Health Commission : SFGTV : November 28, 2024 2:30pm-4:31pm PST : Free Borrow & Streaming : Internet Archive (2024)

supposed to do. go do it. the. >> commissioner chow, present. >> >> commissioner giraudo and commissioner salgado i have the privilege of reading the

the privilege of reading the land unceded ancestral homeland of the ramaytush (rah-my-toosh) ohlone (o-lon-ee) who are the original inhabitants of the san francisco peninsula. responsibilities as the caretakers of this place, as well as for all peoples who reside in their traditional territory. elders, and relatives of the ramaytush ohlone community and by affirming their sovereign rights as first peoples. >> um, the next item on the agenda is the. >> 2. approval of the minutes of the health commission meeting of november 5, 2024. expirations having the before you the minutes are there any additions or corrections? >> all right. hearing none, motion to approve. >> mo to approve. >> i second. >> any public comment? >> is there any public comment on the room in this room on the

minutes i see none remotely any of the two folks for the permission to make public comment. >> no hand. >> all in favor, say "aye." >> aye. >> wonderful. >> the next is general public comment and secretary morewitz has a brief statement. >> at this time members of the public may address the items that are within the jurisdiction of the commission by not on this meeting agenda each member may address the commission from taking action or discussing any item not appearing on the posted agenda, including those items raised at public comment. please note one opportunity to speak per agenda item no individual shall return twice and sent to the e-mail the word health point at dmv if you wish to speak and

- federal law do not permit harassment and not trormgd. thank you. >> so we have a general public comment in the room chris kline please come up. >> for the record, i'm chris not speaking today but the numbers for over dose that is 32 an incredible move in the right direction thank you for the public and all the partners that is an amazing improvement and took effort to make that improvement still work to be done and want to get the numbers under 20 and month and for reference 32, 3 do hundred and 2019. >> and amazing down to 32

simply incredible with all the work and comments the very direct comments and teamsters trust me i sent e-mails to the directors and dr. colfax and i had too was something that was happening shouldn't have been happening and a lot of people especially the department of health dug in and rolled up there is sleeves and figuring out the judge. and there's more work to be done we don't need to get into the attention but high-level what is happening on the pooifblgz but again, the health commission everyone that got up to speak the distri for digging in and rolling up their sleeves and human services we have work to do in the holiday season that is can be depressing but i'm going to be

transitioning for what i do nonprofit work with the ceo nonprofit. and so should be focusing more on that and board member for the local veterans organization so less time here and more time everywhere and give it to the experts to finish what they started and thank you, everyone have a great day. >> thank you. any room public comment. >> i see notice hands. >> excellent move to the next item this is the director's report dr. colfax. >> good afternoon dr. grant colfax, dph director of health with the director's report. >> and a couple of key items we dmv launched an suspicional recovery public education campaign that is the key messages that treatment works and people are living proof it features san franciscans who have benefited from the addiction sharing their stories

the treatment works and recovery from addiction it possible and the campaign is one of the larger effort to reduce over today's deaths for fentanyl and supports from substance abuse and it coincides with a full launch of night time program for people that suffer from fentanyl and an oh, fan would be prohibited from 8:00 a.m. to midnight and continue to make substance abuse treatment available across the system of care, he in the last that 4 years added treatment beds to support people in their recovery that so the living proof campaign is on billboards and social media thank the 9 participants from who have brought their recovery forward

and yesterday um, we had a press conference by the mayor and one of the members emphasized the important of that campaign in the overdose prevention effort and thank you to the team and the behavorial health team. >> 5. .information item: report from the mayor's office on disability. a lot of work and in public comment good news to share yesterday which is that compared to october of 2023 overdose deaths are down by 50 and brings us to for us to date um, overdose death down over 20 percent compared to 2023 and still have far too many dedicates but seeing progress was we make treatment on demand to expand the bed systems to make sure that everyone knows that treatment works.

>> the second item i wanted to highlight is the um, proposition b san francisco asked for the public with laguna honda and zsfg and chinatown very pleased that the promotion needed two-thirds to pass and we are as the threshold the numbers are 72 percent so on behalf of the health commission community & public health committee at the for the san franciscans for this important work so we're excited to show the public um, where that money goes, you know, we're accountable built the has to the 200 and 16 bond that made us

possible to renovate the care across the city and held accountable and for meeting the timeline and the resources. and then i the president to share with you some exciting news is zsfg 0 two staff members to join the team appointed the nursing director and then joan o some key nursing leadership developing in the department and glad to have that happen and one last item i did want to bring up to the commission that we have had -? bay area a case of a flu reported in a patient that is investigated by the state we don't have a lot of information

to share but dr. philip is available to answer any questions. for the commission that is this case was came to our attention this morning and so i wanted to the health commission community & public health committee to be aware of that we're following it and making sure we continue to be as prepared as possible for any flu cases not city no human flu cases report in the city and we're prepared. thank you. >> thank you for the report especially about overdose and the effect of the living proof program and delighted with prop b any public comment on this item. >> a hand remotely please. caller you're unmidnight less elite us know you're there. >> code b.

>> mr. menshaw. >> i had a cold but introduce critique director of hampton he will he's not. he's director of the public health with the emphasis on the award for the public. i know that the agenda approved today was dr. colfax want to - that letterhead needs to be align with the department of public health that includes public is the users correct title dr. colfax.

>> thank you. >> all right. the only comment i see as. >> any commissioner questions or comments. >> yes. enforcing the first time i was on the proportion b lights pleased those of us in china are looking forward to a renovation. i would hope that the bond issue progress would be reported to the commission as we have in the past understanding therefore our role in terms of oversight on the use of those funds for public health and particularly for some of the projects for the timeline and, of course, commissioner surely thank you for having mow clarify that absolutely. >> thank you and the second was on the flu there have been a

number of questions from the members of the public interesting the public is involved in this one in a way sounds the asian flu and got, you know, mixed up with - what the current advise in the city enlarged for i get asked shall i buy eggs or the protections made a vaccine and mr. philip fill us in on the recommendation for the city residents. >> yes. dr. phil will provide you. >> thank you commissioner chow that's an important question thanks for the tints to speak to that the current recommendations at sf and little health

commission the risks of h 5 n one is extremely low and there is no recommendation for necessarily alternating about getting eggs, etc. people are exposed to pully or dairy products and become ill so we were able to follow up and in general there is no specific recommendation. the one opportunity i'd like to take to remind people unpasteurized milk not in the pasttion a potential source for h n one to kill the - we recommend people don't drink ray milk that is the one key message we want people to know

and have no vaccine at that time that is available to the general public and the general public is local dr. colfax and along with the cdc partners. >> any other commissioner questions or comments. >> all right. seeing none, thank you so much. >> and we'll beup on the flu next is financial officer) the health commission will review a presentation on the dph 4th quarter financial report. and this is the first time that drew will be presenting to us congratulations we're delighted to working with you. >> thank you, thank you president green good afternoon commissioners for department of public health here four drew

murrell, dph chief financial officer. a summary our 2023/24 budget for the actuals for expenditures and overall we did the year to the good one hundred and $47.9 million an increase of $27 million from the previous projections. there was comprised of one hundred and $24 million about 7 percent of budget and that was an increase of $222 million from the previous expectation and larger for the improvement for the medicare and laguna honda. >> $23.9 million of one hundred plus is savings that represented $5 million in 3 and that was largely queue to - thank you, for the question on

the transfer in the memo listing $50 million for transfer to h f g the numbers and is financials are closed we have to close every fund and balance on the expenditure wise those numbers are after that. happy to go into more detail. >> so balances is including $32 million in fine revenues and expenditures from the mayor's mid year instructions we all remembered mayor set overall the city needs to close a growing deficit and part of that was saved by the revenue sewer plusses and minuses and combine accounts to $32 million of the $147 million and finally, the revenue surplus includes 18.6 deposits to the reserve we

retain for instances where revenue comes in different than budget below budget per the administrative ordinance retain 5 percent of the budget year plus one revenue from that medi-cal and the management reserve for uncertainty. >> so those um, the next slide has the variances from the third quarter financials and those go over the numbers i presented now the provisional highlights among the distinctions and happy to go into more details for zuckerberg had a net largely comprised of revenues about one hundred and 15 include $70 million of resulting from the fee services

and prior year settlements from budget. thirty of that from medi-cal waiver and finally, a note here again returning from the expenditure side one $.7 million was savings. that is the one .6 targeted in the year preference that effecting came the new zero when we balanced out the fund to one $.7 million savings. um, going to the next laguna honda they ended the year with $41 million deficit largely by $46 million of the budget that was a result of our coincidence dropping during the resiefrgs that is an important point and expected in the third

quarter. >> going to behavorial health. we had revenues $43 million of budget largely $30 million from the medi-cal billings that was where we implemented the epic that would accelerate the billing in the fourth quarter pushed that into the 2023/24 so a lag watching closely in fiscal year 2024/25. >> there was also $12 million from improvement to to the prior years improvements on payment reform they're moving away from the - so a change to the risk of what we are faced with the prior year to this. $6 million from expenditures savings and

comprised (clearing throat) of annual carry forwards from the prior year we were not able to spend and mostly the mayor's. (rustling of papers.) primary care is $9 millionplus we anticipated with the states program. >> and finally (rustling of papers.) population health um, a split of $.9 million surplus about a $3 million deficit. split between the environmental health fees less than the budget that revenue expectative is offset with revenue savings a fee driven anything we don't collect

from fees offsets that and then patient revenues were down .7 due to a change in the medicare billing rights contributed we think that will be mitigated and fixed in fiscal year 2024/25 and finally, (rustling of papers.) we have the revenue management reserve details again section he 12.6 of the administrative annual probation owners allows us to department of human resources to the revenue in the form of management reserves and the require is calculated in the button year plus one with the balance in the reserve and so to try it up for fiscal year 2024/25 and fiscal year 2025/26 that is an additional $4.6 million in management receive reserve to protect us

less than what we expect in the budget. i'll be happy to answer any questions you may have. >> on the reserve. >> go do public comment. >> any public comment on that? >> that's okay i apologize a hand up for public comment. >> and i'll go to mr. menshaw your hand is still up i have three minutes. >> thank you. >> why number 7 on the expenditures the power point presentation is $46 million revenue equivocate for 2023/24 and - but page one thought that city of san francisco and chief financial officer stated 43 pits - so all of a sudden prior years reduce the 2023/24 revenues this

is a slight of hand. unlike chief financial officer the 15 page expenditure report simply eliminated this as a customary pages for the 15 packages for the various division and provided no break out pages for the revenue sub categories that is necessary for the medi-cal revenue why pay the revenue sources and no total operating noticeably missing the general fund from the annual biggest why are the details hidden why was that eliminate and the members of the public secretary any which is dph highland and i'm tracking the costs following the dow with additional costs not

pubically available including tens of millions of dollars with outstanding litigation costs and address maintenance to repair critical infrastructure at hsh and unfortunately, no dph employees have been held accountable for the million dollars and growing expenses. why hadn't anyone been disciplined for those long term care and hospitals. >> and not you item numbers - >> all right. thank you. >> that's the any public comment. >> thank you. >> are there any commissioner questions or comments, vice president guillermo or commissioner chow. >> they had their hand up.

>> do you want to go ahead? >> go ahead. >> thank you for the presentation i did have a quick question on the 5 poerlgz transferred into the management accountability is that an interest bearing got you part of the city treasury that is. >> a revenue reserve gets deposited into the large treasury paneling and interest in that is trouble able to general fund in the reserve so largely to the general fund and budget a way of saying no incurs interest by dependent on earn interest on its own.

>> so every year let's say a sir, plus each year did that 5 percent get added to the previous 5 percent or going to the general fund? >> the former. >> so what happens year-end we take and where we expect to end up before where the revenue is relative in the budget and the funds to make sure that that revenue reserve is fully financed a fully funded number is the 5 percent of the next year budget and plus one. so essentially take the balance not needed role it over and with surplus and - as revenue

prior to the cycle. >> i think i'm not reinventing where we were but many years of various iterations before we have had a developed a uniform method that cross the divisions we couldn't understand what was happening in each division and finance was presented as the health commission on the um, semi annual basis so- >> 100 percent i appreciate the question commissioner chow we have that in this

presentation more than happy to present the details we have those as the kind of backbone. >> sure. >> of where those numbers come from and some of the questions the summary is, of course, also impressive in surplus but looking for details i think that will help us and perhaps avoid confusion. >> thank you. >> i guess i have one or two questions i wonder if you can comment fire code by statements from prior years or shifts in medi-cal and given, you know, what may or may not happen in 2025 plus varies settlements have lagdz in both directions a change in more money can you give us a sense for what to expect in coming years like

settlements pending? are we catch up and what you anticipate and what keeps you up at night with the coming fiscal year obviously what we know about the issues in the budget deficit in the city. >> i think our planning for budget year and plus one is active and ongoing right now. depending on mayors budget instructions for the upcoming fiscal year is fiscal year 2024/25 and, 26 and 27 we're working with the mayor's office and trying to have that picture. in terms of settlements both from the behavorial health laguna honda and preliminary we maintain an active radar into individual programs risks and look at it in terms of what is

audit and at risk otherwise and evaluating the right amount reserve for health unrecognized revenue because we see the state can audit us. um, that is a dynamic process and part of what we are actively planning and saying as new news from the - from the state or federal government reassessing our reserve levels for many programs and part of what the reason we have the management reserve is in order to touch against our test against our (if we will underestimate the risk that is important tool in the management health risk of various claims it is an actual and ongoing monitoring process and something we have revenue numbers this

large want to get sewer plusses and minuses are great but also the flip side to make sure we are budget the revenue and not holding back in terms of a risk tolerance. hope that answers your question thank you for the question. >> and how far back items at least it comes to regulatory oversight there is quite and lag for hospitals i'm wondering issues on the financial side in terms of you say audits and things like that you say things could come up that is good news or bad out there for a while and maybe a significant amount of revenue? >> there always is typically when my city fiscal year we are recognizing my multiple years of claimed revenue. um, the revenues that are at risk for

prior year statements categories range from as old as 10 years depending on the audit risks and window to really just three years ago. a lot of that depends on is individual programs and what the rules are around whether it is are still within the audit window and subject to the state or federal audit or outside of that and have to think about what still is at risk there. in terms of what we or anticipating in the budget year, that is a balance between what we have in the management reserve and what our various prior years holding are to make sure we budget the revenue so we're kind of increasing fidelity to the risks between the two. >> thank you for that that context that helps us some

complex work and the other the use of registry staff a line item wonderful h.r. division has done incredibly well with staffing i'm wondering with that full of anymore full employment will in fact, mitigate those costs and whether the cost of fulfillment employees better if that shifts an issue for so long for so many reasons and daytime i'm wondering how so that in the future. >> we the registry looting in both prior year and current year and what we anticipated in the button and that has come down

more than 50 percent off the top of my head from the 2023/24 utilization as a testament to the partnership between the nursing leadership and hospitals, um, and our contracts division meaning monitor that registry closely and anticipate that our current services authority will last us through the fiscal year same kind of calendar we asked for and seen it come down draim so has come down we're assessing what that means in terms of budget i don't see year offer year but the registry has come down. >> self-defense good to pout what an incredible partnership any other commissioners comments. >> may i have for clarification of a response. >> secretary morewitz your

response to the gentleman i can interpret it i may not get the minutes so if i may if i can get an answer and talk to family members so can the dph put 5 percent of the budget into the management funds i mean both the reserve each year i think that is the question you're asking commissioner salgado your response was high-level can i bring it down for the average person. >> yes. we can. >> we annually are the authority to use reserve surplus in the current year that is that 2023/24 to fund the management reserve and next time revenue surplus for 5 percent. >> each year, each fiscal year. >> that is so simple.

>> dr. colfax. >> commissioner chow. >> have a question. >> your microphone is not on. >> i thought i put into context the revenue is really very special um, mr. wagner was able to create that with the mayor's office and all prior to that was a year by year and because of fluxs from the audits and revenues coming in and we are running around trying to cover the expenditures side and asking for special and having to return and this impressive back and forth created with the gentleman's help the ability to have a reserve for many, many years asked for something to avoid this property of

artificial ups and downs because of our nature the way that reimbursement is given and taken back or added to and so that is why that percent reserve is very unique and since then i believe that we've be able do actually follow the real numbers of how much the costs are not all of a sudden had a big audit came in and brought in another money and the audit took away known and each time we had a questionable year we couldn't understand how that year was costing so i wanted to say that that reserve has really been i think a i'm a needed help to accounting and the finance department but better here for us to understand what the real

costs each year were and i think it is a gem we have to keep. even in hard times can't let someone with mr. wagner as the controller since he helped us negotiate it with the board and the mayor's office but it is something for future commissions to understand that it could be wiped away with the people across the street to might find that they needed that reserve for some other purpose so, thank you. >> for clarifying\a difficult question dr. colfax. >> thank you drying for your first reported and for the record been with the department for some time and as our fiscal

team has dealt with challenges with the coming year and thank you for his leadership. and the fact he has connections and relationships across the city but focused on a number and looking forward to having him to update the commission um, about his work and making sure that even in challenging if anything times our fiscally and make sure the help see san franciscan from state and federal finland's that accounts 70 percent of our budget or from the general fund. >> and commissioners we like to society ourselves with dr. colfax comment thank you. we appreciate the work and

office of compliance and privacy affairs fy23-24 annual report (garrett chatfield, deputy director, office of compliance and privacy affairs) garrett chatfield, deputy director, office of compliance and privacy affairs welcome and before you jump in two presentations part of what i have one topic after the first presentation you may jump go in with questions and after the second presentation go to public comment. >> thank you. >> thank you, commissioner i'm garrett chatfield, deputy director, office of compliance and privacy affairs first up the annual dph office of compliance and privacy affairs in the compliance program the first slide we'll go to that (rustling of papers.) to the 6 items and talk about

them together the overall to make sure the dignity with our business clinical and our business operations. we did the outside education to improve the adoption and to clarify when we talk about is compliance primarily we're talking about entitlements to the adoption that is following standards we submit them and have a disallowance for that (rustling of papers.) so we operate the program in accordance with the state and federal laws. um, compliance for the health organizations coordinated to prevent - to violations of the law so the regulations and the rules and in order to that with federal government established what is known as the (inaudible) so the

o i g general is their position that a health organization reduced fraud misuse for effective compliance programs they is that - every organization is different what you do within the compliances program will be tailored to our organization but i should implement to help guide you, you and walk you through together to have a finding what they are. the first element is a compliance officer for dph that the chief integrity officers for the department and and there are several compliance committees and a which i have committee and each clinical area has a compliance their role to help guide the compliance officer and

their division to make sure we are meeting the requirements and second element is programs and policies 3 promote the compliance. the third element having the communication for a way for people to report concerns they have or issues (rustling of papers.) the fourth element is education and training so um, the federal government expecting to train everyone for the compliance programs and, of course, privacy matters and the 6 element is the internal review on claims to make sure they're meeting the standards. um, the 6 element of responding to the issue giving back money if there are concerns and more importantly corrective actions in place to prevent this

from happening again. and the last element to make sure the standards are in place for discipline for anyone who is um, found liable of abuse. >> and go the slide i'll talk about a little bit what goes on. >> the federal government defines fraud as a intentional disseptic to misrepresent non-payment for benefits for something they're not bieltd to in the healthcare billing for something we didn't do and ways for the over utilization of services letting things expire before people are used with the examples of waste and then abuse are practices improper for outside standards.

so we had had do internal revenue for any was those happenings vietnam veterans. >> garrett chatfield, deputy director, office of compliance and privacy affairs please ask kenya to move the slides. >> i have the healthcare laws and regulations thank you. so there are a few laws that govern this and our conduct as a recipient of government funds the two main rules involve the fraud improvement and recovery act. but it says the federal government can recovery up to 3 times the damages including penalties penalties go up every year because of inflation and with a minimum or a maximum of

28 thousand per violation. (rustling of papers.) >> the next slide, please. is um, the medi-cal reservation of that the deficit instruction for institutions that are receiving over $5 million for the medicaid bones and medi-cal reservation of the federal abuse sorry abuse and false claims act but for medi-cal payments. okay. move on to the code of conduct so the dph has a point of conduct is covers our business practices and describes the commitment to our patients, our staff and public of doing this in a ethical and honest way the main

point for the code of conduct i'll talk about is - basically work hmo and ethically in the code of conduct and respects confidentcy and follow the departmental policies and conduct the billing of best practices and more importantly promote the behavior with the staff and with the population we serve. on the next slide talk about - as city officers governed by the code a conflict of interest boils down do have an actual conflict of interest

and these include things like accepting enlists improper and working on an outside job without approval or using a position for a person opportunity. >> and i'll talk about the opportunities with the health commission and more importantly awareness of governance for the services and know how to apply that and in the oversight role and the federal government considers you for the oversight both sides bodies and fiduciary duty to dph and overseeing that and more importantly they expect you to act in good faith not for personal benefits. next slide, please. all the city employees and

public officials have a responsibility to report compliance whether you are an actual or have a suspicion we want you to tell someone hopefully us you can file a whistleblower complaint but everyone should know they/a duty to report when you see something improper it is your responsible to report that (rustling of papers.) goes for the department as a whole when we come aware of an issue we determined is improper we report that to the federal government sohotline. -

employees provide the

guidance for apps and stash the programs and policies for the staff responsibilities on claims and billing. we do our external revenues to determine might be the department to claims we submit in and our procedures around the privacy. and, of course, we investigate our doing when it relates to privacy and act we investigate bonds on dmv with the controller's office and want to highlight a few things we did last year. um, we took

time to make sure the staff understood the importance of our annual training. we spent a lot of time outreach efforts to keep our completion rate highest from the year before. so we are training is on from august through october every year and during that time we do outreach and make sure that staff does that and also worked think an external protocol standardize the different divisions within laguna honda and one other zuckerberg's and how they handle matters so - and that is staff let staff know what to expect in those privacy investigation and also helps us to track what is going on and standardize it across the board handle to

different and from the compliance program one of the main things for the visit protocol to align and - but helps develop for outreach efforts to the providers within the healthcare system. >> and that slide on the organizational chart where we're in the operations division and an issue with the oh, it does show i'm sorry. >> yeah. >> well we're in the - (unintelligible) with the integrity officers and 26 positions for behavorial health. (rustling of papers.) okay. >> so on the.

next slide, please. talk about some of the alliances at occurred i told him in the compliance program to make sure we are submitting claims we're entitled to not running afoul of the restrictions with the federal government and we do that by internal review and promote conduct and all the conflict of interests will be - and last year, we did alliances for claims. there was a little over 5 thousand dollars we can see on the. next slide, please. comparison for the last (rustling of papers.) 5, fiscal years and it's gone down from the year before. the year 2021-2022 an a follow a

significant amount of the public hospital audits from d c s had a backlog, however, as you can see as the years has gone by in fy2022-23 gone down we are - by an auditor to determine why. we want to know what happened lot of the medi-cal aids for determined not to be medically necessary or adoption was for the clear what happened so we worked with the divisions to make corrective actions to bring those down in allowances ever that is usher or our function to try to understand why it is heaping and um, promote

corrective actions to help reduce (unintelligible) (rustling of papers). >> and the next slide, please. behavorial health services programs. >> that functions differently the other divisions of general hospital we acted like an internal auditor or check system and an app with that but they're also the medi-cal or the health plans behavorial health health plan auditor; right? auditing the contract to make sure their entitled for the services they provide to us that's the bulk of what they do on the next slide take time to explain this and hopefully understand how things change we change so in the past reports to you all were concerns

about the air rates for the priorities and the programs. and what we didn't have a picture of how agencies were performing in our past we selected audit based on programs was is one h can have several programs respect; right? to see how that programming that but we changed that to poll the agency audits and, of course, that means we're phil program audits by looking at each agency when we had had audits this year we saw our error rates going on down 15 percent that means is that that is the amount of claims that were determined to be not payable something on that; right? out of all the claims

they reviewed with 31 agencies did audit and 13 percent were disallowable and in the last year and as you can see the mental health agencies in general improved we do have issues with some of the agencies what we discovered with our audit was some misunderstanding of the existence around the adoption. that was causing the documenttion has to do with with that we worked with the providers to help them clarify and hoping see that come down and one of the things we implemented was to give

questions for us to have a space where we can talk to each other and have communication. outside of the audits; right? and a lot of times we're interacting and understanding what is going on with them and they can understand how we are approaching that. (rustling of papers). >> so in the next slide is a summary of what i said the agency model has helped us paint a picture how the agencies is performing; right? we plan on continuing that going forward, however, in prior years reported to you problematic; right? we included on the next slide, please. an apples to apples comparison for programs so, of course, we know the program audited was an agency. we

significantly did for audits in the fiscal year as you can see 1 hundred and 43 close to the prior. what you'll see here twgdz of them have an error rate over 5 percent our goal targeted goal which is an improvement by the programs; right? prior years were significantly more errors from the programs we audited; right? so less errors on the claims of the auditor program this year. and we're hoping our outreach efforts for the providers are hetch hetchy with that and providing that and continue with those. (rustling of papers.) all right. on the next slide, please. to let you know the limitation effort we do every month we issue a compliance matters preliminarily for the focus on privacy concerns this

is our main outreach on a monthly basis and staff let us know what we're doing they're rodent and the compliance programs and the implementations we need to have (rustling of papers.) and move on to the privacy program on the. next slide, please. so the main goal of privacy program to insure our patient confidentiality and with the partners we work with. um, the main medic we look at how manye (laughter) and how many fines from the breaches so last fiscal year was the last time with the actuals we found fined for that 3 breaches in 2023/24 the dmv maybe he had a backlog but

starting in 2020, 3 resulting in us paying penalties so as was going forward on this report i imagine go have not backlog we'll probably do that and the next slide. gives a snapshot of what what was reported at the brief so i will i'll stop for this and explain the last slide is really what you're looking whole department 200 and 3 investigations. privacy incidents may not result in a reportable breach; right? you can have a um, a violation occur and not in the report; right? under hipaa and for example,

with staff member inadvertently e-mailed a patient for a staff person and can mitigate that and something looking at someone's record, of course, they did that it happens we have to report that out of 200 and 3, 37 were reported to dph and many. what if shows year over see (rustling of papers.) icon averted those in 2021, 15 percent involved incidents were record in 2021-2022. >> 15 percent were report anded and have seen is up tick

in the reportables and seeing that happen this fiscal year measures to hopefully to address that by having privacy officers to additional education targets education in their areas and an finding of the most common reportable breaches and mitigate those going forward our goal hope is next year we report a drop. >> um, every other month implement a policy mitigation for privacy analysts on the campus and she's quite instrumental in helping us draft this and we targeted training pacific islanders on the next slide, please. is the the major

responsibility for providing guidance on the data sharing and work with contract and security and the city attorney's office when they're contracts we're working with a vend that will handle the data, you know, you're confident - since we hav

people (microphone distorted) and ask the training and there's only two applied data (microphone distorted) and understand what they're roles and responsibilities are

are and (unintelligible) (microphone distorted) and hopefully able to (microphone distorted) and about the check and balance the controller's office will defer matters to the dph and (microphone distorted) reports in the matters for the controller's office and the finding of (microphone distorted) from was expected in the report it says focus on the

(microphone distorted) last slide no volume of matters (microphone distorted) the department (microphone distorted) get them to the right person and um, a reminder to staff and really anyone patients or the

public anyone what call that number and um, gives us information can be done anonymously and that that concludesy presentation. my long presentation and i'll be happy to answer any questions you may have thank you for the excellent presentation of the work is complicated and detailed and necessary we appreciate all your work and public comment of the two presentations and a hand i'll unmute hi please let us know who you are and you have limited to 3 minutes per speaker. >> that is dr. palm eerie was curious about the check and balance complainant what are the protections for whistleblower? one of the problems with reporting reporting to make sure

that whistleblower complaint but here it is high especially low level employees and patients and families of patients so i would like to know how as well as they're protected. thank you. >> the whistleblowers are protected. >> thank you commissioners comments and questions commissioner giraudo i have to comment i submitted a number of questions and want to thank you for your timely response and understanding my questions having dealt with compliance department a bit. where it cp mc it is important i really appreciated your timing response

to. thank you. >> you're welcome. >> commissioner chow. >> yes. (clearing throat) thank you for presentation and the coverage of such a broad range of areas that compliance um, office has. i was curious on the b h s year to year comparison. in our record are those the total number of programs or just the programs being audited. >> the programs audited. >> okay. and so a very similar number shows up each year; right? like between thirty and 35. are they the same programs that are non-compliance? >> um, i don't have the details on the specific programs by year to year i would say in

general no, not always the same but some. >> and if there are a few that are the same and have repeaters what type of program is in place for them to improve? that is and that's really what we're after; right? >> that's a great question. so every audit regardless of the repeat offender to provide a corrective action to follow maybe do their own internal to implement what we do to fix that and need to report back to us, we may actually target them for it audits depending on what happens so we have measures in place to help them correct it and then monitor that correction

and then reported to us see what is going on and hopefully improvement at the next audit. >> what if there isn't any improvement was the penalty for not passing. >> we invite the others to take whatever appropriate action they have the power to um, impose a consequence; right? but we'll for the behavorial health system of what is going on. and work with them to determine what is the appropriate action. >> so at that level in other words, you're doing the work but passing the question had to do with a contract back to the behavorial health who are doing the contracts and presuming behavorial health does something

in terms of has been reviewing some of the reports take into consideration for that all that. >> that's a good question. it's one of the things we work hard to coordinate with the behavorial health so they understand how it fits into a they're life and it is the difference between that type of audit and that imposes penalties you're no - and we're looking for disallowance. >> that's what i'm trying to clarify great work and, you know, we appreciate the report that has data and providing here to give us a feeling as to the amount of work and the success you're having so thank you. >> thank you. >> vice president guillermo. >> i wanted to thank you and

for the consent content of the report a wide range of things this office has to track. um, again, i have a question about the behavorial health audit you mentioned in our report the agencies had 43 percent error rate permitting was due to documenttion can you give us an example of the documenttion error and is that with the community college and we're not about the presence of the need for daily notes in the administration and so that was causing a lot of errors. >> because it wasn't there do

we identified that and corrected communicated what at that point really not seemed to be miss finding of the data but. >> is that a digital documenttion so- >> i know agencies don't have epic. >> correct. >> they're not on a monitor. >> that makes 2 more less difficult to do audit. >> no, they actually provide us records for the performances at thatpoint. >> and - but - and then given that misunderstanding has been clarified to anticipate a

entirely a much longer data error. >> right? great. thank you. >> i guess i have one question will be helpful to get context about the programs and also with the denominator balls for example, an offer arching agency i wonder what are the denominators who are the players and are there like can you you give us more behavorial health context. >> there are individual programs; right? but considerably can provide for detail seems you want

information about the specific bathrooms. >> i'm curious like the chart and agency has 10 and another within two. >> a detailed information so where they were in that error. >> exactly. >> yeah. i don't have that in front of me. >> if you have that a- >> (multiple voices). >> of course, we have the data we can certainly provide that. >> that would be wonderful. >> any other commissioner comments and questions this was an excellent presentation and dr. colfax has a few words. >> thank you for making the compliance and fiscal monitoring people will listen to it is said not often found in the field so, thank you. >> thank you, very much. >> everyone was texting. >> thank you for having me.

>> thank you. >> all right. our next item for >> 7. joint conference committee and other committee reports (commissioner tessie guillermo) laguna honda at last welcome back the committee reviewed the executive team report and heard the results from the recent survey that had um, u occurred a week before the annual survey and followed and which hopefully there were no serious deand we looked at the the omissions and have

recertification occurred excuse me - in a monthly basis by the admonition cargo no wait list for admissions and we got a draft copy of the hospital report i think the commission will get the formal report next month so they wait for comments from the committee in order to finalize that report and then we reviewed the human resources and affairs report we do every month and recommending full commission approval of the policies you see on the consent calendar following. >> thank you. >> any public comment. >> yes. we got two folks.

>> mr. menshaw. >> thank you very much. on november 12, 2024, reported to the jcc amigos in until well, not so fast as it is somewhat deceptive. the november 12th state of hospitals change has a net loss of 22 revenues during the same revenues with the discharges and therefore lhh has increased of one .5 patients per month and the public record request the increase to return lhh to the expenses of 10 plus patients that is taking one hundred and - to return to full capacity the 9 hundred most are

9 years a ridiculously state to return and suggests out of copy discharges and please stop feeding misinformation speed up the process and notified the deficit for 2023/24 was due to the census another valid reason lhh must suspended the patient information so when they get reports presentations from the current fiscal year lhh shortfall will start dropping and rely on the general fund. and do our fiduciary duty commissioners to save the general fund we radical increase this to lhh and that will assist with potentially have 5 percent of excess revenue this is not a

rocket science and suspended the lhh. >> one more. >> this is dr. palm eerie want to comment on the data in the executive report november 12th was a cumulative over months and need a monthly breakdown of all categories for rejects and waiting times including the length of ways and the reasons for accepting the rejection in the interest of transparency for all san franciscans when we political the laguna honda our public nursing home we should see what we can reasonably expect but the health commission community & public health committee and the public have a right to know and correct

problems like unreasonable waste or lack of alternatives until little league is rejected or discharged we need to this how a bad um, of discharging or rejection or how out of the county transfers maybe duce to. >> mission for any priority level a lock-down in admissions and people are rejected for the krefkz we need to see that. and especially we need to have grave concern for those who will not do well without skilled nursing care and taxpayer with paying for laguna honda, laguna honda should give us the information

to see how it functioning we can avoid old mistakes and see what isn't working. thank you. >> those are the only public comments. >> any commissioner comments or questions on this report. >> all right. i guess seeing none,h is the consent calendar and have before you the items on the clldz laguna honda jcc recommended have the full commission have a list is there a motion to approve the lists. >> so moved. >> to approve the items on the consent calendar. >> i second. >> public comment. >> i see a hand and check to make sure it is legality dr. palmer have a comment on this item. >> i put down my hand. >> okay. thank you. >> you can vote. >> all in favor, say "aye."

>> aye. >> very good the item passes and so, now go to the. >> 9. for discussion: community and public health committee update (commissioner suzanne giraudo, chair) and we had two presentations the first on the city clinic the work all health with 11 thousand plus visits and the asian-american and hispanic population had the highest rates of s ti. >> westernly also given information that the city clinic is a national leader and biomedical for hiv and s ti for the hiv there were in q-3 there

20244 thousand plus prep starts and then the other figures given for the one 1,000 started with within november 2021 to 2023 with results of a very sharp decline in s thank you. is that is quite a few and the city clinic does excellent community outreach ongoing which they discussed with us and the final closing was because of prop b they were looking for a new building. since there's a old and the next presentation was the behavorial health san francisco behavorial health services act. update. they have 7 service categories and have

finland over 85 programs. a couple of highlights of their program outcomes with the full service partnership one of the um, data points was there was a 96 percent decrease in arrests for youth. they will be giving us information about people in the full service partnership they didn't have this data today and the second thing was presented with the mental health proposition in schools. with noted 53 percent increase in relationship reporting with friends and families. we are also asked for a information about what exactly is the mental health promotion in particularly the elementary schools and then

be getting that information back to us that mark will be sharing a everyone and commend and the peer to peer support services where 95 percent of people reported better understanding of mental health needs of others and how to help people assess behavorial health. the last thing they focused was focusing on they're focusing on excavation and in collaboration with prop one to. >> >> so more to come. >> that's the end of my report. >> any public comment on this

report. >> no public comment. >> how about commissioners comments and questions. >> all right. thank you. our next item is other business any other business? >> no other business? >> some public comment. >> and we'll entertain to go into closed session so moved go into closed >> all in favor, say "aye." >> aye. >> >> all in favor, say "aye." >> aye. >> commissioners give me a few seconds sfgov will be a quick closed session folks you'll not session sfgovtv

>> my name is lauren. i am the owner and founder of farm branch and we are here at farm branch on [indiscernible] third street, on the corner of third and bryant. we started in 2020, so we are a pandemic baby. all the [indiscernible] expresso selection and [indiscernible] full scale brunch thursday through saturday and catering. we do custom catering and events every day of the week and then we serve all the walk-in as well. we became known for our cookies and our [indiscernible] the chipper is a chocolate chip cookie, but it also has a expresso and these chocolate cripies which adds texture. that was the cookie the food network named one of the most iconic

cookies enthe u.s. which is cool. we take customer service and the overall customer experience so important. we are called the hidden gem every day. people say we didants know you existed. we are proud of what we built and what we are doing and we just are really i think excited for people to find us and see how special we are. >> working with kids, they keep you young. they keep you on your tones -- on your toes. >> teaching them, at the same time, us learning from them, everything is fulfilling. >> ready? go. [♪♪♪]

>> we really wanted to find a way to support women entrepreneurs in particular in san francisco. it was very important for the mayor, as well as the safety support the dreams that people want to realize, and provide them with an opportunity to receive funding to support improvements for their business so they could grow and thrive in their neighborhoods and in their industry. >> three, two, one! >> because i am one of the consultants for two nonprofits here for entrepreneurship, i knew about the grand through the renaissance entrepreneur center, and through the small business development center. i thought they were going to be perfect candidate because of their strong values in the community. they really give back to the neighborhood. they are from this neighborhood, and they care about the kids in

the community here. >> when molly -- molly first told us about the grant because she works with small businesses. she has been a tremendous help for us here. she brought us to the attention of the grand just because a lot of things here were outdated, and need to be up-to-date and redone totally. >> hands in front. recite the creed. >> my oldest is jt, he is seven, and my youngest is ryan, he is almost six. it instills discipline and the boys, but they show a lot of care. we think it is great. the moves are fantastic. the women both are great teachers. >> what is the next one? >> my son goes to fd k. he has been attending for about two years now. they also have a summer program,

and last summer was our first year participating in it. they took the kids everywhere around san francisco. this year, owner talking about placing them in summer camps, all he wanted to do was spend the entire summer with them. >> he has strong women in his life, so he really appreciates it. i think that carries through and i appreciate the fact that there are more strong women in the world like that. >> i met d'andrea 25 years ago, and we met through our interest in karate. our professor started on cortland years ago, so we grew up here at this location, we out -- he outgrew the space and he moved ten years later. he decided to reopen this location after he moved. initially, i came back to say, hey, because it might have been 15 years since i even put on a uniform. my business partner was here basically by herself, and the

person she was supposed to run the studio with said great, you are here, i started new -- nursing school so you can take over. and she said wait, that is not what i am here for i was by myself before -- for a month before she came through. she was technically here as a secretary, but we insisted, just put on the uniform, and help her teach. i was struggling a little bit. and she has been here. one thing led to another and now we are co-owners. you think a lot more about safety after having children and i wanted to not live in fear so much, and so i just took advantage of the opportunity, and i found it very powerful to hit something, to get some relief, but also having the knowledge one you might be in a situation of how to take care of yourself. >> the self-defence class is a new thing that we are doing. we started with a group of women

last year as a trial run to see how it felt. there's a difference between self-defence and doing a karate class. we didn't want them to do an actual karate class. we wanted to learn the fundamentals of how to defend yourself versus, you know, going through all the forms and techniques that we teaching a karate class and how to break that down. then i was approached by my old high school. one -- once a semester, the kids get to pick an extra curricular activity to take outside of the school walls. my old biology teacher is now the principle. she approached us into doing a self-defence class. the girls have been really proactive and really sweet. they step out of of the comfort zone, but they have been willing to step out and that hasn't been any pushback. it is really great. >> it is respect. you have to learn it. when we first came in, they knew us as those girls. they didn't know who we were. finally, we came enough for them

to realize, okay, they are in the business now. it took a while for us to gain that respect from our peers, our male peers. >> since receiving the grant, it has ignited us even more, and put a fire underneath our butts even more. >> we were doing our summer camp and we are in a movie theatre, and we just finished watching a film and she stepped out to receive a phone call. she came in and she screamed, hey, we got the grant. and i said what? >> martial arts is a passion for us. it is passion driven. there are days where we are dead tired and the kids come and they have the biggest smiles on their faces and it is contagious. >> we have been operating this program for a little over a year all women entrepreneurs. it is an extraordinary benefit for us. we have had the mayor's office investing in our program so we can continue doing this work. it has been so impactful across a diversity of communities

throughout the city. >> we hope that we are making some type of impact in these kids' lives outside of just learning karate. having self-confidence, having discipline, learning to know when it's okay to stand up for yourself versus you just being a bully in school. these are the values we want the kids to take away from this. not just, i learned how to kick and i learned how to punch. we want the kids to have more values when they walk outside of these doors. [♪♪♪] forward/hospitality. >> heart of san francisco an aide so important diverse culture in the name for remarkable individuals like carlton b goodlett a man wheeg

legacy is at the iconic lashed not just a man of intelligent his journey was far from san francisco good had studies earning a mountain lake cut off road in child psychiatric a city that is is campus for staff's contributions a city with a very different place when dr. good let was around and you would see him on streets like the fillmore and what he did he mrs. minority healthcare to people who that did not have insurance or an ability to pay for that. >> dr. good working hard around city hall meaning he

would load boxes with people and they would go to san francisco state mainly and other places as well and protest these unjust treatments and unfairness of their system. >> dr. good was a america civil service activity with naacp and protested for the discriminations against blacks and public transportation and public housing and the reporter as most people come into the building today don't know who he was was district attorney know that not only was a physician, a activity but also an incredible cardplayer. in his spare time. >> and the won a number i

published and the also ended edited another newspaper wells fargo willie brown and dr. good had a close relationship in the early 90s several groups got together to his own dr. good and put together petitions and worked very, very hard to have the official address changed. >> dr. king's day of the celebration is in january, i got to call from mayor brown which i've known for in many, many years to ask me to change the street sign this is remarkable. okay. >> in january of 1999 right

after the building reopened, mayor brown and i went outside at that moment it was still cold street we shut down the word on the sign that read polk. >> put up the sign that said number one, dr. carlson carlton b goodlett white. >> i think that he earned a certain place in respect of all poem he was just a remarkable individual. unfortunately, we didn't live long enough here to see the street sign

>> [music] art withelders exhibiting senior art work across the bay for 30 years as part of our traveling exhibit's program. for this exhibits we partnered with the san francisco art's commission galleries and excited show case the array of artist in historic san francisco city

hall. >> [inaudible]. call me temperature is unique when we get to do e, meaning myself and the 20 other professional instructors we are working with elders we create long-term reps i can't think of another situation academically where we learn about each other. and the art part i believe is a launching pad for the relationship building:see myself well. and if i don't try when my mom

again. she may beat the hell out of mow if i don't try >> seniors, the population encounters the problem of loneliness and isolation even in a residential community there hen a loss of a spouse. leaving their original home. may be not driving anymore and so for us to be ail to bring the classes and art to those people where hay are and we work with people in all walks of life and circumstances but want to finds the people that are isolated and you know bring the warmth there as much as art skill its personal connection. men their family can't be well for them. i can be their fell and feel it. >> i don't have nobody. people say, hi, hi. hello but i don't know who they are. but i come here like on a wednesday, thursday and friday.

and i enjoy. >> we do annual surveys asking students what our program does for them. 90 plus % say they feel less alone, they feel more engaged. they feel more socially connected the things you hope for in general as we age. right? >> and see when i do this. i am very quiet. i don't have anybody here talking to me or telling me something because i'm concentrating on had i'm doing and i'm not talking to them. >> not just one, many students were saying the program had absolutely transformational for them. in said it had saved their lives.

>> i think it is person to support the program. because i think ida elder communities don't get a lot of space in disability. we want to support this program that is doing incredible work and giving disability and making this program what supports the art and health in different way bunkham art as a way of expression. a way of like socializing and giving artists the opportunity also to make art for the first time, sometimes and we are excited that we can support this stories and honor their stories through art. we hope the people will feel inspired by the variety and the quality of the creative expressions here and that viewers come, way with a greater appreciation of the richness what elders have to share with

us. [music] >> san francisco is a positive impact on my chinese business. >> i'm the founder of joe-joe. i'm a san francisco based chinese artist. i grew up in the bayview district. i am from china i started at an

early age i started at age of 10 my grandfather my biggest inspiration. and i have followed with my traditional art teacher in china:i host educational workshops at the museum and local library. and i also provide chinese writing in public middle school and that way i hold more people fall in love with the beautiful of our chinese calligraphy. it is a part of our heritage. and so we need to keep this culture alive. hand writing is necessary field that needs to be preserved generation toieneration. this art form is fading away. but since covid i have been very

dedicated to this art and i hope that my passions and serving this art form. there are many stores and shopping centers and companies that are interested in chinese cal iing ravi. i feel motivated to my passion for chinese calligraphy in today's world. so people can always enjoy the beauty of chinese calligraphy, from time to time i have a choice to traditional chinese calligraphy to make it more interesting. we do calligraphy on paper. i can do calligraphy different low. >> my inspiration is from nature

and provide calligraphy that was popular style of persons time. i will invite to you check out my website or instagram. and there is some events and updated upcoming events that you can participate. i'm anthony i'm owner of scoop ice cream in the bayview. >> the environment sit down environment to enjoy a bananasplit. root beer floot. shake, et cetera . just creating that environment for people to come and enjoy. they can experience this is cultural driven. we pretty much replicate what our culture means in the

bayview. >> a back story me and my siplings my aunt took us out for ice cream all the time. spend hours eating ice cream and talking and catching up with friends and family of came with an idea. why don't you bring the ice cream shop back has not been one here in a time since the 90's. i thought it would be good to bring something back to a community where i grew up and something with me in business community. my fate is the apple pie flavor made from french cashew milk it is vegan. homemade cashew milk and cocoa nut milk. apples upon cinnamon and nutmeg and create a great desert.

my great grand mother made it from scratch. made ice cream for kids in the neighborhood and made different flavors. sugar free and dairy free. got passion to do it being here in the community and from my family. the meeting will come to order. welcome to the november 15th, 2024 regular meeting of the local agency formation cosi

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