>> welcome >> welcome to the city and county of san francisco health commission meeting this afternoon at 4:00 pm., tuesday, may 7, 2024. i wanted to start by ad litem may is asian american pacific islanders and we are extremely honored to have two members of the commission being instrumental in reforestation the health and needs of asian american pacific islanders population. next week commissioner will not be here going to the 25 anniversary of the white house initiative on asian american pacific islanders and she was also on the ungradual committee and

commissioner chow helped with improving the health of asian-american asian american pacific islanders we're honored to have among us and acknowledge the contributions this month and with that, vice president guillermo will read the land acknowledgement. >> thank you four ad litem the asian american pacific islanders asian american pacific islanders heritage month. 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 so excited the apa hydrogen month i forgot to ask you to call the roll. >> i was going to do that. >> commissioner christian present and commissioner giraudo present. >> vice president guillermo and commissioner chow >> 2. approval of the minutes of the health commission finance and planning committee meeting of april 2, 2024. we have before you the minutes are there any any additions or deletions to the agenda? for the commissioners. >> seeing none, motion to approve the minutes. >> so moved. >> do i have a second? >> second. >> any public comment. >> let's see - any public comment in the room on this item? >> we have a public comment remotely and take public comment and have a statement to read after the comment everyone has

limited to 3 minutes per speaker and i'll unmute you caller are you there? >> yeah. >> on the minutes called. >> yes. please given you have limited to 3 minutes per speaker mr. shaw. >> thank you. >> attorney advise regarding the lawsuit against - >> here we go we - here we go here we go. >> the minutes report that great just before the health commission met to levy attorney advise for the lawsuit concerned about the expert opinion in the executive director stated in the april 15, '24 hour issue that is a decertified and takes years and years through the process -

>> the testimony for the hsh and has my managing this and took until april 29, 2024, for class recertification and stated on april 10, 2024, recertifications of laguna honda hospital and rehabilitation was for the pain and suffering to pms regulations a vacate with this on april 16th we - repeated and with the conference quote it takes a lot to be decertified and didn't just happen. williams and i talk about the laguna honda in a decade or so unquote and took me to the supreme court with dr. declarations by troy

williams a cms but an analysis report we have identified 13 categories that represent the significant improvements for long-standing with the residents and right and freedom. and u.s. and underneath take the cms certification mismanagement and the health commission and on pill 29 for dr. declarations. thank you. >> have a script for public comment the members of the public will have an opportunity to make comments up to limited to 3 minutes per speaker and designed to invite feedback from individuals in the community, however, the process does in the

low all questions to be answered and commissioners questions or comments had discussing an item and making requires and each has comment and written communications maybe sent to the heartache and following e-mail the word health.org commission and dph at.org and spell your name during the minutes not taking a lot of time with the state and federal prohibits harassing conduct will not be tolerated. thank you. >> no more comments a. >> all in favor, say "aye." >> great. thank you the next item is general public comment. >> right. >> so the script i read

pertains except for this item for the items for the listed on the agenda today. and everyone has limited to 3 minutes per speaker one person in the room commissioners, i handed out something to go with the public comment. >> i'm going to read a comment yesterday with the homeless corresponding board we have a urgent request and have over 25 years of verizon high tech crimes for - based out of northern california that is relevant and for several weeks to ask the police commission board of supervisors and several others to gain support for referrals to indictments for several people - as weaponized

packet or and my human sent out a person the normal awareness and. >> (speaking foreign language.) >> i've requested do department of health and director of human health and the department of justice do lodge an investigation where an amount of deaths caused by a few systems to cyber stalk and illegal influence people for politics and person greed and make myself available for the board for investigation of those serious concerns i handed out i sign where they can collect data

for paragraph 4 and 5 with the public health they have failed to share that data military surveillance and also sent to the director of public health and human agencies as a military or my (microphone distorted) and that's the last step before we go to a federal class-action lawsuit and that works for the public health and human services san francisco does in the need a class-action lawsuit especially the people in the room and to figure out and time to act or we'll goshth with the federal lawsuit. thank you. >> and thank you, one remote who would like to make public comment. >> unmuted you caller let us

know you're there. >> i have in conclusion, with the media minutes. thank you. >> that concludes the public comment on this item. >> the next item with as the director's report. >> dr. colfax. >> thank you, president green and good afternoon, commissioners dr. grant colfax, dph director of health i'll highlight a few areas in the report number one, item on the operation on core on thursday april you 25 the health preparation response i'll recover to as sfers has operation an quarry based emergency experience co-spoornd by the medical services agency in san francisco healthcare coalition san francisco fire department and ems and san francisco university of

california and the conducting operation capstone with emergency experiences focuses on the planning that began in 2006 of 2022 multiple objectives including the systems ability to share information across agrees and understanding the ability to handle medical surge and involves over 4 hundred people from organizations working together to make that data success and operations to place in 12 locations including san francisco state and local hospitals. and really an impressive i was able to join with the ph executives and the scale of operation that scenario and the leadership that people showed with the coalition was

great and also want to go out of my way to thank the lodge volunteers were helping with regards to mri that the causality that was rendered was realistically as potential and also just to tell us the size and scale of this experience was extremely imperative and next the alcohol center with the pilots we are now launching a pilot to support over the prevention and treatment for people experiencing homelessness. basically we're using the alcohol center so that after someone goes to the hospital with opioid overdose and support for them to engage with service providers on

medication and take steps for treatment so adapting our center to make sure that people that overdose use the opioid disorder and come to the hospital are able to transition in a safe and supportive environment so we're offering in support of going on off medication we know both methadone are safe aftertreatment for the disorders and reduces the death by 50 percent a key part and president green had a question about the scales effort this is one of those important interventions to do that and another in relationship to our health work and supporting people with disorders is a program called

inspire a management program for people with disorders and coordination with the divisions across the department. contingency management is a treatment it positively enforces the behavior and recognizes that many harm fall - despite their desire to change and contingency management helps to enforce by providing alternative enforcement in the form of positive actions and community and financial incentives. >> so contingency management program you see details there especially with required for people to join and also is incentives and for the participation in this program has been positive. with 18 graduates and one of the few

interventions that is shown to be effective with regards to mebt minutes and cocaine no medication for either of those but showing promise. >> next item i wanted to emphasize the zuckerberg san francisco general celebrated the social worker month inspired the leaders and across the department with the zsfg social workers show the patience patients get the support they need to heal and thrive i want to acknowledge the many social workers including those at zsfg with regards to the month of

march so thank you to our social works and with respect to laguna honda hospital just a recertification the safer oversees from the department of public health for medicare and medicaid the top 0 had say medicaid and medicare the december 2023 medicare recertification survey this is all for revisit surveys addressed correction for the department injures 22 incidents surveyors on monday and executed on friday and the permanent finding that related to the medicare recertification survey and sufficiency to the

correction and the entire laguna honda team that is incredibly proud of this result and we anticipate a single- we my resolve this before recertification and the returning to the laguna honda hospital to review complaints and incidents. so the facility report to start from march 2024 and at that time the surveyors had not exited of facility by the time they have exited the facility and we wait their report on their finding and complaint westbound investigated by regulators and the recertification timeline we'll keep you updated in the regard and that report.

and i'll be happy to answer any questions you may have. >>. thank you. >> thank you. any public comment on the item. >> any public comment in the room. >> all right. i see two hands. >> folks i've given three peninsula watershed in burlingame, california accommodations to please state our code so you're one of those folks. >> i see you're there. >> hi that's dr. palmer when safer oversees exists the laguna honda code it would be nice if you're transparent will be additional citations will delayy services. my understanding is that over citation stands a

recertification for 20 to thirty days and sounds like this is good evening to go on indefinitely. while um, people suffer suffer and wait for nursing home beds. >> we got one more. >> you're unmuted caller and called aa. >> director's report. >> about the g g story. dr. colfax talked about elder san franciscans are in the able to (microphone distorted). >> by little cms untimely decertification in 2022 and dr. colfax several surveyors begin to investigate the facility incidents and patients

complaints an april 29th and still may 3rd dr. colfax failed to list the unanimous and march 26th and 27 and dr. colfax will continue to be investigated i'll may impact the recertification guidelines. and the surveys and others are unethical and meeting the language given the delayed certification leading to dewy certification. dr. palmer is right with a breakdown. dr. colfax used the direction ace misinformation rather than providing accurate information to accomplish recertification and new patient admonition and will wealthy that combination

over $2 million of salaries including french benefits june of a including the district 5 hundred and plus thousand dollars and 4 hundred and 55 thousand dollars $355,000 williams and others and - and the senior with the chad unknown but wealthy salaries and their corrective is unearned but conducting classes for decades and according to cms regulations and within a few hospitals foyer

leading to the did he decertification. should have been a moment of painful shared responsibility. in troy williams joined by mismanagement and governing body constantly changes decertification. thank you. >> that concludes the public comment for this item. >> in any commissioners questions or comments. >> on the director's report. >> ? >> commissioner giraudo. >> i have one question operation on core and whether or not pediatric population with included in the exercise since the venue was a concert event

and kids are usually there and yeah and that's a great question. commissioner we didn't have any volunteers. >> that appeared to be of a younger age. i can follow-up with our team to see if there were scenarios were followed up open where would have been children in that situation. >> i'd appreciate it because it concerns me since some of the issues are quite different i think that is important to know. >> i predator that. thank you. >> thank you. >> i appreciate that. >> thank you. >> commissioner chow any questions or comments on the director's report? >> thank you. >> the report really was quite

interesting and wondering if ultimately because the program is really importance to the city. if we could get a summary as to how dph actually had performed and would be working in conjunction with the rest of the - the departments in the city to be able to respond. to um, such an incidence. >> actually pepper comes to the commission and gives update i can ask for a summary and any additional documents point commission requests. >> that would be very nice thank you. i know the alcohol sobering is a program new and it would be nice to get an update as to the

appropriate time, you know, maybe to see how this is working sundays very exciting. >> absolutely make sure that is included as well. >> thank you very much. and we will will be interested in hearing the progress and for those two very important programs for um, both the very significant champions with amphetamines and the sobering center so thank you very much. >> the next item is the um, proposed move of the howard street and the director of the contractors will present. >> good afternoon, commissioners. and presenting compliance related to the location of the aids foundation

and this is for the location for the aids foundation into he 1035 market street to 940 howard street and protected under chapter 49 because the relocation is for howard street. and um, funding for that program so the proposed relocation is to 940 howard street and to an office building with a three level building on 6 streets the posters for the community meeting and health commission meeting were advertised and put on april 4th and the community meeting held own april 16th at functioning and that was well-attended by the ocii staff

and the foundation staple of staff were no community members that came to the meeting. for there are members of hsh behavorial health that are here wells is foundation aids staff. >> any questions? >> more information for our own our on behalf "no vote" to be taken so any public comment. >> any public comment in the room on this item. >> i see two hands remotely and start with one. >> caller you're unmuted let us know you're there. >> i loaded my hand i'm sorry. >> no worries. >> dr. palmer do you want to

make a comment. >> i didn't lower my hand before sorry. >> no public comments commissioners. >> commissioners questions or comments. >> commissioner chow. >> i had one question which was well, i guess with two. it seems to indicate there would be a relocation when is the relocation anticipated and what are the services that are actually that are by appointment and i assume they're going to be during working hours the services then what i was - >> yes. the services i'm going to have the rent but the site howard opening on may 20th.

>> may 20th? okay.. thank you. >> hello commissioners. i'm the chief of staff and thank you, exporting for the question the services will be on 940 howard street includes our stonewall healthcare program we provide up to clourm services and then also have the community program that is culture programming for a big target population and have culture activities we'll provide at the foundation. >> so those two programs you probably informed residents this may be harder to get to. >> any negative feedback it is

more positive. and our previous building at 1040 market street we had tenants multiple tenants in the believe so had to pass through multiple cleaners clearance is so our clients will not have to jump through the security hoops. >> you'll occupy the entire building? >> i would say and positive move. thank you. >> any other commissioners questions or comments? >> i guess i have one what about i look at our map and curious about the tammy higgason, hims revenue cycle director. of transportation and the parking the one thing that struck me your organizations is phenomenal but over the age of 50 living with hiv and wondering

about transportation getting there what - how you're evolving you think of the people living healthy lives with hiv but from aging is our organization moving into how wonderful you can look at that territory given in the 1980s but occurring how that is involved. >> we have xrrtd we come to the table experts for folks living with hiv and with folks are served with the aging population just in general though we found the partnerships with those types of organizations and providers with the programming to our aging services program that is in your strategy for how aging services

have evolved in the county. >> so what about the transportation and we're trying to - we partner with uber and they use that the services procedure and what a partnership with uber will help with the cost and free transportation, too get to their groups and see their service providers and for accessing as well. >> thank you congratulations on your new home we're extended excited and exemplar organization we're so honors to hear from you and

congratulations. >> thank you. >> anyhow sb 43 and we'll have our director to present. >> good afternoon, commissioners. wonderful to see you today and next slide, please.. thank you. >> so we're going to spend time to talk about two programs the care and 43 next slide, please. and jump to the next slide, please. so first, i'm going to pend time talking about the legislation of 13 three 8 sophomore empowerment programs and san francisco is a

cohort we share programming in october of 2023. was unique is allows for a broad range of petitioners allows individuals to work with the court so a unique opportunity for families makes sense first responders and individuals and entertainment providers trying to pursue and court position and talking about the developments but ultimately some place is not engaged in the services and determined to be to court by the judge can be ordered to participate in treatment for 12 months and additional 12 months a total of 24 months and individuals were diagnosed with schizophrenia a not individual bipolar or major

depression excluding - and it is really intend to be a solution we'll talk about this but this must be upstream for other solutions and next slide, please. so who qualifies care court is specific for people adults and again, for mental illness and an individual has to think not clinton stabilized and engaging in treatment. and have to be meet one of the two criteria unlikely survive safely in the community without

intervention from the court or the types of services are necessary to sure that someone if have a relapse and likely to result for a monetary 51/50 and the least restrictive option people are recovering in the community and likely to benefit from such an emergency investigation we talked about this and - used by someone

conservativeship and people with refer themselves to the care court next slide, please. we have a robust treatment program in san francisco but in the implementation so what we have in san francisco is a team of super service staff for dedicated to and investigate and gave me individuals through the potential cases for care court. that may mean individuals are identified with the care or benefit if from care court we are responsible for investigating petitions from the court which i'll delve into more and one of the things that has been successful is we have an application line while individuals and family members file petitions with the court

that can be a daunting task to go over the paperwork and file that through that process what we did set up a lane for individuals not sure if care court is the right pathway or who don't want to be petitioner they want to maintain the relationship with the person and can he reach out to us, we work to determine in care court is the right program. this allows us to seek cases out of care court not appropriate and make sure we are matching the right intervention additional in october had had 75 cases throat care court convention line and then e-mail address wee in the situations we identified a person is appropriate for care court we had had work and file the petitions to have the

evidence necessary to moved with the petition. >> this is a lot of information and care court has a lot of things so in the middle i lives all the hearings i want to highlight this care court process is a slow process it is as huge benefit to individuals and pretty nor for people's that meet the h when a petition is filed and potential to have a court order it is 5 and a half months not a quick intervention and certainly not replacing a restrictive of intense service but as you can see on the right the department of health becomes involved with the case quickly either where the petitions filed the petition directly with the

court and have worked to engage the individuals via someone engaged in other services. and if not, then it is their petition filed by a family member for example we work with engaging the person and with the application treatment our goal to engage people in volunteer services the process works one of the petition has been filed an individual agreed to the services they enter a care agreement and bunch of court orders that is individual has a way to identifying what types of services their engaging in and the court morpts monitors that but we work through the process someone is not administrative reviews criteria despite our efforts the judge can order that

person to engage. last year to this program individuals are able to access the certificates within the behavorial health and partner working closely with the department of homelessness and supportive housing and homeless housing for those who are experiencing homelessness we are the services are primary with the community-based organizations. because there is a relationship with the court we want to make sure we are differentiate our service staff providing reports to the court and those providing those direct services to individuals. and not everyone is needed in case management imagine those persons need more but there case management to provide intensive case management services to individuals who are court oriented or agreed to

participate. next slide, please. within find question we get understandable care court outpatient how are those done and different. so wanted to share a little bit of this over simplifying those are the differences so we talked about the care court it is unique in filing a position for first injection for those no engaging but limit by the diagnose and the outpatient treatment is someone has previously outcomes to be able to qualify and a broader - people for outpatient anyone with mental illness or but it requires someone has two or more psychiatric hospitalization within the last

6 months and received behavorial health treatment or one or more documents in the last 48 months and a negative input and coveringship other side is we talk about the 43 and one of the things i want to highlight what i'm we're sharing information about the number of circulations we have through behavorial health the report has sporadic languages that protects us or protects individuals where we're not allowed those have gone though the court orders or agreement unfortunately, i'm not able to share those about that is the information you've you you'll not hear today. and i

recognize a lot of information and i wanted to transition talking about some of the 43 recognizing make questions about the report first and i'll be happy to answer any questions you may have. >> we can wait until the end to ask questions. >> commissioners questions or comments commissioner christian. >> thank you, president green hello credit groundwater do you see you the referrals or interventions from the mental illness division or other courts i guess. that would be, you know, i'm not an expert on care courts perhaps but my understanding initially was that path was not considered but i could be totally wrong it's not important but talk about what that looks like the mental

health thinking the care court is adequate. >> the courts similar to a 4/11 have a court order someone that considered for care court we provided a response from the court if someone meets the criteria. um, and a, of course, this is unique and i'm sure doesn't make sense. the person's court will decide a supplies and criminal case and the given the amount of time i think that is less likely in cases that would happen and will be trying to pursue the care court with no criminal charges and not a requirement but those are operate the curt is

understandable if there are benefits people government audit & oversight committee court processes and trying tobacco intentional to answer your question that allows us to assess the individual. >> thanks i - i could again a little bit further if i were in the mental health division and the team the critical team and court of the that care court is set up to provide a lot of the structure that assistance i need. um, so would not be be a 40.6 for the suitability for the care court or? are those even packets yet i'm trying to understand. >> yeah. i'll be honest we've

seen from out counties not in san francisco but i think people happened to have similar cases in san francisco we've seen that happen and navigate that we come up with people have charges out of san francisco and making referrals and so i think about 4011.6 the penal code similar to health court the mechanism we use in san francisco i mingle that is the best way. >> thank you. >> commissioner giraudo. >> please turn on your myself commissioner. >> thank you. >> what are the enforcement mechanisms an individual to note

judge orders oh, well. >> i appreciate that commissioner. the short answer is that the care court relies on the black robe effect with the court and the judge is telling me you do something enforcement mechanisms like a court order that a person was held in contempt and unless necessary meet the criteria for a volunteer hold this is it not the case and persons were working in care court has so show someone is deteriorating and but no true enforcement mechanisms what it comes to care court one pink or thing if someone is unsuccessful that information could be used, aye. >> certificate of

preferenceship is allowed. >> might not be allowed to answer that will you i was curious if there is an unanimous case whatever if you could watch us through from referral through the from those what the decision or position is to understand how um, the process roles. >> yeah. so i'll say in this situation a family member files a petition with the court what happens the judge reviews the case and determines what is the person meets this likely the person has mental illness or a

diagnosis if deteriorating in the community and the primary face if those are sent to the department of health and then reviewed and our job to provide an investigation report back to the court. where we have to answer sporadic information around this to show whether a person needs this and what our recommendation either to push the case of the person by for example, the person's is not engaged in treatment and we tried to engage the person but been unsuccessful and meets the criteria and recommendations the case continue in care court. >> after that there is likely a series of hearings that happen the individual is represented throughout the course of this and have their own representation and support and

can identify someone is important in their life outside of legal representation identify someone and making a friend they trust because those are all closed hearings that allows for that person to be assigned and person as i said to be in the room we work closely with the mental health association to identify who that person is in their life this is to engage the person in volunteer care and what the person is willing to participate and along that process the person can enter into a care agreement they're willing to participate in the across services and willing to meet with a psychiatrist and enter into a necessary agreement

monitored by the court if it is unsuccessful we move forward with the person engaged in the process and coming to court they're saying i'm not interested in the treatment and continue to show our best effort to help the person and they doe rat this is a long process typical in the hearings need to happen the minimum of one and a half months and the courts ultimately say i'm going to order you to participate in treatment we will provide and department of health a recommended treatment plan to the court that may say engagement and case management meet with a psychiatrist and partner with the team to identify be appropriate housing or placement options just an example some things we'll recommend at court orders the

participation whether they enter into the court order thereby updates that happen and the department continues to be the liaison we will get the updates how the suddenly is doing and provide the updates to the court. >> is it just is piggyback initially to quality qualify have to have a diagnosis by someone the schizophrenia specimen or psychiatric disorders. so what happens if one someone delaying the symptoms and no piece of paper or a chart it specifies that

specific dialysis but maybe on the autism or something. >> i appreciate that so you're absolute right have to have a document for diagnoses we do our current electronic health records within the system but request records if private hospitals update and we request a lot of information for we are able to opine if someone qualifies for the program and someone modestly might have symptoms perhaps an office diagnoses but didn't qualify an opportunity to maybe someone is having a different diagnoses but always an opportunity to engage

people in care and make those connections so certainly as department may not qualify for care court but didn't end the journey with us and for certifies and medical staff or maybe our street - it is unclear they qualify we work to engage people and similar to our other treatments we are successful in the court process. >> any other commissioner questions. >> i have been question it is crazy a new feed with an individual been successful lawyer and age 44 developed schizophrenia and the went through varies steps in los

angeles and the judge opposite up saying he would not be forced into treatment what is striking this is adequate said that 50 percent of people with schizophrenia and 40 percent with bipolar actually don't know they have it or deany if a family member submitted e-mails they're against me not hiring me and discriminate the helicopters are outside and no psychiatrists has identified my question though do you deal with those people having either unaware or having been diagnosed and depression what certain quantifications in the judges have a certain amount of training to make those i read

this article i was surprised the judge in this case was missing it was so clear and a lot about the family members describing him and how tragic for children and families and only getting into treatment will be hope for them i wonder if you could combaeth e laboratory and this work to build do trust. >> understand what that person what they're needs are and - but in my experience understanding what someone is willing to respect and sometimes and compromise maybe i would clinically recommend by things like they're willingly and

leveraging those opportunities i think what is part of this case where someone lacks the insight and the fact they're struggling sounds a extreme case i didn't see article but an extreme case experiencing homelessness and judicial determination and article 43 no perfect tool and on a panacea but many tools to help the individuals and put them in a continuum and eventually people will fall there the cracks and tragic to have that experience and something i'll say symptoms there are situations and again, this son-in-law an extreme situation but situations where at the answer is that the person right now didn't qualify owe i

myself have conversations with family members around changes and need you to call us back or have a different conversation i and london are feeling hope also, we try to be providing a lot of education for families members around what is out there for people. and in terms of no requirements as what a judge and expertise that a judge has to have to oversee those types of preceding but i'll say we're fortunate we have with a robust court program and training program before our judicial officer (clearing throat) around the behavorial health needs and really the department as a subject matter expert so

just overseeing that is very have found and a good partner and not true in every jurisdiction. >> thank you very much. commissioner christian. >> one final question dr. involving the coming to care court how do you get them there the judge says go to me through you or through family that your to come to the service central park or whenever at this time and i'm commenting what happens? >> that is not ideal but question a lot of incentives and

the court have investments library we're doing everything we can to support that not just telling them they need to come to court and come to court they get gift cards to incentivize that and some people on point and partner with the legal counselor to meet with them whatever that looks like to representing them and the court allows them to bring people if people are not willing to come we have staff will go out and make that happen. >> a civil outdoor that the court what issue to compel a perch? i'm sure our 100 percent successful you're making but the person didn't come.

>> the why makes a ruling without the person present that, of course, is the judge determination they're willing to do that or not. thank you. >> okay. you and move to sb 43 next slide, please.. next slide, please. . thank you. >> okay. sb 43 deciding on the implemented january 1st of this year and said to highlight this is updating the definition of the facility that is part of short act in 1972 represents the first major change in the actions during that time and we implemented january 1st of this year we really have been a leader statewide in the implementation brookside and providing updates to the state and recommendation to others

jurisdictions to really looking to enter this moving forward. >> so sb 43 was by the senator and amended the exemplification of debilitate and previous to january 1st of this year disability westbound limited to an individual due to confront health issues we recognize in 20.4 more them alcoholism what that amended not just an individual big deal but /* and this is related to mental disorder this supplies all with the low - 51, having for the

valuation including the coveringship so in the legislation is defined by the manual anyone as a presence of 6 out 10 potential symptoms and you're aware and personal safety is the fined in the legislation of one providing without treatment. and unnecessary medical care skewer to prevent an existing medical condition if left untreat will have series bold injury and that is for this different way to look at what we talked about in terms of the disability criteria january 1st and what is it is now

next slide, please. and again, this is into the details that what is cutting-edge a stand alone career for disabilities so what does this look like and again, as we were talking about sb 43 not mean that suddenly everyone will qualify for 51/50 but we have a more comprehensive tool and get closer to serving our vulnerable individuals in our communities. what we anticipate that is new legislation we anticipate as we move there the process more guidance from the state and local lastly what that looks

like it is untested legislation this is our finding as of - as of may 7th our best finding 0 personal safety this is just criteria person safety i want to highlight overlapping with the dangers and what this is not looking at someone to harm themselves but disregard for your person safety samoan running in and out of traffic arrest or assaulted or a victim of a crime failure to thrive or near fatal overdose or hospitalization for example, and necessary medical care might be someone is not or had situations someone has agency refugee or

refusal for care or loss of life we're looking at medical conditions someone is not cared for and have to the nexus they're not caring for those things or the personal safety or basic needs like food, shelter and clobtd or lacks insight. so someone is spending a significant time for substances and at risk of losing a leg dollars something else going on this is a situation we consider a facility or involuntary hold to enter vein for that person and want to acknowledge we all look at this a notice part of our system and a necessary part of our care and our most

restrictive level of care this is for the the answer but something we're looking at as a last resort services in our community but important part an important part step forward and want to acknowledge similar to care the details i will share that we have been involved in many cases to help to identify underutilized criteria for individuals that meets the debilitate criteria the department of health has been involved in one hundred and 66 cases and just to be clear, not one hundred and 66 cases are move forward with the coveringship but been evolved in cases to identify does this person need a level of care and usually the whereas resort to engage someone and what they're

safety in the community. and also includes looking at like outpatient treatment or a restrictive tool to gave me the person. next slide, please. so i want to talk about those again volunteer and involuntary holds with a lot of things about coveringship and what that looks like for coveringship and that

the hospitals - under sb 43 is a recommendation that is submitted to the human service agency the department of disabilities are the ones that liaison with the port we don't do that you provide period of time testimony. someone is in the hospital typically had heaps they move though the poles started with a 72 hour hold and there are no day hold 2450 the conservatorship recommendations that conservatorship 19 can start at any time not requires with the whole subsequence. a rear conservatorship is something that is by the judge for review of the justification and recommendation and typically

lasts thirty days and can be spent for the investigation to happen through the court and then ultimately what la happen the court can issue a permanent conservatorship not last and also to support through the conservatorship as a short-term transition for services. and the the other thing again another important part to support individuals and individual can be placed including in the community which we'll speak about momentary and unlike outpatient treatments are potential enforcement mechanisms with conservatorship or powers of person. and - but an

affidavit for allows them to consent to mole care on a persons on behalf of and affidavit it is yes, this medication i'm sorry an affidavit is a specific medical intervention it is specific intervention and the level is someone needs a p t d or clearance the court having can author on this persons on behalf of the hospital can move forward and the affidavit is an incentive for involuntary and sb 43 allows them to seek medical care on the persons on behalf of unanimously. >> and similar we talked about

what is unique again not required someone be in the has to pursue a conservatorship times when someone is in the community and unstable and not required to seek hospitalization and in some situations conservatorship allows us to have that level of intervention providers do that we support someone in the community in that pathway as well next slide, please. i'll go through sb 43 owe he in san francisco have been sb 43 executive hearing community the district and the department of aging services have been intentional and worked to train the staff around this for disabled under the director of behavorial health very a 16

hundred individuals authorized to be helpful and those individuals go have not training they know the updated criteria which we in the month of december with personally training and people complete in order to maintain the 51/50 authorization and to pro create materials and public sheets along with the and the duktd department of health has an important role to identify the person's when appropriate and providing care for individuals and conservatorship. >> okay. i will pause there that's my last slide. >> commissioner may i check for public comment. >> any public comment in the room and olney public comment

from that on caller. >> see no hands. >> commissioners questions or comments. >> commissioner giraudo thank you for your responses to the question i think i am understanding that but again can be a psychiatrists or a psychologist? >> okay. >> thank you. >> commissioner miller. >> dr. can you solidify my finding before right now um, someone can be 51/50 taken to the hospital and a couple of hours later a psychologist examines them the hospital will not keep them. under that criteria the person - came i right the person can clear and

not be held under the 51/50 someone about look at the history, the conduct that brought them there and the you are rational you are not psychiatric we're going to move forward with them the process is that; correct? >> i'll delve into that and thank you for asking something might but what exacerbates the mental health and often meet the criteria but clear from the substance don't meet the criteria and you're right we have also been required to consider the historic information that is important

and didn't change if someone continues to meet the criteria what that looks like and the disabilities have been an assessment that someone must not be running in and out of traffic arrest insight and might be focused on obtaining substances will prevent being in a situation meets that criteria and acknowledge they're looking at someone needs acute care and does that that is one piece of the puzzle and outside of needing the care someone needs hospitalization or conservatorship in the community with an additional support didn't mean that someone will stay at the hospital it could

delay that we can engage people in a different way and would be beneficial and allows a few things to stand by. >> that 345kz me think about the infrastructure we have to accommodate that that process over the course we don't have to keep people in the hospital and great places like humming bird so if you can share your thoughts how anticipating how your can you help me out e anticipating navigating that. >> absolutely. and the appreciate that and, of course, always looking at what we need to do not just volume but types of events we have available so that is something that is important and what the types of programs like sb 43 and looking at other alternatives services to engage people if places for

people to be and the goals needing a collaboration with at city departments as well and basically looking at we need to like what that might look like a in terms of needs there and that is something we have a lot of conversations with the state and in terms of what types of beds and resources are needed tee accomplish that and certainly not unique in that challenge as city and county and say that i think we do we're finding this is those are not individuals that are (unintelligible) those are people well known to us and have a right to engage people and not necessary people nato system or again have this few but haven't had the tools to gave me them what we're finding individuals generally mental health

diagnoses and sb 43 has given us the tenth to move forward with conservatorship to engage that person we're looking at we have to look at what the services are and we are certainly seeing individuals and looking at as - but think we're well positioned you the department work hard to create and maintain the resources we're intimately involved you talked about if call them challenges but implementing the legislation on the ground that was great of you. so my question is i think i know the answer i heap i'm wrong but any funding that comes with

the bill like the senate bill in the sky. >> expiration i'm sorry you're not inner correct that is an unfunded implementation we're working towards and something we are completed that we believe in our community. >> let us know what we can do if anything to support you and getting those resources. >> thank you >> thank you for the presentation. >> commissioner giraudo. >> thank you so much for your presentation. literally great insight for me anyway personally on i will hope will continue call it services but progresses upcoming funded unfortunately, but you mentioned i think when

you were talking about care court that there say was potentially that there are rental units from outside of the county so i would imagine might happen in the conservatorship process as well. so if there is a community referral or even a family or other referral and for someone that is in san francisco but the family or is outside of county how might - does that differ in terms of, you know, baa we might be able to provide i'm anticipating there are are folks would be looking at this program and saying. okay. we're getting everyone from outside the county and having to provide unfunded set of support and services for those that could

and should actually be, you know, under the conservatorship of a family member out of the county or in some other situations how we had to deal with that and how have we dealt with that? >> i'll say um, certainly family members out of state can file and petition what the state and refer to us as long as the person is residing in san francisco and directed in san francisco they're eligible for a program we certainly want to encourage family members to reach out to us and have a high volume of family members from out of state traveled to san francisco experiencing homelessness or in our community and bring to your attention and work diligently to

reunindication something point individual is interested in we work to make sure the individuals are stable and have services wherever and gone to the extent of hoping people in their home and meeting with family members we have traveled via plane with individuals for individuals family members and secured treatment for that person. >> great. and how is the conservator. >> in those situations the conservatorship was different for example, for individuals who um, i'm losing the word too um,

for individuals that have alzheimer's i'm not ordinary to the time and individual have alzheimer's and someone has a probate conservatorship and conservator is appointed by the court throat department of angling services. >> commissioner chow thank you for the examination but all those programs are trying to help those people that as we know maybe homeless or on the streets and i was heaping at some point and those are just starting along with the programs we could understand the remainder of the programs that

you have as you talked about and tools of trying to respond to the needs finding where the need is and you partially talking about a tool on not just chief informational officer personally abuse we can perhaps understand the totality of the various tools to move the individuals beginning with hypothetical because we have a number of transpeople and how to make an input we seem to layer on different areas each time and obviously the new expansion of

senate bill 43 here's a group of people we've not be able to help with and have to many of those and good programs. that would be good to sort of understand the totality of just taking those blocks we're talking about and here with the tools and if we are able to in, you know, have had a year are year talk about how successful they've been so we've be able to reduce or help, you know, so many people does that make sense? >> i presented that and happy to come back. >> okay. thank you. >> i have one question with the jurisdictions wriek los angeles county are delaying the sb 43

and any thoughts about the red sense sounds we have a better system than we identified individuals and have a commitment perhaps not as far along but you're sense i appreciate the work to be able to move forward with the expansion and needing to support the infrastructure around that and identify what implementation will look like and san francisco commitment we provided a lot of presentation we are very much prepared to move forward with an instrumental in the legislation moving forward. >> so thank you for your work and obviously being at union level it is helpful legislation owe apologize a dr. colfax wanted to respond directly to something and then i think he

had final comments. >> thank you, president green and thank you for the work you're doing i appreciate and mentioning one other county in the state implementing in policeman this year and have all evolved and not up for 20 years so lots of work and i commissioner christians your comment no funding we had to pull funding from other departments and find resources to do this makes it easy you can tell the resources takes i have to acknowledge the doctor the health direction who is active in supporting the work and i did want to give background to

commissioner christians request around around the entering room from some sense people can be 51/50 and heal more and then get better basically that's the narrative and i think from to go back to the point between acute illness and disabilities and those are incredibly important and praefg few clinictions as someone is cleared from this situation would recommend they stayed until they're conservatorship takes weeks in the best case scenario and usually most and don't have the capacity in the hospitals i want to make sure we will follow-up

on this 51/50 and the emergency room or care hospital is no place for someone to sit while waiting for conservatorship and the background on this person and whether those on the health of others we are already overcrowded in the hospitals i want to that i want to put that out there for the record and happy to follow up with my questions the commissioner have. >> thank you for that incredibly important addition information and thank you for your dedication and willingness to use the challenge to address probably some of the most challenging questions we're facing in san francisco we appreciate your excellent presentation and all your work. >> the next item is the fiscal year 2023/24 to help the

reimbursement director will present. >> good evening. >> i'm the reimbursement director for the guide i want to apologize for not available i'm on the tail end of a cold notable to come in for the provision today so here to presents as i mentioned is 24, 25 and fiscal year fiscal year 2024-25 a reminder dph charges for services for the healthcare system and from billing medi-cal and medicare and are incredible to sustaining the services and just as a reminder our adopted patient rates have little relationship the patients are insured or covered through medicaid or medi-cal and for the patients pavements is based on

the fee schedules payment schedules the purpose of this setting this bound is setting the competitive rates. so next slide, please. a high-level too purposes for two main purposes for for the fiscal years one is the manual rate increases to sure that medicaid and middle school e mel's insurance revenue ports of 17 services and two to extend it term rate for in patient services and one year past the current authorization through fiscal year 25, 26 and to expend the rates for the emergency

services and a reminder we worked with a consulted company in 6/9 to revenue the prices for that we had in our in patient sorry for the services and what we noticed compared to the market year at 100 percent we are - the highest equal above many of the other peer providers we submitted to some point in the future to better understand the market and better in order for us to better set the rates in line what, what the market is dedicating in patient trauma purposes and the second we or is second area we are updating the rate is um, three pronged for

the behavorial health services we as the department is increasing rates by 3.08 percent for the fiscal year 2024-25 and 25/26 and you register from last year the rates we set for the behavorial health services we had municipal code fee because many of the patients are recovered by that time and the other physical services setting wrats to increase by 3.67 for fiscal year 2024-25 and three point fiscal year 25/26 with the comptroller's office we choose that why we choose those rates at a base level we with we went throat 2019 study and riled that

or at that time increasing wrats by a percent factor on an manual basis was not necessarily the best way of going about increasing the rates on an annual basis we perform the rate or the market-rate study and we are now committed to performing a risk study. to understand better line ourselves with the market with healthcare marketplace and where we added new rates for service and new reimbursements rates that are set by medicaid and medi-cal we are aligned those with medicaid and medi-cal and best practices with the medicaid we're committed this year i came do

you last year to reevaluate the rates with a strong market last year we'll do this this year we will work to better understand your position within the market with patient rates. >> with that i sorry - yeah. i will take any questions? that you may have. >> thank you. >> thank you. is there any public comment on this item. >> any public comment in the room on this item. >> don't see anyone no one on line and commissioner questions or comments and xog i always find those rates phenomenal. >> and expect for the k hardly

anyone pays any of those rates. i was looking at today at the has remaining that has to put outcome their hospital website all those different rates and then all the different discounts and it would appear that the question of what the rates are are not as important as what you actually pay. my question actually relates for the future and i'm hoping that your going to be doing this study sooner or later to consider doing to sooner because i'm not sure what this new office of healthcare affordability is going to be doing. it gets publicized

healthcare down to 3.5 percent are percent and for certain people actually, you know, modifying that in smaller groups or hospitals and other areas might have challenges but it would get down to three percent in a two 29 the cost of healthcare one of the rates schedules i don't know that's why i think we sooner bring up the rate schedule to the um, local standards even though it is mostly fix perhaps better because of what the state might actually be expecting us to do but it seems scary in terms of caps on healthcare which the

cost of living in fact, remains somewhat higher for many items. and by 2029 will be down to 29 percent that is what they realized this year - this month. i think that that would be behove us to not only accept those but actually see if we can actually accelerated looking at this and keep an eye on that like that. that board is doing so that - i know that on a practitioners how it it effects being paid on individuals per cap case at the private level even in the medical groups so how will the medical groups handle that and hospitals, of

course, a great concern so keep an eye on that on o h c a it is very important and begin the survey sooner would be any advice. >> thank you. >> commissioner chow we're monitoring and the cost limit target and continue to monitor their progress for that office or that commissions progress towards the limit healthcare costs. >> okay. no, that's really reassuring. >> the fee schedule is well above, you know, medicare and what percentages some of the those are 100 percent medicaid it is cutting across the board three percent for the practitioners and even all the expenses how do better to be

safe than sorry three percent rate increases for the two areas identify relate to um, to the fee schedules as commissioner chow said we davlt need to keep pace with cost and in the - i'm wondering how behavorial health and other services versus the fee schedules. >> yeah. so maybe a that have the clarification how we determine our set rates when we have a new services or new program they have a reimbursement code is developed by the cms or medi-cal we'll use the best available medicare data once that rate is set for

example, we set our rate last year, we think that medicaid or payment amount is - then we'll inflate that rate by the cpi we noted. >> so there were new code underappreciation (clearing throat) where i'm confused you set medi-cal's that isly below the fee schedules for the items list you're making a determination how did that relate to the fee schedules we're asked to approve. >> i predator that. >> i should have provided that context we have a mark up against is medicare. >> it is is standard mark up. >> thank you to other commissioners questions or

comments we need motion to approve the rate schedule. >> just before i'm i know to make a comment a new service may not be a medicare or disadvantage i suggest we ask how we find out what the initial fees were we're looking at trying to make sure we are ma'am, missing and ma'am, misses the plentiful makes sense for the new services that are usually excite expensive to understand what commercial rate is and target the commercial rate objective forever medi-cal and mecca certain amount and that will be the max but potentially move on commercial. >> yeah. owe absolutely concur on our experience some of the techniques came along and paid less because if you're saving

money you're not hospitalized and people have surgery but complications the codes is below open surgeries because they have been around longer than i concur we look at that closely and i still move to adopt the new rates. >> second. >> and we have comments. >> all in favor, say "aye." >> aye. >> very good. thank you for the presentation. >> approved. >> next item is commissioner chow from is jcc. >> yes. the j c c held and meeting an april 29th primarily in order to do business to be at the regularly scheduled meeting

for which i want to thank president green for holding an information session when we were schedule but unable to obtain a quorum. at the meeting and you may have read it in the paper and considerable testimony if um, various nurses and other public testimony certainly the working conditions and president green was admirable in accepting the terms and completing the public agenda. and open on information basis. thank you very much. of thank you for that and on april 29th in order to conduct business is review and approve the criminals in closed session intro public comment at that time given and the meeting was a record 10 minutes. thank

you. >> beautiful my public comment on this item. >> to public comment. >> the next item is the finance and planning committee update and commissioner chow will presents present. >> on our meeting prior to this one we reviewed that contracts have them before you and broke down the first contract was with the award and additional four years for that service contracts 2, three, 4 and 5 i think those numbers are right with the health public foundation and there were two for health for various types of administration programs and hiring of subcontractors that would not be done by the

department at this point and the committee asked a number of questions in regards to these but satisfied they represented the programs should be approved. there was a program from h.r. three 60 and dr. payne came to discuss the services that they were rendering and how they were actually looking at their pilot and the pilot being successful in terms of working with the population with a decrease of about - well eclipse of 80 or 85 percent of clients continues to work with the selma rise program this is being extended for 20

two years and um, hope will be we could get a report on how successful this has been and now they're asking for two year extension because it is so successful in terms of their sobering program. the clinic contract is a sort of a full kifshg are circle that was finance in the past and taken offer by 360 health right gave is back to be an is independent program that is what this contract go will will be to fund line mary tip and consumption to the population health division

for with covid orders and so forth not within the skills depended and the amendment that is passed before was to change the start date the original start date didn't include the startup costs we then had four other new contracts the first one was for homeless children's network that is part of the program we heard in terms of blocks internal health and would seem to be inappropriate there and obviously inappropriate funding for the program we - we're so very important and the next contract for to allow the mental health service clients to access lab core that is for the clients need to have convenient

points of service and also life core i think they need this contract to work with the data within our records. the third - contract oh, i can't have with united system for the cancer regulatory our cancer regulatory has retired and while trying to recruit it is important for the function to continue one year contract with united arts systems question are in the process of recruiting someone to manage our cancer regulatory for the department. the last contract was that of the oh, yeah. this is the contract that

services for the population health department i spoke to that so the recommendations approval for the contracts and all the new contracts. >> wanted to make within additional contact on the civil rights program that is ininsight for because the pilot program didn't lend november 1, 2023, through october 31, 2024, d oc compliance moovrnt and so was no performance report appropriated to share with the finance and planning committee. but what it has participated is the - to take into account how he are going to monitor new pilot because the quantitative nature of the d occ process didn't

capture the qualitative element that i think that is important to us in terms of really the city by the bay how can a pilot program indicates has or has not the appropriate measures to continue. funding beyond a doubt a piloted that was a really sort of important thing for the commission to note because we have been so - focused on how you combine the pilots that was helpful to hear that description and nothing to mark for the future. >> thank you very much. and . >> if i could add that dr. used to serve on the commission so maybe more department heads in

the previous commissioners, you know, (laughter). >> wanted to reemphasis question throughout that was a nice merging of understanding the quality of the work being done versus also the financial packs of the and due diligence for the finance so hoping we can do something like that with most of our contracts. >> wonderful any public comment. >> i know that commissioner giraudo and please turn on our microphone. >> on the heels children's network thick i know that is a one for 8 point years but isn't the grant request did it notes

how many people. >> (multiple voices.) >> and yearly. >> yes. thank you, we classified the report we initially not clear it is an average of 50 to one hundred per intaurth with an average of. >> thank you. >> thank you. to other commissioner questions or comments thank you for the report and move to the it consent calendar and identified on the items on the consent calendar based on is meeting 0 motion to approve the consent calendar. >> so moved. >> second. >> any public comment. >> no public comment. >> all right. then. >> all in favor, say "aye." >> aye. >> wonderful. >> next item is other business. >> hearing no other business. >> any public comment.

>> no public comment. >> next adjournment a motion to >> so moved. >> second. >> all in favor, say "aye." >> aye. >> thank you, thanks so much. >> thanks everybody ♪ >> welcome to hamilton recreation and aquatics center. it is the only facility that has

an integrated swimming pool and recreation center combined. we have to pools, the city's water slide, for little kids and those of you that are more daring and want to try the rockslide, we have a drop slide. >> exercises for everybody. hi have a great time. the ladies and guys that come, it is for the community and we really make it fun. people think it is only for those that play basketball or swim. >> i have been coming to the pool for a long time now. it is nice, they are sweet. >> in the aquatics center, they are very committed to combining for people in san francisco.

and also ensuring that they have public safety. >> there are a lot of different personalities that come through here and it makes it very exciting all the time. they, their family or teach their kids have a swim. >> of the gem is fantastic, there is an incredible program going on there, both of my girls have learned to swim there. it is a fantastic place, check it out. it is an incredible indication of what bonn dollars can do with our hearts and facilities. it is as good as anything you will find out why mca. parents come from all over.

>> there are not too many pools that are still around, and this is one-stop shopping for kids. you can bring your kid here and have a cool summer. >> if you want to see some of the youth and young men throughout san francisco play some great pickup games, come wednesday night for midnight basketball. on saturdays, we have a senior lyons dance that has a great time getting exercise and a movement. we have all the music going, the generally have a good time. whether it is awkward camp or junior guard.

>> from more information, visit >> reminder to turn your red light off on your mic to speak and speak directly into your microphone. thank you. this meeting is now being recorded. president heldfond you may begin the retirement board meeting of may 8, 2024. >> thank you madam secretary. you want to call the roll? >> mr. driscoll, present. president heldfond, present. mr. thomas, present. mr. engardio, present. thank you, a quorum is present. >> call