to 3 minutes per speaker and my buzzer will go off when your comments are done.

>> we'll get three people to come up i have. >> (calling names.) >> one no name great panthers come up it will be wonderful. >> this kind of has a alice in wonderland land quality i have to say i'm michael ryan from the progressive neighborhood the city is willing to led black populations suffer decades along epidemic of cancer from radiation and organic solvents now the city is letting the neighbors declare the shipyard

save to allow the building of fabulous offers it is about capacity and the city health department has a major roll in allowing this to happen this department has blood on its hands and demand you fire the person who lied to the community and try to get kinds of monitoring done and demand you shop cooperating with the wind fall projects at hunter's point and treasure island and the clean up is not possible because of sea level rise but need to declare them off limits. thank

you. >> dr. >> i'm a former elected member of hunters ship i can't do i found the subcommittee and did the assessment the founder and the principal investigator by monitoring program and i will submit to you for your work and point out hiv the best way to do everything you're trying to do is advocate for the restoration that is a 3407b8 meeting attended by the regulators and stakeholders open to the public and funded by the federal government. but i want to point that out 2010 grand juror report is to correct an area of

communication and the moose important thing i want to say have a responsibility to aid active x purse along the western basin line the shipyard contaminated areas we are people to have radioactive concerns in 124ir both sides and share with you the 5 years understanding the hunter's point by a monitoring program the phase one regulatory that consists of 75 people the majority who currently live within half a mile of because of the elements that we are seeing in people as young as four and people or black and white and female the

finding we have simply document that the risk of exposure is based on how long and how close you live to the navy base some of the chemicals we dedistrict are - >> (calling names.) >> and metals cancer causing chemicals and simply walk of blocks if third street and thomas come to a fence line that didn't have - didn't have simple curtains on that and people living within 60 feet of that we elevated a woman in an homeless

r v living at the fence line and came down with cancer and the regulatory. >> your time is up. >> thank you very much. >> someone from - welcome. >> thank you i'm ann san francisco gray panthers i'm glad to see this neighborhood is getting this renewed and attention i think it is really so longs overdue 50 or 60 years. but, you know, um, the shipyard is like a real estate project rather than a public health initiative with the hunter's point has been suffer for many years and hearing this just

delayed is just denied and this is like a long time for the active nutrition and attending the um, the meetings and environmental meetings as i have all you hear in the background the survivors in the room and what - you hear about their grandmothers and grandchildren it is all there, you know, all there out in the open so, please it is wonderful to have you on the team and great panthers this is the gray panthers in the past and continues tobacco and we appreciate (unintelligible). >> thank you. >> i don't have any more slips from people anyone else want to make a comment in the room. >> anyone on the.

>> yes. one more public comment i may please unmute the caller am caller please let us know you're there. >> hi this is dr. teresa palmer and member of the panthers i hear - do here much about one person who was presented from being excess to the toxic dumping or one person dr. sunshine talked about a curtain on the only is fence line and still no curtain how hard to um, san francisco should note taking a building and no -

all the efforts should go into shielding cleaning up the land and shielding the community from the toxic stuff and um, when i hear it sounds like damage control and not real action to me. and i'm sure flood i do not live in hunter's point thanks a lot of. >> please unmute the last caller. thank you. thank you for your advocacy we appreciate it and go to the commissioners questions or comments. >> commissioner giraudo. >> i'd like to thank you and dr. phillips for really moving forward on our august 23rd comments and encouragement to do forward with the community. so

that .38 been heard and prosecute to the full extent of the law our efforts i know there more to come i want to say our committee was vocational in trying to pursue forward owe you're following there i want to make sure that just for the record that dph is not responsible for the actual testing of the soil or any of that what you're doing is what this department is responsible for. and with the public in going forward in um, with the plan. i'm going to ask you to um, i think a 5-year plan since since this is a topic of extreme interest to our group we could then have a follow-up at the end of each year rather than at 5

years. i think that would be both informative and helpful not only for us but also for the communities as well. so, thank you. >> if you commissioner. >> commissioner christian. >> thank you combhirg thank you for all you do and this presentation is a huge step in the right direction that we this commission engaged with the department about a number of months ago. and so thank you for that and very glad to see is building out of this and how dr. philip you and your colleagues created a path and sharing that wugs i appreciate the engagement it is first and most necessary thing to begin and continue to do but the words that i feel is

missing i don't see it is advocacy the power point the point of listening and understanding what the community needs what is true and what we can document and as duty it is my feeling that wrong our responsibility to advocate on behalf of the community for the communities health and welfare and we have a very unique situation the navy well the federal government ones the land and they're cleaning up to san

francisco to figure out whether or not we're going to accept the land time has shown us paths is not as clean as it was meant tobacco and most simply probably because the rising water we will never have definitive i'm not a scientist but have issues of danger by rising to the surface what i want to understand is your view of what urging to side with the results of the engagement all the information that you gain as a result of being in the committee and work with the community quinn with the community i understand that is not with the department of

health city and county of san francisco to make the navy do anything but i feel a responsibility and our ability to stand there and say that's what we're legends and size taught us this is adequate angle adequate whatever it is i don't know for some parts past the point of acceptance but i'd like to understand what role you are imaging this department this aspect of the department will have if not after it listens and understand what the community that means and aside from standing beside the community and the members as a whole bring their concerns and their data to the department and.

>> thank you commissioner christian. >> we see a really to uplift the concerns in the community. i think part of this is those concerns are ongoing. and so i think we have taken an approach we want to establish those lines of communicates we are deep in the and we may not be in a position of authority to directly addressal the issues but that's where our engagement with the department to bring those parties to the table in the community so those concerns are voiced to the correct agency and while your work and time we learned this has not happened on a consistent basis that is part

of our approach to get the answers directly to those responsible parties realtime and i'm glad the 5 years review has been mentioned as advocacy this is a moment we'll have a document lays out what is supposed to happen and valuation of what has occurred and so community voices can be heard in the process so most immediate steps i think given the community the access to the document um, and then two-week not just having them in stages but making sure that that is submitted them to a way to have meaningful opportunities to engage that is for us to see in the room at the table and in communication with regulatory agencies and the fair market value to say we want to make sure that the community that

members have the documents presented to them in a way they can have meaningful opportunities to participate anticipate also, we see in our role to be in the room when the community members are giving us information is that understandable? is this thoroughly explained to the um, to the standards that the community is hoping? folks have place to voice their concerns and listening to it and is that the right piece? that is what i've seen in terms of our needs and most immediate phase and obviously those continue to view over time. the reason we have expertise in the enter disciplinary former we're covering all the components this complex issue requires to give a comprehensive response to the

issue and that has been a definitely significant part of our new approach on the issue. >> i appreciate that. plans of the role thank you for that explaintion i have a question where is the advocacy from the department as you can see it when the information has been brought forward very important to make sure that not only understand when the committee is feeling and experiencing by being in the land but to be - at the table when theirs discussion with navy or dialogue where the navy. again wrong but it seems to me for the department to be more than someone sitting by the side of the community advocating

for its not covering every issue but people have the capacity scientistly to whookt what the information is and say put the finger on the scale that is a problem needs to be - will not solve our issues do you understand what i'm seeing saying i'm trying to understand is the plan you are creating and building out where is that advocacy to bring the department expertise whatever it is to the o to the table and not just sitting by the way side to understand what the navy is saying. >> chair, if i may answer that that is a broad range of issues with the air and other things it is difficult to speculate but

areas in a which we'll see science and standard we may hear that maybe something we have technical experts looking at the plans and in the situation that were to arise we would have a voice and who knows what is direction is public communication or letters or public - i hesitate to speculate about that action until we know the issue that we have in which we disagree with the past that is happening your point is well-taken and that is in the range of responsibility that we should see for ourselves. >> dr. philip i respect our prudent desire not to speculate on something we shouldn't be aspect latin but about i think

what i'm asking the word advocacy to be built into the plan and certainly advocating for but - clearly we must always say and we must be able to say we're advocating as best we can for the health and safety of our community whatever that means at the moment i appreciate your, you know, your rig about that but i'm asking for this plan i'm grateful for as a continues to develop pack it clear that we will be advocating for the health and safety of the community that based on the science and experience and data that has been collected and will

be collected based on historical reports about those leads that people living own the land have encountered and the data points necessary to have because i feel that is our responsible. >> thank you, commissioner i believe that we haven't made it explicit but to make sure that the health is protected and point is well-taken we'll be explicit to make sure that is what we have in the internal discussion and frame our work. >> because, you know, in my brief time on the community compared to some folks that is how we the department approaches everything. and so thank you for that. i think that is absolutely necessary for when you to redraft the supplemental plan

and use the word advocate and talk about how we will advocate as we always do on the on behalf of the health and safety for our community so from my perspective which is not as deep as my of the public commenters the the president has not done that in the past. >> thank you very much. and appreciate your work and comprehensive and i've learned you, you to be but feel we need to be much stronger and release this our community and can't sit but as the navy tells us and whatever judgements we have scientifically to say we have no authority to - to make them do

anything but not sign off on what they think. >> commissioner chung. >> again, thank you deputy director for the presentation and i just want to i'm not not here to speak for the commissioners commissioner christian and i came from the same place which is when we were on the human rights commission and hearing about those stories and hearing about the complaints that the community had and unfortunately at that time our hands were tied and like couldn't figure out how to do something. and so this is an amazing opportunity for us to be able to as a team like for the people of san francisco because

that's our job and that's also what we do and what commissioner christian said with the efficacy because harm possibility to that of the residents at hunter's point and like out there and any other recourse. we could because of this process show that those were the harms that were done and, you know, what it will be like this is really the important part like we can say oh, we found out about this and do this to prevent that and we are ready to talk and sounds like it is irreversible. >> i'll point out the three

commissioners that talked about are part of committee so everyone shares the passion with that issue and commissioner chow has his hand up. >> oh, (clearing throat) yes, thank you and i also do appreciate the dialogue that the commissioners have expressed i mean for further understanding the actions that we're going to be taking on the community that goes along with the um, enter disciplinary guides here director philip has again re234u68d to make sure the health and safety of the resident and i do think that while i would say this is actually one of the best

presentations on what we are going to be looting doing at hunter's point. and at the beginning of our role that is to then take the issues they have not only hear the issues by do whatever we as the department should be doing um, and this is a way from the exact technical work that the navy is doing and i think that is everything just appreciating us really important. and brings up my concern that i see that there is a lot of opportunities for community output. >> communication. but it didn't actually give us - and this might be what um, um, what

was said we don't have the data about the health status in the manner we'd like for hunter's point we certainly have a great deal of initiatives for the entire communicated and particle in the bay and being sure we have a subsection and finding the rest of bayview didn't have the same types of toxic issues that it appears unexplained. as we're going through this work it is hunter's point table shipyard update i think we need to as wearing investing in the hunter's point community we don't lose insight the hunter's

point committee is the focus we already have the asian-american initiative have been worked own the entire table and really an important substance of that. and with a number of different committees and groups and communities hearings wondering that as you gives this report talks about this and this is, of course, your unworking structure whether you found some of the actually duplicative or do work on different community um, opportunities influx i think i haven't found the more i heard the presentation and kind of like at least over a half of dozen committees and whether they're duplicative or

overlapping it is important as you proceed on this to, you, know, refine that and make sure that your not also then, you know, taking your own time and resources that we have that we're just getting support and that we're duplicate indicating some of this this is - to understand the columns the residents of hunter's point. with the fact will be a 5-year report that is going to close in march we're seeing that we

should continue to be monitoring that and rather than waiting one year that we should have some sort of progress that comes back and have a 5-year plan when it comes out and in the final form could have we can understand what that was all about and particularly what they're looking for in the future and we then understand how well integrated structure this new - team put together actually be able to function at this time i leave that to the president to schedule that and for the wait for the annual report but our - so that we should get an interim

report. >> i really appreciate our presentation i think the explanation of work to engage the community is helpful and we understand that you have notice hand in testing you have no hand in mediation and i think what should some of the commissioners that minutes will be helpful with the report to have you come back and give us your impression we like to hear from the communities what they think and our interactions we don't have access to the organization and those determining the safety of the area. and will be helpful that report i don't know if the public over 5 hundred and 50 pages and with the background will find it difficult to terminate but knowing that you

brought together this team take the comments from the public and take the concerns and put them into context and been the analysis for individuals at the navy and other organizations with the federal government can understand we have what we can translate for the public interim with the impact with those i've got to tell you have the power to clean this area up wonderful to hear how they will get the comments not only for the dph submits to the members of the public who might as well and review those and what works for you come back and give us your expression how the navy reacts we are here to advocate for the residents and want to know within the limits of our jurisdiction so does that sound

reasonable? we are appreciative have been work and dr. king we're pleased to see you as part of this effort and from your - dr. phillips we appreciate the presentation and look forward to hearing more and thank you very much for being here and doing all the work and before we move on to the next item if i may in the bathroom on the first floor take a deep breath it is lovely and intense so, please feel free to leave when we are rbo about to make sure we are taking care of ourselves. >> we love being on the commission secretary you takes care of of us. >> all right. now the next item.

>> the first of two hearings that's informational and to remind everyone the haefks can only say we think that the changes that are promoted will or will not giving affect the health of san franciscans if you want to hear we want to hear in the public and uc and hear more about the proposed changes and then at the next meeting we actually um, take a vote. so we have several individuals here we'll start with hoffman from the department of health and uc from the st. mary's. >> all right. >> hello additional good

afternoon or good early ooefrng i'm planner with the department of revenue planning and here for the first of two proposition q around the acquisition of hospitals and. next slide, please. and in preparation for this presentation you all received a memo for the acquisition and also want to note we have representatives from the dignity health and -. next slide, please. give you a little bit of background on november 28, 2023, notified the haekts is ucf has the operations of st. mary's and st. francis and on monday february 5th announced they have an agreement for the acquisition and the organization closed the

operation in the spring to the presentation i'd like to have the summer and pass by the violators in 1988 and asked that private hospital have a privacy notice for closing of an in patient or outpatient facility and with the level of services provide or prior to the leasing or selling or transfer of management additional and authorized the health commission to make a determination of whether the report will or will not have a detrimental impact at health commission didn't have the authority to change the um, of proposed action i want to note the california attorney general the presentation to review the acquisitions and approve continually approve or

disproof the transaction. have fined the agreement and required to community hospitals st. francis more like and medical center and the associated outreach of clinics 1, 2, 3, 4 san francisco the transaction will add 5 hundred and 69- beds in san francisco and the acquisition will bring spreadsheet services next slide, please. beginning with st. mary's medical center accredited nonprofit general hospital across the street from

golden gate park and highlights have listed on the slide to not comprehensive with the services at st. mary's and speaking about a few the unit is a short-term inpatient for adolescent and the only adolescent and this is a intensifies program that is run in conjunction with the unified school district st. mary's exams is home to the st. mary's house center that provide primary care and special services and hiv care and the women's health center for screening and diagnostic test services. and then in addition prior by dignity health medical center there are critical serviced that are located on the campus and

that includes the full beds and minimum wage center that is operated by the behavorial health and includes the hospital san francisco which is 60 beds critical care hospital and i'd like to note the community health is a long term partner the department and in providing healthcare services for the health and safety and dph clients receives services at st. mary's and st. francis and inparty and the counseling program and. next slide, please. france memoriam hospital is an accredited nonprofit care hospital and providing healthcare for more than one

hundred years and sfansz st. francis and is a critical resource and make ups the tenderloin and civic center and at with the burn center the only burn center and a unit an essential service and the france more like gender institute that provides transgender patients and families care next slide, please. the uc sf is a medical foundation and associated for st. francis and st. mary's and the acquisition didn't include the clinics operated within dignity health and bell health you've seen across the city and the parties have the services about the clinic provides with the health

clinic to u sf health so the clinic that is since 2019 served many patients for three 2 thousand visits each year. next slide, please. . so those services and some of them are mental illness own a prior slide but dignity hospital has behavorial health and emergency services for the bay of san francisco and some are mentioned on the slow down and behavorial health and emergency care are essential services for the city and has specified with the capability results from the acquisition is their intent to expand genders care programs and maintain the adolescent and adult programs for patients are hiv and u f health helps with

the emergency department and plans to make early investment in into the departments. next slide, please. not only introduce the hospital but this slide is a summary of transaction and uc sf maintains all the st. mary's existing services and investment plans and extra and state their haight for as far as and st. francis to continue to - or dignity health statement of common values so as hospitals will no longer be subject for the productive care direct and i abortions will

there. regarding tahoe at uc sf has a retention of employees for both hospitals and state that st. francis and st. mary's will maintain their health staff and the city will serve more patients at st. mary's and st. francis and increased staffing if necessary. regarding the patient care uc sf has access to all services and providers they have today and will continue to honor all insurance agreements presently available other as far as and st. francis st. mary's. finally uc sf has engaged with many stakeholder and will have

community-based organization as they integrate. next slide, please. for the next slide i'll talk about the utilizationtion for st. mary's and st. francis and this provide a unique population by the community hospitals and unless otherwise data provided to dph dignity health. next slide, please. so from 2019 to 2023 st. francis has inpatient discharges and st. mary's with an average of 4 thousand plus discharged and uc sf has includes mount zion and

mission bay since 2019 uc sf has 10 thousand discharges of patients and in patient from uc sf has a 2019 volume and since 2020 a patient discharged from st. mary's and st. francis. additionally i want to note - accordingly to date into california department of health access information in 2022 approximately 36 percent of in patient westbound residents of san francisco. and -.

next slide, please. another way to look at utilization is occupancy for the beds and cupidity over a period of time. here. >> occupation for st. mary's and st. francis the figures show three uc sf have a higher-upcy rate from st. mary's and st. francis and involved those are lower occupancy arthritis than self hospitals next slide, please. >> like i mentioned before st. mary's and st. francis serve

distinct people's and distinct from those at uc sf hospitals as i mention earlier in the highlights to provide a greater understanding the patient hospital a positive recommendation. so data from 2023 more than 57 st. mary's and sfarns were adults over the age of 65 and half identity as non-white or multi racial and st. mary's and st. francis are or those uninsured i'll talk about that in the next slide. next slide, please. so across in patient and outpatient encutters st. francis

has a greater proportion of insured folks. >> and since 2019 st. francis has an increase in the patients and beneficiaries for in patient and in 202349 percent ever sfarns were medi-cal and as provided by the uc sf committed to care for all patients regardless of their ability to pay for st. mary's and sfarns next slide, please. so briefly i'd like to discuss the san francisco hospital utilization landscape and impact the acquisition on healthcare costs and access. in 2022 uc sf had

thirty percent of all in patient for hospitals facilities and so uc sf commitment for programs across the hospitals and insuring the transition for patients after the acquisition uc sf sympathy of /* the acquisition of dignity hospital clinics in san francisco will lead to a more xhoefltd health care market in the xhoefltd health market medical groups are a large share and acquisitions have higher healthcare costs and the quality of patients care.

and also limited to the consolidation so therefore the extent of the impacts of uc city of jacksonville dignity hospitals associated clinics on healthcare costs and quality is unknown at this time. next slide, please. so to conclude i'd like to reiterate some things regarding the acquisition. uc sf community and st. mary's and st. francis with full service community hospitals and maintaining the existing hospitals offering to the community and uc city of jacksonville provide the out patient clinic benefits and for retaining st. mary's and other

hospitals and committed to have behavorial health and entering services sophomore san francisco and uc sf pubically stated will honor all insurance a reasonable degree of medical probability for st. mary's and st. francis. next slide, please. to conclude any presentation the department has provided the following regions. the uc city of jacksonville violations for dignity health and st. francis and st. mary's will for the have a did he recall impact to the services and contingent about the amendments with the existing payers and organizations currently covering services at the hospital and contingency on the expanding services at hospitals and clinics and contingent about maintaining or increasing staffing in support of operations of the hospitals and clinics. and the department

recommends that the health commission do periodic update regarding the acquisition and hospital interaction process and as a reminder you all have a copy of the draft resolution it is the recommendation for our discussion and recommendation today next slide, please. and thank you for your time and to our president and ceo of st. mary's and st. francis to present on behalf of the dignity health. >> she did an amazing job thank you for that and happy to be here and appreciate being front of the board with the colleagues of uc sf that is important and the think we have -

next slide, please. i will share one of the reasons in san francisco i live in san francisco and move here three years to be the cfo for the two hospitals two amazing medical centers in san francisco communities for many, many, many years. serving some vulnerable population and what i love is the two hospitals what i love is the mission and share with that a little bit more. next slide, please. we heard about st. mary's and got a lot of details what we do there and unique services provided here we talked about already and one of the first, i v clinics st. mary's and program we started there. and do well into the future next slide, please. st. francis i think started by the

clinicians and became a nonprofit and all of san francisco and tenderloin it is our clientele and walk there everyday when i come do work and take care of a very long population and i appreciate how well our clinicians take care of that and take that seriously and once again we have the burn unit the largest burn unit in northern california and amazing services and our gender affirmation services this is unique no st. francis and looking forward to flourish indeed. >> this is sharing the unique services the rights year i wanted to highlight st. francis the highest number of psychiatric transfers of any hospital in san francisco. and we take care of that population extremely well zuckerberg san

francisco general hospital and do an amazing job in making sure we have the resources to the station and something we're going to continue and share with the education program as st. mary's and family internal medication as well as orthopedics and the community-based program that works with the writers and want to stay within the community and for our program and continue to work. next slide, please. and we talked about peer mix this is an important component and the government care for commercial insurance within our hospitals and has to do with

with not graded healthcare system in san francisco we be two hospitals have a small clinician foundation and practice and in our hospitals not a large healthcare system that u sf brings to the board advertised a good picture and costs and challenges you'll talk about in a little minute. next slide, please. and strengths to hospitals. once we picked out with the quality care at at community hospital different care and academic studies we got extremely long term employees had a deep knowledge of work we do and our connections with the city to have the right services for patients as well and have an streamline compassionate and a loyal physicians and many have gone for the residency program informs st. mary's and take care

of our patient and happy to have an open medical staff that practices within our hospitals and have the best quality in the city and st. mary's medical center was recognized of 250 top hospitals and our challenges hospitals have been changed financially by a number of years and coming out of covid really impacted that dramatically and struggled with the hospitals to reinvest the structure and reinvest in the care we provide as well so a challenge for us and a lot of that has to do with with the high - we have challenges for green stamp passions has to do with with st. mary's and st. francis looks like with knowing what our challenges are and recruit san

francisco and recruit into a something that is not created for the healthcare system for us and sizings issues we have i'll never forget upgrades and by 2030 and got infrastructure not be able to invest in with did hospitals that partnering with uc city of jacksonville will help us manage and covid next slide, please. i can't think of a better partner to partner with the future of us moving forward and this is the largest procedure of medi-cal in the state of california and uc

sf is a large amount of patients in san francisco and i think that st. francis has the next you highest highest and the 34ugs have a shared mission for a lodge time to take care of the populations and san francisco is a great partner and when we saw covid with the vaccinations station we work closely with uc sf. next slide, please. so the acquisition we heard by sfarns i want to reiterate potential will retain community hospitals it is extremely important as community hospitals are much more flexible how we provide the care for patients much more affordable and being a

community hospital is a real big plus for the transition that is occurring. we will increase access care for patients and have to take care of more patients with the healthcare system and help with the uc sf with the challenges and those challenges are complex patients can't get care at the hospitals go to uc sf we can help to take care of the complex patients to help that is a win for both of us. and as we increase our volume and increase growth that brings additional staff both our organizations that will take care of that. and once again i think this mr. there access to

patients in san francisco and beyond san francisco. as well as. a huge component what we're trying to accomplishment. next slide, please. and talk about staff the workforce are with the two hospitals the uc sf is committed we'll see growth and need to recruit for staff to support for both the hospitals and staff will be pled by the community hospitals itself them which i think that important component we have condominium air transparency with the staff and members in the town hall 98 percent staff we talk to are extremely excited and we have - staff and positions have excited about the transportation and is

transaction for the patients moving forward and our our clinicians will practice and care for patients but more resources to help them moving forward. >> so. next slide, please. i'm extremely excited about the transaction a small picture of those hospitals will been around a long time and there to access and allows us to be right part so thank you for your time i appreciate you letting me share my thoughts on the transmissions. thank you. commissioner now hear from uc sf. >> good evening. >> i'm president and ceo of the health, i actually took the

job two years ago a return to the bayview i'm originally in nashville and moved out here and lived in the haight and worked in mountainview and did the reverse commute and had friends received care at both st. mary's because that was right the closet has to where i lived and i invited patient at st. francis so taking this job and talking about this transaction functionally based on the fact that uc sf has learned a lot in the journey of being part of pandemic and understanding how we worth to have a greater impact how we alcoholic look at our reality health and the the reality for the city of san francisco we saw an opportunity

to work together with st. mary's and st. francis we've seen our occupancy in hospitals increase and the wait times to try to get into our hospitals we saw the hospitals at st. mary's and st. francis to leverage a tradition of caring for the community to leverage the transaction of understanding the city of san francisco and a workforce positions were dedicated to their population we thought a way to work together to see a greater impact on the community and teacher of resources at st. mary's and sfarns st. francis so conversation going on for years resulted in the present transaction to really puss the pieces together and have an impact on the city of san

francisco. next slide, please. i'm going to move through the slides that is really quick but i try to have the slide here and like the departments presentation was color-coded and a little bit better so i want to just to be clear, we want to make the healthcare services more acceptable for all san franciscans and beyond the data in the prior presentations there are so many things at st. mary's and st. francis would have a greater impact only make the investment to the program and services and the people and that's what you end up getting the city to do we're going to that lets talk about the services we will retain the services by both hospitals and there are significant patient is

population we have you'll be able to continue to see that same dr. whether or not they're a u c sf faculty member or not but retain the employees part of st. mary's and st. francis there are no layoff plans as part of the transaction we want to see more patient in the hospitals urging to have to not only retain the staff you have but grow staff that's our point and have to make investments and, you know, as dean brought up several years the challenges at st. mary's and st. francis resulted in less within their mission like to and we'd like to fill in that gap coming in one of the major goals to make those assessments and discussions in earlier presentations the other services and built and equipment

we can do but one thing we want to emphasis those are through that acquisition creating a new position at uc sf with the medical center - that's why you heard that 20 percent of only three 26 of our population at the main hospital from the city of san francisco why are other patients there? traveling near and far to get treatment whether cardiac arrest help we train figures as well as pharmacists we acquired st. mary's and st. francis we had a unique position that focuses on the san

francisco one that is focused not only on complex services for the communities but it is really not as angle extension of the work in st. mary's and st. francis but augmented by the resources and staff at uc sf we see the best of bow worlds take to separate healthcare systems and put them together we do together neither one of us has done on our own we are only to welcome in st. mary's and st. francis and can show us how to do this is a a more community-based level nonetheless not only bring in investment. >> other services that will port is the patients. so for san francisco we think we'll

preserve the emergency rooms and provide more access too important services in the city and bringing in uc sf we hear open weekly and monthly basis hundreds of patients we turn. >> and trying to transfer in we don't have that within the by leveraging st. mary's and st. francis we'll be able to accept for patients into uc sf many californians depend on us for to make that transition a reality we try to do number one, to continue to maintain the relationship the community-based organizations at st. mary's and st. francis and continue to work with today and maintain those relationships and want to thank the many city organizations who provided letters of supports for the transition and we've worked

with many of them but many other organizations given the early stage of planning for the transition still for work to do the second thing we need more leadership to lead the division and our president of our and i i can't let we pickled her one the person's that understand academic mentioned and prior to working she worked for community hospitals and understands um, community-based care and the private care we wanted a leader to lead the division will put to expertise there so i'll let her lead us through the following slides and lie her to come up

here. >> thank you, commissioners. >> for having us here today and maybe we can go to the next slide and skip to the transaction. and that will be the next slide, please. and before i jump into as mentioned i did have experience in communities health at uc sf for 9 years and loved every minute of that and worked in the health community system for 10 years and loved every minute of that and this might be too much information but flu to honolulu so i truly value what it does and the communities healthcare is provided in the community and especially uc sf i learned

because my family had to travel to for conference care and rely on the community hospital workplace with that i'll talk about things that maybe not said because i think you've heard the commitment and understand the model and i want to address some of the questions were sent to us so we can be as efficient as possible and a question that was related to care and how this works that we will actually have the communities vision we can truly commitment to the affordable cares act and keeping

to keep the contracts, you know, it takes two organization to sign off but as a partners to trust us and work with us and release the contracts so we can continue services. it is true that many of the services provide at st. francis and st. mary's are for the priority and all added uc sf we were trying to get the contracts they were not there we worked collaborating as much the programs provided in the hospitals today including the behavorial health rehab we made a capital contribution and continue to support that program among other things and another point i'll make that we are planning to make investments and this is in the neighborhood that is 75 to one hundred million dollars in

one year and i'll talk about why we need time to understand the timeframes for all investments but critical equipment purchases need to be made and upgrades focused on doing decision makers without disrupting all the operations to so we have a list i can almost guarantee will be more than one hundred million dollars we have to side things right now and that's what we're focused on next slide, please. i think this is said a few the but excite to build on the legacy that is in place at the two hospitals and associated clinics we have been partnering in several areas that we see immediate opportunities to boosted our hospital plan we work together and that hospitalized medication program

is a health program for the graduate and caucus that is based on at st. mary's and working together on for about 5 years now. we see opportunities to see more of the cardiology and patients that wait pretty long to get into u sf we example create more access at st. mary's and st. francis and i mentioned we're tloshg what the status of equipment is and know those two hospitals are two of the few hospitals not on (unintelligible) and are also bring them on to the u sf i mentioned we're focused on 345ed

improvements that is because stability and supporting the people that worked to hospitals for many years. we are planning on about a two-year integration process we don't know but will take us approximately two years to get all the systems and infrastructure and other support in place and we are still working on that plan it is plan that centers on supporting people and the way we're doing that by no disruption to allowing people opportunities to brings on day one we hope not too much a actually we're working carefully with the community health to continue to use some of the things they have in place the we're going to be the owners and some of the

systems will be different than c sf and will change it to over time and as i mentioned we're asking everyone to honor the contracts in place that's what we intend to do and another way to honor the history and the miss information by keeping the name and while also a little bit of uc sf st. francis we think that a great way to signify that uc sf is part of a hospitals but want patients to be familiar with those hospitals that many have been seen for a long time and it is same reason we are with medical staff models something we believe will allow the patients to see their

clinicians. >> so we talked about - like they would appreciate united states uc sf enter the hospitals next slide, please. and as i mentioned our work is just beginning hope that we can make this transition as early as the end of march we don't know many things cvr can happen we can actually transition those

hospitals and so were working on for planning for day one and engaging the leadership and medical staff at the hospitals liner more about their culture and share about our and will continue to do the same with others community members and learning a lot not only what we think should be done at the hospitals but what we can do better at uc sf and welcome the feedback and we'll be better with both community cameras and operations. next slide, please. and we do actually better said

after we those hoses are more than hospitals they're community centers and host a lot of programs that work directly point community and support a lot of vulnerable populations and we continue it learn more about the partners who we are and what the hospitals have done and build on those things that are even outside of walls of what is provided here. my next slide might be the last one and we are excited about the transition the value of st. mary's and st. francis and all the people that work there and we think uc sf will be better and san francisco will be better that will ultimately evaluate healthcare altogether so we're

i'll be happy to answer any questions you may have. >> we're going to come back with recommendations if you like. >> thank you for the work that went into the presentation and so good to know your mission are oil to make healthcare more assessable for everyone if san francisco and appreciative of all the information. we have public comment which will start with and honored to have former president sonya here we'll get the people like i said up and start with her and i have i'm sorry it looks like seymour and kristen at an garcia as the first three commenters please remember when the timer goes off your time is up. >> and great to see

commissioner chung and commissioner chow it is one day i was sitting at your - only the

program at that time and in the entire bay area. >> during my tenure 20 years now expanded the services in the counties over the past year we have continued it serve families even after the pandemic and through the hospital and with great problems because we went

there from providing a lot of services in-person to um, line trying to continue the services and hopefully we can continue to improve the mental health and this wouldn't have happened without the support and commitment of st. francis hospital i'm so pleased to hear that uc sf helped and will continue the program at the facilities without that can this program will stop probably so i think that is one of the best out mergers i've seen and that a person - i receive my healthcare though st. francis and uc sf i

looked forward to seeing this. >> thank you. >> thank you. >> my name is dale in the tenderloin for thirty years and not complaining about that just to be clear, but a lot of the things that city didn't make sense this does. this make perfect sense of this collaboration and that is about collaboration. and st. francis we're afraid of losing wouldn't have going this collaboration going on we can't lose st. francis it is one of the most traumatic neighborhoods not sfaifbs and entered into the tenderloin four minutes as st. francis and 12 minutes to

zuckerberg san francisco general hospital and it is life and death we can't chance that i can personally say when i got to the hospital i found out my blood pressure was 22 over 11 it is important we get that collaboration and another example i'm a veteran, 8 years ago and contracted prostate cancer the virginia said we don't have the capacity to trait you but we know who does and i was (unintelligible). >> thanks to organizations being in the city. you know, we're so near st. francis and near the tenderloin we have a

buses fire station if acquisition and necessary and will handle that well and sat on the tenderloin on the st. francis tenderloin workforce for 10 years and so i got - i love st. francis and know what it does for our neighborhood and covid came in we got myself - we in the tenderloin have one of the low fats - facing uc sf with indemnification and appreciate what we learned from that with covid help means more than checking my blood pressure do i have a home or relationship. all

those things when uc sf was on the ground that is like a marriage made on a heaven and i'm going to glad you limitations to the donations and presentation and sure you'll help support this acquisition because it is really a win-win. and made a win-win someone lose something but i see nothing but a win-win for our citizens and our reputation. >> times up sir. >>. thank you for your time. >> thank you, thank you for your comments that's the best. >> good evening for northern california. >> and very long title i'm here to show our support for the acquisition in a time when reproductive services and gender

this is acquisition is the policy of restricted services lose for the expansion of services san francisco san francisco. normally i've had meeting and happy to convince the commissioners not to approve the institution from coming in and taking over the hospital but in the situation a no-brainer so as part of the my organization and healthcare workers on the on the ground we're here to support this. >> thank you, next are susan, ruben and janna. >> good evening. >> interestingly to hear the

other comments and thank you for the opportunity to provide any comments i'm susan a long term san francisco resident and the neighbor of uc sf campus and the advisory group and policy consultant. my bottom line is this transaction is true my interest to make sure this will improve the um, for san francisco and beyond the near term that is outlined in the presentation and worst case scenario despite the intentions and great effort with the operational improvements is knowledgeable and skilled administrators u c sf to invest in both sides of compliance and the city will be faking (clearing throat) downsizing

beyond 2030 and the other um, and for the right sized investment going forward and once the transition is complete will be a by uc sf will be a public hospital based on my finding will nowhere else be subject is to many of the state regulatory approval authorities and second, we need to see additional information on what positions uc sf will take the communities to (microphone distorted) particularly in the area of internal medication and need additional information on the strategies to be financial that will anticipate profit in year

two when we have two hospitals with $10 million observe is last couple i ask you consider on the progress of the acquisition and i expect you'll do this and clarify the structures for the community division equity and uc sf negotiating the new contracts and three that is a little bit longer than st. mary's and st. francis maintains straight hospital and reporting for financial organization quality i'll other data such as dph and office of healthcare

accountability. >> ma'am, your time is up. >> actually your time. >> i have a long - >> yes. and commissioner you have them. >> mr. chavez. >> good evening. i'm ruben chavez a deputy direct the senior center and thank you, for having me the senior center works with st. francis memorial hospital things or shrinks we opened the door in 1972 and work together to provide health and port for low income insuring they have everything they need to remain living individually in the tenderloin neighborhood and the senior supports the acquisition of st. francis and st. mary's and uc sf we have a relationship and building that sfansz will be stronger and with

the acquisition to maintain the building approach as mentioned together and again, we appreciate being here and. thank you for your time. >> . thank you. >> thank you. commissioners i'm the vice president of the policy and external fairs for those of you who don't know we're a nonprofit facility serving one hundred and 12 thousand mostly low income patient and here to support the acquisition of st. francis and st. mary's by the state of california san francisco we believe this is supportive for the long-standing hospitals and we believe that bringing st. francis and st. mary's into the health system will expand the access to health nationally known exerts that specialize in

healthcare and pleased for the commitment to retain the services and insuring that patients are local access to the special care needs and eager to work with uc sf and have worked more cooperation within the centers and have patients and the complexity of our care we know our community and speak many languages and the research in the nation it is so important. the emergence room is important po are san jose the surroundings neighborhoods because seems san francisco is small for low income and people travel to zuckerberg san francisco general hospital we're pleased to hear that st. francis and st. mary's medical center opened are staffed and we are eager to continue to build own the system to make sure the next

generation of cost providers including doctors and nurses and behavior health specialize will be skilled and looking forward to working with the hospital on that. thank you. >> thank you. >> i believe one more request on this item and it is from san francisco greg hansen. >> hi ann gray pan theres another one of the lodge time consolidation of the san francisco we think back to one saint luke's this is something has the accessibility and rush too so as our first speaker suggested we hope the commission has a um, you know, a monitoring

and some kind of accountability all those that sounds great but a - and i think that is wonderful i love the hospitals are great and all in the details we know that. thank you very much. keeping our eye on that on it thanks. >> thank you. >> now anyone on the remote line. >> yes. hymie unmute. >> caller let us know you're there please. it is dr. teresa i'm here to worry about the merge i think everything said sounds good but we know the history of a big hospital taking over the hospitals in san francisco has resulted in being promises and

soundly cuts to mental heartache care and especially for in insured and shut down of hospitals. we've lost children's hospital we've lost a lot of the culturally sensitive the under served as saint luke's and a lot of just to be clear, long terms (microphone distorted) rehab beds given the cool cut when hoses merge in san francisco i really would like to have the information put in stronger words to its resolution rather than (background noise.) talking about periodic (background noise.) i would like to hear. the health commission advocates for the under served in san francisco (background noise.) and closely monitors a much

needed program services and the health commission requests a quarterly specific information on services unique to st. francis and st. mary's. we hope to find the needed services are enhanced and in deed will never be sacrificed to an emphasis on the generation of revenue eviction of (background noise.) and capture of the most lucrative market there. i (background noise.) (microphone distorted) the incentive is really to capture the most lucrative market share and not serve under served (background noise.) and (microphone distorted) in the direction the public system and um, get the people with the great insurance. >> this was happened with all

other hospitals and the health commission really loves monitor this closely and ask hard questions i know you have no power to change anything but have the power to change people that breaking their promises this is the duty (background noise.) to uphold care (microphone distorted) for the much needed services in san francisco. thank you very much. >> all right. thank you dr. palm and please unmute caller 7. >> patrick it is for that uc sf continue the outpatient services i was diagnosed with skin cancer in august of 2022 and substantially surgery by

fancy and the exert on and on cost and dr. brent special land use in specialize - insuring adequate to insure - (microphone distorted) he was followed by a year as an outpatient near the saint pacifica and dr. less than performed it is critical that uc sf continue and chief of surgery thank you. >> that of these the last public comment. >> thank you. >> how about commissioner. >> item no. 6 - consent agenda - action item. >> xorgz. >> thank you for the presentation at that hour (laughter) i appreciate it. i have a

concern. that (captioning is ending at this point due to the time limit provided for captioning)

recite and, uh, monitoring. that is correct. okay. and is this a new division that you started or are there, uh, examples of other facilities in which you have done this in yet with, uh, private hospitals? no this would

be the first time for ucsf health. oh, okay. okay. uh that's helpful. uh, would you be open? um, i, i do believe, like, um, uh, commissioner chung had said that there is value to prop q and stating clearly what you had all declared to us as we declare, whether it is or is not, uh, uh, beneficial, uh, or detrimental, depending on which way you want to actually, uh, state the uh, resolution in the future. uh, and, and, uh, even though it is not binding, it is often cited as being the public, uh, position that was taken. so so, uh, uh, we, you know, don't stop you from working, but we are holding you accountable. and the public arena for certain items. so we really appreciate the collaboration that you are talking about with the other hospital programs. and uh, staffing. uh to concerns that we

have had here. uh, and we're wondering if, uh, you would be open to then, uh, us, uh, specifying more, more, uh, in detail a reporting mechanism back to the commission, which would then help, uh, also understand the progress being made. yeah. i think we should have our staffs work together to figure out what's the most meaningful way to do that. um, i certainly think that given, um, the fact that ucsf is a public institution, there's a lot of reporting we do in general that is public, that may or may not be satisfactory to you. so we can certainly, um, have our teams collaborate and see what the right level of reporting is. but we are a public institution and we have no, uh, we have no qualms about being transparent about how we're performing. okay. yeah. no, i think the

issue would be how we're performing in terms you're performing in terms of the key transaction. and now i think we need to add the mental health programs, uh, into this because, uh, uh, as, as we're doing this integration that would, uh, help us and the public understand that, uh, uc is carrying out the , uh, intent that they have here . or if not, then why not? uh, so, uh, which is different than, of course, public reporting to regular agencies. so i really would appreciate that. uh, sure. uh i do have some, uh, suggestions, which i will, uh, uh, provide to the secretary later in terms of the, uh, different whereases, especially in light of the discussion going on here, uh, as we, uh, uh, look at the, uh, resolution, unless you want it to take some of those now, but, uh, i, i think it would be good to see a

revised resolution with some of the suggestions that i've already submitted. and uh, which the commission also has spoken to and may wish to also submit, uh, prior to us, uh, coming together again. and i think it would be good that we work this with uc and saint mary's, uh, saint francis to be sure that, uh, it can be acceptable to everybody, commissioners, due to the time i suggest that we do the wordsmithing of the resolutions via email, and then you all can discuss at the next meeting, since we have other things we have to get to as well. i have no problem with that. and i think we would like to see several iterations of this, uh, to be sure that everybody's, uh, uh, desires are actually then, uh, added in and that we also have a consent, uh, or if not, at least know where the dissent may be from. um, uh, the, uh, parties involved. commissioner guillermo, thank

you. um there's, uh, i know that there's limited time, uh, because everybody's hungry, but i did want to be able to, um, make some comments. i'm not going to address the infrastructure or legal issues, uh, at this time. uh there's plenty. i'm sure that you're subject to with the ag, uh, alone. uh, and so although it is a question that i have in terms of what is the impact of anything, the ag might have to say with the with this acquisition relative to the comments that you've heard, uh, from folks today? uh, but i do want to say, as somebody who is affiliated with, uh, dignity health, uh, and common spirit until just recently, uh, and knowing, uh, how hard uh, both entities were, uh, worked over the years, uh, to come together sincerely to serve the interests of san francisco, but also being very realistic about the impacts of the health care delivery

system that both of these entities represent, particularly in california and particularly in san francisco. so probably the most complex, uh, and the most difficult set of, uh, issues and problems to solve. um, uh, throughout the country in terms of what we're facing now. and so, uh, it would be difficult to try to hold, uh, any sincere effort, uh, at this to conditions that we don't know, uh, are that, uh, that might we might face in the future. uh, but i do believe that with what you said today, uh, and what you commit to, um, is sincere. uh, and i do know that that, um, there is support from the founding sisters of saint mary's for this, uh, and, uh, the medical staff, uh, previous owners of saint francis

, uh, to this, uh, acquisition. so want to support, um, what the historic local, um, uh, interests and stakeholders, uh, have, uh, because they are still around, and so they are. it's not like they're sort of some historical, uh, um, artifact that doesn't exist. but the reality of what the needs are in san francisco, uh, and what, uh, the excess capacity that can be created from this acquisition mission, uh, has more promise than detriment. i believe. uh, notwithstanding all the concerns around seismic and the costs that that's going to, uh, hold, uh, being able to maintain license, uh, quality and safety standards, uh, for the kinds of, um, patients that that you're going to be increasingly seeing. i think, uh, at both sites, particularly the uninsured, uh,

the medi-cal and the medicare, most vulnerable populations in san francisco, which historically has been the mission of both saint mary's and saint francis and i hope to see, uh, that mission, uh, expanded, uh, throughout the uc system. uh, that's operates at least here in san francisco. so my understanding and my experience from past, uh, involvement in, uh, hospital system mergers is, um, i guess as well as hospital mergers, uh, has to do with and being able to maintain the integrity of the intent, uh, to increase access, improve quality , uh, and safety has been, uh, the difficulty in the cultural, uh, merger, uh, between entities . ucsf is a academic institution and operates in a certain way that is not antithetical, uh, to community hospitals, but certainly is not familiar to,

uh, and so i do think that that culture that is embedded in the mission of the hospitals is something that really can't be taken lightly. uh, when, uh, dignity health and, um, uh, chc merged into common spirit. one of the things that was done was a cultural audit, uh, that really tried to level set the missions, uh, of both entities and so i would offer that as something that you might want to take a look at and see where there are, uh, opportunities for, uh, that culture and that, uh, sense of mission to align even more, uh, definitively, really glad to hear that, uh, that there won't be any change in the staffing, the workforce, and in fact, there might be expansion. i do have questions about whether leadership will be able to maintain their leadership roles, because the history of, uh, the leadership, i think, at both hospitals, uh, uh, is one of wanting to serve

the community very, very deeply and often times without any reward, uh, and without any acknowledgment, uh, and often with a lot of criticism. um, uh, so, uh, that is something that we, you know, again, uh, hope to see, uh, even though and, and i think that the last thing that i'll say is the opportunity for saint francis and saint mary's to finally, now merge their data , their operations, uh, their i mean, this is decades. maybe i think, given how old the hospitals are, uh, a centennial sort of event, to have the two hospitals be able to now it's an opportunity to merge, uh, truly, uh, under the, uh, um, the opportunity that, um, are presented with this merger. so there's still a lot of questions. uh, and we would still like to see, uh, a lot of, um, uh, information about how

this is going to happen, uh, and regular updates, maybe not quarterly, but certainly, uh, quite regularly, particularly after the ag weighs in. uh, and so, um, just want to voice, uh, i know this was probably a longer comment than anybody wanted or expected, but, uh, it's a once in a lifetime opportunity to talk about, uh, uh, these historical hospitals, uh, saint mary's in particular. for me, i had sisters that were born there, uh, in the old hospital, uh, so, um, uh, wish you all the best of luck. uh, but please, uh, take what you have heard and what you will be hearing very, very seriously. uh, and we will hold you, uh, to the extent that we possibly can. and the community will for sure, uh, hold you accountable to the promises that you make and to the missions that you want to accomplish. thank you. thank you. actually, commissioner gilmore, now that you've been so eloquent, i get to say less so.

so we really we realize as you've given this presentation, how much work has gone into this, how much collaboration? i think, um, when you said intentional, um, i think a lot of things have maybe happened without this kind of forethought and this kind of, um, interest in maintaining the cultures. um, commissioner gilmore was talking about saint mary's. i have a office mate who 70 years ago, her dad was only given privileges as a chinese surgeon at saint mary's. everybody else turned him down for privileges and i have a son who is in the burn unit at saint francis for three weeks, about a year and a half ago. so, you know, these are critical hospitals. many members of the community have had very positive experiences and, you know, we'd like to maintain that. and i think the aspect of culture, especially for the community, because we all realize that you absolutely need more beds. and it makes perfect sense that an inpatient perspective. but as others have said, you know, the outpatient component of this is something we are concerned about, especially the mental health,

the medi-cal and some of the patients who, you know, have been hearing about blue cross annual, um, issue with you seem worried whether, you know, well, now they not be able to go to saint francis, saint mary's too. so some of these things, i think are, are worth, um, uh, explaining in greater detail. so um, we will we will, uh, recraft the resolution with a commissioner chao's recommendations and some of the wording, as well as some of the concerns about the, uh, medi-cal and the mental health and, um, we will, um, uh, we probably would appreciate some kind of update both from our df staff as well as you see, perhaps every six months for the first two years, we can we can talk about what works both for the df and for uc. and uh, and saint mary's, saint francis. but um, obviously we've heard from many stakeholders who are enthusiasts in favor. and so i suspect the resolution that we have at our next meeting will be positive. so we will, um, we will proceed from there. and we're so

grateful for everyone's staying at this late hour and for all the information you shared with us, thank you so much. yeah, i also, um, wanted to thank everybody involved in this effort, including the df, um, policy and planning team, ucsf dignity. um, and really for being open to, um, the comments from the community and the commission to ensure that we are providing the best health care in san francisco, which i know we already do, but we always can do better. so thank you. thank you. all right. well i guess we go to our next agenda item, which is the laguna honda hospital and rehabilitation. rehabilitation center closure plan and cms recertification update for mr. pickens. oh, good evening again, commissioners. pleasure to be back with you. um, to provide you with this update on the status of, uh, cms recertification for laguna honda hospital next slide. as you recall, we had our medicare recertification survey in early

december of 2023. uh, that survey served as the, uh, required, uh, second medicare care recertification survey, um, used in that the medi-cal survey from august of that year served as our first medicare survey. so we completed what's known as the reasonable assurance period, uh, when we had that certification in december, uh, as we shared before, those results, uh, showed significant improvement over our prior cms monitoring surveys with overall findings and lower scope of severity. consequently, um, we, um, drafted and submitted plans of correction to california department of public health on january 13th and 17th, respectively. uh, those plans of correction, uh, have been reviewed by the california department of public health and have been sent to cms for their review and is what they are

currently, uh, next slide. thank so it's a it's important to note that at this time we are not yet recertified in the medicare program. uh, the next step is for cms. and, uh, to approve the plan of correction that is forward to them. uh, then cms and cdc will then state that we have successfully completed the plan of correction. and then based upon that, cms will then make a determination as to whether or not laguna honda is certified. uh into the medicare program. uh, once again, so, as you can imagine, we, uh, remain laser focused on medicare recertification at this time. and our long terme sustainability of the corrective actions and all the processes that have improved over the last

two years. so. sorry okay. uh, next slide. okay so, uh, also would like to, uh, update you on the status of discharge of residents who no longer require skilled nursing level of care. you will recall, from march of last year, 2023, we received specific, uh, direction from the department of health and human services, uh, to begin to, uh, uh, discharge the residents who no longer met skilled nursing, uh, level of care and had skilled nursing leave, uh, needs . uh, we have been our teams at laguna also, including the department of homelessness and, uh, supportive housing and our, uh, department of aging and adult services as well. all come together and starts initiating

those, uh, discharges in april of last year, there have been a total of 22 laguna residents who still needs discharge to community. and currently, there are 45 currently laguna residents in that category of no longer requiring skilled nursing care. next. so that concludes my update. uh, to the commission. as always, we, uh, provide a jc, uh, a much more detailed update and, uh, and as you know, uh, those updates are reported to you, uh, via, uh, the chair of the laguna honda. jc happy to, uh, take questions or comments at the appropriate time. thank you. thank you so much. is there any public comment? yes. we've got two hands. uh, jaime, please unmute. uh, caller ten. caller ten please, please let us know that you're there. hi. it's doctor palmer. um, my question

is that we've been told, um, at these meetings that even when the hope for medicare recertification occurs is a full readmissions will not resume. and we need, uh, the people of san francisco need to know what is the plan for resumption of admissions and one health commission meeting? there was something called a sustainable transition plan mentioned. and there are also references to tiered readmission as well. what does that mean? what will the tiered system san franciscans in need have a right to know how long they must await a bed. we also need to know what is the written plan for outreach to survivors of the victims. um, last time it was will be a plan. well, what is the plan? and we need outreach to san franciscan

sports out of county for, uh, nurse home during this nearly two year closure. what is the plan for outreach to out of county? uh, san franciscans that were forced to go to stiff far away from friends and family. it's also notable that there is a class action suit on behalf of laguna honda residents. now being pursued. expert testimony attested decades of that government under multiple mayors health commissions and directors of health. how will the governance of laguna honda change so that this institution does not return to business as usual? once the regulators back off of this whole process has been agonizing, we can't afford to repeat it. we need our public nursing home. um, do we need, uh, to make changes? um, do we need to have the board of

supervisors weigh in on the governance, please advise. all right. um, thank you. uh, please unmute. caller seven. pretending his problems with regulatory compliance will eventually, magically straighten out on its own will not solve laches noncompliance with regulations as i testified on february 13th, 2020, for each health commission member must read the christopher cherny declaration filed in superior court case cps 25 17064 involving the tommy thompson et al. lawsuit supporting making it a class action case in an upcoming court proceeding. on may 24th, 2024. chinese declaration is a damning indictment of this health commission's collective, abject failures as lhhs governing body between 2019 and 2024, involving lack patient sexual abuse scandal in 2019, page 13.

attorney's declaration stated that 2019 lh 60 day reform. plan authored by grant colfax and troy williams failed because lh failed to address its colossal failures of governance and management. this commission failed, providing meaningful governance. we have to consider. whether this health commission's failures and inaction as lhs's governing body, will serve as a lesson to effect meaningful change of you as health commissioners, leicester continued failures, permanent lack stefan cisco's board of supervisors must act to enact some other independent oversight of governing lh. since this commission has failed to provide actual governance of close to 20 years, turning finger for commissioners who served during the 2019 patient abuse, sex scandal, including commissioners edward chao, cecilia chung, lori green and tessie guillermo, who each remain health commissioners to this day. let's not forget

former health commission president dan bernal, who recently resigned, and i agree with doctor palmer. shame shame on each of you. as health commissioners who have contributed to this decades long problem at lh. okay, that is it. are there any commissioner questions or comments on the laguna honda report? all right. uh, seeing none, we will go to the directors report. well, good evening, commissioners. um, grant colfax, health director, you have the director's report in front of you. um, i would ask you to refer to read it. there's lots of stuff going on in the department. um, just really quickly. great event. um, with the san francisco foundation in a couple of weeks ago, several key leaders honored, including doctor hammer, uh, the best

team, and, uh, doctor andre campbell, um, incredible leaders in health. and i also just wanted to call your attention to a lot of, uh, work, um, and events of the department has been supporting or attending or partnering on with regard to, uh, black history month. um, obviously, i'm happy to answer any other questions, but wanted to, um, respect the commissioner's time tonight. thank you. thank you. is there any public comment on the director's report? i see no hands. any commissioner comments or questions? all right. seeing none, we will go to the joint conference committee report from laguna honda commissioner guillermo. okay, i'll make this very short. uh, we received the executive team report as, uh, you have, uh, so it was essentially the same. we uh, uh, had an air, uh, update and, and, um, we're using were you waving goodbye? oh, okay. um, and, um,

the, uh, uh, in closed session, we reviewed the, uh, report, and, uh, the credentials report. and if i may add, the committee recommended that the full commission approve the two items on the consent calendar. um, yes . that's all upcoming. is there any public comment on the laguna honda report? yes. there's one hand, uh, jaime, please unmute. caller seven. as i testified on february 13th, 2024, you must each read attorneys tommy thompson lawsuit declaration because on page eight, he asserted lhs's regular deficiencies were rare in scope and severity for sneff primary do this governing body's abject failures. on page 30, cherney asserted the $30.6 million in resulting consulting fees, legal fees. i am not hearing, okay,

that's the end of the comment. thank you. all right. then the next item is the consent calendar. and you have before you the items we, um, have been recommended by the jcc to approve. and i gather we need a motion for approval. i so move to approve the consent calendar. second, any public comment on the consent calendar? i see no hands. i'm going to give it 10s. there's a hand. uh, jaime, please unmute. caller seven. please begin. mr. minute, i see your hand, but i'm not hearing anything. obviously, when any patient's wheelchair becomes inoperable, whether a personally owned facility provided a

standard or custom wheelchair due to needing wheelchair repairs, there, at risk of losing their mobility and in many cases essentially become bed bound, reduced to being unable to get out of bed. there have sometimes been reports of patient wheelchairs malfunctioning without repairs for weeks at a time. indeed, i recall that cms cdf issued citations against lh before, during and after lh was decertified in april 2022, alleging lh was neglecting patients health care because their inoperable wheelchairs weren't being repaired in a timely manner. while this health commission is theoretically barred from interfering in lh day to day operations, this commission should nonetheless recommend that any and all lh wheelchair policies and procedures include strong language that wheelchair repairs should receive number one priority for use of the lh patient gift fund to patients. fund wheelchair repairs. all

right. thank you. all right. so we'll do roll call. vote yes. uh, commissioner chao. yes commissioner. limo. yes, commissioner. green. yes, commissioner. gerardo commissioner. christian. yes. and commissioner chung. yes. the items on the consent calendar have been approved. thank you. now, i wonder if i can have permission, perhaps to put off the community and public health committee update. do any of the commissioners have hesitancy? is that all right? yes. all right then we will table that to the next meeting. and now we'll ask if there's any other business, any public comment, any public comment for other business item 13 being a second, i see no hands. all right. we'll entertain a motion to adjourn. so moved second allowed the roll call vote. we'll start with commissioner chao. yes mr. chung ? uh, yes, commissioner. christian. yes, commissioner. gerardo yes, commissioner. guillermo. yes and commissioner.

president. green. yes. thank you. thank you everyone. everyone. >> i am supervisor melgar. i am the supervisor for district 7.

[music] i am a immigrant to san francisco. my family came when i was 12 from el salvador during the civil war. this place gave us security, safety and an opportunity to thrive, so i love the city deeply, and as a mother of three kids who have grown up as city kids, i'm grateful for everything the city has to offer for people like me and families. i have been politically involved my whole life, either in government or a non profit worker and i care about the community. i care about people around me, and i want to make sure that as the world changes around us, other people have the opportunity that my family did. >> we are back in san francisco post pandemic. so important to be out supporting our businesses, supporting our neighbors. >> i'm the first woman to represent the district, believe it or not. i'm the

first latina elected to the board of supervisors without an appointment first ever, so i do think that (indiscernible) i want immigrants to be represented, women, moms, people that have different experiences because that brings richment to our decision making and i think it makes for betting decisions so that inspired me to run. district 7 is one of the most diverse districts in san francisco both in economics and ethnicity. it spans north from golden gate park. it includes all the institutions in the park, the wheel. the music concourse, mew seem to the south to the daly city boarder and west to the organization. includes the zoo (indiscernible) all those fun things and to 280 oen the east.

includes city college, san francisco state. i had ucsf parnassus so very large geographically. it is mostly single family homes, so it is the place where for generations family (indiscernible) nice parks, lake merced, mount davidson. >> this is like a village within the city, so we are very close nit community. we tend to band together and try to support one another and it is a friendly place and families and people to have a cup of coffee and check out the park. >> ocean avenue, which is the southern end of our district is vibrant commercial corridor that mostly cater tuesday the local neighborhoods and the students. as you go further west you have the mall which has some of the best pan asian food offerings in the city. if you haven't been there, it is

really fun. as you go up a little bit further, there is west portal avenue, which is a very old school commercial district where you can still find antique shops and cobbler shops and as well as like more modern restaurants. it is definitely hopping and full of families on any weekday. >> i'm matt roger, the coowner or (indiscernible) >> carl, other coowner in west portal. >> we are a neighborhood hardware store. been a community institution since it was founded in 1936. we had a little bit of everything. (indiscernible) to gardening or gift buying. >> my entire experience in san francisco is this community. it is a very small town feel for a big city. the community is caring and connected. >> what makes me excited doing business in district 7

is i know it sell well. i grew up here. i knew a lot of customers, parents of friends. it is very comfortable place and feels like home. >> if you go up north, you have the innerpz sunset commercial corridor which has a awesome farmers market on weekdays and plethora of restaurants. there is everything you need. >> friendly and safe and (indiscernible) i love they bring their kids with them. they teach them how to use their money, and it is something you dont see in too many markets in other communities. i love to see the kids come and talking to you. it is something different then i see from (indiscernible) >> the ev access to transit in inner sunset and ability to do a lot of shopping on foot, and

now the improved biking with jfk closed to cars, because we have a 4 and a half year old who rides her bike. we now have a safe place to go and ride bike jz don't have to to worry about traffic. >> graffiti continues to be one of these things that during the pandemic just got out of control everywhere in the city and i do think that it is hampering our recovery of commercial corridors, so some of the volunteers on west portal avenue, some of the merchants got together with interns at our office to do some hands on abatement and we have been doing it regularly. we are doing it once a week and we have a wonderful neighbor, carrie organizing and storing the paint and supplies in her office on west portal, but this needs more then just a volunteer efforts. >> i'm grateful for the collaboration. we passed

legislation at the board and put $4 million in the budget over the next 24 months to help the department of public works hire laborers and labor apprentices to abate the graffiti on private property on commercial corridors. i think that for a couple years this recovery strategy so we can get back up as normal after this awful pandemic. participatory budgeting is a pot of money that is available every year for district 7 neighbors to propose projects that improve the neighborhood and the district. anyone, any organization in the district can propose a project and then it's a vote. it is popular vote. we have 14 projects just approved and they span from you know, a vegetable garden at aptos middle school to

pedestrian safety projects on (indiscernible) it runs the gamut, but it is wonderful because it allows people to be engaged in a real way, and then to see the outcome of their energy and work, because the things get improved in front of them. >> i like it is really close to the parecollect parks and bunch of businesses as well as a calm feel. it is a very peaceful feel even though it is close to a lot of things. (indiscernible) also not boring. there is stuff to do too. >> so, there is lots to see and

experience in district 7. [music] [♪♪] fisherman's wharf, this is a working wharf and it's part of the beauty of the san

francisco area. >> before the restaurant, before the t-shirt shops. >> at first the fishermen would go out and do the harvesting. they process the crab. >> it really is industrial. it is fish processors. >> it's a working, living, breathing place. and it's a great place to visit and there's a lot of history. >> i'm a third generation italian fisherman. we're one of the oldest fishing families at fishermen's wharf. my family's been working here since 1908. my boat's called the lovely martha. sport fishing means when you come out and catch your own fish on the boat. commercial fishermen come out, catch fish, it gets processed and they sell it to a store. they're selling crab off the boat. there's nothing more fresh than a crab.

our crab are sweeter and better tasting. the meat is firmer. >> more crab. >> we love crab. we love the people out on the boats. they're awesome. >> what a good meal tonight. >> we just barely got down here in time. we would have come earlier if we knew how much fun it was. >> this is the place to get crab if you're looking for it. >> some of these boats have salmon permits. so every boat kind of does a different thing. you can come down here and have wild caught salmon that was just caught that morning or the night before and there's nothing fresher than that. >> that's the whole thing of coming out on a party boat. you can catch your own crab, lock cod, halibut, salmon, you can't get that kind of fish. >> now the consumer can just buy here if they want to and take it home which is great. or they can buy it here and take it to one of the restaurants and they can have a glass of wine and enjoy the crab we just brought in for them. >> come on over. it's great. nice and beautiful here in san

francisco and the port. definitely come. >> our fishermen are super excited. it's great to have the public come down here and interact. >> it's a whole experience for the family, where they bring the kids and interact and say wow, the crab's alive. it's going to claw me and everything. >> they really get excited they're coming down here and posting their recipes or pictures of the food. or their kids picking up the crab. they're making a whole experience out of it. >> it is going to give the locals a part of san francisco that was taken away from them. >> now i have a reason to come back. >> i had a guy the other day come and say he hasn't been down to fisherman's wharf in 10 years. he said i'm going to come down here every weekend. i forgot

>> (music). >> hi, i'm emmy the owner of emmy's spaghetti i offers working that with some kind of fine dining and apron and feeling stuffy and in the 90s in san francisco it was pretty pretense in a restaurant in the restaurant scene i want to it have a place to have a place for

my friends to guess i started the restaurant a no better place the outer mission spaces were available that's when i opt in two 10 he start with all people and work with them and the events they create one of the events we do every year and backpack give away and give piaget away and a christmas part with a santa and bring 5 hundred meatballs and pa get and we're like in the mission not about them knowing where the food comes from but a part of the community. and my restaurant emmy's spaghetti and fun banquet

and san francisco not the thing that everybody knows about we stay under the radar we show the showcase i take it food and we started to eat we wanted to have comfort food and that a claims friend from i take it and helped me create meatballs and dealing evolved over the years in the beginning one plate of spaghetti and a meatball we tried to make the portions as big as they could be. and now we have quite a few types pasta dishes with a la begin and meat sauce or have a partition to a lot of food we are at a point with all the

favorites i don't change the menu often 0 i eat here so much but everything is fresh your cocktail menu is the best it's ever been one thing on the menu our magazine ghetto we change the flavor one of the fun things it is served in the historically we're known emmy's spaghetti as a friendly place and when i opened i wanted my friend to be welcome and other parents to be welcomed and it is very for this is a place for families especially in san francisco and this is where though hold their celebration important i mean you're coming to a family restaurant and you're coming for o to a fun place i love being the owner and pretty sure my

life i enjoy running the psta spaghetti place i hope to be here a while we'll see how it goes we everyone is a friend we're hoping you'll be a [music] >> san francisco is known as yerba buena, good herb after a mint that used to grow here. at this time there were 3 settlements one was mission delores. one the presidio and one was yerba buena which was urban

center. there were 800 people in 1848 it was small. a lot of historic buildings were here including pony express headquarters. wells fargo. hudson bay trading company and famous early settlers one of whom william leaderdorph who lived blocks from here a successful business person. african-american decent and the first million airin california. >> wilwoman was the founders of san francisco. here during the gold rush came in the early 1840s. he spent time stake himself as a merchant seaman and a business person. his father and brother in new orleans. we know him for san francisco's history. establishing himself here arnold

18 twoochl he did one of many things the first to do in yerba buena. was not california yet and was not fully san francisco yet. >> because he was an american citizen but spoke spanish he was able to during the time when america was taking over california from mexico, there was annexations that happened and conflict emerging and war, of course. he was part of the peek deliberations and am bas doorship to create the state of california a vice council to mexico. mexico granted him citizenship. he loaned the government of san francisco money. to funds some of the war efforts to establish the city itself and the state, of course. he established the first hotel here the person people turned to often to receive dignitaries or hold large gatherings

established the first public school here and helped start the public school system. he piloted the first steam ship on the bay. a big event for san francisco and depict instead state seal the ship was the sitk a. there is a small 4 block long length of street, owned much of that runs essentially where the transamerica building is to it ends at california. i walk today before am a cute side street. at this point t is the center what was all his property. he was the person entrusted to be the city's first treasurer. that is i big deal of itself to have that legacy part of an african-american the city's first banker. he was not only a forefather of the establishment of san francisco and california as a

state but a leader in industry. he had a direct hahn in so many things that we look at in san francisco. part of our dna. you know you don't hear his anymore in the context of those. representation matters. you need to uplift this so people know him but people like him like me. like you. like anyone who looks like him to be, i can do this, too. to have the city's first banker and a street in the middle of financial district. that alone is powerful. [music]

>> i'd like to call the meeting to order. roll call, please. >> commissioner safier here and vice president rivera here. >> commissioner maxwell we'll be be here soon. >> mi