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tv   BOS Public Safety and Neighborhood Services Committeee  SFGTV  May 31, 2021 1:00pm-5:31pm PDT

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>> good morning. welcome to the thursday, may 27th meeting. i am gordon mar joined by vice chair stefani and matt haney. i want to thank our clerk and thank sfgovtv for staffing this meeting. do you have any announcements? >> yes, in order to protect public, board member and city employees during covid-19 the board of supervisors committee room is closed. this is pursuant to various local, state orders in effect.
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committee members will attend through video and participate to the same extent as if present in the committee room. public comment is available for each of the three items on the agenda. channel 26 and sfgovtv are streaming the call in number at this time. your opportunity to provide comments on today's agenda are available by dialing 415-655-0001 once prompted into the id for today. (187)017-0254. press pound twice to be connected to the meeting. when you are connected you will hear the discussions. your line will be muted in in listening mode. when your item of interest comes up dial star 3 to be added to the speaker line. prompts will indicate you have
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raised your hand. wait until you are unmuted. you may begin comments. call from a quiet location, speak clearly and slowly and turndown your television, radio, streaming device to access today's meeting. everyone must account for time delays and speaking discrepancies between live cover age and streaming. you may submit written comments by e-mailing me john carroll, clerk of the neighborhood services committee john.carroll at sfgov.org or send to our address at city hall. clerks office room 244. at city hall's address. of course, as always all contact
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information can be referenced from the front page of our agenda for today's meeting. mr. chair, items on today's agenda will appear -- items will appear on june 8, 2021 agenda unless otherwise stated. >> thank you. before we begin i would like to take a moment of silence in memory of the nine victims of the latest mass shooting in san jose yesterday. these were public servants, fathers, husbands, community members. our hearts go out to families and community mourning the loss of lives. please call item 1.
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>> ordinance amending administrative cloud to print the police department from using, deploying, launching or firing of extended impact weapons, kinetic impact projectiles, chemical agents, disorientation devices and military grade equipment during law full assemblies and in our circumstances. call 415-655-0001 and enter the meeting id. press pound twice. if you wish to speak dial star 3 to raise your hand. mr. chair. >> thank you, mr. clerk. thank you, supervisor haney for bringing this item forward and for all of your work and also that of your staff. this is important policy around
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police use of specific types of force during lawful assemblies. the floor is yours, supervisor haney. >> thank you, chair mar and supervisor stefani for hearing this item today. there have been significant changes to the legislation. i will in my comments discussing why this came forward to begin with and what it will do, i am going to describe the amendments we put forward today. i want to thank you, supervisor mar for cosponsorship as well as supervisors ronen, preston and chan for early commitment and support. this past tuesday marked one-year anniversary of the murder of george floyd, and as we remember this time last year, millions of people in the middle
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of the pandemic flooded the streets across the nation forcing a reckoning on racial injustice in the country. we also saw around the country was a frightening response to these protests that often included rubber bullets, tear gas and unacceptable use of force on people who were demonstrating against injustice. that moment really was to recognize everywhere how essential the right to protest is and how important it is to do everything to protect that right. we like many jurisdictions all over the country through the process of looking at locally. i want to say to start off that san francisco did not see many of the really unacceptable types
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every responses that we saw all over the country including across the bay in oakland with the use of tear gas. there has been a commitment to more effective forms of crowd control here in san francisco. i want to recognize the leadership there. that doesn't mean we can't continue to make progress and do more. we have to make sure there is clarity for our department and officers that there is transparency, accountability, clear steps that must be taken. that we are really clear in our own laws about what is unacceptable and what should never happen here in the city and county of san francisco. this is happening at the state level, in other counties and cities. it needs to happen in san francisco even if you recognize we are further along than those other jurisdictions. this legislation comes from a
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very fundamental premise no one should ever now or in the future be gassed by chemicals or shot be rubber bullets when they step out to speak against injustice. the amendments before you today reflect a lot of work that happened since we first introduced this last july. we have had many meetings with sfpd, community organizations, advocacy groups and unions to come forward with what is in front of us. i believe that this has shaped the legislation positively and reflected input we received from front line medical experts on crowd control and i think has strengthened the legislation. i also say that one of the reasons this took longer we wanted to make sure we reflected what was happening at state level. there is a bill ab48 which
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passed the public safety committee offered by member gonzalez. it reflects ab48 and some things are unique. i will describe what this will do and what the amendments are. similar to ab48 this legislation would prohibit indiscriminate use of kinetic energy and chemical agents on protesters. minimum standards for use the weapons by law enforcement and require verbal warnings. it will require data collection on the use of and resulting injuries from the use of lethal weapons by law enforcement. this is consistent with the use of force policy and our city attorney incorporated language to make sure what is currently
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in use of force language is consistent with what the legislation requires. the big picture goal is to prevent people gathering in crowds in assembly or protest or when out for other reasons, for example, post game celebrations in the city, prevent them from being hospitalized and suffered severe injuries when crowd control devices are used. the amendments are straightforward including cleanup language and highlight the background of the legislation and efforts sfpd has made in the past and currently to avoid excessive force we have seen in other jurisdictions. the amendments in the legislation do the following. delete reference to law full
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assembly impact weapons, kinetic projectiles. disorientation devices as crowd control tactic except in limited circumstances. what we want to prevent is the use of kinetic projectiles, rubber bullets, military grade equipment and tank like vehicles and flash banks to control crowds. chief scott and his leadership explained to us sfpd does not use these weapons to control crowds. it is important for us to codify this in the law. the last legal weapon they do utilize are of important focusing concern. these are extended range impact weapons like beanbag rounds and chemical agents like oc spray, gel, pepper sprays or mace.
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for these less lethal weapons we are making changes that are very important to clarify how these can be used and when and the requirements associated with them. an officer must assess lower level of force are feasible. two. must determine if there is an immediate threat of death or serious bodily injury to one or more persons and the use of the weapons is necessary to restore safety. third must ensure the use of chemical agents complies with every aspect of the use of force policy including de-escalation and time and distance and training. the applicable mandatory first aid. they must identify individuals in criminal activity. they may not use extended range
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impact weapons indiscriminately in people not engaged in violent criminal conduct. 5. chemical agents or extended range impact weapons only be during a riot as defined by code 404. still prohibited from using kinetic project tiles rubber or plastic bullets. if they use the extended range impact or chemical agents or riot. there are reporting requirements. there needs to be a report within 10 days during any extended range impact weapons used during a riot. that istum rewhat this legislation will do. it will advance the safety of our community, residents, and also provide greater transparency and clarity to what we are expecting for our
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officers and our department. i do want to leave you with some facts about the use of these weapons. while they are often referred to as less lethal to the use of firearm, research and investigations have shown these crowd control weapons cause severe injuries, acute medical conditions and in some cases death. there are numerous reports of bystanders and reporters seriously injured by projectiles and chemical agents used against protesters. 93% of racial injustice protests were peaceful. police were more likely to respond to force. 115 were shot in the head or neck between may 26 and july 27 of 2020 at protests immediately following george floyd's death. 20 suffered severe eye injuries,
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seven lost an eye according to the american economy of optomology. they have used tear gas against police brutality. there are reports of injuries from tear gas canisters fired by the police. if our residents do not feel safe peacefully protesting, we are silencing them. we know san francisco has not had some of the more severe incidents we described here and has sought to be a leader in crowd control. this is a furtherance of that, next step in that. there is still more to do to codify policies to provide greater clarity to increase reporting requirements, to align with state law, and this will protect our residents. with that i will turn it back over to you, chair mar.
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i am happy to answer any questions. i do believe there are representative sfpd here. they aren't planning to present. they can answer questions. >> thank you, supervisor haney for your leadership and work on this important legislation. for almost a year now. supervisor stefani. >> thank you, chair mar, and thank you, supervisor haney. i don't know if you had a presentation beyond that, but i wanted to concur with you in your remarks about the frightening response we saw to the protests in some other cities other than san francisco. especially i think what we saw in portland was reprehensible by our federal government and the injuries sustained there.
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i know a lot of moms on the front lines of that. i appreciate that you recognize that our police department is well ahead of the game when it comes to this and what we are doing is codifying what the police department has done already. i think it is something we can be proud of in san francisco we are ahead of the game on this and the injuries you spoke of are not injuries we have seen in san francisco. i think it is important to recognize that and recognize what we do well in san francisco and codifying this is great and the fact we have a police department ahead of the game on these issues speaks volumes who we are in san francisco. if you don't have a presentation. i was going to ask a few questions if there is a police representative here. i will wait to see how you are presenting the rest of your amendment and the legislation itself. >> that was it for me.
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i agree with you with everything you said there. i appreciate those comments. i agree what we saw in other cities and i am glad that didn't happen and we don't want that in san francisco. this is a furtherance of our steps to take to ensure that will not happen. i didn't have a further presentation. you are welcome to ask me questions or sfpd. i think diana from the police is on the line. >> thank you, supervisor. one question about something i heard of in terms of moving forward with the amendments or legislation whether or not it is completed if that is required before this item moves out of committee. >> so my merchandising and there might be somebody from city attorney to answer that.
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i am not going to be asking for the item to move out of committee today. in part, because of the amendments because there is further meet and confer. i hope to have the amendment adopted and continue it to the call of the chair so i can continue to meet and confer. >> perfect. thank you. >> thank you, supervisor stefani. i have a question, supervisor haney for clarification so i understand the full scope of this. the legislation would prohibit sfpd from using kinetic impact projectile agents and disorientation devices during a lawful assembly demonstration,
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protester gathering. it would allow the use of extended change impact weapons in very limited situations, including immediate threat of death or serious bodily injury. i just want to see if you could explain the difference between the extended range. >> the kinetic impact weapons are rubber bullets, tear gas, flash bangs. sfpd can explain this. they don't use those currently. that is some of the things we have seen in other cities we want to codify those can't be be
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used here. for the extended range, the extended range impact is like oc spray. we want to provide more clarity in rare situations in which those can be used and increase the de-escalation tactics required if they are used. in the case a riot is declared they could be used. there is reporting requirements and new set of steps in de-escalation required for those types of weapons. we are essentially banning, which is thankfully the practice already, tear gas and rubber
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bullets dan resfor use for crowd control and extended range the beanbag rounds that we are creating new levels of both reporting and limiting the scope of how he can be used. >> got it. thank you for that explanation. thanks for all of your work on this. it is in alignment with our use of force policies. thank you. maybe we could go to public comment. mr. clerk, are there caller on the line? >> we are working with jim smith from department of technology to bring in callers waiting on the line. if you are watching on channel 26 or through sfgovtv if you wish to speak call in now by following instructions on your screen.
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i will review. dial 415-655-0001 today's id1870170254. pound pound twice and star followed by three to speak. for those already connected press star 3 to be added to the queue to speak for this item. if you are in the queue continue to wait until you are prompted to begin. you will hear a prompt to inform you your line is unmuted. we have 12 people in line. please bring us our first caller. >> good morning. i am wesley safe for glide. i support this. for generations san francisco residents from black and brown
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communities are painfully aware of police violence in the city and elsewhere. these are ubiquitous and it is irrefutable a disproportionate number of it is citizen are people of color including the numbers of the glide community. other jurisdictions are taking these out of the hands of police. this is not enlightenment by the police establishments. this comes directly because of the millions of ordinary people who participate in demonstrations following the murder of george floyd especially young people of color who marched to face horrific police violence and fight for change. we must reimagine public safety
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so people likely to face disproportionate police contact, immigration status issues and unhoused can exist and exercise rights without the fear of being targeted by a military police force. please support this legislation. as you evaluate the budget. please fund the response team and other programs that provide resources for all san franciscans. >> thank you. mr. smith. next caller, please. >> nick robinson senior legal adviser for not-for-profit law creating supportive legal environment for legal activists and nonprofits around the world. i support this bill to limit the ability of the san francisco
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police department to use the less lethal weapons. last year during the racial justice protest we saw journalises and peaceful protesters injured by the police as they were used against protesters in over 100 cities. this under cut the american's right to peaceful protest and led to litigation against police departments. at least a dozen municipalities have enacted legislation to restrict when police use these weapons. we are tracking our states that are considering same legislation. by enacting will demonstrate leadership. >> thank you.
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next caller, please. >> the right to protest is first step with law enforcement reform in san francisco. there are numerous reports of peaceful protesters healthcare professionals and reporters seriously injured by kinetic projectiles. the crisis monitor found 93% of the protests were peaceful. police were five times more likely to respond with force than the antilock down protests. we need to protect the right to protest and ensure safety when protesting the enforcement agency controlling the protesters. i have personally protested in october of 2020 when sfpd officers forced protesters and pepper spray and pushed so hard even when screaming at the
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officers to stop pushing out of fear of people falling to get trampled they pushed so forcibly i fell a couple feet off the sidewalk hard on my back with another man on top of me. i was sore and bruised. this is uncalled for. thank you very much. >> mr. smith, next caller, please. >> hello. i am gus calling in support in the right of safely protest. use of less than lethal equipment should never be deployed at protests. the less than lethal equipment has been documented to result in serious harm and injury and sometimes even death as we saw
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last summer. as protester in san francisco last summer around the same time as the gorge floyd protests in the nation. i bear witness to the force of the sfpt. further i support to right to protest ordinance to restrict use of any kind of equipment, chemical agents or disorientation devices to further potentially harm residents and restrict the first amendment right to protest. thank you very much. >> next caller, please. >> good morning. i am a san francisco native from
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district 2 support the right to safely protest legislation. i feel passionately because this prioritizes safety of residents. they feel comfortable expressing freedom to assemble and not silenced out of fear. 85% of all eye injuries from kinetic impact projectiles resulted in permanent blindness. no reason or excuse for these weapons on the street. we must codify this. this is an important step to protect human rights in our city. i urge supervisor mar, stefani to cosponsor this resolution. thank you. >> next caller, please. >> i am a d1 resident.
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h. [indiscernable] the media are showing protestors shot at with rubber bullets. what we have seen in the past summer with killing of george floyd is discrepancy between law on the books and action. the chemical agents and disorientation devices are being used for the first amendment right. they should be able to protest without being fear of being injured. thank you. >> next caller, please. >> i am calling to support supervisor walton's right to
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protest. i am with sciu. we are members. they have been the essential services to keep our county and city clean and safe. [ inaudible ] the movement that is going on for the last year and a half. they have been protesting. these are mostly women, immigrants, children of immigrants. they are showing courage to exercise their fundamental american right to protest. yet they are faced down by intimidating weapons. these are essential workers doing the most american thing to do and they are being unjustly injured by these so-called
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nonlethal weapons. [indiscernable] i urge you to pass this common sense legislation. thank you. >> thank you for sharing your comments. next caller, please. >> i am rebecca. the reason they don't call these nonlethal. sometimes they kill us. there is a protester in oakland who lost part of his skill and brain to a tear gas container years ago. unarmed black and brown civilians have been killed. police were antagonistic to them. i want to remind people the united nations outlaws the
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weapons. we shouldn't defend chemical weapons. when we march after dark in san francisco. we are terrified of a militarized police force. some folks force kids to wear helmets at demonstrations. i was arrested a few years ago. this called me a fing pitch. charges were dropped because they were intimidating us for no reason. they enjoy using these weapons against us. do the right this and protect our right to safely protest. thank you. >> next caller, please. >> good morning. i am call inning support of
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supervisor matt haney's legislation. i am a student and resident of bayview-hunters point. as san francisco joined the nation and call to police brutality, i had friends, family members too nervous to attend socially distant marches in fear of police retaliation they have seen on the news. we must use our rights to peaceful assembly without being a victim of the issue we are speaking out against. this conversation for police reform especially since young people are actively involved in the demonstration. voting yes means that you are supporting the safety of all classmates and young people who want their voices heard. this is way very start to demonstrate that black leaves matter. thank you. >> mr. smith, next caller,
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please. >> hi, i was in oakland and experienced first hand on you aggressive the weapons were. there was no place to protest. i was shot with a flash hand grenade while protesting. i sustained perforation in the left ear and i could hear wind coming in and out. i still recoil when i hear loud noises. i found myself panicking at the sound of firecrackers. it is the loud bang they shot at me. i was able to recover. i saw a woman shot at. i don't know if she was able to heal. i should not have to look at how
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to make tear gas. the amount of fear and harm it does is danging. i encourage all board of supervisors support this common sense legislation that should be required a long time ago. no one should be punished for exercising their right to protest. >> next caller, please. >> i am in berkeley california and physician with physicians for human rights. i worked to research the health effects of crowd control weapons. recently we published a report on kinetic impact projectiles, rubber bullets. they are much more. it is called shot in the head. 115 people with significant head injuries over a short three
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month span in 2020. many were in california. you are welcome to see the video for yourself. there are a number of other research outfits to share. when crowd control weapons are used unnecessarily we see more injuries, disabilities and death among unarmed civilians. more specifically, rubber bullets and impact projectiles are dangerous when used in crowds at short and long-ranges, any range. teen gas is used around the world. many people especially children and those with luck problems are specially vulnerable. we are at a place to ensure the weapons would be better regulated to guard against dangerous over use. it is my hope this legislation
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can protect the right to protest and safeguard the health and well-being of people demonstrating to make their voices heard. >> thank you. next caller, please. >> good morning. i am john jacobo. i am mission district 9. i am calling to support supervisor ronen, walton and haney's right to safely protest legislation. this is something that is crucial not just for us in the mission district, ground zero for protests on 24th street, but for what it will represent for the rest of the country in terms of ensuring we have less lethal weapons with ensuring we have support we need when exercising
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first amendment rights. san francisco should be the example for the country and the world in how we treat our folks out protesting things that are unjust. definitely supportive and i want to ensure this moves forward and we continue to build on this proking. >> thank you. mr. smith any further callers? way may have one more. >> hello. mission district native. father of two children. i come from a family protesting having our voice validated. it is generational. i support the legislation. i bring my kids to protest. we have elevated our voices as a population in the city.
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this is the way we are heard. i do support this bill. thank you. >> thank you very much for sharing your comments. next caller, please. >> we have no more callers in the queue. >> thank you sfgovtv. public comment is closed. thanks, supervisor haney for all of your work on the right to protest safely ordinance. i am pleased to cosponsor this important legislation. >> you want to make your rocks in a motion? >> sure. i don't know if supervisor stefani had questions or if we wanted to hold those for when it comes back. that is up to you. i do want to appreciate everyone
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who called in. we had a lot of support and feedback from the medical community and nurses who treated some of these injuries and who know first hand the damage they call as well as people that works to protect journalists which are injured as well. i appreciate everyone who called in. we have been a leader in crowd control. this is the next step in that work. it is thoughtfully drafted. we take a ton of input and we will continue to. the motion that i want to make when given the opportunity to move the amendment. then i will make a motion after that to continue to the call of the chair.
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>> thank you. i think we can go ahead with the motions right now. a motion to accept the amendment and to continue to the call of the chair. >> on the motion offered by member haney that the ordinance be amended as presented. vice chair stefani. >> aye. >> member haney. >> aye. >> chair mar. >> aye. >> mr. chair, there are three ayes on the amendments. on the motion also offered by member haney that the ordinance now be continued to the call of the chair. vittheir stephanie. >> haney. >> mar. >> there are three ayes. we will work with your office to figure out when to schedule this item again in this committee.
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mr. clerk. please call item 2. ordinance amending the administrative code to require the department of public health, homelessness and supporting housing, human services and department of emergency management to develop and submit to the board of supervisors departmental overdose prevention policies. call 415-655-0001 and press pound twice to connect and press star followed by number three to enter the queue to speak. the prompts will indicate you raised yard hand. your line is unmuted and that is your opportunity to comment. >> thank you, supervisor haney for your leadership on this important issue.
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the floor is yours. >> thank you again supervisor mar and stefani for another one of my items. today the legislation in front of us would require city departments and grantees including shelters and navigation centers to create and implement overdose province. this is in the middle of another staggering horrifying increase in overdose deaths. 146 died in january and february this year. 80 in 2020. in april additional 106 died of beingsal overdose. 252 deaths in four months, 2021 it is a worse year for the worst 712 overdose deaths.
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many thousands were saved as a result of narcan reversals and the support and intervention of both outreach workers, front line responders and peers. despite the most deadly epidemic our city has faced for a number of years and this year. there is no law requiring city departments and grantees create the over coat prevention policies. there is effective monitoring or access to treatment and harm reduction. this will change that requiring overdose plans and policy. it will require the department of public health and housing and
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homelessness and emergency management and human services to submit to the board of supervisors annually a dental policy to describe how they provide direct services to a client using drugs. many of the people who die of overdoses are housed in housing that is partially or city funded. each department must address how to provide drug treatment and where the department imposed information about syringe access and disposal and on site response ponzi. that is the on personnel. ensure staff will work with people using drugs receive adequate training and strategies
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and describe the process by which they will ensure the grantees that manage profit on behalf of the department and provided direct services to drugs implement overdose policy. this reflects a policy that quists for dpu not extended to other departments. in addition to extent this goes further in terms of what is required. the overdose crisis is sateddenning. we need a response to the scale and focus of the data-driven coordinated and approach to covid-19. we can save lives. what we are doing now is not enough. we need to enthat all sites respect people are served.
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housing, shelters, to stop overdoses and give people support they need. as budget chair i am committed and i know you are as well to ensure that we provide additional programming and support including in the recently announced opioid response team and the outreach teams with treatment with mental health sf for mental health implementation establishing office of coordinated care and other steps we must take from the front line response on the street to coordination of people in need who the distribution of narcan. it all has to happen at much higher levels than now. it has to hand within all of our city funded grantees and providers. i think we have a very patchwork
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approach. this creates a uniform standard for all who work with people in danger of overdoses. i want to underscore we all have to be part of the solution. this is an epidemic unlike any we have seen in a long time particularly fentanyl and every department we all have to step up and ensure policies to save lives to get people to treatment and ensure access to life saving tools. i recognize the safer inside coalition on the front lines without reach to community members to the foundation glide and the drug policy alliance and
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rti and front line workers who save lives every year. i want to thank eileen from the department of health who will present on this legislation. thank you, eileen, for joining us today. i am happy to answer questions about the legislation and what it would accomplish. thank you, chair mar. >> chair mar: supervisor stefani. this is a humanitarian crisis as we hear presentations from those who are presenting on this topic, i want to ask you because it is not define understand the legislation. what is meant by overdose prevention strategies? i am looking at page four lines
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4 through 6 to work with people who use drugs receive training in overdose prevention strategies. what does that mean? does overdose prevention strategies mean talking to people about recovery? what does it mean after narcan which is very important. what do we mean by overdose prevention strategies? i think given the crisis on the street it has to mean everything. i am not sure. i think your legislation is great. i fully support it. i just want to get clarity what we are talking about here. thanks. >> i appreciate that question and also i am sure folks from the department of public health will be able to describe what this would mean in practice.
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i do at least as far as i de dee it that it must include training and how to apply narcan and immediately save people's lives. i also believe it must include helping people get access to treatment so that they can stop some of the behaviors putting them at risk and get support in doing that and be provided with the options available to do that. the legislation does speak to treatment in a number of places. we could potentially be more explicit about that. i think that when you are operating a shelter or housing the bear minimum that people are trained in how to apply narcan.
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strategies to provide monitoring and oversight of folks in danger of overdose. with that in addition how where they providing access to people beyond that in terms of treatment or other forms of care or that could address the underlying addiction? >> p-1 of the programs will provide harm reduction programs and services. we are explicit about treatment. we could add amendment we are talking about overdose prevention strategy we are talking about narcan. that should be obvious. there are other aspects to what it needs to look like.
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maybe eileen can speak to that as well and see if there is a way to make that more explicit. >> thank you. maybe we can go to the presentation. are you ready to present, eye eileen? >> yes, i am getting slides up now. >> thank you everybody.
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thank you, supervisors, i work at the department of public health in a branch called community health equity and promotion. i have been before the committee to share the work we do with people who use drugs and also to support legislation for overdose prevention sites that was brought forth by supervisor haney. today i am here to provide collective response from dph and city partners at hsh and hsa to this overdose response legislation. as supervisor haney mentioned, we have a long history of doing a lot of work with people who use drugs. many of the steps outlined in the legislation we at the health department have been doing. we know that clients are responsive to culturally competent services delivered in a manner that demonstrates
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respect for individual dignity, personal stress and self-determination. we are going to build off that long history of the lessons learned and also of the great collaborative work with hsa, hsh and dem during covid response. we are committed as city agencies to collaborative approach to overdose prevention. we recognize responding to overdose is a shared responsibility. we are committed to that. these conversations and the collaborations were already happening. thank you, supervisor haney, forgiving us a framework to elevate our efforts. this slide outlines requirements in the legislation that
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supervisor haney went through. all of these things posting the access to the syringe schedule and the naloxone and training and response policy would be inclusive of what the continual services. the ability to reverse overdose but hearing supervisor stefani's comment it absolutely includes what the other services are and i think we can capture that in the first bullet of plan for how departmental programs will provide drug treatment and harm reduction services. [please stand by]
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legislation will do is give us a much clearer framework so we can have consistency of how we address the overdose crisis. over the next few months, we're going to be working very closely to solidify that plan. we have a process. this is our timeline for the next six months. we're sharing knowledge, we're learning from each other, and we're strengthening opportunities for we as city agencies to address the overdose crisis collaboratively. we recognize, as i said earlier, that this is all of our responsibility.
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over the summer and the fall, we are going to develop and adopt a shared vision for our work, identify resource needs, and engage stakeholders for feedback. and we look forward to coming back to this committee to report back to the board of supervisors our work in december of 2021, to report on our progress and what the implementation plan will look like for each of the city agencies. while we're all very different, we're also committed, as i said, to addressing this crisis and to acknowledging the requirements of the legislation. and we look forward to reporting back to the board of supervisors, and at that time we will also likely have budget needs for fiscal year '22/'23,
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because while d.p.h. has funding to support our providers, to have this additional training and education, my partners at h.s.h. and h.s.a. will also need that financial support to be able to really provide that education and training. at this point i guess it is open to questions. >> chairman: great. thank you so much, ms. lockrin for that presentation, as well as all of the other departments. thanks again, supervisor haney, for sponsoring this important legislation. that would really build off and strengthen the efforts that have been happening, and ensure that we have a comprehensive program and strategy to address the crisis on our streets. supervisor haney? >> supervisor: i don't
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know if supervisor stefani was -- i can jump in real quick in the meantime. i appreciate that the presentation and the commitment -- i know this is going to take resources. what we're talking about, making sure that every department that touches folks who may be using drugs and all of the grantees -- it is a massive universe, right -- has access to training, has best practices around monitoring folks, best practices to implement getting people who training and care, and it is a framework and commitment and a reporting to reach every part of our system, whether it is city-run or city-funded, to help prevent overdoses. and so d.p.h., even though
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not all of the grantees are d.p.h. grantees, it will require loot of work from d.p.h. to work with the other departments to implement it with them. and i just wanted to say that i've had these conversations with other folks at d.p.h. and other departments, and we are going to make sure that including with prop "c" funding potentially, that we're really prioritizing harm reduction, and that we are aligning some of the other things that are happening from a funding perspective, from a harm reduction perspective with this policy, and so i think it is really well-timed for us to step up our efforts and to have kind of a guiding policy around that. because, you know, ensuring that all of the supportive housing staff are on board and trained in how to use narcan and how to identify how to get
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people more help, that is a huge undertaking, and some of it sort of happens in various places and such, but it is going to take a lot of coordination and staff time. but it is very much necessary, as i think we all agree. and so i recognize that there are some cost to this, and we're working on making sure this is aligned with the other programs that have been started, including the s.r.o. program that we funded recently and got started and the mayor has been very supportive of, and i think this policy will really complement and strengthen all of that work. >> chairman: thank you, supervisor haney. supervisor stefani, do you have any questions or remarks? >> supervisor: thank you, chair mar. i think the reference to -- i think it is page three, lines 18 through 19, including the policy addressing how department departmental programs will
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provide drug treatment and harm reduction services, i think that can incorporate what i'm looking at. i think we'll have to wait and see what is developed, but i think it is very parent that those that are looking to do this look at the recovery working groups' recommendations about pier specialists, people who are involved in space recovery, and that that has to be a part of it. and i would be -- i think that has to be included somehow. i hope that people realize that to be drug treatment, but i just want to make sure. and i guess we'll have to see what people come up with. but it absolutely has to include all aspects of how we treat drug abuse and drug addiction. >> yeah. and if there is sort of a part of this with the -- you know, even in the
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definitions of such, where we can say that more clearly, i'm happy to work with you on something for that, for a vote for the full board. i don't think that would be a substantive amendment, but i think it is -- you know, the recovery summit and the various options and things that were involved there i think should absolutely be a part of the treatment options that people are given exposure and access to. >> thank you, supervisor haney. i do agree with that. i think it is very important to listen to people who have actually experienced addiction themselves and have found recovery or found solutions to their own drug addictions, that those individuals absolutely must be listened to, and their thoughts and ideas houn ideas hw they avoided or got
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through their opioid addiction. that has to be at the forefront of people's minds when developing these policies. >> chairman: great. thank you, supervisor stefani, for raising those questions and points. and these are issues that, yeah, we've discussed a lot in this committee, you know, through your hearings. thanks, supervisor haney, for your response, positive response, to supervisor stefani's request. why don't we go to public comment. mr. clerk, are there any callers on the line. >> clerk: thank you, mr. chair. we're continuing to welcome with jim smith in the department of technology to bring us public comment callers. for those who are watching our meeting on cable channel 26 or through sfgov.com or elsewhere, please call in by following the instruction that is should be displaying on your screen at this time. that would be by dialing 415-655-0001, enter i.d.
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1870170254. i'll repeat that number: i.d. 1870170254 press the pound symbol twice, and then press *3 to enter the can queue to speak. and for those already on hold in the queue, please wait until you are prompted to speak. mr. smith, could you pling bringus our first caller, please. >> caller: wesley saver calling on behalf of glide. i'm calling in support of this legislation. the number of people who have died from drug overdoses in san francisco has been rising at a staggering rate with the tripling of the death rate in only three years, and
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outpacing covid in the city. this loss of life is exceptionally high, but i don't think this comes as a surprise either. in a similar hearing in 2019, providers warned the possibility of increased death in 2020, and against factors that have contributed against overdose for decades. the increase number of deaths last year is tragic, and this year it is even more overwhelming, similar to what supervisor haney also mention the, i want to highlight and thank the people who use drugs, who experienced homeless, they have done a tremendous job of successful reversing overdoses, spreading awareness, and limiting the transmission of disease. if not for this work, our city would be losing thousands of people each year. we cannot end overdose until we end structural violence like poverty and
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racism. overdose will continue so long as we neglect and criminalize and put barriers amongst us. we need spaces for drug use. please provide them with the resources that they ask for. thank you. >> chairman: mr. smith, could you bring us the next caller, please. >> caller: hi. this is laura. i'm the director of the harm reduction policy. i want to thank supervisor haney and the committee for holding this hearing. among the things that all agencies need to do moving forward is assess when and how they can add to the menu of services that
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they're providing. i really appreciate the department of public health's leadership on this and would like to see some of these other agencies follow their lead on adding supervisors so that this echoes a bit of wesley saver's comment. one of the things we need to do to address overdoses and overdose fatalities is to address the structural vulnerabilities that lead people to overdose. we know people are at great risk when they're leaving the hospitals, leaving jails, leaving treatment, the first 73 72 hours after leaving institutions, people are at risk. so ensuring that as people are leaving facilities, that they've got maloxone with them, they have a safety plan, they're connected to other services. we also know that overpolicing and police presence can increase
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people's overdose a bit. so ensure that our policing practices are not inadvertently introduces overdoses. and it is not just police carrying narcan, although that is helpful, but it is making sure we're not overpolicing so that people either try to hide from view, where they can't be seen, and those are things that things that people overdose with. just to keep all of that in mind. thank you very much for holding this hearing on this important issue. >> chairman: thank you for sharing your comments. >> clerk: mr. smith, can we have the next caller, please. if there is a caller on your line and you have
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heard that your line has been unmuted, that means it is your opportunity to provide public comment on agenda item 2. >> caller: yes. can you guys hear me? >> clerk: we can. please begin. >> caller: yes. can you hear me? >> clerk: yes, we can hear you. please begin. >> caller: i'm sorry. i just got off another zoom call. i'm, like, okay, what is going on. i'm felicia jones, and i'm a weapons disparity in the black community, and i have a master's degree in chemicals and i'm counseling with emphasis on chemical dependency. i've been working inside the jails for 20years and in the field. harm reduction is good, but it is not a one-size-fits-all. since harm reduction came into san francisco, harm reduction really harmed the black community.
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in the black community, we get clean more or less by abstinence programs. you can't have people who want to seek recovery with abstinence and then have harm reduction for folks right there with you. harm reduction is you meet people where they are. they may still be smoking crack or may still be using, but at the same time, we're still in the program. i look back at all of the black-led rehabilitation programs, and when harm reduction came, it caused a lot of these programs to close down. and so, you know, with san francisco, there is no really rehabilitation programs in the community of black people. and so, again, this is a concern. also, with d.p.h. and looking at who they fund, they make it so hard for black people to -- for black-led organizations, i should say, to get funding, and take us through all of these
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complicated things that they have to do. take, for instance, west side community health, mental health. i've been reading some of the e-mails, and just having them punishing them for 10 years around programming and not giving them money and all of these things -- i mean, it really is a disgrace of how black san franciscans are treated in san francisco in all aspects of our lives. [buzzer] >> chairman: thank you, felicia jones, for sharing your comments. mr. smith, could you bring us the next caller, please. >> caller: yes. hello. i am the founder of the h.i.v. long-term survivors right here in san francisco. and i work with lots of people growing older from the lgbtq and other communities. and, of course, also my latinos. one of the first things i want to say is age --
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again, age -- during drug overdoses and drug problems, age has no limit. one of the things that i want to emphasize is about the prevention side of it. my story is, like, i've been a user. and when i went to try to stop, i was literally told that i didn't qualify because i was not doing enough. that kind of hurts me a lot because, again, any person should be stopped before we end up really in a huge problem. another problem from my community is about trust. many members of my community are latinos, and they don't trust the system. it is very, very important that we
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>> we've been waiting for four years to see a supervised injection site. and finally, i just want to
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say as we go moving and clearing out encampments throughout the city, when d.p.w. throws away a personal's narcan, along with their personal belongings -- it is drug users that are doing most of the heavy lifting when it comes to saving lives out there, and we're sort of at cross purposes as we're sending the city out and throwing away property. >> chairman: thank you for your comments. mr. smith, are there any further callers in the queue? >> clerk: we have one more in the queue. >> chairman: thank you. >> caller: hi. i'm formally homeless. i've been in the community for some time, and i've seen the impact of the current crisis on our community. one of the things i really
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want to bring up is the nexus of being lgbtq to using, and the fact that people that are lgbtq, some of us, like myself, define ourselves here in san francisco and don't respond well to tough love. i think that abstinence -first programs come from a tough-love stance, and it is going to drive people away. so we really do need to make sure we're having a variety of responses to the overdose crisis that are appropriate for all of our residents in san francisco. so that we're not missing pushing any of our residents away. i just want to underline that all solutions are important. thank you so much. >> chairman: thank you for your comments.
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mr. smith, could you bring us the next caller, please. >> caller: hi. can you hear me? >> chairman: yes, we can. please begin. >> caller: my name is seth katz, and i work in harm reduction. i've lived in this city for 10 years, and i work specifically with drug users in this area. i think that everybody wants the same thing here: we want to reduce overdose-related deaths, but for that to happen, we need the funding to support access to treatment, and that includes harm reduction. i see up to 100 people a day, and they tell me firsthand that harm reduction services acting as treatment, acts as a continuum, helped save their lives and the lives of people they love. we have to listen to people who use drugs. it is shame and stigma that lead people to hide their use, to use quickly without
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safety plans, like narcan, and we're here to empower individuals to take steps to reduce that harm. we're all here for that shared goal of less overdose-related deaths. we know this works. we know we need all sorts of treatments and options. we know we need to reduce these barriers to increase access to treatment services for people who use drugs. i urge this committee to increase funding to access to harm reduction. we've been doing harm reduction and prevention work for decades. so thank you for your time. >> chairman: thank you for sharing your comments. mr. smith, are there any further callers in the queue now? >> clerk: we have one more caller. >> chairman: thank you. >> caller: good morning, supervisors. my name is denny smith. i've lived in san francisco
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for 47 years, and i live in the tenderloin currently. i really support the treatment on demand coalition's outlines for repairing the city's homelessness and drug use difficulties. and i would like to add that i think another large contributor to the problem is an extreme hesitation on the part of physicians at san francisco general and the satellite clinics, where most of the homeless and drug-using population gets its care. to get appropriate opioids or recovery treatment when they're requested, i think some of that hesitation comes from the war on drugs. but i think perhaps also the administration's (indiscernable) and san francisco general have control over that. over the years, i have personally paid for opioids
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on the street for a friend who had ryder's syndrome, because he can't get pain relief from his physician. right now i'm trying to get opioids for a friend with cancer, who's physician had a satellite clinic and will not release or dispense medication. i think it really is a big problem, in addition to everything else people have suggested today. thank you very much, and thank you, supervisor haney. >> chairman: thank you for sharing your comments. i understand we have one more caller in the queue. mr. smith, could you please connect us. >> caller: hi. i was born and raised in san francisco, and today i submit public comment in my role as a licensed clinical social worker at the offices of the public defender. we're a member of the treatment on demand coalition, and i'm here to share my support for treatment on demand, which is an approach to support, advocate, and reduce the
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abuse and suffering that marginalized san franciscans have based under systematic and structural negligence. for those who are unhoused or have mental or substance issues. priorities must center the dignity, care and support of individuals in recovery. there is so a lack of treatment access for overnight support and intensive case management and housing for people with mental health needs. [inaudible] harm reduction and low threshold, and aging and specific community-based treatment options. there are so many barriers and wait times for san franciscans to access treatment services. this is exacerbated when law enforcement agencies become the gatekeepers of
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rehabilitative services for incarcerated clients. we're here to call on san francisco's elected leadership to trust in the request for a need for non-law enforcement access to treatment on demand. we want you to consider the physical, mental, and social safety of all community members of san francisco. thank you. >> chairman: thank you for sharing your comments. mr. smith, could you connect us to the next caller, please. >> clerk: , if you have heard that your line is unmuted, that is your opportunity to provide public comment with regards to the item. i'm receiving word that the caller we just unmuted has hung up. mr. smith, do we have any
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further callers in the queue? >> we have no more callers in the queue. >> chairman: thank you so much, mr. smith and mr. clerk. public comment is now closed. colleagues, thanks again for another very informative and important hearing on the drug addiction and overdose crisis in our city and how we can better address it. this is a really urgent problem. thanks for your presentation and participation. it looks like we are joined by supervisor safai. supervisor safai, did you want to make some remarks? >> supervisor: no, i didn't want to make really any remarks, but i had a question specifically for d.p.h. it was something i heard -- i heard some of the callers -- supervisor haney and i were out in the tenderloin yesterday with a mother that has been really advocating for a stronger program compelling
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people into treatment. we're working on a program like that, that is abstinence-based. so that is important. but my question for d.p.h. is: do you have the statistics on how many of the people that overdosed -- how many of them had been in any type of treatment program recently or near recent, before they overdosed? do you have that information? i understand that some of the programming, the treatment programs that you have, the average stay in those programs is about five to seven days. and i know they're low barrier. i know there is a whole spectrum of treatment. i'm just curious how many of the people that overdosed were recently part of any of the treatment programs that you offer. if you don't have that information today, that is something we'll be sending an official letter to you
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guys asking for that data. >> thank you for your question, supervisor. i do not have that information on me. i can any anecdotally that oftentimes people leave treatment and they're at high risk of overdose, and that's because they had stopped use and then they used the amount they were using previously. but that may be discussed in the next hearing, or that would be a question for my partners at behavioral health. >> supervisor: okay. great. thank you safe. thank you, mr. chair. >> chairman: thank you, supervisor safai. colleagues -- supervisor haney, do you want to make some closing remarks and a motion? >> supervisor: sure. thank you, chair mar and thank you supervisor stefni and ms. lawforn for your work. i know there is going to be a hearing right after this, and we're going to go into some of the issues around
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treatment in much more greater depth. the basic and fundamental reason for this legislation is to ensure that every single one of our departments, every single one of our providers, grantees that may work with people who are using drugs has a plan to stop overdoses. and that means that getting folks into treatment wherever and whenever possible and ensuring strategies to have access. it also means training staff and having affective access to narcan, which saves lives. this is about all of us doing more and stepping up and not having a patchwork response, but having one that is coordinated, unified, and elevated. with that, i want to make a motion to move this legislation to the full board with a positive recommendation.
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>> chairman: madam clerk, if you could add me as a co-sponsor, i would appreciate that -- oh, mr. clerk. sorry about that. >> chairman: thank you. mr. clerk, please add supervisor safai as a co-sponsors. can you call role on supervisor haney's motion? >> clerk: on the motion offered by member haney, that the ordinance be recommended to the board of supervisors. vice chair stefni? >> aye. >> clerk: member haney? >> aye. >> clerk: chair mar? >> chairman: aye. >> clerk: mr. chair, there are three ayes. >> chairman: great, thank you. it will be sent to the full board with positive recommendation. mr. clerk, please call item 3. >> clerk: agenda item 3 is a hearing to provide an update on the fiscal year 2019, 2020 treatment on demand report. members of the public who wish to provide public
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comment should call 415-655-0001, enter i.d. 1870170254. press the pound symbol twice to connect to the meeting, and then press star followed by the number three to enter the queue to speak. the system prompt will indicate that you have raised your hand, please wait until the system indicates your line has been unmuted and that will be your opportunity to provide comments. mr. chair? >> chairman: thank you, mr. clerk. i think this hearing is a good followup to the hearing we just had. and it will allow us to really get into more detailed discussion about the extent of our drug treatment programs in the city. thank you so much, supervisor mandelman, for sponsoring the hearing, along with supervisors stefani, ronen, and haney. >> thank you, chair mar. and thank you for having
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this hearing here this morning. i am -- all right. i have some comments. i think there is going to be some conversation this morning about the timing of the report that we received, the treatment on demand report that we received yesterday evening, in which the members of the public, i imagine, don't have access to. so treatment on demand has been the stated policy of the city and county of san francisco for nearly a quarter century. since the passage of proposition "t" in 2008, the department of public health has been required to submit an annual treatment of demand report to this board. the legislation is very simple. i think in light of the timing of the report that we received, i'm going to read from it a little bit. it is a simple little piece
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of the administrative code. for those following along at home, you can find it at section 19a .30. there is a title. there is finding and purposes. "notwithstanding any other provision of public law, the department of health will maintain substance abuse services and treatments commensurate for the demand with these services. demand will be measured by the total number of substance abuse slots, and the total number of individuals seeking such slots, as well as the total number of residential treatment slots, as well as the number of individuals seeking such slots. the city and county shall be flexible in providing various treatment modlities for residential substance abuse treatment services and medical substance abuse
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treatment services. the department of public health shall report to the board of supervisors by february 1st of each year with an assessment of the demand for substance abuse treatments and present a plan to meet this demand. this plan should also be reflected in the city budget. the city and county shall not reduce funding staffing or the number of substance abuse treatment slots available for as long as slots are filled or there are any number of individuals seeking such slots, and nothing in this section shall diminish" -- blah, blah, blah. it is very simple. it's a simple requirement that makes a lot of sense to me and my lay, non-public health professional brain. we have a goal. that goal is to be able to
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provide treatment on demand because as some of the speakers who called in for the prior item noted, when someone is ready, that's the moment you want to get them. and they may not be there six or seven or 10 days later. and the department determines how we'll meet that goal that allows the mayor and this committee to -- it is a gaps analysis and it is supposed to inform the budget. as i said, it makes a great deal of sense to me. but it is not clear to me, the fact that san francisco is following the letter or spirit of prop "t." in fact we do not follow the letter or spirit of prop "t." we had a meeting back in the fall of 2019. the annual prop "t" reports were reviewed at that 2019 hearing and they were notably thin documents that painted a picture that was
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radically different from the treatment providers, advocates, folks in recovery, and indeed many members of this board, who districts are home to far too many folks suffering from mental illness and addiction. in 2018 and 2019, there was no way for residential treatment or residential stepdown treatment, and a wait of just one week for outpatient treatment, intensive outpatient treatment, case management. the san francisco described in that report had enough treatment capacity to meet demand, no significant gaps were identified, and no additional funding needs were identified. so the road seemed like a road exercise, a piece of paperwork to get done each year, and a piece of paper to which no one would pay much attention. now, this year's report, delivered the evening before this hearing, three months
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late, and certainly in no way able to impact the mayor's budget, still doesn't meet the letter and intent of prop "t." we talked about the timing. this document, as i said, is not available to the public. my legislative aide here on monday has made repeated efforts to try to find a place on the interwebs, where these prop "t" reports live, and has not been able to find them. that, of course, is annoying to me and difficult for advocates, but it raises the question of what, if any, role these prop "t" reports play, in the planning, not to mentioning budgeting for san fúancisco's substance abuse treatment efforts. and then there is the substance of the report, which we're going to hear more about today. again, i have not that extensive time with this report, neither has the public, but it seems to me that the contents are a
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covid-time variation of the story. the report seems to be saying that the pandemic was rough, but otherwise don't worry, san francisco, we've got this. well, approaching a thousand overdose deaths a year, i done think you got this. i wanted to have this hearing to provide some time for this report. though, again, i thought we would have more time with it before this hearing. and an opportunity to discuss what is in the report, what is not in the report, and what should be in these reports going forward. the prop "t" framework makes sense to me as the basis for an annual guess analysis, which seems like a useful thing. but clearly no one is using it that way. and the world has changed since prop "t." in addition to the explosion of local overdose deaths at a scale that would have horrified the drafters of prop "t", and horrifies all of us, san francisco also
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has a new framework for behavioral health in the city in mental health s.f. so how can we may the reports more relevant and useful, and provided in a timely manner and are easily accessible to the public? does prop "t" even ask the right questions for 2021? and should we be asking different ones? how do the reporting and analysis requirements improper "t" fit with the other reporting and requirements in mental health s.f. and elsewhere? i've asked the department of health to present on the prop "t" report, and also hope to begin, in this hearing, a conversation about the ways in which we might amend prop "t" to meet the annual review process -- i have here more robust, affective, and useful in meeting the goals of treatment on demand. we can start with robust, affective, and useful, because it not clear right
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now they're any of these things. i want to thank supervisors ronen, haney and stefni. and i want to thank the advocates and drug advocacy workers -- they have been on the front lines doing this work for many years, and i thank them for that work over that time. i want to thank erin mundy in my office for all of her work on this issue. today we're going to hear first from the department of public health, with introductory remarks from dr. hillary coonans, followed by dr. david patting. and after d.p.h., we're going to hear from the difficult probation department, with steven, victoria, reentry policy
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planner, and sarah, public service aid, and the final presenter will be laura thomas, director of harm reduction policy of the san francisco aids foundation, and then we'll have public comment, and i think my colleagues want to talk. >> chairman: thank you so much, supervisor mandelman. supervisor stefni? >> supervisor: thank you, char mar, and thank you, supervisor mandelman, for calling this hearing again. and before we get into the presentations, i just want to take a moment and express my deep dissatisfaction. supervisor mandelman called for this hearing, which i co-sponsored, in march. which is one month after the treatment on demand report was due. it appears, as supervisor mandelman just said, and as we all know, that this
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report wasn't ready until late last night. and my cursory review of it, again, as supervisor mandelman went into a little bit, indicates that the author of the report believes that we as a city are basically meeting our treatment on demand obligations. and i just -- you've got to be kidding me. i am not disappointed just because this report was late. i'm disappointed because the overdose death crisis is probably the single biggest catastrophe facing our city right now. and the manner in which this report was prepared and presented reflects very badly on the city. i don't believe anyone walking around this city believes we're meeting the need for drug treatment or mental health services in this city. we all see overdose deaths
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in the streets every day. we hear about it. we read about it. for every death, we know there are hundreds more near-death experiences. i know many of you on the front lines on effort -- i know many of you are on the front lines of this each and every day. i know many of you know people who have suffered from an overdose. i know many of you know people who are addicted. i do as well. i know many of you have reversed overdoses yourself. so it really bothers me when we as a city represent the public so poorly on something that is so important. it does not reflect the dire urgency with which we must address this crisis. i feel like given what happened back in 2019, when
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we received the treatment on demand report, which is maybe two pages, saying that we were meeting our goals, which at that time supervisor mandelman and i were aghast, and here we are again, in 2021, when the report was due on one of the worst crisis our city has faced, was due a few months ago, and we get it last night, on the eve of this very important hearing? this is not check the box activity. so i'm very interested to hear the presentations. i'll withhold my questions until we have received the presentations. but we have to do better. i want to thank you, supervisor mandelman, for continuing to call for these hearings. we just absolutely have to treat this crisis with the urgency that it demands. thank you. >> chairman: thank you, supervisor stefni. i don't see any other colleagues on the roster, so
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supervisor mandelman, i'll turn it back over to you for the presentation. >> supervisor: thank you, char mar. i believe we have first up, new in her job, dr. coonans. >> doctor: good morning, supervisor mandelman, supervisor stefni, and others. thank you for inviting us to provide testimony. i just want to say a few introductory words both about my commitment to working and really doubling the efforts to address this crisis. i share the comments of both both supervisors, as well as the prior commenters, thato we need to do better and find ways to address what is really the most serious crisis of my professional career. i think as you have heard, i am recently from new york city, where i worked for
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many years as an addiction medicine and primary care physician in the bronx, which is another extremely hard-hit and long-standing area of the country in terms of overdose. i know that with additional approaches and resources and creativity, that this city no doubt has, we can address the crisis that is before us. i very much welcome supervisor mandelman an opportunity to continue to speak further about ways we can both measure and change both our reporting, importantly, which no doubt needs to be more timely, as well as ways to incorporate the treatment on demand work into the very important work that is going on across the city, both with mental health s.f., as well as other initiatives. so i want to just reiterate how much i share your sense
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of urgency, and that we need to do better. i, too, supervisor stefni, have been working with folks for many years, who themselves have experienced substance disorders, and i have run programs, and i really concur with your highlighting the importance of people with lived experience in sharing part of the work of the city. i am very much here to listen to the supervisors and to the public comments, and want to now turn the presentation over to my colleague, dr. david pating, who is on our substance abuse services team. he has been assigned to special projects, and he will he'd our presentation and be able to answer
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questions. >> doctor: good afternoon, supervisors. if we could have our slides for presentation, please. >> chairman: thank you. >> clerk: thank you, mr. pating. just a moment. mr. pating, do you have a couple of your presentation? are you able to share your slide? do you have presenter access? >> doctor: yes, i do.
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>> clerk: great. >> thank you very much, supervisors, for allowing us to speak. as director coonans has mentioned, i'm very sorry for the timelessness of this report. during covid, it has been difficult to access clean and reliable data. the prop "t" asked for 2019 and '20, which would have ended last june, and we're givingyou the 2020 data, which is the covid year. so i'm going to explain this for you in the way that we think of treatment on demand in a more contemporary way. one of the problems with the treatment on demand ordinance is that it was written in 2008. as you know, the affordable care act came in at 2010, which then set up a whole
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national structure for quality services, reporting, and the movement towards managed care delivery. so the state has taken this up in 2016, as you've heard in prior hearings, and by 2018 we are in full managed care as an organized delivery system. what this means is that there are standards to provide evidence-based care, evidence-based assessments on admission, so people are properly based, there is good use of resources, and there is optimal care. and there are also standards with regards to reporting what i think the treatment on demand tries to get at, but it divides this treatment on demand into three different categories. what you'll see here are the categories we're going to address. besides medical necessity, meaning that you need treatment because you have a level of threshold that
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meets that treatment, then we look at was the treatment offered timely? was there enough places that you could go to to get that treatment? and how satisfied were you with that? we believe this is actually what the treatment demand app is asking, and on the basis of this we can identify what were the gaps and what do you need for budget. so this is the timely access report that we'd like to, again, look at 2020. so this is fiscal year '2, '3, '4, which is january through june, and estimates of our q-12 for 2021. so you're getting basically the year 2020. with regards to the average timed access, we are meeting the same-day services for opioid treatment programs and peri
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natal. we have our treatment of 24 hours, and san francisco standards for perinatal treatment. it is interesting to know, with regards to these levels of care, prior to the drug medi-cal expansion of which we're one of 19 counties in california that are doing this expansion -- the rest of the counties are not -- if we didn't expand according to the medi-cal offering, we would really mostly end up with the opioid treatment and perinatal benefits, and the city responsible for all of the other services. but with drug medi-cal and the organized delivery system, we're actually now able to recoup funds for another extended range of withdrawal management,
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residential treatment, residential transitional living, which is called stepdown, which is really an alternative to housing here, and intensive outpatient services. by using the state monies, we're now able to optimize monies throughout out system for other kinds of services. >> buzz: reimbursement with regards to treatment is really important. we are meeting the 24 to 48 hour requirements of the state and of ourselves. residential treatment is averaging five to six days wait, and we're getting people about 95% of people in within the 10 days. residential stepdown and the outpatient treatment services, we are having somewhat of a difficult during covid, making sure that we have enough beds. outpatient treatment during covid essentially had to shut down for many months
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until we figured out how to offer telecare because people could not congregate nor come to a group setting in outpatient treatment. the residential treatment difficulties have related more to -- although we started residential stepdown in july -- october -- july of 2018, within 18 months, we filled up 200 beds of clients that will stay six to nine months. so often we have gotten the complaint we don't have enough long-term treatment. the goal here is and what we offer is 291 beds of 90-day treatment, and 100 beds of nine months to one year treatment, and we have a lot of beds that people can move into. but we actually don't have enough at this point of the stepdown transitional beds, and we're looking for that. and i'll discuss that in just a-minute. in regards to timeliness, we
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are meeting medical necessity. with regards to whether we have enough beds and where the gaps are, i would say that our network advocacy, the number of beds we contract with -- here i want to say the use of the term "beds" or "slots" is no longer accurate. what we contract for are the days of service, and the days of service are based on average stays and average number of beds that we might need. but the city actually has no reserved beds. providers fill the beds as they're available, and we make sure that they have enough available beds and they're reimbursed on a daily rate. we do do a bed count based on our approximate estimate of how many beds we should be holding in reserve, but, again, beds do not equal service. with regards to the kinds of services we have, we have
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enough outpatient opioid treatment programs. we have 2900 patients in outpatient opioid treatment. and a capacity probably of going up to about 5,000 opioid treatment slots. so there is adequate capacity there. same thing with our residential perinatal services. we have about 30 perinatal beds that we keep open all of the time for instant access for women who are pregnant, or who have just delivered and their children, and we actually have 21 of those open right now because during covid, there is a shortage of perinatal clients approaching treatment. and, lastly, we have a very good supply of residential beds for jail. our primary provider for that is the salvation army, but also health rights through 60, and salvation army has over 20 openings as of today. mostly because they're recovering from
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covid-related needs to partly restricted treatment, but they have good adequacy. [please stand by] .
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>> this impacted our jail releases in the december-january, february period. we had jail services emptying out. we were able to get most clients into beds. spanish speaking clients had difficulty. as jail beds began to fill up we had competition between hospital discharges that were coming out as well. these are some of the things in the report related to covid. covid was most difficult between june and december when we were just starting. by january, things settled down. i will say we have shortage in
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outpatient and residential transitional living, essentially housing that we offer with regard to people getting into long term or needing long-term support. we have a shortage. we are looking at dual diagnosis complex medical model where people come out of the hospital with mental health and medical issues. this is a model that works. if there are gaps, these are the areas with gaps. we are looking at the last three. step down, out patient, dual medical beds. we need spanish language and that is what we are struggling with the most. >> i know my time might be running out. >> supervisor mandelman, did you have questions right now? >> i will wait until we are through.
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>> we are almost done. thank you very much. we are audited with regards to the standards twice annually. independent audit by external reviewer called eqro. they look at the timeliness and level of care assessment and outcomes. they are required to do client-centered and community centered performance improvement projects. they conduct focus groups of clients that have been in treatment or completed treatment. the medi-cal services they look at cost and utilization and they conduct focus groups. we have not had any complaints regarding access to the focus groups nor do we receive many complaints on the complaint line regarding timely access or the
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services. in fact, in recent client poll of 802 clients in services, 92% of the client reported that they agreed that the services were both timely and operated good times and in good locations. lastly, that is services. what about with regard to the overdoses in the community? we are very focused on overdoses. all of those that want treatment we will get them in and do our best even during covid to find spaces for them. even when there are no other spaces and all shelters are full. we were able to make it work putting clients in every available open unit service we have. there are still people on the street that need outreach. we are aware of the clients in the bayview that need to be outreached, and the various other communities. now our main focus, particularly
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under mental health san francisco is to reach out with low threshold services. we are offering these. you can get treatment during an ipad during covid. we hope to continue this in the next year and expand this. we are offering addiction consul consultations and detox at shelter-in-place hotels and the sites. we have expanded the opiate replacement treatment on the streets and the pharmacies to get people medicine. we have put naloxone everywhere in the city. every harm reduction site you will find it everywhere we we we flewedded the city. we -- flooded the city.
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maintaining alcohol clients on prescribed alcohol on the shelter-in-place hotels. that is what we did last year. this coming year we will open the drug sobering center. we will be opening expanding the tele view and moretelli care. this is the boom of covid to use tele services. we will expand to methamphetamine-using population. we will use peer counselors to navigate from hospital to services from access points to the services and connecting those services to homeless care services and the assessment services. we have to be announced comprehensive mental health san francisco overdose prevention plan broader than what i
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described to you now. this is really the focus of the future. we can talk to you about treatment on demand. what we need to talk about making sure we are filling the managed care obligations with access annette work and satisfaction to meet the demand. more importantly we need to move to low threshold to do outreach. this is what we are focusing, this is what you asked us to do and what mhf is focusing on. the 18,000 on the street that are everywhere else including the african comment in the bayview that we have been hearing about. this is where we need to be. we are open to communicating and talking with these communities to figure out how to offer more entry into our system. i will open it to questions.
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i know there will be a lot. very sorry for the timeliness of this report, but to let you know, with regard to the services we are doing well for those that have the criteria that need the services. we need to expand to the areas where you tell us where you have concerns and you hear concerns. >> thank you so much for your presentation, for all of your good work. supervisor mandelman. >> could i stop the slides so you can see. >> thanks. >> that is the end of the dph presentation, right? >> yes. >> i appreciate the apology for the lateness, but it doesn't explain why. who is responsible forgetting these reports done by february 1st to the board?
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>> the substance abuse division in coordination with or policy division. >> who is in charge of that. >> supervisor mandelman can i step in here and take responsibility and say it won't be late again. i apologize. it will be under my supervision going forward. i was not here, as you know. it will will not happen again. >> and just to reiterate. the legal obligation is for this to be done by february 1st. it informs the budget process now is done. in march the department before you had arrived. in march the department was put on notice that they would have to come before the board of supervisors and present on a report that by that point auto have been months old. my office is reaching out to your department during that time asking for this report, when it
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would be done. the report finally arrived the night before the hearing. it is ridiculous and unacceptable. i know you understand that. i am underscoring that. as someone who has expressed to you and this is not your fault, my lack of confidence in behavioral health, in san francisco, this does not help that. thank you for taking responsibility for something that is not your fault but it has got to change. i also don't understand -- nobody has this answer. i don't understand why we don't present these documents publicly. why are they not accessible on a website. by february 1st, you know, this thing is up somewhere and people
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can look at it. love it or hate it or argue with it or whatever. i am done with that lecture. i would like to ask a question about sort of what i am greening from the pen -- gleans is that the department of public health the managed care obligations under affordable care have taken care of the obligation under prop d. did i hear that. >> it is hard to understand what prop d is asking. we don't talk in terms of slots or medical substance abuse slots or individuals. these are not collected data with meaningfulrel levance.
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>> that may beings sense to me. i am not sure it is right. it is one of the things we think about altering the voter approved ballot measure we need to think about that. i think the correct way to do that analysis might be to figure out what the prop t analysis looks like and explain it has been superseded or there are strong compelling reasons why that is not the bright way to think about the gaps. looking -- i am not sure. now, i would like to look at the slides with the timely access. i am not a public health professional. i am an elected official who doesn't think about managed care compliance, and i do because i
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have to here. i don't know as much about it as you do. the idea the regular sold san franciscans understanding treatment on demand and appeal. we have so many people struggling with substance abuse disorder in san francisco. we know that stopping or reducing use of substances is really hard. we know that sometimes people have to do it more than once, sometimes many times. i think that my understanding from talking to people who know more about than me. there are windows of insight people have. they are willing, interested, might engage. you might lose them the next day. they might go to the program, start detoxing or go to residential treatment program and walk away.
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that is also part of how this works. you want to have there to be as little friction in getting folks in those doors. there are some people if you say awesome, good on you for wanting to go into residential treatment, my unhoused friend, i think i can get you in eight days. which apparently meets the medi-cal standard by two days. doesn't feel like that meets the letter or spirit of prop t. >> with regards to demand, that wasn't well defined in the act. demand could be one thing. if i want it now and today. that could be appropriate if it was needed. looking at the aaa making sure that we are using efficient,
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cost-effective and client-centered care with regards to cost and effectiveness, the state has mandated we look at what is needed. this is the medical necessity. anybody that wants it and it is medical necessary we get in. that is the combination demand. people are looking at i want it. i guess it would be similar to if you have a headache and you go to the doctor and you want a ct scan. he might prescribe something different first to manage your headache or it could be a migraine. you are insisting on ct scan. that is the disconnect to make sure clients get what they need. if it is not what they want, we begin to explain. we have a formal process where people do not get what they want. they can file a grievance. we have to address the grievance
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and they can escalate up to independent review if they are not getting what they want. we get very little. last year i am not aware of any of those. i understand the complexity of it. this is the way that healthcare works. >> again, for my lay and less knowledgeable perspective than yours, the notion of someone who has been convinced by an outreach worker that treatment is something to try. filing a complaint because they have a hard time getting in. does not make sense to me. i guess i wonder and would love for the department to think about and as we have these conversations about updating prop t. how many people do we lose?
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who gets lost? how many people express willingness to go to treatment? where do we lose them in the next several days, next year? maybe that is not treatment on demand. maybe we need to expand what we are measuring to make treatment as effective as possible. i know the experience of people, and i am thinking supervisor haney may talk about this. he has shared. he has tried to get help for people saying, yes, i want to go to treatment. people are ready for treatment and even with the case best case manager, it is days and days. maybe they are committed. if you are struggling with that and you have got underlying mental illness and you are not housed and you have a bad day, it just seems like i think we need to take another look at
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those items where we think we are doing adequately like in patient residential and then i suppose for the areas where we think we are not, you know, if we are relying more on outpatient and not meeting that goal, these reports need to explain how far we are falling short and what the gaps are. even if it is not dph's job to provide the housing unit that goes without patient treatment spot, we can't know the gap, what the problem is, how to solve the problem if we don't know. gee whiz, we think there are 300 people if we could have given them housing unit and gotten them into treatment the next day, 100 of those would have
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stuck. to meet that need, madam mayor, board of supervisors you would have to cough up hundreds of millions of dollars. why wouldn't we provide that gap analysis for the mayor and the board and the world to see? that is, i think, the spirit of prop t. maybe it doesn't go to that detail. that is what i would like to drill down on with you and other cosponsors and anybody else interested, treatment on demand coalition on figuring out what people would like to see in these reports. again, i am not the expert. i know this is not a useful gap. this is an advertisement how you are complying with medi-cal
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requirements. this is not useful to shape and how we approach substance abuse. why our intuition might be wrong about some of these things. the other things that would be useful, as i said, what can we do to support sobriety. maybe the data slows you really needy tox and somebody to talk to in the first two days and in patient slot is not going to get better outcomes over a year or two, but you know what? another 200 step down beds would. trying to have that analysis. then the other thing that one of the areas where we are doing good and maybe this is true, yes, good, jail, residential
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treatment in jail seems to meet the need and i am sure we will hear for people in jail whether or not that is true. we are going to hear from adult probation next. i am curious to hear from them about whether or not for their population we don't have pre-trial here are we able to get appropriate treatment to that subpopulation? we need to think more about the different subpopulations we are trying to get substance abuse treatment to. particularly justice involved in various stages of pre-trial, probation, all of these areas. my sense is we are not close but you wouldn't know that from this report. my conservations suggest we are not close. you wouldn't know that from this report. is there an issue or one of the
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things i heard is gosh it would be great if we could get people in-patient treatment outside san francisco. that would benefit some folks. don't see it in this report. don't see that analysis of the different kinds of modalities that might meet the needs of different folks that shouldn't be asked to return to tenderloin to outpatient treatment program. the other thing i would really love and this may or may not be part of updated approach to prop t. i would like to challenge public health to think about how to do this is measuring over population health, not just individuals. how are we looking at addiction overall? are we reducing addiction in san francisco? preventing folks from starting?
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are we getting folks who have used in the past not using? is there any way to measure at population level whether we have success or not. i don't know. i would ask you to do that. i don't think measuring narcan given out does it. you know, the last thing is treatment on demand. we need to induce demand. we need to be getting more folks. i know there is creative thinking from the response teams about when people do overdose. we can do different things to keep them from dying the next time they overdose. we can intervene to get them, you know, to get them into programming and how do we if we are meeting demand, there is a problem. we are not doing enough to increase demand. we need to fix that as well.
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those are my questions and comments. >> may i respond to one of the two items? >> yes. >> the logic model you propose of defining the gap pan linking to budget, i really like that. we feel like we have been struggling with treatment on demand requirements and frame demand to get us to a useful place. if that is the logic model you propose, that is excellent and the way to do it in a -- not managed care setting but manage in a way that is effective and efficient. my director is here. i will defer to her how to do that. second thing is subpopulation. that is one of the issues with treatment on demand lumps everything together. we do well with some things. in other areas people have a
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need. it is hard to build a system that tries to address and prioritize women that are pregnant, high risk, two persons there baby and mom, that are using iv drugs at risk for overdose. high priority for us. justice involved. high priority for us. we really want to invest in these services. it is hard at times to do them all when you are measured by one global standard. define treatment on the website. people see one number but the variants. why so many pregnancy beds? that is by choice so they get in right away? why do you have 5,000 opioid treatment slots? because that is what we need. i think a defined view will move
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the conversation forward. outreach measurings and inducing demand are interesting. i will give that more thoughts. i don't want to give something rushed. i appreciate the sincerity and thought you put into it, supervisor. this is a helpful start. welcome to have these conversations. >> if i can also just weigh in and thank you, supervisor and doctor, for your comments. we are open to thinking about best ways to report and most importantly to measure our work and to measure in order to create the best possible response to the issues of substance abuse and overdose in san francisco. i am very committed and open to rethinking what we need to amplify a lot of great work
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going on that i really want to acknowledge many colleagues in san francisco providers and advoctes and health department. i hear your concerns. i want to respond to one thing substantively which is i love the expression induced demand. i want to frame what you heard from the doctor what we term low barrier, low threshold. that is exactly it. that approach is exactly coaxing people into and supporting them to undertake healthier behaviors. whether it is cessation of drug use altogether or taking steps in that direction so they don't
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die, so they protect themselves and loved ones. that is exactly what low bearer, low threshold work does. i think framing that in ways to make sense to you, to the public to make it as understandable as possible would be very, very helpful. >> i think connecting, drawing the connection to the public between these harm reduction approaches and actual outcomes and improvements in those outcomes is important. again, maybe something for the prop t report or something elsewhere. i am sensing around me growing questions and concerns about harm reduction and whether it is serving those goals. i think we need to be clear about how it is doing that and that it is not. are we inducing demand for
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treatment or drugs? you know, i think there is question about that from my colleagues and from myself. i want to be able to belief that you are right and that we need to proceed in the way with harm reduction. we need to be clear about that we are measuring outcomes and be able to show that to people to give them confidence in our approach. >> thank you, supervisor mandelman. i will look for the responses. supervisor stefani, you are next. >> thank you, chair mar. i want to turn to the report you provided last night on page 1. i notice that at present narcotic replacement therapy has twice as many clients and twice as much spending as other
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treatment modalities. how are you defining narcotics. there is also controlled substance. i want to understand what you mean by narcotics and replacement therapy and why is it that we are spending twice as much on marchchotic replacement therapy as opposed to other treatment modalities? >> the budget for narcotic replacement therapy is not preferred term. it is the term that is provided by the federal government. that is what they call it. we call it opioid treatment programs or therapy. it might include using meth -- methadone. we consider medication and treatment.
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notice re-addicting something. there is great evidence when people are stable their lives come back together, families come back together. otp, opiate treatment programs is the term we prefer to use. the reason this is doubled. this is the number related to the med-cal medicaid reimbursement for these services. we put together a budget that is based on what we anticipate will be the utilization and then based on that, that goes to the budget that we account for and three years later we reconcile with the state and the money comes back. this is state reimbursement and whatever extra funds the city needs to fill with regards to any perceived gap. reimbursement how we come up
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with that number from external reimbursement sources. that allows us when we get reimbursement to have more general funds for the programs for outreach. we want to maximize those medi-cal and medicaid dollars. does that answer? >> yes opioids on that line. our last hearing was on overdose and opioids. this is treatment on demand which is substances including alcohol, cocaine, methamphetamine, opioids. what about those not exclusive narcotic users, those that aren't using opioids? seeking other forms of treatment. >> more editorial. we are using the use of fentanyl
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everywhere. it is hard to find a person just using methamphetamine any more. most people are using methamphetamine are still using opioids. noleverybody using opioids are using methamphetamine. there is a one way. we are seeing combined use. with opiate treatment there is a med. methamphetamine has no medicine. we mostly have social treatments. we are hoping to expand one of the best evidence-based treatments called contingency management. this is incentives. not necessarily money, something valuable. it doesn't have to give every time. a target card you may only get it if you hit a lucky number. this drives behaviors. i think working with your kids what i used to do to get them to
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go to sleep or in the car and motivate them. it does work. it improves outcomes 60 to 70%. senator weiner submitted a bill that would allow medical to pay and bill. next year we will expand these services. dr. martin is leading that. if you need more information i can find out. for homeless they are in residential treatment. >> we did a resolution at the board of supervisors which i could-sponsored supporting senator weiner's bill on contingency management. obviously, i think we all know and especially you in the field. i have many friends and family members in recovery.
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addiction is a beast of disease. living in the mind of that individual i think there the is no one size fits you will approach to addiction. there seems to be ongoing polarizing view versus harm reduction when all are needed. i am just wondering not just with opioids with other addictions in terms of meth, cocaine, alcohol. alcoholism is a huge driver of many social ills. they need help, too. i am wondering is there a feeling ever amongst those in this field at dph sometimes people cannot use safely. i am not talking about opioids, addiction in general. when i where dr. hammer son what
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we are responsible for is preventing death by giving them resources to use safely. i don't know if that was with regard to opioids. knowing a lot about addiction sometimes the person wants to hear they can use. it is denial they don't have to give it up. giving it up is not necessary. it may very well be for that individual. is there a sense among providers and people in your field that sometimes people can't use safely? it is not me trying to make editorial on it. i am wondering and asked other doctors this question. how dph approaches that given what i read in the "new york
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times." >> i have been practicing psychiatry for 25 years. we have those conversations all of the time. before treatment for hepatitis c which was a miracle. the state pays for all treatment. it works. it is amazing. before we would have people come in and they would have to have liver transplants. we would say look, you have one more drink you will not have the transplant. you are not going to make it. we do that. that is an individual patient relationship. we are looking at policy level. how do we make rational policies regarding treatment. they are semantics for harm
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reduction. i know of no peer abstinence program that isn't flexible. i ran a program in san francisco. we were having clients that couldn't stop using heroin. we couldn't turn away from them. we have to make sure some clients are able to be safe. on a program level we adopted harm we deduction. we had people abstin nat, not abstinent. there is a range of different services and what you are asking about can we develop or expand the different timeds of services? we have to talk with our providers. salvation army is very good. long-term track is abstinence.
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they are allowing flexibility. the most important thing in any treatment and particularly addiction is that people keep coming back and so if you keep people out and you lose opportunity to help them. meet them where they are at, you know what? i know you may not want this, let's hang in there. i know you are relapsed. i still want to work with you. that is harm reduction. we have a relationship. if i don't have a relationship i am leading you back to the street. if you are going to use, you are going to diane no liver transplant. i would say you need to be abstin at. as a policy we want programs as broad as possible.
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the clients that are homeless or using alcohol we want them in care. you are telling us get them in treatment, please. we are saying they continue to drink. that is not the message. they need to take them in. when they need it which is medical necessary we want them in there. there is high functioning programs. salvation army do best in getting high functioning clients in the door and working in one year. not everybody is as lucky. >> i appreciate that answer. i love salvation and me. one of my best friends went through it. i agree with you. i appreciate that. where there may be some tension
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is that we are hearing from people in recovery or people that have come in the hearing i have had at the recovery summit working group when we listen to the recommendations. they are saying for them to be around medically assisted treatment was very difficult for them. not to say we don't have them. we don't do that to meet the person where they are at. the people with substance abuse want be to make sure there is no judgment around me for people suffering from this disease. for me i think it is very important that we listen to them. we have people from separate directions saying this is what we are doing and it is working for us, please listen to us. could we invest in that as well? not to eliminate what we are
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doing with regard to harm reduction and the other methods we are using. can we supplement from what we hear when they tell us this works for us? that is what i have been pushing, supervisor safai as well. i do want to say one thing about opioid therapies. very effective. i read something from a professor at stanford putting every addicted person on maintenance is not viable. i am trying to read as much as i can on this. it only works for one drug or opioids. they refuse and half are off it within six months. the need for other interventions not just medically assisted
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treatment when someone needs all of the support and avenues to be able to weather the 12 step based program or whatever it is. we need to provide that as well. i know funding has changed. what hasn't changed is the cities of addiction. that house not changed. maybe the way to get reimbursed might have been changed. we have to come at this at all level. i am also with medically assisted treatments. my understanding there are no fda approved medications for cocaine or methamphetamine addiction. do you believe that is a correct statement? >> definitely for methamphetamine. fda approved, yes, for cocaine. there are antibodies.
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i don't think this is approved yet. so yes. >> nose are all my questions. i appreciate your thoughtful responses. thank you. >> thank you, supervisor stefani. supervisor haney. >> thank you, chair mar. i appreciate all of the questions asked and covered a lot of the concerns. is it correct -- i was looking at the report itself on the face of it. that we have 390 residential treatment beds and 56 residential detox beds? how do we define what those are and how many there are? is that total? this report is hard to read what is going on here.
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>> we have 56 detox beds. we have 241 residential beds. those are 0 daybeds that we can extend -- 90 days. we can extend to 150 if they meet medical criteria. don't think of just 90 days. necessity drives the time not the time driving treatment. 241. and 193 transitional living. 90 or 120 medically needed. then transition because they are homeless to one of 200 beds. those started a year and a half ago. they run out. they are so successful. we have great outcomes.
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people save and save up f.b.i. money they have down payment on rent be and have a job. we use state and federal funds. we need to double. we hope to get 150 or 200 more. there is treasure island expansion going on. 241 and 193. that is around 400 beds. >> i am happy to hear you say we need more. sometimes when we read this report it is hard to say we are meeting the standard and people are getting spots in a set amount of time acceptable. yet when you take a step out for considering the crisis in our city and on our streets around untreated addiction that that sounds like a small number of
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beds overall. it is not something that increased over the last year, according to this. outpatient, case management actually they are a significant decrease over one year. you know, i think supervisor stefani and mandelman spoke to this. putting aside the report itself and how it is laid out. i think there are questions and concerns and have been for years about the methodology of these decisions and presentation around it. there continues to be a strong feeling from those of us who are representing neighborhoods that are impacted by these issues and residences impacted.
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a serious disconnect between what is presented as meeting the standards and expectations of proposition t and what people are experiencing in the field and what they are seeing as patients or clients or service providers. other folks spoke to that. i raised this at the last hearing a while back that supervisor mandelman called. he also spoke to this. some of it if we put barriers how referred, access on the front end, coordination of access when they do express interest that the point at which we begin to measure the amount of time it takes to get them in starting to feel arbitrary.
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>> if i do not qualify or not referred or not cord mated in a way that we start measuring at point a, we are missing the story. i want to know and i think it is men mental health sf. what is it that we are offering? is it effective and appropriate to the people who need it? some of the folk have spoken to different examples of that, but if we have only a certain type of program that is serving folks in a certain way, you know, some people aren't seeking that, not staying in that. not meeting their needs. this is another set of things
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that is a part of whether we are meeting treatment on demand. how people get there to begin with. then once they are there. whether they stay or not or effective to them. i realize that is the overall system of need. i think that our standard here should be looking at the overall need, whether people are showing up to ask for it or not and how we are meeting that and where all of the strategies we are using. judging on whether we are getting to people effective and ever i realize that is not the way we defined our mandate responsibility under prop t. it is a big disconcerting
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consideration what we see out in our city and on the streets on a regular basis from patients and providers to hear their experience and to see the report that essentially generally presents things as though we are doing pretty well. the frustration it doesn't feel like we are doing well. bridging that gap is the challenge we face. you can respond if you want. no further questions. i want to flag that. it has come up again and ago and againit is a frustration to.
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we may want to rethink how we measure these things in a way more helpful and meaningful. i am not sure this is that meaningful in what it demonstrates for us. >> thank you for your comments. it is my goal and as public health official and new to this city is to address what is visible on the streets as well as meeting the real needs of san franciscans to reduce overdose and the very real experiencing with substance abuse disorder including access to care that people want in a timely fashion. i really look forward to working with all of you to think about
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presenterring information that feels confident with what you are all describe ego the fights. that is what our partners are experiencing to try to gain care for clients or individuals in san francisco. to create and i think there was norm us opportunity. you are all aware of the work that is happening in mental health sf and better care coordination i shrewding metrics to see how we are doing and to make progress when we are not doing well.
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>> we are looking at communities, african-american community, those homeless, community of fentanyl and opioid users, so many lifestyles and pockets the way people are using. we should begin reporting not only the beds but types of beds and types of communities we need to impact. with regard to that, one of the problems that medi-cal did. try to move to uniform system. they created a system that is so burden some and bulky. we are losing people at the door because of evaluation. we tried to cut the evaluation.
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rather than full, we do half now and half later. if people are at high risk, they just overdosed. look go in and we will figure out how to pay this later on. unfortunately we can't do that for everyone because it is a burden. we are aware there are things that we are trying to work with the state as best we can in terms of meeting criteria so they are not disallowed, meeting needs of clients and using financial obligation in the most expedient way. i would welcome more detailed conversation. not just general demand, where, which community, c person? how does this fit to our priorities. those are the questions we need to give you answers for as well.
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i think that will move the conversation rather than getting a report. you can't figure it out. how can you help us because we are alsoutioning together. help us move forward. >> thank you. we have two presentations. i want to note we received a presidential action memo from president walton appointing supervisor mandelman to replace supervisor haney at 1:00. >> thank you. we have adult probation and fine
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folks from there. no longer an intern. congratulations. >> good afternoon, supervisors, i am steve. director of the adult probation department joined by victoria. the three of us bring a special dynamic. three formerly incarcerated people who overcame battles with drugs now in leadership roles. i want to thank supervisor stefani for supporting recovery and reentry. supervisor safai for believing in our work and fighting to turn the recommendations to a place where people can get clean. i want to acknowledge the work
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of adult project, aids foundation and slide and outreach teams. their efforts are saving lives each day. i want to recognize sarah short and thomas. your efforts are not unnoticed. our work. it was created in 2011 to do three things. one, supervisor operations of the community corrections partnership. two, public realignment and three to monitor portfolio every entry services. there are a ton of conversations in san francisco. you will hear things like why is law enforcement involved in things. when the rest of the city departments weren't thinking about justice involved people. the adult probation department
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was in contract providing services to the most vulnerable people who per penal code must live in the city. our clients have been failed by every public system. when we fill that void in 2011, people should be recognizing the work we do and the success of our program. we currently manage 24 professional service contracts all with community-based organizations. that is 53 reentry programs in san francisco. in 2017, in partnership with the university of california san francisco, we launched california's first behavioral health focused multi services clinical reentry center to provide case management, mentoring, peer support and medication medical. we fund 16 transitional housing
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and two custody programs. these programs house 350 justice involved people each day. released from the county jail, state parol, on pre-trial diversion, local probation and federal probation. we also fund career development and other supportive services for justice involved adults. i want to turn it over to victoria who will talk about the drug treatment services. >> thank you, steve. hi, i am victoria westbrook reentry policy planner for adult probation. formerly incarcerated and struggled with methamphetamine addiction for over 20 years. we had a work order with department of public health for 2012. i will focus on the last three fiscal years.
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we fund residential treatment beds. this was provided by the department of public health as well as 360 and harbor life. in 18-19 there were 432 referrals for drug treatment. of these 129 enrolleds in treatment and 34 completed. 47 days from the referral to get the client into treatment. 1920. there were 273 referrals leading to 140 treatment enrollments and 49 completions. for this fiscal year the averaging number of days in treatment was 41. current year 161 referrals and 88 enrollments and 15 completions. this has taken 49 days to get someone in treatment on average. there may be outliers for the
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days to enter treatment because some clients are in custody prior to entering treatment. i do not believe the repersonrals are from people in custody. 40 days to get clients in treatment beds we fund is too long. i am in the middle every ferals for treatment by the staff and i was able to get clients in to treatment the same day through phone calls. including clients that were in custody. prop t said between one to 8 days to get into residential treatment. i don't see how this is possible. if it takes 40 days to get clients into beds we fund not funded by drug and medi-cal. we have only two options right now. 360 and harbor life. if the client is unwilling for the six month program. that leaves one option. we have had many complaints about the treatment service at health right 360.
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nowhere to get away from drug use. it is challenging to say the least to stop using drugs. it is more challenging to stop using when people in the same facility are high on marijuana and pain medications. we don't have a good sense what is being required of our clients to complete treatment. what does completion mean? it seems to be based on 90 day treatment stay. rather than drug free. there is no longitude amtraking of post treatment in san francisco. it no secret drugs are a problem in san francisco. you need to incentivize clients for treatment. you heards the housing programs we fund. a couple years ago we header over and over again why should i
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go to treatment. i will have nowhere to live after i complete. we consider this to be a valid concern. to meet the needs in 2008 we created recovery pathway initiative. it provides two years of free transitional housing to any client who completes 90 days of residential treatment. many clients this has supported the journey through recovery. in 2018 we hosted san francisco recovery summit. soon after we launched the working group. it met over a two-year period. developed recovery matrix and launched a survey. the data with the information gathered from the focus groups led to the recommendations. in an effort to tackle the drug crisis and improve outcomes for
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those struggling with addiction. in october 2020 these recommendations were unanimously supported by the reentry council, which includes public defender's office. in february of this year supervisor stefani called a hearing for a forum for the department of public health to hear from recovering addicts. to include the san francisco response to addiction we need to expand treatment options. city needs an all hands on deck approach. it is a major crisis. we need a safe site to harm reduction to management and abstinence based programs. >> i guess the question comes
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down to is san francisco currently meeting the treatment on demand needs? the answer is clearly no. it comes down to values question with the department of public health. i am often shocked to hear what medical doctors say. it is interesting. if they were shooting dope and in the tenderloin if they had the same answers to the question. i don't get it. people in san francisco are not getting well. the people that are in thetren whichs doing the word. glide, felton, aids, they are saving lives every day. for those that want to escape that after their lives are saved, there is no outlet. it is one lane.
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you cannot put somebody who does not want to be around opiates in a place where people are on pain management. i heard the psychiatrist say that. i will tell you how often my clients say, please, i cannot be clean. all i want to do is shoot dope. we heard a medical professional tell us that they mix all of these modalities to one program. it makes no sense. how are we going to meet the needs of justice involved people? simple. we need to expand treatment options. that means on one ends of the spectrum we need safe consumption sites, harm reduction strategy. we should invest as much money from harm reduction as the people on the front line tell you they need. once they are saving lives and for those off drugs completely
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we need a place where they can go and be away from drugs? what does that mean. the city funds 486 treatment beds for people on methamphetamine. what if i don't want to be in that treatment center? we can have a longs discussion. the role of the department of public health should be to fund providers to save live in the community. i don't find it to be the role of the department of public health to help people be loaded. it is the role of the department of public health to help people change their lives. to save them so they can regain their place in the community. it is astonishing the things i hear. again, you fund programs now doing incredible work in the
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community. people are like blaming them for overdose deaths. they are not to blame. the problem there is no escape for people. they are stuck out there. i want to talk about what we are doing to support the ongoing needs of justice involved people. first, we do fund residential treatment and detox beds. not 30, 60, 90 days. ics months treatment. i was on the phone with the director of the treatment program this morning. they are on six months and want to stay longer. no problem. it doesn't matter the medical necessity. it was what the client wanted. clean, treatment, wants to stay, should be able to stay. next thing we connect clients to medication. at reentry center we provide clinical case management. we have been doing contingency
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management since before it was popular. city-wide to manage reentry. we have been working for clean drug tests. we don't test at the department. it is a tool to help clients stay clean. we are medication manager on site with nurse. outpatients drug treatment program on site. clinical therapy through department of health. the star program. i heard the doctor mention salvation army. i do think the department of public health does not fund that directly. i think those funds are from the board of state and community corrections. the star programming and prior to that lead does a good job of connecting people to treatment and case management.
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holelisicty across the board for department of public health i have concerned about their values and addiction. another way that we help justice involved people meet ongoing needs. we developed community support networks through positive directions, circle, solutions for women, men's movement and black is beautiful. we have housing programs. we prioritize clients from treatment into housing. there is some concern earlier supervisor safai mentioned about how quickly people leave treatment. it was told to me they leave within seven or eight days because of bad assessment. i don't think so. you should go to those programs. it is culture. you don't feel like you belong. i have been in recovery and
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treatment. i was in the treatment program for five years. the day i went to that program i wanted to leave. the only reason i didn't leave because everybody in the program was just like me. i had never felt at home like i felt there when i entered lansing street. it was a place where people understood me. the community has been telling elected officials what they need. elected officials and the department of public health are not listening. you will hear from a leader in the community momentarily. my advice listen to what he is telling you and take notes and figure a way to implement what he is asking for. i know supervisor safai and morris are working diligently to get the recommendations over the finish line. we are so grateful for
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supervisor stefani for the hearing in february to recognize that the community should have a voice and needs a voice. last question how are we expanding access to treatment? we are trying to use it as alternative to incarceration. people don't need jail or prison. people need to get lives together. not using jail or prison as the only means to address the consequence. we need to use treatment. we do extensive outreach for clients with behavioral health needs. the star program, we are investing in programs that meet the needs of clients. last as i mentioned over and over again is really important. listen to the community. it is just so important. i don't see it happening across the board in san francisco. i will turn it over to west side
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community services and positive directions and hope that he can fill you in on the needs he is seeing every day. >> thank you, steve. good afternoon everyone. as this death toll from this opioid crisis continues to mount. i see families in obituaries about loved ones who passed away from overdosing. i especially want to acknowledge someone who passed away yesterday. she was in a struggle. as supervisor has started this with the moment of silence for the people in san jose. i would like to take a moment of silence for the people who have overdosed.
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thank you. i had a lot of things to say. after herring this today. it is really in a way depressing. in a way i can understand how people who are witnessing what we see will need therapy to director this is no disrespect to you or the department of public health. i have to say this. they talk about law enforcement and the police killing african-american community. i have to say the department of public health is as bad as the police because they are killing us. the reason i say they are killing us is because we are sitting here having a conversation. what has been out of everyone's
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mouth from the department of public health is not what we see. this is spoken by quite a few people. this is not what we see on a day-to-day basis. me working in the field for 25 years witnessing how the system works. it doesn't work on behalf of african-americans or people of color. first the department of public health is not keeping us safe at all. we feel harmed every day by seeing needles walking children to school. people loaded in fronted of the school, not protected at all, no, heeducation about it at all, families when loved ones die, nowhere for families to go to process the emotions, thoughts or feelings. they project them on the children or community or on each other, which results in them doing exact same thing what they are grieving about. what we had to do as an agency
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like you were talking about having beds available. we had to purchase showing you how the department of health failed us. we put people to treatment or detox, never could do it. we had to go perform the beds in detox. five beds but place a person there to work to assist our five people to assist the beds with detox to put people in there immediately when the person comes to ask for help. we have influx of population in bayview asian and latino community. we have so many latino people that we had to create a house for them alone because they have access to no treatment. women don't have a place to go
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to access treatment. this is what i mean when i say the department of public health is failing us. not assisting us. we are doing this not with support from department of public health and city of san francisco but through san francisco adult probation department funding beds to do it. we are doing it through churches which insist houses in the community that allow us to use houses. sometimes don't charge us anything for it. it is still a cost to be able to run a house on a day-to-day basis. what i am asking for is increased funding for treatment for wraparound services, all substance abuse disorders. stop separating and pitting substance abuse separate because it is an issue. the other thing is -- i have to say this.
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right now it is almost like wartime. the way this was treated today is like we are not in wartime. i understand the name for bandaids on situations, narcan and all of that. what is wrong with telling the person not to do it today? i don't see the problem with that. that is not encouraging at all. especially in a community suffering from so many other ills. additionally i recommend that we need culturally competent substance abuse disorder services and treatment programs with an anti-racist framework. because i truly believe like how the department of public health is killing us. the framework is on a racist theme. it no way to be able to fulfill needs to help the people of color. in the african-american culture
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what we depend on is in a personal relationship. same i was seeing you talk about on here that everybody talked about working together, but we need that in treatment also. what happens is like someone was talking about earlier. when medi-cal came in they spend more time on documentation than talking to the person. in our what we have to do is turn it around and just put our energy and our money into the individual and not in the paperwork. also, we need more emotional support groups and classes to deal with the loss of loved ones and loved ones currently using. i get calls every way where can i go to handle this and talk about this? what we have to do? spontaneous create that.
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another thing we need is the faith-based communities to be involved in service and treatment. the collaborative efforts. black and latinos, the church is key for support and spiritual leadership. most programs in san francisco you cannot talk about that or you lose your funding. if you are going to tell people what else they can do and can't do, you can tell them they can use drugs, it is cool. makes no sense to me. also, we need to involve the whole community in this. diverse community partnerships. i truly believe in community partnerships and working with police, probation, department of public health, working with everyone that is involved with the individual that is in their lives that we really truly have
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to work together. it can't be just conversation. it means sitting down with differences with one another work those out to help an individual. one of the most important things is that when we do that, when we exclude people, we create enemies. if you have an enemy, that means we ain't working together. i strongly support the adult probation in san francisco because a lot of times people say we can't have criminal justice system involved in helping people. if you excludes the criminal justice system, what are they going to do? police are killing our community. people are going to be indifferent. they are part of the process also. you have to include them. you can't exclude anyone. they say so with this also.
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i support the san francisco adult probation. i thank them for allowing them for letting us on this call. i give you credit. you had to sit here for three or four hours. if you do this on a day-to-day basis i commend you for your work and thank everybody for allowing me to be on it. >> thank you so much for the presentation. are you guys done? >> we are done. if there are questions, we will answer them. >> feel free. >> thank you so much. this is a good follow up to the hearing that supervisor stefani held back in february on the recovery of the working group
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recommendations. thank you. supervisor mandelman. >> yes, i want to thank director ad a.m.i. and his westbrook and akbar for the presentation. for the work they do. i think they have highlighted the disconnect between what we are seeing in terms of these prop d reports and the experience of the people trying to get treatment for folks. i think as we look at updating prop t and working with dph to do that, adult probation and providers like west side community services are an important part to figure out what information more particularly than in the prop t legislation will help pullout the information that is relevant like the fact that wait times
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are not days, it is 41 days that is horrific. that is not just the pandemic. that several years. there is work to be dub. i thank them for, particularly in akbar, demanding the system not give up on people. recognize that there are people who are going to struggle for a long, long time. we have to take care of those people. we don't want them to die. also recognize that while we take care of those folks to keep them alive we shouldn't abandon anybody, particularly african-american people. there is supervisor stefani. >> i can wait until you are done. >> i am done.
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go ahead. >> thank you. i just wanted to extend my thanks as well. i think the passion is there because they themselves have found recovery and they are passionate about it. they know what it has done for their lives and they want to give that to others. that is commendable. i love working with you. i know there are a lot of things we need to look into based on what you have reported especially victoria about the number of days and discrepancy between what dph reported and you reported in terms of getting people to treatment. what do we do next in terms of you working with dph. how is that going to happen? continuing this pattern of coming back to hearing and not
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being heard cannot continue. i want to have dph to reach out to all of you so we can move forward with this in a collaborative manner. you are passionate about this. you know it saved your life. i remember victoria when you said and you had people in tears. your life got bigger when you found recovery. you were in a cell. that was powerful. nobody wants anyone to sufferin' carceration. that is not the point. we want people to find what works for them in terms of dealing with any addiction that is on their back. it is an alberttros around people's necks. there is various ways to do it. recovery the ways you spoke of. medically assisted treatment, harm reduction.
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we have to be united and how we go about this. we have to. look at the streets. i can't thank you three enough. i don't have questions right now. i didn't realize we had another presentation. i will stop and listen to the next presentation. thank you all. >> we will move onto our final but not least speaker laura thomas, director of harm reduction of the san francisco aid foundation on the treatment of demand coalition and after ms. thomas we will go to public comment. >> thank you. i will share my slides now.
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>> thank you very much.
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i am here presenting on behalf of the san francisco treatment on demand coalition. first of all, i want to thank the supervisors for holding this hearing. i want to also appreciate the department of public health presentation. i am excited about doctor k un an's arrival. i want to appreciate citied and victoria for presentation as well. you are going to hear a lot of similarities between what we are asking for and what atd is asking for. in particular, the need to listen to and include the voices of people who are most affected by substance abuse and substance abuse disorder. treatment on demand is a
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coalition of both neighborhood residents and community-based organizations working to improve access and available of mental health and substance abuse across the full continuum of care. obviously, we are here because of prop t and people have gone into detail on this. the goal is to improve access and yet in many ways access to treatment has not gotten better since 1997 but has gotten worse. this is the problem and this echoes many things said. low income san franciscans face substantial barriers to accessing treatment including eligibility, lack of integration, criminalization and
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for many the most effective way to access treatment is to encounter the criminal justice system. certainly everyone in the criminal justice system needs access to healthcare, treatment, dignity, respect. no one should have to get arrested to access healthcare. overall, you have heard this before. there is a lack of funding for parts of the system. in particular a lack of coordination from one program to another or one institution to another. those who actually seek treatment often cannot easily access it. that should be the overall goal for this system. this comes from the stop the reinvolving door report coordinated by the coalition on homelessness. data collected in 2019. report published pre-covid and
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published last year. they were surveying unhoused and marginally housed people. i want to make it clear they found about a third of the people that they surveyed identified substance abuse as significant challenge. we know there are housed people who have substance abuse disorder and also unhoused people who do not have you stance abuse disorder. we don't want to conflate the two. look at this vulnerable population and we found for many although not all treatment did in fact help meet their goals and address their underlying issues. it is working for the people who can get into it. a third of those surveyed reported barriers for treatment.
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we need to do better. access was confusing. the wait list too long. disability issues, linguistic assess issues. so what we are doing and some of this goes back to supervisor mandelman's questions at the very beginning of this hearing. we want a comprehensive needs assessment of the existing services and funding to identify where the gaps are. we need to have this information so that we can plan for the system overall. we want to see more resources or supportive housing, case management, low threshold drop in centers and treatment beds. we recognize this system of care is not just about treatment beds. it is about everything around
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those beds as well. we want to make sure community voices are being represented as we create these policy solutions. >> what are we asking for? we are asking for comprehensive inventory re-evaluation of services including barriers to care. we want to make sure we are asking the right questions to understand the needs and barriers. planning for services should include people with lived experiences. we want to fix the gap in services to ensure that people are able to smoothly transition from one part of the system to another. we are very concerned about proposals to increase law enforcement of the solution to the overdose problem. in over policing and jailing can
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increase overdose responsibility. we need to address the needs in the community. we want to broaden the definition of mental health support and substance abuse support. low thresholds drop in services, safe place to rest and warn meal are as important for somebody as sense of well-being as chin services or hospital care. we want to strengthen and expand harm reduction and ensure that services are culturally as inclusive as possible and address language, cultural, access to phones or computers, history of trauma, family status. we need more models in more
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places in more neighborhoods to mead people's needs. in particular, i know that the previous item on this hearing covered this somewhat. we need to be prevents overdose deaths and keep people alive to access these healthcare treatment and recovery options. if we can't keep people alive all of the treatment beds in the world won't do any good. we need to step up the community harm reduction to prevent overdose deaths in all settings. i know it is a broken record. we need supervised consumption services yesterday and better address the causes of overdose vulnerable. the 72 hours after release from the jail and people are
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vulnerable to overdose. we hope the board will emphasize the perspective of someone looking for treatment and not able to find it and scale up city programs to bridge these gaps so that people know what is available and how to access it. these are some of the references in here and that is it for my presentation. thank you for holding this hearing. we are ready to do what we can to ensure that we are asking the right questions in these reports. i appreciate the work of the department of public health and the work to extend services, but we need to do so much more and
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in particular we need to collect the right data and ask the right questions so that we know that our efforts are going to good use. thank you. >> thank you, laura, for that presentation and for all of the important work of the treatment on demand coalition. supervisor mandelman. >> thank you, chair mar. i want to thank ms. thomas and the treatment on demand coalition. my legislative aid and i started attending the meetings shortly after i was elected. it seems like a really important thing for the city to be doing. this notion of a comprehensivegan analysis to get revisited each year to inform our annual budgeting. if we aren't able to do what we would identify through that exercise failing means we will
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never meet the need. i want to thank the coalition for pushing on this. i am hoping and i want to take although we got off on a bad foot with dph today and i don't think the treatment on demand reports they have been doing are adequate in any way to meet the needs of the city now or really the intent of the legislation. i am grateful for the invitation and their openness to think about how to turn these prop t reports into something that might be part of the overall comprehensive needs assessment in san francisco. it is part of mental health sf and we can have great conversations with the coalition. i would point out that the perception of the treatment on demand coalition it takes
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getting arrested to have a better shot, not great experience of accessing treatment services, but the sense that is better than for the noncriminal justice involved population is more troubling if we look at apd numbers which show terrible access for people criminal justice involved. this is going to be a robust conversation going forward that will not end with this hearing but lead to some legislative changes and new approaches at dph. that is all i have got. thank you, ms. thomas and thank you to the coalition. some folks may have called after four hours. >> supervisor stefani. >> thank you.
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i just had a clarifying question. on one slide about what you are asking for the board no increase of law enforcement solution. we need alternative responses to come from the community. are you referring to adult probation in terms of the programs they provide? >> i am specifically talking about policing and the way in which aggressive policing increases overdose risk. for example, people may use their drugs more quickly because they are afraid of being seen by police or arrested by police and that may mean that they misjudged the amount of substances that they are injecting. that will increase overdose risk for them or if they are trying
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to hide in a place where they won't be seen, they won't be seen if they overdose by a passerby. you know, i think it is -- i do appreciate the ways in which sfpd carry naloxone and bart officers carrying naloxone. we can increase vulnerability by overdose by using police as a response. >> you will still be working with police to make sure they have narcan and how to administer it? the numbers are high in terms of the overdose preventions that police provide because of narcan. >> i am not saying that. you still want them to do that, right? >> i want police to have naloxone on them. the numbers of overdose reversals done by sfpd pales in
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comparison to those done by people using drugs. we certainly do want police to continue to have nailing ox own on them. absolutely. >> -- naloxone on them. >> thank you for clarifying that. that is all i have. >> thank you. maybe we can go to public comment now. are there callers on the line? >> thank you, mr. chair. we are working with department of technology to blink in the public comment callers in the queue. for those watching our meeting on san francisco channel 26 or sfgovtv or he wills where follow instructions on the screen by dialing 415-655-0001.
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id1870170254. press pound pound and then press star followed buys 3 to enter to speak. press star 3 if you wish to speak. those on hold in the queue continue to wait until you are prompted to begin. we havics callers have raised hands for comments. first caller, please. >> this is jennifer from coalition on homelessness. i did not expect to speak first. thank you so much for having this hearing. i wanted to just add really good presentation and wanted to add some stuff specifically around our report that we did.
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the problem with a lot of problem was the system not completely touched on. one of the pieces that we are finding at least with the unhoused community which by the way many of the folk have not been in treatment for the past five years. what seemed to come out of the survey there was other issues that ended up being more priority in terms of basic survival. another thing that came up a lot that the is deeply connected. we interviewed about 600 people and it was intensive survey with universities involvement. this connection to housing and people feeling like when they
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had been in treatment and they had been in treatment several times and they ended up back on the streets. they were not interested in going back to treatment. they felt like it would be a waste of effort when they knew they would be worse shape when they were back on the street. the connection to housing is very significant for unhoused community members in terms of both success with treatment and even at this point trying to get folks into treatment. other things that came up that i think are really important and by the way it was about a third of the unhoused people. >> thank you very much for sharing your comments. next caller, please. >> i am with public policy and
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community organizing. life expecting of tracks woman of doll. [indiscernable] if we go to the root cause it intersects with social and economic impression of marginalized lbgq communities of color and mental health and without adequate shelter. accessory cover reis not the same top, middle and bottom. the fact we have separate category for treatment on demand we are not doing enough for substance and mental health. not a criminal justice issue. true treatment on demand will be holistic,en come bus community love and not pulling up by the bootstraps if you don't have
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boots or the straps are broken. >> next caller, please. >> supervisors this is the second time i have listened to this topic. what you are doing is in the middle of pandemic we have to pay attention to what you are saying. you go on and on and on. just have one are two presentations because the more presentations you have the more we have to listen to and traumatize us. we have to go to the location by 450 golden gate to see what is happening.
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san francisco has gone to the hogs. the presentation we need more people of color. we are fed up listening to the whites telling us what to do. they are behind the killing going on in the community. blacks are dying. you know what? we have police who are black and mayor that are black. they don't give a damn. many of them have not been given an opportunity and they are dying. they are watching this. you are talking. [indiscernable] where are the changes happening in the san francisco general hospital? this is bull. supervisors family members who are on drugs or something, that
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is your problem. don't bring that to our attention. we don't have empathy for that. [indiscernable] go to the pow-wow. >> thank you for your comments. could we request that meeting attendees not members of the committee please turnoff cameras while we take public comment. next caller, please. is there a caller on the line?
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>> good afternoon, supervisors. thank you for calling this hearing and the opportunity to comment. i am policy director at comes family services resident of district 8. i want to register support for treatment on demand and holistic approach to treatment that provides access to everyone who is experiencing a need for mental health and substance abuse treatment. we are facing an extreme crisis in the streets right now. we have stepped up police presence that is not comprehensive response to the problem not making families feeling safer. we want to support harm reduction response to the
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crisis. we want to uplift the needs of pregnant women who use drugs who need the treatment and stable housing paired with it. i also want to uplift the need for broader conversation about mental health in our community. i am hearing a lot about substance abuse. it is important to promote safe injection sites and pair housing with is services. it is critical to think about mental health needs of children, families and youth. we have families in shelters where children are regressing in behaviors. basically wetting the bed and having nightmares and using food to control the uncontrollable situations and lives. we are not funding adequate services for those folks for the families and we are not funding services embedded in the programs and not providing the
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level of housing to get them into the stability where they wouldn't be experiencing those symptoms of traumas of homelessness. i want to uplift the need. >> thank you. next caller, please. [indiscernable] >> the issues myself. next door neighbor had severe issues. his family was distraught about not being able to get treatment
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for him to get him out of jail but nothing happened. this is an issue of racism. 70% of oak land's homeless are black. we need lower levels of care instead of waiting for things to get to the advanced stage. i also feel like in the context of such need that we are talking about conservatorship the only way out. so many people have said there is no such super substitute for permanent supportive housing. 70% of san francisco homeless people. [indiscernable]
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they were driven out by high rent. the city policy to encourage luxury housing. the policy would do that. so be it. thank you. >> next caller, please. >> i live in san francisco. i want to say it sounds like the people are falling for the lie that harm reduction approaches. it bizarre in terms of access services. it is jarring because we aid people with harm reduction services towards sobriety every
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day. i can speak for my experience. i like to hear that they wished they had cold turkey abstinence and intervention. that can be a death sentence. the last time i overdosed in 2015. the harm reduction and accessible treatment options allowed me to be the kind of member of society that people in this call are speaking as though i need to be to be deserving of care. it didn't work for me. day in and day out for the people i serve and work with unhoused drug users and people on the call talked about front line workers and harm reduction, reducing opioid related deaths. you have to provide the funding to back these words. listen to drug users about the treatment they haven't been getting on demand and need.
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volunteer with harm reduction. people say the same things over and over. they have inquired. they can't get into because of the barriers. if they were fearful of strictly programs because of stigma and control and lack of understanding that leads to death. >> thank you very much. next caller, please. >> this is david elliott lewis treatment on demand coalition. the reason i am age to do community organizing today is because of the treatment i demanded abreceived about 16 years ago when i needed it. treatment on demand works. i am an example. in 2005 i was unhoused in need of mental health treatment.
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it took about a year of trying to find permanent supportive housing back then. it only took a few weeks of trying to get hooked up with the san francisco system of care by walking into a public mental health clinic, asking for help, getting assigned a therapist that i got to see on a weekly basis with a weekly 50 minute session that was helpful in me pulling myself out of the dark depression into alive that i can now function and give back to society. i know it works.we don't have i. it should be easy to get. many of the clinics lie behind unnamed, unmarked buildings. mission mental health is invisible omission street near
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23rd. it is not labeled. 1380 howard is unlabeled. many in the community don't know it offers walk in treatment. again, we need labeled accessiblevis visible behavioral health treatment for mental health and substance abuse. we are close but not there yet. please take the recommendations seriously in this meeting. thank you. this is david elliott lewis, treatment on demand coalition. >> next caller, please. >> on behalf of glide. there are so many different proposals to be considered along these lines and so many other proposals that intersect with
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the addressing of the needs. i want to lift everything shared we laura thomas, and the other harm reduction members of demand members. flied is a cause and -- glide is there. the more likely they are to develop acute needs. san francisco must increase funding for all behavioral health treatment to implement the competent system of treatment that acknowledges and addresses these approaches. we need to be prioritizing the trained professionals from community-based organizations with a track record of service to prove more beneficial than the opportunities when it involves engagement with the criminal legal system which is for the perpetuating trauma and
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contributing to further incarceration of up house of un. >> next caller, please. >> this is bryan edwards. member of treatment on demands coalition. i want to make clear the comments are bryan edwards, private citizen. as a drug user most of my life. i have been around drugs and users, for the last 18 years i have been around people in recovery in one form or another. i will say that the last time i went into recovery it took me almost 8 weeks to get to the program i wanted. that program is the reason why i am here today. i am one of those that looks back at 2020.
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it was one the best years of my life. i was able to get good work done with many people on the call or supervisors, people who presented. you i hear the language of harm reduction versus abstinence and it sidetracks us. i still use drugs today. when i hear someone said sfph is as bad as sfpd. i poured my first glass of wine today. i am not clean now. through the help and support and they played a huge role in this of the san francisco department of public health and one of the providers. i have a great life and i am able to manage the drugs don't do me. they help me get through life. a large portion not because -- this is my third time through
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rehab. i know that routine. you know to be someone in san francisco who is basically i am not going to make a ton of money in my life this. is what i do is advocate for people. to watch supervisor preston and his eviction moratorium and not be -- >> thank you for your call. i understand there is one more caller. please connect us. >> hi, i would echo the calls for expansion of mental health treatment because if you have ever tried to access mental health not just specifically for drug treatment just in general. it is a nightmare regardless of what insurance you have. let's say you have ppo
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insurance, access the procedure is you go to the insurance company website, figure out who is in network, call a bunch of therapists, leave numbers and hope somebody calls you back. if you have medicaid they have a special number for you to call and you leave your name with somebody and you wait for like a day or so for somebody to call you back to screen you for what sort of help you might need. then they give you a referral and you have to call these other people in hopes that they can fit you in for an appointment. then if you have an hmo like kaiser, good luck with that.
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i know that the public high schools used to have drop in therapy appointments with counselors. everything is on zoom now. i don't know how that works. accessing mental health treatment in general is just a nightmare. that is not how the stigma behind it. a lot of people aren't aware it is an option. if that is not an option obviously people are going to look to things like alcohol and drug use as a way to take care of their problems. >> thank you for sharing your comments. next caller, please. >> good afternoon, supervisors. i am and destone with h.i.v. advocacy and san francisco aids
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foundation. i am calling to support treatment on demand. there are a lot of barriers for low income san franciscans. i think it is crucial to expand access to services and reach people where they are with care. it is critical to address the stigma around substance abuse and those that use drugs. the more we continue to increase it and kind of continue to shame people who use drugs around substance abuse the less able they are to access treatment in a way that is helpful and this just leads to cycles every lapsing and heightened risk of overdose. i am calling in to highly support and urge the board of
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supervisors to support expanded access and lowering paperriers and harm reduction framework and reduce stigma around substance abuse and people using drugs. also bringing them to the table to make sure we listen to their voices. creating systems that support and truly care for them. thank you. >> thank you for your call. next caller, please. >> hello. i am a resident of district 3. supervisor mandelman, i will say i truly appreciate your comments about the accountability issues and filing grievance. we are falling short on many fronts. i worked with the work force development specifically
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homeless, veterans and individuals we all recognize that the pandemic exacerbated the key words immediate and all. allowing ever individual access to this treatment when they are at the critical point. deciding they want it is crucial. timely access contrasts with
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policies that emphasize punishment. we are suffering one of the worst crisis in drug abuse and usage. expanding treatment on demand will address the addiction it helps creating safer communities for every resident in san francisco. i calm upon the elected leaders to trust in the long-term solution for residents to access for the treatment they need when they need it. i ask leadership respect the request for expanding treatment options and making treatment on demand more readily acceptable. >> next caller, please. >> yes, david grace. i live in supervisor haney's district. i am a member of sign and
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display union. i noticed that david mentioned there were a couple sites that didn't have signs on them. i would be glad to petition the union for signs if needed. second thing, early about an hour ago one of the participants mentioned that medicare was a problem in payments. i hope to get more information to help with the lobbying in that. i wonder if it is an issue of anonymity or patient privacy and that medicare doesn't pay unless they get more details. finally, tracking bad batches. in traveling through the tenderloin recently there are a bunch of women obviously on some strange new drug. i am wondering if there is a tracking of new bad batches that go on. i don't like to necessarily see people arrested for things like
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this, but if the dealers are introducing strange new things like bath salts and what not, if there is a way to track the dealers when bad batches show up. thank you. >> thank you for your comments, david grace. any further callers? there are no further callers mr. >> thank you, mr. clerk. thank you everyone who spoke during public comment. public comment is closed. thank you, supervisor mandelman for calling for this hearing and your leadership on one of the most urgent and challenging issues in the city. the drug addiction and overdose crisis playing out in our city. this is another long but
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important hearing and discussion about these issues. highlighting how we still have a long way to go and a lot more to do to address this crisis. this is timely today as we are in the midst of the budget process right now. i think we are all committed to ensuring more investments in the budget for drug treatment programs and smarter investments and better coordination of programs. thanks. i thank the presenters for all that you do as well. supervisor mandelman. >> thank you, chair mar. i know this is a long hearing. the flight of the chair but i think this was important and i
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think data reporting is not necessarily the sexiest thing. if we make smart investments to get a handle on the substance abuse crisis in san francisco, it is going to take us figuring out what we are trying to measure and getting regular reporting and then using that data to inform decisions we make. i think that is part of mental health sf. i have spoken with supervisor ronen. i would like to do the next step on this to work with cosponsors of this hearing and treatment on demand coalition and department of public health, adult probation and stakeholders to figure out how to make this reporting not the exercise that it has been for many, many years now where a document is produced
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to not be used by anybody for anything but rather though fulfill the intent of prop t to have a document to help shape and improve our response to the substance abuse disorder in san francisco. i would like to take that offline and have meetings with folks to figure out some changes we can make. legislatively. i would like to leave this hearing open to the call of the chair if the committee is willing to do that in case it is useful to bring this back for additional conversation with the committee, but i think the next steps are offline conversations. i will be reaching out to all of the presenters and other folks to try to make that as useful as possible. thank you, chair mar and committee members, supervisor
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stefani for being here and to supervisor haney who could not be here at the very end but i know is very committed to this problem and to solution to the challenges. thanks everybody. >> thanks, supervisor mandelman. supervisor stefani. >> thank you again, supervisor mandelman for leading the hearing. i am a huge proponent of treatment on demand. thank you presenters and those who called in. there was a comment made by someone who called in about the idea of the terms thrown out in this recovery field. i wasn't dirty before. he is absolutely right. the stigma around the disease of addiction is so unfortunate and
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unnecessary. it has to be dealt with as well. i remember being at public safety hearing a while back for a liquor license hearing. the person presenting said there is a bunch of alcoholics. i said to him, you need to be careful with your words. alcoholism is a disease for many. there are people who are recovering alcoholics. that term has such a potent way of shaming people. or the term addict or whatever. back to the matter that many people i know speaking from my experience greatly suffer and their families suffered because people have been addicted to substances that they don't want to be addicted to. they have taken many strides and pains along the way. a lot of pain to try to recover. i so admire people who are in
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recovery. that doesn't mean i don't admire people who are not. it is a hard thing to do or people who continue to use drugs. it is something that we have to -- any type of shaming will get no good results. it struck me when he said that i wasn't dirty before. you are absolutely right. those who suffer from the cities of addiction and substance abuse disorder are not dirty, nothing wrong with them. it is like another disease. we should be more loving and accepting and work hard with one another to understand where we are all coming from. what each of our experiences are. those who continue to use, that want to use, don't want to use. found a different way. we have to listen to each other. this problem is too great and too many people are hurting for us to put up walls to pass
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judgment upon each other, pass judgment upon those who we are trying to help. thank you, caller for what you said because it is a opening. we have to be very aware of the stigma when it comes to addiction and making sure that we are helping everyone we can with everything we have. thanks again. >> thank you, really. >> i would move that we continue this item to the calm of the chair. call the roll, mr. clerk. >> motion to excuse member haney from the vote on this action. vice chair stefani.
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>> aye. >> member mandelman. >> aye. >> chair mar. >> aye. >> there are three ayes on the motion to excuse. then on the motion offered by temporary member mandelman the hearing be continued to the call of the chair. vice chair stefani. >> aye. >> member mandelman. >> aye. >> chair mar. >> aye. >> three ayes. >> thank you, mr. clerk. this will be continued. any further business? >> no further business. >> we are adjourned. have a good afternoon. everyone.
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>> what we're trying to approach is bringing more diversity to our food. it's not just the old european style food. we are seeing a lot of influences, and all of this is because of our students. all we ask is make it flavorful. [♪♪♪] >> we are the first two-year
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culinary hospitality school in the united states. the first year was 1936, and it was started by two graduates from cornell. i'm a graduate of this program, and very proud of that. so students can expect to learn under the three degrees. culinary arts management degree, food service management degree, and hotel management degree. we're not a cooking school. even though we're not teaching you how to cook, we're teaching you how to manage, how to supervise employees, how to manage a hotel, and plus you're getting an associate of science degree. >> my name is vince, and i'm a faculty member of the hospitality arts and culinary school here in san francisco. this is my 11th year. the program is very, very rich
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in what this industry demands. cooking, health, safety, and sanitation issues are included in it. it's quite a complete program to prepare them for what's happening out in the real world. >> the first time i heard about this program, i was working in a restaurant, and the sous chef had graduated from this program. he was very young to be a sous chef, and i want to be like him, basically, in the future. this program, it's awesome. >> it's another world when you're here. it's another world. you get to be who you are, a person get to be who they are. you get to explore different things, and then, you get to
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explore and they encourage you to bring your background to the kitchen, too. >> i've been in the program for about a year. two-year program, and i'm about halfway through. before, i was studying behavioral genetics and dance. i had few injuries, and i couldn't pursue the things that i needed to to dance, so i pursued my other passion, cooking. when i stopped dance, i was deprived of my creative outlet, and cooking has been that for me, specifically pastry. >> the good thing is we have students everywhere from places like the ritz to -- >> we have kids from every area. >> facebook and google. >> kids from everywhere. >> they are all over the bay area, and they're thriving. >> my name is jeff, and i'm a
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coowner of nopa restaurant, nopalito restaurant in san francisco. i attended city college of san francisco, the culinary arts program, where it was called hotel and restaurant back then in the early 90's. nopalito on broderick street, it's based on no specific region in mexico. all our masa is hand made. we cook our own corn in house. everything is pretty much hand made on a daily basis, so day and night, we're making hand made tortillas, carnitas, salsas. a lot of love put into this. [♪♪♪]
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>> used to be very easy to define casual dining, fine dining, quick service. now, it's shades of gray, and we're trying to define that experience through that spectrum of service. fine dining calls into white table cloths. the cafeteria is large production kitchen, understanding vast production kitchens, the googles and the facebooks of the world that have those types of kitchens. and the ideas that change every year, again, it's the notion and the venue. >> one of the things i love about vince is one of our outlets is a concept restaurant, and he changes the concept every year to show students how to do a startup restaurant. it's been a pizzeria, a taco bar.
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it's been a mediterranean bar, it's been a noodle bar. people choose ccsf over other hospitality programs because the industry recognizes that we instill the work ethic. we, again, serve breakfast, lunch, and dinner. other culinary hospitality programs may open two days a week for breakfast service. we're open for breakfast, lunch, and dinner five days a week. >> the menu's always interesting. they change it every semester, maybe more. there's always a good variety of foods. the preparation is always beautiful. the students are really sincere, and they work so hard here, and they're so proud of their work. >> i've had people coming in to town, and i, like, bring them here for a special treat, so it's more, like, not so much
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every day, but as often as i can for a special treat. >> when i have my interns in their final semester of the program go out in the industry, 80 to 90% of the students get hired in the industry, well above the industry average in the culinary program. >> we do have internals continually coming into our restaurants from city college of san francisco, and most of the time that people doing internships with us realize this is what they want to do for a living. we hired many interns into employees from our restaurants. my partner is also a graduate of city college. >> so my goal is actually to travel and try to do some
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pastry in maybe italy or france, along those lines. i actually have developed a few connections through this program in italy, which i am excited to support. >> i'm thinking about going to go work on a cruise ship for about two, three year so i can save some money and then hopefully venture out on my own. >> yeah, i want to go back to china. i want to bring something that i learned here, the french cooking, the western system, back to china. >> so we want them to have a full toolkit. we're trying to make them ready for the world out there.
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>> well, good morning, everybody, and welcome to union square. hello, san francisco. it's a beautiful sunny day here, and the fog has lifted, perhaps like the collective proverbial covid fog that we've all been stuck in the last year. my name is karen flood, and i'm the executive director of the union square business district, and we're so pleased to see you today, and so many visitors. we have missed you all. we have missed the visitors and the workers in union square who come here to dine in our fine restaurants and stay in our beautiful hotels and dine in our shops. but we know they will be back, and