00:00:07 >> the secretary will call the
00:00:09 roll.
00:00:11 >> commissioner pating,
00:00:11 present.
00:00:14 Singer, present. Chow,
00:00:15 present.
00:00:17 Chung, present. Sanchez,print.
00:00:20 Present. Approval of the
00:00:21 meeting
00:00:22 September 6, 2016.
00:00:25 >> the minute before for
00:00:25 approval is
00:00:29 motion is in order. Mokez and
00:00:30 second.
00:00:31 Are the corrections to the
00:00:31 minutes
00:00:32 before you?
00:00:36 >> I submitted small
00:00:37 corrections to our
00:00:41 secretary on the mental health
00:00:41 question
00:00:43 in the tenderloin and asked if
00:00:43 there
00:00:47 are outpatient or hospital
00:00:48 prms.
00:00:50 >> what page are you talking
00:00:51 about,
00:00:52 commissioner? And I think it
00:00:53 is page
00:00:56 5. Page 5, paragraph 1,
00:00:59 question 2.
00:01:01 >> and you are changing that to
00:01:02 read
00:01:02 what?
00:01:05 >> he would like more
00:01:06 information how
00:01:09 mental health impacts
00:01:10 homelessness and
00:01:12 hospital treatment for those
00:01:12 homeless
00:01:13 in the neighborhood.
00:01:15 >> okay, in addition.
00:01:16 Commissioners
00:01:21 any other additions? Or
00:01:22 corrections?
00:01:24 if not, I'll accept that as
00:01:25 part of the
00:01:27 motion unless there is
00:01:28 objection. All
00:01:30 in favor of the minutes please
00:01:31 say aye.
00:01:36 All opposed? The minute
00:01:37 approved.
00:01:39 >> item 3 is direct as report.
00:01:42 >> thank you director garcia.
00:01:44 >> good afternoon
00:01:45 commissioners.
00:01:47 Welcome srf state students we
00:01:48 have
00:01:51 several nursing students in the
00:01:52 audience. Maybe raise your
00:01:53 hand.
00:01:55 >> welcome to you all.
00:01:57 >> future nurses you May have
00:01:58 heard ed
00:02:05 lee announced a navigation
00:02:06 center at
00:02:14 the end of 25th street is
00:02:14 opened
00:02:16 [Inaudible] Provide onsite
00:02:16 essential
00:02:18 service and work towards
00:02:18 permanent
00:02:21 housing for the most vulnerable
00:02:22 homeless in san francisco. We
00:02:24 want to
00:02:26 acknowledge that new navigation
00:02:26 center.
00:02:28 Our job is to help with the
00:02:28 clinical
00:02:31 support of the centers. Also,
00:02:32 as you
00:02:34 know, we have been working on
00:02:35 lean
00:02:39 education series and just had a
00:02:41 dph
00:02:42 executive retreat. I'm looking
00:02:43 at
00:02:44 outcomes and trying to explain
00:02:45 the
00:02:47 outcomes and what I call the
00:02:49 bilinguality of lean since this
00:02:49 is
00:02:51 japanese model of management.
00:02:52 We want
00:02:55 tomake sure it is bilingual for
00:02:55 the
00:02:57 public and commissioners to
00:02:58 understand
00:03:00 it. We have been addressing
00:03:00 health
00:03:01 disparity among african
00:03:02 american and
00:03:03 latinoen san francisco for many
00:03:04 year jz
00:03:06 to address some of this we have
00:03:06 the
00:03:07 support of the centers for
00:03:07 disease
00:03:10 control who is awarding racial
00:03:11 and
00:03:13 ethnic approaches to health
00:03:13 grants to
00:03:14 organizations across the
00:03:16 country to
00:03:17 implement initiatives and san
00:03:17 francisco
00:03:20 department of health was
00:03:21 awarded in
00:03:23 2014 and started the program as
00:03:23 a
00:03:24 result of the program which aim
00:03:25 tooz
00:03:29 provide financial activities
00:03:29 to
00:03:31 patients across the city and
00:03:32 link to
00:03:33 physical activity opportunity
00:03:33 so sthra
00:03:34 link on there if you like to
00:03:35 see the
00:03:37 video. You will hear about the
00:03:37 report
00:03:39 showing decline in hiv
00:03:40 infection but we
00:03:42 still need to work on
00:03:42 disparities and
00:03:45 just as a update on the health
00:03:45 record
00:03:48 we where close to nearing a
00:03:48 decision
00:03:52 using ucsf electroning health
00:03:52 record.
00:03:55 We are reviewing their
00:03:56 proposals and we
00:04:00 of course have a plan b if that
00:04:01 doesn't
00:04:08 work contingency plan and will
00:04:09 give
00:04:10 update. I will leave it there.
00:04:10 One
00:04:12 other thing is acknowledge
00:04:12 lesley
00:04:13 [Inaudible] For national
00:04:14 leadership
00:04:15 program to build culture of
00:04:16 health
00:04:18 through robert wood johnson
00:04:18 foundation
00:04:22 is lesley is a incredible rn
00:04:22 at the
00:04:24 hospital and now [Inaudible] We
00:04:25 want to
00:04:27 congratulate her on the
00:04:28 fellowship.
00:04:29 That is the end of my report.
00:04:31 Jx thank
00:04:32 you. Commissioners questions
00:04:33 to the
00:04:36 director on her report or any
00:04:38 other
00:04:41 items? I have one public
00:04:43 comment.
00:04:45 >> mikem putrals
00:04:57 >> where is there timer? It is
00:04:57 3
00:04:59 minutes, right? Give me a
00:04:59 third second
00:05:02 warning, please. Mikem
00:05:02 putrals. I
00:05:05 want to address what barbara
00:05:06 put in
00:05:07 this directors report about the
00:05:08 decline
00:05:11 in hiv infections. Of course,
00:05:12 I'm very
00:05:14 happy all the numbers are down.
00:05:17 However, there is still this
00:05:18 missing
00:05:22 compunt component of a
00:05:23 concerted
00:05:27 campaign by dph to first of
00:05:29 congratulate those over 50 and
00:05:30 60 who
00:05:33 have survived this plague.
00:05:35 Congratulate us for creating
00:05:36 community
00:05:37 models such as [Inaudible] To
00:05:37 bring
00:05:41 down the infection rates and
00:05:42 for those
00:05:46 who were involved in act up and
00:05:47 street
00:05:49 protest for doing screaming
00:05:50 that
00:05:51 produced millions of dollars
00:05:51 for
00:05:53 programs in san francisco. I
00:05:53 think it
00:05:57 was a year ago susan phillip
00:05:58 from std
00:05:59 unit was here and presenting
00:06:02 her nps.
00:06:04 Number. I brought it up I had
00:06:04 a
00:06:08 conversation with her about her
00:06:08 division. Offering praise to
00:06:10 gay men
00:06:14 for controlling std's, taking
00:06:16 responsibility for getting
00:06:16 tested and I
00:06:20 don't see anything. Okay.
00:06:20 There
00:06:26 really is a need to get with
00:06:26 gibbing
00:06:28 gay men praise for surviving
00:06:29 the plague
00:06:31 for all that we have done and
00:06:32 to help
00:06:35 undo some the stigma.
00:06:35 Regarding what
00:06:38 is in here and thais is also in
00:06:39 the
00:06:41 chronicle about the african
00:06:42 american
00:06:47 men have the highest infection
00:06:48 of hiv
00:06:51 among white men. I want hard
00:06:51 numbers.
00:06:54 Aaron aulday reported on
00:06:55 percentages of
00:06:58 hiv numbers among african
00:06:59 american men
00:07:02 and women and there were no
00:07:03 hard
00:07:08 numbers behind and percentages
00:07:08 and
00:07:09 that is important. When you
00:07:10 say rate
00:07:12 is 140 per 100 thousand what
00:07:15 does it
00:07:17 translate into? Does that
00:07:18 equal 12
00:07:22 cases, 120 cases last year? I
00:07:23 want
00:07:25 specific numbers behind the
00:07:27 percentages. Thank you.
00:07:30 >> urng thank you.
00:07:32 Commissioners
00:07:36 questions? Commissioner
00:07:36 singer.
00:07:40 >> director garcia, I was
00:07:42 hopeic you
00:07:43 can expand where we are with
00:07:45 the
00:07:48 electronic helths regard. The
00:07:51 paragraphers are similar as you
00:07:51 go
00:07:52 through the process.
00:07:55 >> so, we have been working on
00:07:55 a
00:07:58 proposal, a rfp with ucsf to
00:07:59 funds them
00:08:02 to organize the process of how
00:08:02 they
00:08:05 will submit to us the cost. We
00:08:05 are
00:08:06 just receiving the first cost
00:08:07 and the
00:08:09 staff are involved having
00:08:09 conversations
00:08:11 about that cost insureing there
00:08:11 is no
00:08:14 duplication of the cost and so
00:08:14 they are
00:08:17 work with closely with ucsf.
00:08:18 Cost will
00:08:19 become a major concern for us
00:08:22 because
00:08:23 we have a certain amount of
00:08:24 money
00:08:26 allocate d so that is just
00:08:26 beginning
00:08:32 with the ucsf leaders so
00:08:32 imagine in
00:08:34 the next couple weeks we will
00:08:34 have a
00:08:36 understandic ing of the true
00:08:36 cost of
00:08:39 what the proposal says so staff
00:08:39 is
00:08:41 working closely with staff
00:08:41 today so
00:08:43 don't know the answer today but
00:08:44 will
00:08:49 come in inning coming days. As
00:08:49 soon as
00:08:51 we know I will let the
00:08:51 commissioners
00:08:52 know because I know that is
00:08:52 important
00:08:53 to you.
00:08:54 >> as you talked about in the
00:08:55 past
00:08:58 here, there is the tension
00:08:59 between the
00:09:01 cost of implementing it and
00:09:01 cost of
00:09:03 being late given the
00:09:04 requirements of
00:09:06 having a [Inaudible]
00:09:10 >> we are taking that into
00:09:11 consideration and have a
00:09:13 timeline when
00:09:16 to determine the cost of this
00:09:17 electronic health record
00:09:18 through the
00:09:20 partnership with ucsf.
00:09:22 >> how should we think more
00:09:24 specifically about dates that
00:09:24 things
00:09:26 that have to be get done by
00:09:27 what dates
00:09:30 so we can be fully implemented?
00:09:30 I
00:09:32 think it is 1919, but you
00:09:33 probably know
00:09:34 more.
00:09:37 >> I can't give the drop dead
00:09:37 date but
00:09:41 tell you the thecs next 2
00:09:42 weeks we
00:09:43 need the clarifyed number.
00:09:44 Greg is
00:09:46 here, bill is not. Greg can
00:09:47 probably
00:09:48 get the date of the next phase
00:09:49 in terms
00:09:51 of having a understanding
00:09:54 whether we
00:09:56 we'll go 33 through with this.
00:09:58 The
00:10:01 electronic health record is
00:10:02 more
00:10:04 expensive than we can affords
00:10:07 we have a
00:10:08 plan. We are trying to clarify
00:10:08 the
00:10:10 numbers and see greg coming to
00:10:11 the mic
00:10:13 and can give the other dates
00:10:13 when we
00:10:14 need to have that decision
00:10:15 made.
00:10:18 >> commissioners, greg wagner
00:10:19 chief
00:10:20 financial officer. Under the
00:10:20 agreement
00:10:24 we are working on under ucsf we
00:10:25 had on
00:10:27 September 15 just last week was
00:10:28 the
00:10:31 date of their initial draft of
00:10:31 the
00:10:33 proposal as director garcia
00:10:33 said. Our
00:10:37 team is currents ly combing
00:10:37 through
00:10:40 that and work wg ucsf to
00:10:40 clarify. We
00:10:42 have a second date of October
00:10:43 15 for
00:10:47 ucsf to submit a revised
00:10:48 proposal that
00:10:49 should reflect further
00:10:50 discussion
00:10:52 between the two agencies about
00:10:52 scope,
00:10:55 but what is covered,
00:10:56 aboutologist
00:10:58 director garcia said, are we
00:10:58 making
00:11:00 sure everything is counted once
00:11:01 but not
00:11:04 twice. We'll go through that
00:11:06 refinement and have revised
00:11:06 proposal
00:11:10 for ucsf October 15 and then we
00:11:12 have a
00:11:15 chance to make a determination
00:11:16 internally about what is next.
00:11:17 If we
00:11:20 go forward we shoot for January
00:11:20 15 for
00:11:22 the date for completion of
00:11:23 contract
00:11:29 negotiations with ucsf.
00:11:34 >> January 15 finish contract
00:11:36 negotiation with ucsf?
00:11:37 >> yes.
00:11:48 >> how do and feel about
00:11:48 getting that?
00:11:48 >> we are all working on it
00:11:48 very
00:11:48 actively so we have a series of
00:11:48 7 or 8
00:11:50 workstreams going on. It is a
00:11:52 ambitious target, but we
00:11:55 selected that
00:11:56 target by looking at the
00:11:57 timeline to
00:12:02 hit our 2019 milestones. We
00:12:02 also are
00:12:05 as a part of the process
00:12:05 validating
00:12:08 those dates and timelines, so
00:12:09 we will
00:12:11 do our very best to hit it. I
00:12:12 think we
00:12:14 got all hands on deck trying to
00:12:15 do what
00:12:17 we can. There is nothing
00:12:18 magical about
00:12:20 that date. It is not something
00:12:21 that is
00:12:26 set in stone or law, but that
00:12:26 is
00:12:28 ambitious target we are giving.
00:12:31 >> maybe you can give us
00:12:31 oversight
00:12:33 advise. What should we focus
00:12:36 on in our
00:12:40 role? Which sentinel knows
00:12:41 that would
00:12:43 confirm we are getting to this
00:12:44 points
00:12:49 and on track because the
00:12:49 installation
00:12:51 could not be more important for
00:12:51 the
00:12:54 quality of clinical care we
00:12:56 deliver or
00:12:58 the financial integrity of the
00:12:58 hospital
00:13:00 and wider system in the next 15
00:13:01 years.
00:13:04 If it is hard to know-I have a
00:13:04 hard
00:13:08 time to know the things-which
00:13:09 dates
00:13:09 should we care about?
00:13:13 >> we will have-I don't know
00:13:13 the
00:13:15 timing but we have a update
00:13:16 scheduled
00:13:19 for the commission and at that
00:13:20 time
00:13:24 will have doctor eu and bill
00:13:24 kim and
00:13:26 they can shed more light in
00:13:28 terms of
00:13:29 what does the program look
00:13:30 like, what
00:13:32 is there timeline for
00:13:32 implementation.
00:13:36 We are focused vore very much
00:13:37 now on
00:13:38 identified if there are issues
00:13:38 in the
00:13:41 program that are kind of no
00:13:41 goes,
00:13:44 either there is functionality
00:13:45 we can't
00:13:48 use based on our needs and uc
00:13:49 system so
00:13:51 identifying those gaps and the
00:13:51 other
00:13:57 big one is barbara mentioned
00:13:57 is cost.
00:13:59 In the short term where the
00:14:00 focus is
00:14:01 looking at the financial model
00:14:02 and
00:14:04 doing comparisons to benchmarks
00:14:05 so when
00:14:08 we do come back to you I think
00:14:08 the area
00:14:10 of focus will be looking at
00:14:11 what is the
00:14:13 financial model or cost and
00:14:13 benefits in
00:14:15 terms of dollars and timeline
00:14:16 and also
00:14:18 the findings from that analysis
00:14:19 in
00:14:22 terms of what can ucsf system
00:14:24 cover all
00:14:25 the functionality that we need.
00:14:25 How
00:14:27 are we thinking about decisions
00:14:28 in
00:14:32 terms of phasing in of the
00:14:32 various
00:14:36 elements of the unified ehr and
00:14:37 what
00:14:39 that looks like over time and
00:14:39 the
00:14:41 extent to which we are able to
00:14:42 adopt
00:14:49 the ucsf-ehr in the as is form.
00:14:49 That
00:14:52 is big determination. If there
00:14:52 are
00:14:54 areas we need to make
00:14:54 modifications to
00:14:58 the stistm to system it meet
00:14:58 our needs
00:15:02 those can be incompatible with
00:15:02 what
00:15:04 ucsf needs to do or coast or
00:15:05 timeline
00:15:09 implication so those are things
00:15:09 we will
00:15:11 talk to you and focus on when
00:15:12 we bring
00:15:13 back a hearing at the
00:15:14 commission.
00:15:15 >> I do want to let you know
00:15:17 our staff
00:15:19 and ucsf staff have been
00:15:19 working hard.
00:15:22 They have large meetings they
00:15:23 are going
00:15:24 through all the data and
00:15:25 information
00:15:26 and it is working really well
00:15:26 in terms
00:15:29 of the workgroups. You are
00:15:30 slated for
00:15:32 January 3 update but will
00:15:34 guarantee if
00:15:38 there are changes we'll come
00:15:39 to you
00:15:40 before then.
00:15:43 >> further questions to the
00:15:43 director?
00:15:45 If not we will go to the next
00:15:46 item,
00:15:47 please.
00:15:49 >> item 4, general public
00:15:50 comment and
00:15:53 fl is one request.
00:15:57 >> michael putrals, please.
00:16:02 >> hello. I'm running for the
00:16:03 bart
00:16:07 board and I'm here to follow up
00:16:08 with
00:16:11 barbara about my request to you
00:16:12 for a
00:16:14 emergency helths declaration
00:16:15 regarding
00:16:17 the bart plaza at 16th and
00:16:18 mission
00:16:21 street. Where we left it was
00:16:21 larry
00:16:23 stringer was going to look at
00:16:24 my
00:16:26 request for this emergency
00:16:26 declaration.
00:16:28 I haven't heard from him. I
00:16:29 don't
00:16:30 know what is going on with
00:16:32 that, but
00:16:36 the part the reason why I want a
00:16:39 emergency health declaration is
00:16:40 because
00:16:42 it would greatly help
00:16:43 coordinate all of
00:16:47 the variousagys agency that
00:16:47 have some
00:16:50 control over these two plazas.
00:16:51 We are
00:16:54 talking about sfmta, muni, the
00:16:59 department of parking and traf
00:16:59 fic,
00:17:04 clear channel, pg & e, jc duco,
00:17:08 department of public works and
00:17:11 bart.
00:17:13 Trying to coordinate all the
00:17:13 entities
00:17:15 to get on the same page about
00:17:16 cleaning
00:17:20 up the pigeon poop, pigeon
00:17:21 abatement,
00:17:23 needles are being left in
00:17:23 theplaza and
00:17:26 since I'm talking about
00:17:26 needles, I'm
00:17:29 putting the idea out to bart
00:17:29 that they
00:17:32 got to look at having a
00:17:33 permanent drop
00:17:36 off box. Right now the two pit
00:17:37 stops
00:17:38 during the hours they are there
00:17:39 they
00:17:41 have the boxes where you can
00:17:42 drop the
00:17:46 needles, but if it is midnight
00:17:46 and the
00:17:48 pits stops are not there folks
00:17:48 just
00:17:52 leave the needles around so
00:17:53 instead
00:17:55 calling 311 to get request made
00:17:55 to
00:17:59 center the needles pimed
00:18:01 picked up we
00:18:04 had secure box squz think will
00:18:04 greatly
00:18:07 assist pub luck health.
00:18:08 Barbara, what
00:18:11 I'm asking you for is someone
00:18:12 at dph to
00:18:13 coordinate getting out to the
00:18:14 plaza to
00:18:16 inspect all of the public
00:18:17 health issues
00:18:21 that need addressing there.
00:18:21 One thing
00:18:26 I have asked everyone for is
00:18:26 have
00:18:31 contacts at pacific gas and
00:18:31 electric
00:18:35 because the overhead electrical
00:18:35 cables
00:18:39 belong to pg & e and where the
00:18:39 pigeons
00:18:45 are roousting. Pg & e doesn't
00:18:47 have a
00:18:48 pigeon abatement prm and
00:18:49 instead trying
00:18:52 to get dpw to clean up the
00:18:53 pigeon poop,
00:18:56 if the pigeons were not rooting
00:18:57 on the
00:19:00 wires it would greatly help
00:19:00 public
00:19:00 health.
00:19:03 >> I hear you, michael. We'll
00:19:04 get back
00:19:04 to you.
00:19:08 >> thank you Mr. Putrellis.
00:19:09 Next item.
00:19:12 >> item 5, the report back from
00:19:12 todays
00:19:13 community public health
00:19:15 committee
00:19:16 meeting.
00:19:21 >> commissioner pating.
00:19:25 >> yes, we heard two
00:19:25 presentations
00:19:28 today. The first one by Mrs.
00:19:28 Tracy
00:19:30 parker who is the direct
00:19:30 orphthe
00:19:35 community health equity and
00:19:35 promotion.
00:19:36 This was a annual report to
00:19:37 look at the
00:19:40 status of the division, so we
00:19:40 want
00:19:43 today make sure we had a full
00:19:45 understanding of the range of
00:19:45 the
00:19:46 activities as well as the
00:19:47 opportunities
00:19:50 and challenges. Good report.
00:19:50 Will
00:19:54 tell you they are thriving
00:19:55 providing
00:19:58 city wide health equity and
00:19:58 propotion
00:19:59 activities primarily through
00:20:00 their the
00:20:03 community engagement and
00:20:05 community
00:20:10 health equity actirfbties. The
00:20:13 programs include hiv and
00:20:14 hepatitis c
00:20:16 prevention, community
00:20:16 [Inaudible]
00:20:19 Engagement, new comers health
00:20:20 program,
00:20:21 tobacco free, pedestrian
00:20:22 safety,
00:20:23 substance user health, healthy
00:20:24 heart
00:20:27 san francisco and safe and
00:20:27 healthy
00:20:28 environment. All these
00:20:29 programs fall
00:20:30 under one division and within
00:20:31 the
00:20:33 division are other small
00:20:33 programs. To
00:20:39 help this make this more real
00:20:39 they-Mrs.
00:20:40 Packer shared with us the
00:20:41 things that
00:20:48 they were doing in the tinder
00:20:52 tenderloin. I the demonstrate
00:20:53 the
00:20:58 collect ive impact. The hcv,
00:21:01 help
00:21:03 patitis screening and primary
00:21:04 care
00:21:06 treatment occurring in the
00:21:07 tenderloin.
00:21:09 Looking at the branch level of
00:21:10 services
00:21:13 that black african american
00:21:13 health
00:21:15 initiative was actively
00:21:16 involved in
00:21:18 theteneder loin looking at the
00:21:18 health
00:21:20 disparities issues in the
00:21:20 tenderloin.
00:21:21 At the program level there was
00:21:22 a lot of
00:21:25 emphasis on std prevention in
00:21:26 the
00:21:28 tenderloin knowing it is a high
00:21:29 msm as
00:21:32 well as population with a lot
00:21:33 of iv
00:21:36 needle use. Lastly, a
00:21:37 individual
00:21:40 program level we received
00:21:41 outcomes
00:21:42 around newcoming health program
00:21:42 and
00:21:44 health insurance enrollment.
00:21:44 These are
00:21:46 just examples of the different
00:21:47 levels
00:21:49 that our program operates in at
00:21:49 the
00:21:51 single community. If we look
00:21:52 tat
00:21:54 bayview and chinatown and the
00:21:54 mission
00:21:56 and across town, chet is in
00:21:58 there and
00:22:01 doing activities at all levels
00:22:02 to
00:22:06 improve and our health quality.
00:22:06 This
00:22:08 is different than service, this
00:22:10 is
00:22:11 helths promotion and in some
00:22:12 ways we
00:22:14 feel it represents the most pr
00:22:14 gressive
00:22:16 elements of our health
00:22:16 department as we
00:22:22 look to prevent disease and
00:22:22 disparities
00:22:24 of communities at risk. So, we
00:22:28 concluded with really two major
00:22:31 questions. One is what do we
00:22:32 feel this
00:22:35 division-what are the strengths
00:22:38 weaknesses and challenges and
00:22:39 do they
00:22:41 have what they need to go
00:22:42 forward?
00:22:44 Mrs. Packer felt they were
00:22:45 supported by
00:22:48 the department and other city
00:22:48 offices
00:22:49 but they are facing a challenge
00:22:50 of
00:22:52 being a new division that is
00:22:52 coming
00:22:54 together and being integrated.
00:22:54 When we
00:22:57 asked what that meant they said
00:22:58 previously prevention services
00:22:59 had been
00:23:01 divided into several
00:23:02 continuums, one of
00:23:04 the community based sfd
00:23:05 programs,
00:23:07 another is hiv prevention
00:23:08 program and
00:23:10 the broader range of community
00:23:10 health
00:23:11 promotion programs and these
00:23:12 were all
00:23:15 separately funded so besides
00:23:15 being
00:23:17 separate divisions they are
00:23:17 brut into
00:23:19 one house. All the funding is
00:23:19 now
00:23:22 coordinated and this is a
00:23:22 growing pain
00:23:24 over the last year is how to
00:23:24 get
00:23:26 everybody on the same page but
00:23:26 felt
00:23:29 they are working very well. We
00:23:29 have
00:23:31 seen presentations through the
00:23:34 commission that we are really
00:23:34 hitting
00:23:39 all burners with collective
00:23:41 impact.
00:23:42 Another area of concern or
00:23:43 challenge is
00:23:45 federal funding for example,
00:23:46 hiv
00:23:47 prevention and treatment
00:23:48 dollars have
00:23:54 deminshed in the post aca era.
00:23:59 Fortunately the city budge t
00:24:00 filled
00:24:01 into make findsing available.
00:24:02 They are
00:24:05 very valuable but it added to
00:24:05 the
00:24:06 changes the division had to
00:24:07 work
00:24:09 through. Lastly, given that
00:24:11 our public
00:24:12 health approach has been to
00:24:13 build
00:24:15 collective impact across
00:24:15 multiple
00:24:17 domains and communities, this
00:24:18 is the
00:24:20 division that is primarily
00:24:21 charged with
00:24:23 implementing a lot of that
00:24:23 collective
00:24:26 impact work. Sustaining and
00:24:26 building
00:24:28 the backbone for that
00:24:28 collective impact
00:24:31 is a challenge. How many
00:24:31 positions,
00:24:35 how do we fund those positions,
00:24:37 particularly when federal grant
00:24:37 have
00:24:38 limitations on the amount of
00:24:41 administrate ive dollars used
00:24:42 for the
00:24:45 very important data services
00:24:45 that show
00:24:47 the impact we are building
00:24:48 towards is
00:24:50 occurring. I think we left the
00:24:52 conclusion Mr. Chung and I this
00:24:54 division is doing good work.
00:24:54 We have
00:24:56 seen the work they are doing
00:24:57 here and
00:25:00 the tenderloin and reassure you
00:25:00 I think
00:25:02 we are in good hand with health
00:25:03 equity
00:25:05 and promotion. Any questions
00:25:06 on that
00:25:08 item and will move to had
00:25:09 second?
00:25:14 >> my question actually relates
00:25:14 to as
00:25:16 they are doing health promotion
00:25:17 and you
00:25:21 have just a plethora of
00:25:22 programs in
00:25:24 here, house does it involve our
00:25:24 health
00:25:25 system?
00:25:33 >> if you are working in the
00:25:34 tenderloin
00:25:36 and bayview and have clinics do
00:25:37 they
00:25:38 interact with the clinics to
00:25:39 bring that
00:25:42 same message into the clinics
00:25:42 and I
00:25:45 know there was-there continues
00:25:46 it be a
00:25:48 attempt to take the public
00:25:48 health
00:25:50 message and be sure our health
00:25:50 network
00:25:53 is also participating in those
00:25:54 messages.
00:25:56 >> we didn't address that
00:25:56 question
00:25:59 because we were look ing at the
00:26:01 division but understand the
00:26:01 issue. We
00:26:03 had several preebious other
00:26:05 conversations that have come
00:26:05 up. What
00:26:09 they did address was that the
00:26:09 programs
00:26:13 under their division are active
00:26:13 lee
00:26:16 looking to link individuals at
00:26:17 risk to
00:26:19 health services. At the health
00:26:21 promotion level there are
00:26:21 linkage
00:26:23 services out of the deversion
00:26:23 so there
00:26:27 is a latd that level of
00:26:27 interface.
00:26:29 The other programs with regards
00:26:30 to std
00:26:32 and hiv and help c, I heard
00:26:32 from the
00:26:35 other presentation they are all
00:26:35 both
00:26:37 within the public health domain
00:26:38 as well
00:26:40 as the clinic domain.
00:26:41 Everything in
00:26:43 public health is not
00:26:43 necessarily
00:26:44 followed up in the clinic and
00:26:46 everything in the clinic isn't
00:26:47 necessarily public health.
00:26:50 >> if I May add to that. One
00:26:50 of the
00:26:52 main goals that we have in the
00:26:53 public
00:26:54 health division is insure we
00:26:55 have a
00:26:57 coordinated effort with our
00:26:57 clinical
00:27:00 system so as a example, tracy
00:27:00 works
00:27:02 closely with the primary care
00:27:03 system
00:27:05 and susan phillip works closely
00:27:05 with
00:27:09 the clinics to insure the
00:27:09 clinics work
00:27:11 closely with them so via
00:27:12 practice doing
00:27:15 that. We have a sit a wide
00:27:18 responsibility and not just
00:27:18 network so
00:27:20 that is a expanded role with
00:27:21 all the
00:27:23 other networks but assure you
00:27:23 they work
00:27:26 closely with san francisco
00:27:28 health
00:27:29 network and that is goal I have
00:27:30 public
00:27:31 health division and network to
00:27:31 really
00:27:33 work closely together to insure
00:27:34 as we
00:27:37 move to some oaf these areas
00:27:38 that touch
00:27:40 the clincock aspect of the
00:27:40 service the
00:27:42 network is volved in that
00:27:43 process:
00:27:45 >> we have seen isin heart
00:27:47 health and
00:27:50 infant health and emergency
00:27:51 preparations. We have seen
00:27:52 this level
00:27:54 of integration which is unique.
00:27:56 >> maybe as we do that
00:27:57 presentation we
00:27:58 should highlight a bit of how
00:27:59 we do
00:28:00 that where the network and
00:28:01 think that
00:28:03 will be good as part the
00:28:03 presentation.
00:28:04 >> I think that is what I was
00:28:05 looking
00:28:07 for. I know that is a
00:28:08 important
00:28:11 objective that you have and we
00:28:13 have and
00:28:15 just want-I was looking at the
00:28:16 diagram
00:28:20 would have been nice to say and
00:28:20 over
00:28:22 here-because there are so many
00:28:23 elements
00:28:25 that they are doing but that
00:28:26 was just
00:28:28 sort of-I know san francisco
00:28:28 health
00:28:31 network is in this community
00:28:32 partnership and was trying to
00:28:33 be sure
00:28:36 and explore and drether garcia-
00:28:41 >> I think you will see in the
00:28:41 next hiv
00:28:44 report and highlight the
00:28:44 clinical
00:28:45 aspect.
00:28:45 >> good.
00:28:48 >> thank you. You want to go
00:28:49 on with
00:28:49 the second report?
00:28:53 >> the second report is
00:28:54 coupling of
00:28:59 public health with climate
00:28:59 resistance.
00:29:01 [Inaudible] What I think is the
00:29:01 most
00:29:03 exciting areas of public health
00:29:03 work I
00:29:06 have seen over the last year or
00:29:07 two.
00:29:09 we are in the middle of a heat
00:29:10 wave and
00:29:13 we had on average 5 extreme hot
00:29:14 days a
00:29:17 year in the last several years.
00:29:19 By
00:29:24 2100 our kids lifetime we will
00:29:25 have 90
00:29:27 extreme heat days projected in
00:29:27 the
00:29:29 average year. With climate
00:29:30 change and
00:29:32 no about it dependent on
00:29:32 whatever party
00:29:35 you are a member of, it all b
00:29:36 coming
00:29:40 and will see predictions larger
00:29:41 heat
00:29:44 variances, higher sea levels
00:29:46 and other
00:29:48 storm related anomalies. What
00:29:49 we heard
00:29:53 was a report that looked at the
00:29:53 city's
00:29:56 preparedness particularly the
00:29:56 health
00:29:58 identifying both heat zones on
00:29:59 heat
00:30:02 maps as rain maps and flood
00:30:03 maps mpt
00:30:05 areas at risk, populations and
00:30:06 our
00:30:09 citizens that were at risk and
00:30:09 in
00:30:12 January we reveal hopefully a
00:30:13 plan to
00:30:15 address the risks. The
00:30:16 presentation is
00:30:18 so exciting I don't want to
00:30:19 preempt it
00:30:21 by give thg presentation in
00:30:22 advance but
00:30:25 very excited that san francisco
00:30:25 along
00:30:27 with new york are two cities in
00:30:28 the
00:30:32 united states awarded cdc
00:30:32 grants to
00:30:34 address the issue of climate
00:30:35 change on
00:30:36 the health of the population so
00:30:37 this is
00:30:40 a effort to lead the nation
00:30:41 and the
00:30:44 world on what cities can do to
00:30:44 address
00:30:46 global climate change.
00:30:48 >> you expect to bring a
00:30:48 presentation
00:30:49 to the commission?
00:30:52 >> yes, we are thinking
00:30:53 January, is
00:30:56 that right director garcia?
00:30:57 >> there will be
00:30:58 recommendations that
00:31:00 they are still developing and
00:31:01 will
00:31:04 come as part of the
00:31:04 recommendsation
00:31:06 approval process and come the
00:31:06 end of
00:31:08 next year to give the final
00:31:10 recommendation so likely
00:31:10 January,
00:31:13 February it will come to you.
00:31:15 >> so, our secretary will be
00:31:15 sure to
00:31:19 calendar this. Thank you. Any
00:31:24 questions to Dr. Pating? If
00:31:24 not, then
00:31:29 weem wole we'll proceed.
00:31:30 Thank you
00:31:30 very much.
00:31:31 >> there is no public comment
00:31:32 and move
00:31:34 to item 6 which is health
00:31:34 impact
00:31:37 assessment single room
00:31:37 occupancy hotels
00:31:39 in san francisco and resolution
00:31:41 introduced August 2 which you
00:31:41 will vote
00:31:49 on today.
00:32:31 >> good afternoon
00:32:32 commissioners. Thank
00:32:35 you for having me twice in one
00:32:36 day. My
00:32:38 name is cindy [Inaudible] Work
00:32:39 in the
00:32:41 office of policy and planning.
00:32:41 on
00:32:44 August 2 I gaiv gaiv a full
00:32:46 presentation to had health
00:32:46 commission
00:32:48 on the health impact assessment
00:32:48 about
00:32:51 improving the health of
00:32:52 residents in
00:32:54 sro's and introduced a
00:32:54 resolution
00:32:56 asking for support of
00:32:56 recommendations
00:32:58 from that report. Today what I
00:32:59 will do
00:33:01 is give a very quick recap of
00:33:02 the
00:33:04 report and talk about the
00:33:05 stakeholder
00:33:07 input we have gotten since we
00:33:07 presented
00:33:09 to had health commission and
00:33:10 then talk
00:33:11 about the slight modifications
00:33:12 we made
00:33:14 to the resolution and again,
00:33:15 ask for
00:33:18 your support in passing this
00:33:21 resolution. So, just to recap
00:33:22 from the
00:33:24 beginning of the project it
00:33:24 started
00:33:26 approximately 3 years ago with
00:33:26 the
00:33:30 health commission passing a
00:33:30 resolution
00:33:32 requesting to conduct a health
00:33:32 impact
00:33:34 assessment. About a year and
00:33:34 harfl ago
00:33:37 I presented a update and last
00:33:37 month for
00:33:39 the first time we presented
00:33:41 this report
00:33:42 in entirety to the health
00:33:43 commission.
00:33:45 The need for this report was
00:33:46 spired out
00:33:49 of pressure that were put on
00:33:49 sro
00:33:52 operators and tenants of sro's
00:33:53 because
00:33:56 of rapidly rising rent,
00:33:56 affordability
00:33:59 issues with the cost of
00:34:00 upgrading
00:34:02 buildings, increasing
00:34:03 homelessness and
00:34:04 substance use issues. I think
00:34:05 it is
00:34:07 important to note department of
00:34:07 public
00:34:09 health has taken a active role
00:34:10 in
00:34:12 addressing challenges around
00:34:12 sro's.
00:34:15 Going back to 1990, the health
00:34:18 commission had passed a
00:34:19 resolution,
00:34:22 which had advocateed for
00:34:24 sprinklers in
00:34:26 sro buildings after a rash of
00:34:27 fires had
00:34:29 taken place. In 1999 we
00:34:30 started our
00:34:31 direct access to housing
00:34:31 program within
00:34:35 the health department. 2004
00:34:35 our hot
00:34:37 team work would stabilization
00:34:39 units out
00:34:43 of sro's. 2008 the
00:34:44 environmental
00:34:46 health branched passed
00:34:46 inspection
00:34:49 program which inspects the
00:34:49 units and
00:34:52 unit of sro's for health and
00:34:52 sanitation
00:34:54 issues and just last year we
00:34:55 hired a
00:34:58 psychiatric social worker to
00:34:59 accompanyany environmental
00:34:59 health
00:35:02 inspectors to help with
00:35:02 behavioral
00:35:04 issues such as hoarding. Today
00:35:04 we'll
00:35:07 talk about recommendations the
00:35:07 helt
00:35:09 commission can help support to
00:35:10 continue
00:35:13 our long standing presence with
00:35:18 supporting tenants of sro's.
00:35:18 Just a
00:35:21 recap on the process of the
00:35:21 health
00:35:23 impact assessment. The
00:35:24 department our
00:35:27 team had gone through a ver
00:35:27 extensive
00:35:28 exploreitary outreach process
00:35:29 and
00:35:30 stakeholder engagement process
00:35:31 to help
00:35:34 select spauls policies. We did
00:35:35 22
00:35:38 stakeholder interviews and we
00:35:39 convened
00:35:41 3 advisory groups that
00:35:42 represented over
00:35:44 30 city agencies and
00:35:45 non-profits to
00:35:48 help identify issues. With the
00:35:50 specific goal of finding a
00:35:51 policy
00:35:54 solution that helps improve sro
00:35:56 management and reduce health
00:35:58 disparities and code vilaishzs
00:35:59 in
00:36:02 support of safer sro's
00:36:03 environments.
00:36:05 After we went through the
00:36:05 process we
00:36:08 ended up with a lot of great
00:36:08 policy
00:36:13 solutions and program ideas and
00:36:15 basically that focus on 4 major
00:36:16 areas.
00:36:18 They focused on looking at
00:36:20 unsanitary
00:36:23 conditions. Looking at the
00:36:23 safety.
00:36:26 Minuteal health and also around
00:36:27 interagency coordination. In
00:36:28 order to
00:36:32 select policy issues for health
00:36:32 impact
00:36:35 assessment we use a screening
00:36:35 matrix
00:36:38 and principle tooz come up with
00:36:39 the
00:36:41 ones we conduct our health
00:36:42 impact
00:36:43 assessment for. We came up
00:36:44 with a menu
00:36:46 of policy squz the 3 we
00:36:47 conducted just
00:36:49 to recap was about a mandatory
00:36:50 training
00:36:53 for sro operators, increase
00:36:53 data
00:36:55 collection on sro facilities
00:36:56 and also
00:36:59 the increased use of data
00:37:00 analytics for
00:37:03 code enforcement processes.
00:37:03 So,
00:37:06 quickly just recap the
00:37:07 analysis. We
00:37:10 looked at baseline conditions,
00:37:12 neighborhood health status and
00:37:12 spoke
00:37:15 with focus groups around sro
00:37:15 operators.
00:37:18 I won't go through all the
00:37:19 data but
00:37:22 note the highlights and try to
00:37:23 address
00:37:24 some of the questions that the
00:37:25 commission raised during the
00:37:27 last
00:37:29 presentation. So, I know there
00:37:30 are 530
00:37:32 sro buildings in san francisco.
00:37:34 88
00:37:35 percent within 6 neighborhoods.
00:37:36 This
00:37:38 includes the tenderloin, south
00:37:39 of
00:37:41 market, nob hill, russian hill,
00:37:42 mission
00:37:43 and chinatown. The
00:37:44 presentation was
00:37:46 supposed to take place in the
00:37:48 tender
00:37:50 erloin so the commissioner was
00:37:52 interested how many buildings
00:37:52 are in
00:37:55 the tenderloin. 200, so 38
00:37:56 percent the
00:37:58 sro's are in the tenderloin zip
00:38:00 code of
00:38:01 94102. When you look at the
00:38:02 violations
00:38:04 we are seeing so health code
00:38:04 violation
00:38:09 in the sro, the highest are
00:38:09 around
00:38:12 animals and pest, mold, res
00:38:12 use,
00:38:14 sanitation and structural
00:38:15 conditions.
00:38:16 We also looked a that
00:38:17 neighborhood
00:38:20 health status. If you were not
00:38:20 able to
00:38:23 measure the health outcomes of
00:38:24 sro
00:38:28 residents drerth directory we
00:38:33 calculated the hospital and er
00:38:34 emission
00:38:35 rates. A lot of the data was
00:38:36 talked
00:38:38 about last time meeting in the
00:38:40 tender
00:38:43 erloin but just to recap, we
00:38:45 saw as mu
00:38:47 rates twice as high as sth city
00:38:49 wide
00:38:54 average. Falls two to 3 time
00:38:54 average.
00:38:57 Self inflicted injuries 3 to 4
00:38:57 times
00:38:59 the city wide average. The
00:38:59 helths
00:39:01 commission had a question about
00:39:03 the
00:39:05 average lejt of rezentially of
00:39:07 a 10
00:39:09 tenants. I spoke to a sro
00:39:10 operator
00:39:12 that estimated each hotel turns
00:39:13 over a
00:39:15 resident about 40 percent
00:39:16 turnover rate
00:39:18 per year. It gives you a idea
00:39:18 of how
00:39:20 many times people are moving in
00:39:21 and out
00:39:23 of these rooms. As I stated
00:39:24 last time,
00:39:26 the tenderloin and souckt of
00:39:26 market
00:39:28 both have the highest rates of
00:39:29 violations and also have the
00:39:30 highest
00:39:35 rates of hospitalizations too.
00:39:35 We also
00:39:38 spent a lot of time speaking
00:39:39 with sro
00:39:41 operators and did key informant
00:39:41 nrlt
00:39:42 views and lanchlg focus group
00:39:43 to
00:39:45 understand the effectiveness of
00:39:45 a
00:39:48 operator training. The focus
00:39:48 grup
00:39:50 revealed the operators had good
00:39:51 knowledge of the health code,
00:39:52 the fire
00:39:54 code and the building code, so
00:39:54 it was
00:39:57 unlikely if we did a training
00:39:58 that
00:39:59 focused on code enforcement
00:40:01 that it
00:40:05 will improve health. They
00:40:05 didn't
00:40:07 understand how the city
00:40:07 departments
00:40:08 work together or what each city
00:40:11 department did. They lack
00:40:11 knowledge
00:40:13 about health outcomes and poor
00:40:14 housing
00:40:16 and what the connection was.
00:40:17 And they
00:40:21 also talked a lot about mental
00:40:21 health
00:40:23 seeing it as a big streser on
00:40:23 the
00:40:25 operator but other tenant that
00:40:26 resided
00:40:30 in the building. Lastly, we
00:40:31 did lot of
00:40:33 work looking at best practices
00:40:35 and data
00:40:37 around data analytics and were
00:40:39 able to
00:40:44 find that help improve business
00:40:46 processes around housing
00:40:46 inspection.
00:40:49 We found that data analytics
00:40:49 alone will
00:40:52 not lead to vast increase in
00:40:53 help but
00:40:54 supported with interagency
00:40:55 support and
00:40:59 leadership can really lead to
00:41:03 greater
00:41:05 participation into the process
00:41:05 and more
00:41:08 traernz paerns and efficiency.
00:41:09 We
00:41:11 came up with a list of 5
00:41:11 recommendation
00:41:13 which I will go through. One
00:41:14 was a
00:41:16 mandatory training for sro
00:41:18 operatorsthality that focus on
00:41:19 work wg
00:41:22 the tenant population. This is
00:41:22 around
00:41:25 increasing knowledge of health
00:41:26 outcomes, understanding the
00:41:26 role of
00:41:29 each city to how to work and
00:41:30 engage
00:41:31 with tenantsism the second was
00:41:31 to
00:41:35 create a cultural competent
00:41:36 consolidated education material
00:41:37 guide
00:41:40 for operators. Since there are
00:41:41 3
00:41:41 departments-many different
00:41:42 departments
00:41:45 that serve sro, creating a one
00:41:45 stop
00:41:47 guide to easily find
00:41:48 information that
00:41:49 will help with business
00:41:50 practice and
00:41:54 also support tenants. The
00:41:55 third
00:41:56 recommendation is
00:41:57 standardization on
00:41:58 housing inspection data mpt
00:42:02 this is
00:42:04 including collecting more
00:42:05 attribute
00:42:06 about sro. There are
00:42:07 department of
00:42:08 public health, building
00:42:09 inspection and
00:42:11 also the fire department that
00:42:12 collects
00:42:15 nrfgds information on housing
00:42:17 inspection and within those
00:42:17 department
00:42:18 there is different housing
00:42:19 units and
00:42:21 there is no way the data
00:42:21 systems talk
00:42:24 together so we are want to be
00:42:26 able to
00:42:28 standardize the information to
00:42:29 look at
00:42:32 different trend and be
00:42:35 proactive. The
00:42:38 next recommendation is take
00:42:38 the
00:42:40 information and incorporate
00:42:41 into it
00:42:43 business process and create a
00:42:44 interagency housing data
00:42:44 subknhitsy to
00:42:47 establish and track these
00:42:49 performance
00:42:52 measures. And so, we presented
00:42:53 this
00:42:55 report in interity to the
00:42:55 health
00:42:57 commission and have also
00:42:58 presented to
00:43:01 the 6 other organizations over
00:43:01 the
00:43:03 last month. We did the health
00:43:06 commission, the sro task force
00:43:06 chaired
00:43:12 by department of building
00:43:13 inspection.
00:43:17 Tr hip. We presented to
00:43:17 multiple
00:43:19 branches and subprograms within
00:43:19 the
00:43:22 department of public health
00:43:23 which is
00:43:28 population health director and
00:43:30 also
00:43:31 healthy housing. Lastly to the
00:43:32 central
00:43:34 market and tenderloin housing
00:43:36 subcommittee. There were 6
00:43:37 things that
00:43:40 emerged from talking to these
00:43:41 stakeholder and feedback we
00:43:42 got. The
00:43:45 first one is conformation. The
00:43:47 different departments talked
00:43:47 about
00:43:51 support the findings and
00:43:52 related to the
00:43:54 work they did within sro's and
00:43:55 their
00:43:56 tenants. There was a lot of
00:43:58 conformation about these issues
00:43:58 and
00:43:59 recommendations and that we
00:44:00 were
00:44:01 building a foundation to
00:44:03 address these
00:44:05 issues of tenants and
00:44:06 operators. The
00:44:09 second theme that emerged is
00:44:11 sustainability. A lot och the
00:44:12 feedback
00:44:14 stressed in order for the
00:44:14 report
00:44:16 recommendations to be effective
00:44:16 they
00:44:18 have to be sustainable. This
00:44:19 is also a
00:44:20 recommendation of the health
00:44:21 commission
00:44:22 and so this is something we
00:44:23 added into
00:44:27 the final resolution. The
00:44:27 stakeholders
00:44:28 recommended there is funding
00:44:28 allocated
00:44:31 for the implementation and that
00:44:32 city
00:44:34 leadership was really important
00:44:34 for
00:44:36 these recommendations to be
00:44:37 implemented
00:44:41 and successful. When we
00:44:41 presented the
00:44:43 data people were interested in
00:44:44 us
00:44:46 taking a deeper dive. People
00:44:47 wanted to
00:44:48 see more of the connection
00:44:49 between
00:44:53 housing and sro tenant health
00:44:54 and
00:44:55 relationship between operator,
00:44:57 buildings and different
00:44:57 conditions. To
00:44:59 take the foundation that we
00:44:59 built in
00:45:02 the report and see more
00:45:02 specific
00:45:05 analysis that further look at
00:45:06 specific
00:45:09 health outdcomes. The other
00:45:10 thing
00:45:11 talked about is the need for
00:45:11 more
00:45:14 social services and resources.
00:45:14 One
00:45:17 thing that came up was around
00:45:17 financial
00:45:20 improuv provement which is
00:45:20 something
00:45:21 outside of the health
00:45:22 department said
00:45:24 domain but the need to
00:45:26 establish a
00:45:27 centralized form of capital
00:45:28 that the
00:45:30 sro operator could use to make
00:45:31 the
00:45:34 needed physical improvements.
00:45:35 Also
00:45:36 there was-we heard over and
00:45:37 over for
00:45:40 the need for more supportive
00:45:40 social
00:45:43 services. Now we have one
00:45:43 psychiatric
00:45:44 social worker work wg our
00:45:45 section
00:45:49 program and think we heard
00:45:49 over and
00:45:51 over we can expand the program
00:45:51 if
00:45:53 funding is available to provide
00:45:53 more
00:45:55 resources to these tenants. We
00:45:57 heard a
00:45:59 lot around substance use. I
00:46:01 think that
00:46:05 was prevalent in the tenderloin
00:46:06 health
00:46:08 commission. Stakeholders are
00:46:08 concerned
00:46:09 about trend in substants use
00:46:10 and
00:46:12 overdose. Lastly, people
00:46:13 really liked
00:46:16 the idea of the housing data
00:46:17 work group
00:46:21 and all steak homd holders
00:46:21 involved to
00:46:22 be success fm. That is the
00:46:24 steak
00:46:27 akeholder information and
00:46:28 feedback. We
00:46:32 made a small modficaigds to the
00:46:32 health
00:46:34 resolution. We at #d a section
00:46:35 on
00:46:36 stakeholder feedback and added
00:46:38 a sexz
00:46:40 on limitation so people
00:46:40 understood the
00:46:43 scope of the project and would
00:46:43 could be
00:46:45 done and could not. I felt
00:46:45 when we
00:46:47 went back to present people
00:46:48 were trying
00:46:50 to broaden the scope so to make
00:46:50 sure we
00:46:53 work within a context and what
00:46:54 our
00:47:00 limitations were. Lastly, we
00:47:00 are
00:47:03 adding additional data from the
00:47:03 medical
00:47:05 examiner about drug overdose to
00:47:06 the
00:47:09 report. Okay, so where are we
00:47:10 now? We
00:47:12 are hoping for support in the
00:47:13 resolution today and right now
00:47:17 we are
00:47:19 investigating existing
00:47:20 legislation for
00:47:21 implementation of the
00:47:21 recommendation.
00:47:26 In June the city legislation
00:47:26 passed
00:47:28 around code enforcement which
00:47:29 offers a
00:47:31 great pathway to implement
00:47:32 these
00:47:34 recommendations around the data
00:47:36 analytic and code enforcement
00:47:37 piece.
00:47:39 Additionally, in July there was
00:47:39 a san
00:47:41 francisco civil grand jury
00:47:43 report that
00:47:45 looked at suggestion frz
00:47:47 department of
00:47:48 building inspection and fire
00:47:49 department
00:47:51 where department of public
00:47:52 health can
00:47:54 dove tail on for
00:47:54 implementitation
00:47:56 around the last 3
00:47:57 recommendations.
00:48:01 There seems a lot of momentum
00:48:01 for
00:48:02 implementation of the
00:48:02 recommendation
00:48:04 city wide and so we are excited
00:48:05 that we
00:48:08 have support from other city
00:48:09 departments to move forward and
00:48:11 pathways for some of the
00:48:17 recommendations to be
00:48:17 implemented. We
00:48:19 are hoping for support from the
00:48:20 commission that is a catalyst
00:48:22 for
00:48:24 recommendations around
00:48:25 consolidating
00:48:27 materials and doing trainings
00:48:28 for sro
00:48:29 operators. We know that there
00:48:30 is a
00:48:33 opportunity for dilshz work
00:48:33 additional
00:48:35 work to be done beyond the
00:48:35 scope of
00:48:37 this report. When we present
00:48:37 thood the
00:48:38 health department there was a
00:48:39 lot of
00:48:41 interest in programs and
00:48:42 departments
00:48:43 providing more analysis and
00:48:43 also work
00:48:45 wg the dta and work we have
00:48:47 already
00:48:50 done. That's a recap of the
00:48:52 presentation and the
00:48:52 stakeholder
00:48:54 feedback. Happy to take any
00:48:54 questions
00:48:58 about the report or about the
00:48:58 resolution.
00:49:01 >> thank you. Commissioners we
00:49:01 have
00:49:06 one public comment, Mr. Michael
00:49:08 putrellis.
00:49:14 >> hello. Michael putrellis
00:49:15 again.
00:49:16 First of all, thank you very
00:49:16 much for
00:49:20 that report. I learned a lot
00:49:22 and I was
00:49:25 informed by my girlfriend who
00:49:26 is nurse
00:49:28 that many of the folks who are
00:49:29 hanging
00:49:33 out at 16th and mission street
00:49:34 bart
00:49:36 plaza residents of nearby sro's
00:49:38 and
00:49:40 that the bad environment at
00:49:42 16ict th
00:49:45 and mission is contributing to
00:49:46 sro and
00:49:50 homeless folks with asthma and
00:49:50 other
00:49:56 environmental problems, so
00:49:57 -that's a
00:50:00 reason I'm intersested in this
00:50:01 report
00:50:03 because I think it adds urgency
00:50:04 to all
00:50:06 the agencies that have a
00:50:06 responsibility
00:50:10 at 16th street to start
00:50:11 coordinating
00:50:13 regular washings, getting rid
00:50:14 of all
00:50:15 the debris, everything that
00:50:16 creates a
00:50:19 unhealthy environment there. I
00:50:20 have a
00:50:23 question about the resolution
00:50:24 on page
00:50:29 2, it is bullet item 2 and
00:50:30 starts
00:50:31 off-hospitalization and
00:50:32 emergency room
00:50:34 administration rates. At the
00:50:35 end there
00:50:37 is a strike through. What it
00:50:38 reads is
00:50:39 deaths from drug overdoses are
00:50:40 high and
00:50:44 if increase. What is there is
00:50:46 substance use disorder is a
00:50:46 continued
00:50:49 health problem. My question is,
00:50:51 ful
00:50:53 there are drug deaths from
00:50:54 overdose
00:50:56 that are high and increasing,
00:50:56 please
00:51:00 say it. Don't take it out of
00:51:00 the
00:51:03 report. I don't understand why
00:51:03 you
00:51:05 have a strike through there.
00:51:06 Thank
00:51:06 you.
00:51:11 >> thank you very much. Is
00:51:11 there
00:51:15 further public comment? We
00:51:16 are
00:51:18 prepared for questions to the
00:51:21 presenter.
00:51:24 >> thank you very much for a
00:51:24 wonderful
00:51:28 report. [Inaudible] As last
00:51:30 time. I
00:51:31 will vote to support this
00:51:32 resolution.
00:51:33 I think it is very important.
00:51:34 i want
00:51:36 to ask a practicate question.
00:51:36 If we
00:51:38 were to approve this, who
00:51:39 actually will
00:51:43 do the training and who will
00:51:43 put
00:51:46 together the manual and then in
00:51:47 terms
00:51:53 of the continued efforts
00:51:53 particularly
00:51:54 interdependental, who is the
00:51:55 ones
00:51:56 primarily take thg lead with
00:51:57 that?
00:51:58 >> there are 5 recommendation
00:51:59 so for
00:52:02 the first 2 that focus on the
00:52:02 sro
00:52:03 training and putting together
00:52:04 the
00:52:07 educational material, we have a
00:52:07 draft
00:52:10 implementation plan that isn't
00:52:10 shared
00:52:12 but identified department of
00:52:12 public
00:52:13 health who will take the lead
00:52:14 so that
00:52:15 something we will look for
00:52:16 funding to
00:52:19 initiate those projects. For
00:52:20 recommendations 3, 4 and 5 the
00:52:21 department of public health
00:52:23 would be a
00:52:27 partner in implementing those
00:52:29 recommendation squz talked
00:52:30 about we
00:52:33 feel there are pathways for
00:52:34 recommendations implemented
00:52:35 through
00:52:36 legislation supervisor wiener
00:52:37 passed in
00:52:40 June through this civil grand
00:52:40 jury
00:52:42 report and also the mayors
00:52:42 office
00:52:44 started a housing committee and
00:52:44 we feel
00:52:46 there is a opportunity to have
00:52:46 a data
00:52:48 subset of that committee to
00:52:49 move
00:52:50 forward with recommendations.
00:52:50 As we
00:52:54 are working on the report there
00:52:54 have
00:52:56 been tracks that have formed
00:52:56 during the
00:52:58 process that we feel twee we
00:52:59 can use
00:53:02 for the last 3 recommendations
00:53:02 to
00:53:03 implement them.
00:53:06 >> those interagency
00:53:06 commitments are
00:53:07 already there at least in
00:53:07 spirit if not
00:53:08 in fact?
00:53:14 >> spirit, yes.
00:53:17 >> [Inaudible] Great to
00:53:17 identity.
00:53:18 Commissioner singer.
00:53:23 >> I second commissioner
00:53:24 patings.
00:53:26 Congratulation on the report it
00:53:26 is a
00:53:29 important piece of work so
00:53:31 congratulation to you and your
00:53:31 team.
00:53:34 But I also want to beaver away
00:53:35 on a
00:53:37 practical question is, it
00:53:40 is-all the 5
00:53:42 recommendations are seem
00:53:43 sensible and
00:53:44 credible. Some of the data
00:53:46 that you
00:53:49 gathered substanchates
00:53:50 conclusions that
00:53:51 many people understood already.
00:53:53 Had a
00:53:54 instickt like this is going on
00:53:56 and we
00:53:58 can do better. I think it is
00:53:59 really
00:54:01 important to have these data
00:54:01 driven
00:54:03 conclusions and have some of
00:54:04 the
00:54:07 recommendations that you-that
00:54:08 are
00:54:10 proposed about sustainable data
00:54:13 gathering. Using it because it
00:54:14 is main
00:54:16 purpsh is keep people focused
00:54:16 that
00:54:18 these are real issues that turn
00:54:19 out to
00:54:20 be real health problems for
00:54:21 real
00:54:23 people. The thing I'm curious
00:54:24 about is
00:54:26 sort of the other end of that
00:54:26 which is
00:54:30 what are the consequences if
00:54:31 people
00:54:35 don't get up to code and don't
00:54:35 do
00:54:37 things-what will change in the
00:54:38 future
00:54:39 if they don't behave according
00:54:40 to what
00:54:43 the city requires them to do?
00:54:43 So that
00:54:46 in fact it is not just a data
00:54:46 gathering
00:54:48 exercise, but it actually
00:54:50 changes a
00:54:51 meaningful amount of people
00:54:52 lives.
00:54:54 >> I think that is really
00:54:55 important.
00:54:56 One thing I want to note is in
00:54:57 the last
00:54:59 report substantial report done
00:55:02 on sro's
00:55:06 was 2008 so this revitalizes
00:55:06 the issue
00:55:10 and lays a framework to move
00:55:10 forward.
00:55:13 Since there is no central city
00:55:16 department that manages sro the
00:55:16 data
00:55:17 gathering activities are a way
00:55:18 of
00:55:19 bringing different city
00:55:19 agencies to
00:55:21 work together to solve the
00:55:21 problem. I
00:55:24 think it is really important to
00:55:24 centralize the information
00:55:25 since we
00:55:26 have multiple city agencies
00:55:27 working on
00:55:29 the problem. I think having
00:55:30 more eyes
00:55:34 on the data will help initiate
00:55:35 more
00:55:36 planning activities together
00:55:37 that will
00:55:39 help sro's. I think for
00:55:41 example, if we
00:55:42 could spend more time and look
00:55:44 at a map
00:55:48 of sro's and know where the
00:55:49 highest
00:55:52 violateers are we can spend
00:55:52 more
00:55:54 resources and have less time
00:55:54 the
00:55:56 condition existed so have
00:55:57 enforcement
00:56:00 issue where there was a problem
00:56:00 with
00:56:02 pests, those tenants are
00:56:03 exposed to
00:56:07 health issues so we diagnose
00:56:07 them
00:56:10 quicker and abatement times
00:56:10 shorter,
00:56:13 the people will see less
00:56:13 impact. I
00:56:16 think that is one way with data
00:56:18 is how
00:56:19 more efficiently use city
00:56:20 resources to
00:56:22 pinpoint the problem jz solve
00:56:23 them
00:56:24 faster so people are less
00:56:24 exposed to
00:56:26 the the potential health
00:56:26 impact.
00:56:30 >> your logic totally makes
00:56:30 sense and
00:56:34 is what you hope happens in
00:56:34 society,
00:56:37 but it is also somewhat utopian
00:56:37 in
00:56:40 terms what will go down in
00:56:41 practical
00:56:44 realty. I am wondering whether
00:56:44 you
00:56:47 feel you need more enforcement
00:56:47 tools to
00:56:52 make sure that you are not
00:56:52 solly
00:56:57 relying on the good gracious of
00:56:58 everyone but have a hammer to
00:57:00 make sure
00:57:02 that people then do what they-
00:57:05 >> I understand what you are
00:57:05 saying.
00:57:07 Enforcement woin housing is
00:57:08 difficult.
00:57:10 Opposed to a restaurant where
00:57:13 there are
00:57:15 violator you can shut them
00:57:15 down.
00:57:17 Housing we can't relocate every
00:57:18 tenant.
00:57:19 We dont have the housing
00:57:21 evaluate and
00:57:23 it isn't something that is
00:57:23 possible.
00:57:24 The recommendation for the
00:57:26 training is
00:57:29 mandatory training. Sro
00:57:30 operators to
00:57:31 receive certificate of
00:57:31 sanitation they
00:57:33 need to go through the training
00:57:33 so
00:57:36 hoping by providing education
00:57:38 and more
00:57:39 praactive approach it lesson
00:57:41 the needs
00:57:42 for enforcement mechanisms
00:57:43 which are in
00:57:45 place to fine building owners
00:57:47 if they
00:57:49 have violations. We have a sit
00:57:49 a
00:57:51 attorneys office-I think we are
00:57:51 trying
00:57:53 to look more at the upstream
00:57:55 aproem
00:57:57 approach because that isn't
00:57:57 that
00:57:58 successful because that is what
00:58:00 is in
00:58:02 place now. We looked at that
00:58:03 in the
00:58:04 beginning and think there are a
00:58:05 lot of
00:58:08 people thatped to see more
00:58:09 enforcement
00:58:11 and decided to provide
00:58:11 education and
00:58:13 training that lessen the need
00:58:14 for
00:58:15 enforcement because during that
00:58:17 proactive training spend those
00:58:17 health
00:58:18 impacts dont take place in the
00:58:19 first
00:58:22 place. The enforcement is is
00:58:22 the
00:58:24 action has taken place and
00:58:24 impact felt
00:58:28 and it is more of a punitive
00:58:28 tool. I
00:58:30 do agree with you. It could
00:58:30 have been
00:58:32 one other the other, it is just
00:58:32 a
00:58:33 difficult thing with the
00:58:34 housing around
00:58:35 enforcement.
00:58:38 >> it is interesting to see how
00:58:38 it
00:58:41 unfolds and think they are not
00:58:41 mutually
00:58:42 exclusive.
00:58:43 >> one thing we said is since
00:58:44 there
00:58:45 isn't a lot of best practices
00:58:46 around
00:58:47 the recommendations that we
00:58:47 made that
00:58:49 is really important that we
00:58:49 evaluate
00:58:51 and monitor these
00:58:51 recommendations to
00:58:53 make sure they are doing what
00:58:54 we they
00:58:55 think they would do so I agree
00:58:55 and
00:58:57 thank you for that input.
00:58:58 >> commissioner chung.
00:59:01 >> thank you for the
00:59:02 presentation. The
00:59:03 question I have is like when I
00:59:05 look at
00:59:08 the resolution like there are
00:59:09 points
00:59:15 that mention about how it
00:59:16 effects the
00:59:21 poor health outcomes including
00:59:22 mental
00:59:23 health and [Inaudible] When I
00:59:25 look at
00:59:27 the recommendations like I just
00:59:28 feel if
00:59:35 we know that these are causing
00:59:35 the
00:59:39 symptoms we are not
00:59:40 addressing the
00:59:42 symptoms. Is the rational
00:59:42 behind it
00:59:45 because there is another
00:59:46 piece. Like
00:59:48 the language of substance use
00:59:49 is a
00:59:55 continued health issue. I
00:59:57 think that
00:59:58 we quantify it more to list
00:59:59 what type
01:00:01 of health issues are or we
01:00:02 should just
01:00:05 like revurt back to death from
01:00:06 drug
01:00:10 overdose because it seems death
01:00:12 prevention is more concrete
01:00:12 than saying
01:00:14 there are issues related to
01:00:15 substance
01:00:17 use.
01:00:19 >> so, to address the first
01:00:20 question
01:00:21 about-I think what we are
01:00:22 trying to do
01:00:25 is address the upstream causes
01:00:26 instead
01:00:27 of addressing the symptoms.
01:00:28 Our goal
01:00:30 is to prevent people from
01:00:31 having those
01:00:33 illnesses. The housing
01:00:35 conditions are
01:00:37 substandards housing caused by
01:00:38 the
01:00:39 housing violations so having
01:00:41 mold, or
01:00:44 having things that lead to
01:00:45 falls. Not
01:00:46 having railings, these tr the
01:00:48 types of
01:00:50 issues that cause these
01:00:51 symptoms around
01:00:54 asthma or injuries or copd, so
01:00:55 our goal
01:00:59 is look at upstrome up stream
01:01:00 and try
01:01:03 to mitigate the housing
01:01:03 violations. As
01:01:05 far as the symptoms go we have
01:01:06 the elth
01:01:07 network in place and
01:01:08 psychiatric social
01:01:10 worker-there is a lot of people
01:01:10 not
01:01:12 specifically through these
01:01:13 recommendations, that work on
01:01:14 trying to
01:01:16 connect tenant to resources.
01:01:16 Our goal
01:01:21 is to look upstream at the more
01:01:26 social
01:01:27 to minimize those.
01:01:30 >> how do you minimize impact?
01:01:33 >> we will put together the
01:01:33 housing
01:01:34 data committee that will look
01:01:35 at
01:01:37 different types of metrix and
01:01:37 track it
01:01:41 over time. I think what I
01:01:42 mention,
01:01:43 looking at abatement. How
01:01:44 quickly we
01:01:49 find problems and quickly they
01:01:49 are
01:01:51 resolved is less people expose
01:01:51 today
01:01:53 that potential housing risk.
01:01:53 Or how
01:01:55 will we pinpoint enforcement.
01:01:56 If we
01:01:58 resolve the housing condition
01:01:59 problems
01:02:00 more quickly, and there is a
01:02:01 lot of
01:02:02 evidence that point that
01:02:04 training the
01:02:05 mandatory trainings work to do
01:02:05 that, we
01:02:08 should see downstream reduction
01:02:09 in
01:02:12 these health problems among
01:02:12 tenant. I
01:02:13 think it is really important
01:02:14 that as we
01:02:16 look at implementing this plan
01:02:16 that we
01:02:22 look at performance metrix to
01:02:22 track
01:02:25 changes from the trainingsment
01:02:25 . They
01:02:29 May not look at primary health
01:02:29 outcome,
01:02:34 they May look at secondary or
01:02:38 terterary points of data.
01:02:43 >> I'm have ing a bit of
01:02:43 [Inaudible]
01:02:46 Trying to make it more of the
01:02:47 concrete
01:02:50 idea because there is a
01:02:51 statement the
01:02:55 research is [Inaudible] For
01:02:56 mental
01:02:56 health.
01:02:57 >> yes.
01:03:02 >> people living in ovcrowded
01:03:05 conditions, excess noise and
01:03:05 -these
01:03:07 types of conditions link to
01:03:07 mental
01:03:10 health and I apologize I dont
01:03:11 have it
01:03:13 here but in the last
01:03:14 presentation I had
01:03:16 a diagram that looked at the
01:03:17 policy
01:03:19 change jz mapped the health
01:03:19 outcomes.
01:03:22 You look that primary,
01:03:23 secondary and
01:03:24 terterary sources how they are
01:03:25 linked
01:03:29 and a lot of this data is
01:03:31 pretty well
01:03:33 documented in peer reviewed
01:03:34 journals
01:03:36 around direct link of health
01:03:38 impacts on
01:03:38 housing.
01:03:41 >> I apologize because I only
01:03:41 remember
01:03:42 half.
01:03:45 >> I know, I don't expect.
01:03:46 There is
01:03:49 acologist causal link between
01:03:49 that and
01:03:53 as you look at the policy
01:03:53 proposals and
01:03:55 then you look at the stups
01:03:55 between
01:03:57 them, we are looking at
01:03:59 changing those
01:04:01 mitigate steps to effect the
01:04:03 health
01:04:04 outcomes. It isn't a direct
01:04:04 link when
01:04:07 you look that policy but have
01:04:07 made sure
01:04:09 that is the purpose of our
01:04:10 report of
01:04:14 looking at the health impacts
01:04:14 and
01:04:15 policy decisions and making
01:04:16 sure if you
01:04:20 did these type of
01:04:20 recommendations it
01:04:23 will change the health
01:04:23 outcomes. The
01:04:26 draft the report even though we
01:04:26 will
01:04:27 add another section is on line
01:04:28 on the
01:04:29 website so I can send a link
01:04:30 and you
01:04:35 can look at that information.
01:04:36 You
01:04:38 asked about the substance use.
01:04:38 Just to
01:04:41 let you know, we are looking at
01:04:45 multiple sources of data around
01:04:48 substance use. We look at er
01:04:49 emissions
01:04:56 and data from a medical exam
01:04:57 iners
01:04:58 office.-
01:05:00 >> saying the substance abuse
01:05:01 is high,
01:05:03 overdose is high is contrary to
01:05:03 the
01:05:05 city wide but to say it is
01:05:06 increasing
01:05:09 concern within sro's I'm
01:05:09 comfortable
01:05:11 with that. If the commission
01:05:13 would so
01:05:14 accept that change I think we
01:05:15 can say
01:05:19 that it would be increasing in
01:05:20 sro's
01:05:22 not the city as a whole.
01:05:25 >> I think that might help to
01:05:25 address
01:05:27 that the reason is because we
01:05:28 stated to
01:05:30 generalize it is harder-
01:05:32 >> it is generalized in the
01:05:32 other
01:05:34 direction as well. That was a
01:05:35 data
01:05:36 point cindy brought the last
01:05:37 time so
01:05:40 will probably read something
01:05:41 like,
01:05:43 deaths from drug overdoses
01:05:44 increase in
01:05:46 sro's therefore substance abuse
01:05:49 disorder is a continued health
01:05:50 issue so
01:05:53 we keep that data point in that
01:05:54 resolution. I'm comfortable
01:05:55 with that.
01:05:57 >> yeah. Maybe that is what
01:05:59 got me is
01:06:01 the style.
01:06:03 >> come back to that wording as
01:06:03 we get
01:06:05 into the resolution.
01:06:06 Commissioner
01:06:06 pating.
01:06:08 >> this is a small comment on
01:06:09 what
01:06:10 commissioner singer raised with
01:06:10 regards
01:06:14 to the inducing behavior change
01:06:15 in the
01:06:17 sro owners and managers as well
01:06:18 as the
01:06:21 tenant. I think we can look
01:06:22 at-it is
01:06:33 issue of the carrot. Why you
01:06:34 didn't
01:06:35 include the language on
01:06:37 enforcement or
01:06:38 incentive in the resolution I
01:06:39 hope you
01:06:41 will consider them use all the
01:06:42 tools.
01:06:45 I think some owners might
01:06:46 respond very
01:06:48 well to support as well as
01:06:49 small grants
01:06:52 to induce changes that on a
01:06:52 matching
01:06:54 basis perhaps I think we have
01:06:54 seen this
01:06:57 in many community based
01:06:58 projects.
01:07:00 However you go about it is
01:07:02 don't
01:07:07 forgetd it is a carrot on a
01:07:08 stick.
01:07:10 Just doing business as usual
01:07:10 May not
01:07:12 get to a education issue and
01:07:13 May got
01:07:15 get to had end point either.
01:07:16 Do you
01:07:19 think of promoting this as a
01:07:20 sustainable behavior change for
01:07:21 the sro
01:07:22 leaders and leading their
01:07:23 community.
01:07:25 This is building the community
01:07:26 in the
01:07:29 tenderloin with them at the
01:07:29 forefront
01:07:31 making it a better city.
01:07:33 >> just to piggy back on that
01:07:35 that is a
01:07:37 234 siteful comment if you
01:07:37 connect with
01:07:39 what you discussed about
01:07:40 climate change
01:07:43 earlier. Some of the most
01:07:46 successful
01:07:47 programs inducing change
01:07:48 whether in
01:07:49 fisheries or prairies have been
01:07:49 the
01:07:53 programs where they mary the
01:07:53 kind of
01:07:58 things you are doing with real
01:08:02 economic
01:08:04 incentives where May benefit on
01:08:05 good
01:08:06 behavior. I don't know if that
01:08:08 is
01:08:12 rates sro's qualifiedfelt you
01:08:12 are
01:08:14 better situated to figure that
01:08:16 out but
01:08:18 marying this public health
01:08:18 approach to
01:08:21 solving real problems with some
01:08:22 real
01:08:25 modern day economic incentives
01:08:26 for the
01:08:27 actors in the community is
01:08:29 likely to
01:08:34 yield much better results than
01:08:34 you
01:08:36 imagined and worth spending
01:08:36 time to do
01:08:37 that.
01:08:38 >> maybe getting partners to
01:08:39 help. We
01:08:41 have downtown corporations
01:08:42 impacts by
01:08:44 the sro's maybe this will build
01:08:44 good
01:08:46 dmunties down there.
01:08:48 >> so, I have one more comment
01:08:49 also
01:08:55 from commissioner sanchez.
01:08:59 >> just want to state that
01:08:59 there is a
01:09:04 old saying in scine tific
01:09:05 research,
01:09:07 the dif ference between basic
01:09:09 and
01:09:10 applied research is time. I
01:09:11 think you
01:09:13 gairfb us a real excellent last
01:09:13 time
01:09:17 and this time pertaining to
01:09:18 starting in
01:09:26 1999 and before them in the
01:09:27 health
01:09:28 department asked to take a look
01:09:30 at
01:09:33 different variables including
01:09:34 unit and
01:09:37 bed bugs. We asking as a
01:09:38 public policy
01:09:40 board to put fees to these home
01:09:41 owners
01:09:43 and to these people who take
01:09:43 these
01:09:45 people so this way their
01:09:45 feeerize going
01:09:48 up and up and up from different
01:09:49 agencies. The fire
01:09:49 departments, the
01:09:57 housing department, health de
01:10:00 paement
01:10:01 department. The work the
01:10:02 department
01:10:03 has done to pull together the
01:10:04 agencies
01:10:06 to look at the data on who is
01:10:06 doing
01:10:10 what, therefore you're database
01:10:10 your
01:10:12 particular department is shared
01:10:13 with
01:10:14 your database in another
01:10:16 department and
01:10:17 another department. It is
01:10:18 interesting
01:10:20 because it shows on the radar
01:10:20 we
01:10:24 concentrate on the same bogey
01:10:24 and unit
01:10:28 and there are 4 or 5 different
01:10:28 agencies
01:10:32 valve and 4 or 5 different
01:10:33 outcomes.
01:10:35 One says excellent and one
01:10:35 violation
01:10:37 and one says no way and one
01:10:38 says more
01:10:40 training. All I say is when
01:10:40 this was
01:10:42 graut r brought before us it
01:10:42 was a fact
01:10:45 that we really need hard data
01:10:47 and I
01:10:50 remember student we knie in the
01:10:50 city
01:10:52 who happened to go to san
01:10:53 francisco
01:10:55 state. He was a top
01:10:56 [Inaudible] At san
01:10:58 francisco state from the
01:10:58 mission,
01:11:01 family lived in the sro in the
01:11:01 mission.
01:11:05 Belonged to the boys club and
01:11:06 he was
01:11:08 vairb concerned about data too
01:11:08 and
01:11:11 maybe different things. To cut
01:11:12 to the
01:11:15 chase, he went on from sf
01:11:16 state, his
01:11:17 wife graduated from sf state
01:11:18 and went
01:11:20 into the nursing. He became a
01:11:24 physician and turned out of uc
01:11:25 and
01:11:28 harvard and back at ucsf.
01:11:29 Doctor
01:11:31 steven bushard. The top
01:11:34 special ist in
01:11:37 reference to asthma effecting
01:11:38 people of
01:11:40 color. He was on national
01:11:40 public radio
01:11:50 last week and this week. He
01:11:50 has taken
01:11:51 a look at-take a look autothe
01:11:51 totality
01:11:51 what we are looking at and this
01:11:51 what
01:11:51 this department is doing.
01:11:51 Let's take a
01:11:52 look at all the variables
01:11:54 effecting how
01:11:55 families live, how people live.
01:11:56 But
01:12:00 let's combine the database to
01:12:01 look at
01:12:02 what is happening. Many years
01:12:03 ago I
01:12:06 served the national health
01:12:06 commission
01:12:09 and a major concern we had sl
01:12:11 the fact
01:12:13 that the minority communities
01:12:14 are not
01:12:16 involved within the database
01:12:16 insureing
01:12:18 pertaining to outcomes and
01:12:19 measurements
01:12:22 and department of public health
01:12:22 here is
01:12:24 one of the key leaders
01:12:25 addressing not
01:12:28 national modelsx but who do we
01:12:28 serve?
01:12:30 Who are we service in the city
01:12:32 of san
01:12:33 francisco? The populations
01:12:33 have
01:12:37 changed over time but
01:12:37 populations
01:12:39 represent a unique opportunity
01:12:39 that
01:12:43 have new interventions and new
01:12:43 public
01:12:46 policy addressing on how we
01:12:46 service
01:12:47 because we where a public
01:12:48 agency. We
01:12:51 are not a corporation. Wells
01:12:52 farg or
01:12:54 and others. X number of
01:12:54 dollars goin
01:12:56 and out. They make [Inaudible]
01:12:57 We are
01:13:02 a public agency involving
01:13:03 training,
01:13:05 supervision, xhitded to making
01:13:06 sure we
01:13:09 have the best outcomes using
01:13:11 the best
01:13:12 database and think the
01:13:12 department has
01:13:15 taken a major stand and really
01:13:17 presenting to the totality of
01:13:17 san
01:13:20 francisco some new ways to take
01:13:21 a look
01:13:23 at this particular cohort. So,
01:13:24 I just
01:13:26 want to congratulate. I think
01:13:27 we will
01:13:30 vote and move on but still
01:13:30 have a
01:13:32 number of questions and
01:13:32 concerns, but
01:13:35 think the peer review from the
01:13:37 different agencies already is
01:13:38 triggering
01:13:42 sml more oversight. More due
01:13:44 diligence. More efficacy and
01:13:45 research
01:13:47 in plotting and signing your
01:13:48 name as
01:13:50 that inspector and signing your
01:13:51 name as
01:13:54 superriser who is training
01:13:54 student to
01:13:56 visit and work with our
01:13:57 agencies and
01:13:59 that is part of our mission. I
01:13:59 just
01:14:02 want to say, well done and look
01:14:02 forward
01:14:05 to even more positive outcomes
01:14:06 as we
01:14:10 clabilate collaborate with the
01:14:11 agencies looking how our people
01:14:12 lib in
01:14:13 this great city of san
01:14:13 francisco.
01:14:13 Thank you.
01:14:15 >> thank you.
01:14:17 >> commissioners, I believe we
01:14:17 have
01:14:19 offered a number of suggestions
01:14:20 on how
01:14:22 to help with the implementation
01:14:23 and
01:14:24 also been thinking about the
01:14:25 issues
01:14:27 under the whereas and how to
01:14:28 clar fay
01:14:31 the importance of this.
01:14:32 Didn't hear
01:14:34 any substantial discussion in
01:14:34 regards
01:14:36 to the recommendations we are
01:14:37 asked to
01:14:39 endorse. I believe that we are
01:14:42 prepared to move forward on the
01:14:43 resolution unless there are
01:14:44 furpther
01:14:45 comment. A motion for the
01:14:46 resolution
01:14:49 and then we can try to craft a
01:14:51 resolution in the several
01:14:51 suggestions
01:14:53 that are made. Is there a
01:14:53 motion?
01:14:54 >> so moved
01:14:56 >> is there a second?.
01:14:57 >> second.
01:14:59 >> moved and seconded, the
01:15:00 first
01:15:01 recommendation that has come
01:15:02 out of
01:15:05 this discussion is rephrase
01:15:06 the area
01:15:10 that had spoken of the issue of
01:15:14 the
01:15:15 mortality from drug overdose
01:15:16 and
01:15:18 increase substance abuse. I
01:15:18 believe
01:15:20 director garcia fs ready to
01:15:21 give a
01:15:24 sentence and substitution we
01:15:24 can
01:15:24 accept.
01:15:27 >> overdose is increasing and
01:15:28 substance
01:15:30 abuse is a continued health
01:15:31 issue to
01:15:34 focus on.
01:15:37 >> so, we have been-the reason
01:15:37 we made
01:15:39 this more general is because we
01:15:40 looked
01:15:42 at data from the medical
01:15:43 examiner and
01:15:45 only looked at a 3 year trend
01:15:45 so did
01:15:47 ntd feel it was fair to make
01:15:48 the
01:15:49 analysis when it goes like
01:15:50 this.
01:15:51 >> that is quhie I was
01:15:52 concerned with
01:15:53 that comment because when you
01:15:54 say if
01:15:55 you make a general statement,
01:15:56 so I
01:15:58 think we should just maybe
01:15:58 point out
01:16:02 drug overdose in sro's are
01:16:02 concern for
01:16:03 the commission.
01:16:05 >> the medical examiner office
01:16:06 is
01:16:07 committed to work wg us and
01:16:07 providing
01:16:10 more data, it is long process
01:16:10 and
01:16:11 before I came here I was on the
01:16:12 phone
01:16:13 with him trying to gelt things
01:16:13 sorted
01:16:15 out for the report so we will
01:16:15 make sure
01:16:17 it is well documented in the
01:16:18 report. I
01:16:20 just want to make sure we are
01:16:20 putting
01:16:23 something that is correct.
01:16:27 >> so, now I hear two different-
01:16:30 >> I will go with cindy because
01:16:33 she is
01:16:34 in direct communication with
01:16:36 the me.
01:16:38 >> the recommendation is put in
01:16:39 dects
01:16:40 from overdose are high.
01:16:43 >> I wouldn't put high, I would
01:16:44 put
01:16:46 increasing.
01:16:49 >> increasing. [Inaudible] The
01:16:50 lack of
01:16:51 consistent data.
01:16:53 >> we would just have to-I
01:16:54 think it is
01:16:56 important for us to
01:16:57 >> increasing.
01:17:00 >> as a whole it is increasing
01:17:00 and
01:17:03 issue with the sro.
01:17:05 >> substance abuse is
01:17:05 increasing?
01:17:06 >> yes.
01:17:07 >> you make the correlation
01:17:08 between
01:17:10 overdose and drug abuse, which
01:17:11 is the
01:17:11 connected.
01:17:12 >> okay.
01:17:15 >> say that one more time km
01:17:16 ?
01:17:18 >> I would say what you said
01:17:18 which was
01:17:22 there are increased drug
01:17:23 overdoses in
01:17:25 srow.
01:17:28 >> currently it says deaths
01:17:29 from drug
01:17:29 overdose-
01:17:33 >> I would not put high because
01:17:35 comparing to what?
01:17:37 >> increasing and-
01:17:40 >> substance abuse disorder
01:17:40 continues
01:17:41 tobe a health issue.
01:17:43 >> substance abuse continues to
01:17:46 be a
01:17:49 health issue-continued health
01:17:50 issue.
01:17:52 Okay. So, is there a motion
01:17:53 for that
01:17:54 amendment?
01:17:55 >> motion to accept.
01:17:56 >> okay, and a second?
01:17:57 >> second.
01:17:59 >> all in favor of that
01:17:59 amendment say
01:18:00 aye.
01:18:01 >> aye.
01:18:03 >> okay. The second thing I
01:18:04 would ask
01:18:09 is that we actually move the
01:18:09 last
01:18:11 whereas to resolve that the
01:18:12 health
01:18:16 commission request department
01:18:16 report
01:18:18 back in a year on the progress.
01:18:18 Not
01:18:24 sure we need to-against the
01:18:24 goals.
01:18:27 Modify to say one year report
01:18:27 back.
01:18:31 >> yeah, I will move that but I
01:18:31 might
01:18:34 move to the last-
01:18:39 >> yes, the last after the
01:18:39 therefor.
01:18:43 And just to give a reason-I'm
01:18:44 glad you
01:18:46 sited the 2008 report because I
01:18:49 remember it which was
01:18:49 considerbly
01:18:52 shocking to all of us I guess.
01:18:52 Here we
01:18:55 are 10 years later, 8 years
01:18:57 later and
01:18:59 still having the problems but
01:19:00 better
01:19:03 defined as to what to do so I
01:19:04 think to
01:19:05 answer commissioners concern is
01:19:06 what we
01:19:08 are going be trying to track
01:19:09 and
01:19:11 understand and see if we can
01:19:11 also
01:19:13 assist in improving if we are
01:19:14 not
01:19:16 moving the needle where we
01:19:16 want, this
01:19:21 will ask there be report back.
01:19:22 So with
01:19:23 that then does that simply
01:19:25 moving and
01:19:26 becoming a resolve and agree
01:19:27 with you
01:19:30 it is following and be the last
01:19:33 resolve. With that then, are
01:19:33 we
01:19:35 prepared for the vote? And f
01:19:37 we all in
01:19:41 favor say aye. Opposed.
01:19:42 Therefore the
01:19:44 resolution is adopted. Thank
01:19:44 you very
01:19:44 much.
01:19:47 >> thank you very much for your
01:19:48 engagement on this report and
01:19:49 your
01:19:50 thoughtful comments. I really
01:19:51 appreciate it.
01:19:54 >> thank you. We will wish
01:19:55 that you
01:19:57 have success and we have a good
01:19:57 report
01:20:01 in the coming year.
01:20:06 >> item 7 is hiv epidemiology
01:20:06 report
01:20:08 and strategy to address
01:20:09 disparities.
01:20:26 >> it is on the top on the
01:20:55 right.
01:20:59 Thank you director grar sia
01:21:00 and
01:21:01 commissioners. Susan searen
01:21:02 the
01:21:05 director of the hiv
01:21:05 epidemiology
01:21:07 section and here with hymen
01:21:08 scott is
01:21:13 medical director of bridge hiv.
01:21:14 To
01:21:16 oriented to where we siten the
01:21:17 org
01:21:20 chartd. The section is in the
01:21:21 branch
01:21:24 that is down here. Dr. Scott
01:21:25 works in
01:21:27 bridge hiv and also we work
01:21:28 closely
01:21:30 with the disease prevention and
01:21:30 control
01:21:33 branch in the population health
01:21:34 division, community health
01:21:36 equity and
01:21:37 promotion branch, population
01:21:37 health
01:21:38 division and primary health on
01:21:39 the
01:21:42 health network side. All these
01:21:42 brarns
01:21:45 help manage the hiv prevention
01:21:46 and care
01:21:49 prms that wewill mention in the
01:21:53 presentation. So, what will do
01:21:54 is
01:21:58 highlight some information from
01:21:59 the
01:22:01 recently released hiv annual
01:22:02 report and
01:22:04 highlight first of all the
01:22:04 positive
01:22:08 trend we see and new diagnosis,
01:22:10 declines in death, late
01:22:10 diagnosis and
01:22:12 items along the care cascade.
01:22:13 What we
01:22:16 found is not all san
01:22:16 franciscan's
01:22:18 experienced the same implement
01:22:18 so will
01:22:22 point out the significant
01:22:22 health
01:22:24 disparity by race, gender and
01:22:25 among
01:22:27 people that are homeless. Dr.
01:22:28 Scott
01:22:30 will talk about efforts getting
01:22:31 to zero
01:22:34 has done to address these
01:22:34 disparities
01:22:36 focusing on existing hiv
01:22:37 prevention
01:22:39 care and treatment program and
01:22:39 new
01:22:42 programs that are designed to
01:22:42 help
01:22:44 achieve health equity. This
01:22:45 first
01:22:47 slide looks at the number of
01:22:49 new hiv
01:22:52 diagnosis, deaths among people
01:22:53 with hiv
01:22:55 and total living cases in the
01:22:55 city.
01:23:00 The green line-we have a pretty
01:23:00 steady
01:23:03 and sharp decline in hiv
01:23:04 diagnosis. If
01:23:08 you start 2012 we went from
01:23:09 453 new
01:23:12 diagnosis to this year only
01:23:12 255. They
01:23:14 are very happy to see that
01:23:14 twend
01:23:16 continuing. If you look at
01:23:16 deaths it
01:23:20 is basically pretty steady, so
01:23:20 the
01:23:23 deaths reported in 2015 and
01:23:23 2014
01:23:25 include all deaths among people
01:23:25 who
01:23:27 dide in california or san
01:23:28 francisco,
01:23:30 but we also get death
01:23:31 ascertainment
01:23:33 from the national death index
01:23:34 and that
01:23:37 is complete to 2013 so when
01:23:39 that data
01:23:41 becomes available so we spblth
01:23:41 the
01:23:44 number of people who died in
01:23:45 2014 and
01:23:47 15 will go up. Because we have
01:23:48 now
01:23:49 diagnosis each year than deaths
01:23:49 the
01:23:52 number of living casing
01:23:53 increasing so
01:23:55 have all most 15 thousand
01:23:57 people living
01:24:00 with hiv in the city. Other
01:24:00 positive
01:24:02 trend is that overall most
01:24:03 people in
01:24:04 san francisco especially
01:24:05 compared to
01:24:08 nationally are aware of their
01:24:09 hiv
01:24:11 infection. That is really a
01:24:12 result of
01:24:13 some very strong efforts to
01:24:14 make sure
01:24:17 people test frequently so they
01:24:17 test
01:24:20 very close to when their
01:24:21 infection
01:24:23 occurs and people at risk for
01:24:23 hiv.
01:24:25 Another positive thing is that
01:24:28 the new
01:24:29 diagnosis decreased by 17
01:24:30 percent in
01:24:32 the last year. The time before
01:24:33 when we
01:24:36 were very excited to see it go
01:24:39 to 309
01:24:43 was 19 percent decrease so
01:24:44 watch it
01:24:46 and hope to see the same
01:24:47 percentage of
01:24:49 decrease. Survival is
01:24:50 improving. What
01:24:54 we find is we have aging
01:24:54 epidemic in
01:24:57 san francisco. Now about 60
01:24:58 percent of
01:25:00 people living with hiv are over
01:25:00 the age
01:25:03 of 50 and all most a quarter
01:25:03 over the
01:25:05 age of 60. Then we see late
01:25:06 diagnosis
01:25:08 and a late diagnosis is defined
01:25:09 as
01:25:11 somebody who test frz the first
01:25:12 time
01:25:14 and progresss to aitds within 3
01:25:15 munthd.
01:25:17 That declined from 21 percent
01:25:18 in 2012
01:25:28 to 16 percent in 20 15.
01:25:28 Nationally
01:25:30 that number is 23 percent. We
01:25:31 are
01:25:32 missing some slides because
01:25:36 this is pdf
01:25:40 instead of -- there is animation
01:25:41 in
01:25:44 there.
01:25:47 >> while we are waiting can you
01:25:48 talk
01:25:49 about the fact you are saigsent
01:25:49 leader
01:25:54 in the surveillance area? Not
01:25:54 many
01:25:56 other entities have the level
01:25:57 of data
01:25:59 you can-and work you have done
01:25:59 trying
01:26:01 to share that with other cities
01:26:01 and
01:26:03 counties, is that correct?
01:26:06 >> well, I think we-what we do
01:26:07 well in
01:26:09 san francisco is one thing we
01:26:10 leverage
01:26:12 all the cdc funding we get so
01:26:13 fupding
01:26:15 for core surveillance which
01:26:16 most of the
01:26:18 data is talking about. We also
01:26:19 get a
01:26:21 money for medical monitoring
01:26:22 project
01:26:28 among people with hiv. Better
01:26:29 care.
01:26:30 Incident funding and we get
01:26:32 money for
01:26:33 molecular surveillance and try
01:26:33 to
01:26:35 integrate all those programs to
01:26:36 do
01:26:40 things that we are not the core
01:26:40 surveillance. For example,
01:26:41 when we
01:26:43 talk about treatment, we are
01:26:45 doing we
01:26:48 call a perspective chart on
01:26:48 every
01:26:51 living case to collect nrfgz on
01:26:53 treatment. Trying to updrait
01:26:58 addressing to fiend out who
01:26:59 lives
01:27:00 [Inaudible] And then what we do
01:27:01 is work
01:27:04 vore closely with getting to
01:27:05 zero to
01:27:08 smake sure this data is useful
01:27:08 for
01:27:10 people. Not just collecting in
01:27:10 a
01:27:11 registry but we are reaching
01:27:12 out to
01:27:14 people to figure what they need
01:27:14 and
01:27:16 analyze it in a way that make
01:27:16 sense to
01:27:19 them and make it is available.
01:27:21 >> commissioner singer asked me
01:27:22 if I
01:27:24 know how you collect your hiv
01:27:25 related
01:27:27 deaths data and don't know so
01:27:28 can quee
01:27:31 ask you? How do you know kn
01:27:35 there are